Browse publications by year: 2020

  1. Ida J, Kuzuya A, Choong YS, Lim TS
    RSC Adv, 2020 Sep 07;10(55):33040-33051.
    PMID: 35515051 DOI: 10.1039/d0ra05439a
    Nucleic acids have special ability to organize themselves into various non-canonical structures, including a four-stranded DNA structure termed G-quadruplex (G4) that has been utilized for diagnostic and therapeutic applications. Herein, we report the ability of G4 to distinguish dengue virus (DENV) based on its serotypes (DENV-1, DENV-2, DENV-3 and DENV-4) using a split G4-hemin DNAzyme configuration. In this system, two separate G-rich oligonucleotides are brought together upon target DNA strand hybridization to form a three-way junction architecture, allowing the formation of a G4 structure. The G4 formation in complexation with hemin can thus provide a signal readout by generating a DNAzyme that is able to catalyze H2O2-mediated oxidation of 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS). This results in a change of color providing a sensing platform for the colorimetric detection of DENV. In our approach, betaine and dimethyl sulfoxide were utilized for better G4 generation by enhancing the target-probe hybridization. In addition to this serotype-specific assay, a multi-probe cocktail assay, which is an all-in-one assay was also examined for DENV detection. The system highlights the potential of split G-quadruplex configurations for the development of DNA-based detection and serotyping systems in the future.
  2. Vengidasan L, Yunus MA, Yusoff NM, Yahaya BH, Ismail IS
    Asian Biomed (Res Rev News), 2020 Aug;14(4):159-167.
    PMID: 37551388 DOI: 10.1515/abm-2020-0023
    BACKGROUND: Glucose-6-phosphate dehydrogenase (G6PD) is essential to produce reduced nicotinamide adenine dinucleotide phosphate, which is required to protect cells against oxidative stress. G6PD deficiency is a genetic variation that may lead to hemolysis with potential consequences, such as kidney failure, and patients often experience low quality of life.

    OBJECTIVES: To establish a simple, efficient, and optimized method to produce a G6PDViangchan variant and characterize the phenotypes of recombinant human wild-type G6PD and G6PDViangchan.

    METHODS: G6PD was amplified by polymerase chain reaction (PCR) from a human cDNA plasmid, and the gene for G6PDViangchan was amplified by initiating a mutation at location 871 (G>A) through site-directed mutagenesis. Protein expression and western blotting were conducted after successful cloning. The enzymatic activity of both proteins was assessed spectrophotometrically after purification.

    RESULTS: Both amplicons were successfully cloned into a pET26b(+) expression vector and transformed into Escherichia coli BL21 (DE3) cells for overexpression as C-terminally histidine-tagged recombinant proteins. Western blotting confirmed that both proteins were successfully produced at similar levels. The enzymes were purified by immobilized metal (Co) affinity chromatography. Postpurification assay of enzyme activity revealed about 2-fold differences in the levels of specific activity between the wild-type G6PD (155.88 U/mg) and G6PDViangchan (81.85 U/mg), which is consistent with earlier reports. Analysis in silico showed that the coding change in G6PDViangchan has a substantial effect on protein folding structure.

    CONCLUSIONS: We successfully cloned, expressed, and purified both wild-type G6PD and G6PDViangchan proteins. Such a protocol may be useful for creating a model system to study G6PD deficiency disease.

  3. Bagudo AI, Obande GA, Harun A, Singh KKB
    Asian Biomed (Res Rev News), 2020 Oct;14(5):177-186.
    PMID: 37551265 DOI: 10.1515/abm-2020-0026
    Acinetobacter species, particularly those within Acinetobacter calcoaceticus-A. baumannii complex (ACB complex), have emerged as clinically relevant pathogens in hospital environments worldwide. Early and quick detection and identification of Acinetobacter infections is challenging, and traditional culture and biochemical methods may not achieve adequate levels of speciation. Moreover, currently available techniques to identify and differentiate closely related Acinetobacter species are insufficient. The objective of this review is to recapitulate the current evolution in phenotypic and automated techniques used to identify the ACB complex. Compared with other automated or semiautomated systems of bacterial identification, matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) demonstrates a high level of Acinetobacter species identification and discrimination, including newly discovered species A. seifertii and A. dijkshoorniae.
  4. Ismail A, Reffien MAM, Ibrahim NM, Sobri HNM, Abidin NDIZ, Rusli SASS, et al.
    Glob J Qual Saf Healthc, 2020 Nov;3(4):134-138.
    PMID: 37260578 DOI: 10.36401/JQSH-20-10
    INTRODUCTION: Globally, stroke continues to become a significant public health issue contributing to one of the significant causes of morbidity and mortality. The study aimed to describe the characteristics of patients with stroke who were admitted to a teaching hospital in Malaysia and to determine the factors associated with length of stay (LOS).

    METHODS: This is a single-center, cross-sectional study using in-patient data maintained by the Case-Mix Unit of a teaching hospital in Malaysia from 2016 to 2017. The study included all patients with International Classification of Disease (ICD) code 164 (stroke, not specified as hemorrhage or infarct). The significance of association was determined using nonparametric tests in the form of the Mann-Whitney U test and the Kruskal-Wallis test.

    RESULTS: A total of 162 stroke patients from 2016 to 2017 from Case-Mix database were included in the study. The age ranged from 31 to 97 years old. The minimum and maximum LOS for patients with stroke ranged from 1 to 17 days. The severity of illness was found to be significantly associated with longer LOS (p < 0.001); however, age, sex, and presence of co-morbidities did not show any significant association.

    CONCLUSION: Despite its limitations, this study is an essential first step to examine the characteristics of patients with stroke and to determine the factors associated with LOS.

  5. Saidon N, Anuar NA, Meng CK, Chuan OT, Mui TS, Gin GG, et al.
    Blood Cell Ther, 2020 Aug 25;3(3):44-47.
    PMID: 36714175 DOI: 10.31547/bct-2019-017
    Hematopoietic stem cell transplantation (HSCT) is now widely practiced worldwide. It has the potential to cure many hematological diseases, such as acute leukemia and thalassemia. As an emerging country, Malaysia has made advancements despite many challenges. HSCT has evolved rapidly since the first pediatric allogeneic HSCT case in 1987. The first adult HSCT was performed 5 years later in 1993. Currently, a total of 13 hospitals offer HSCT services throughout Malaysia. These include private healthcare services, substantially funded government hospitals governed by the Ministry of Health, and partially funded teaching hospitals governed by the Ministry of Education. Until 2015, 1,987 allogeneic and 1,648 autologous HSCT procedures were performed. This article narrates the history and development of HSCT in Malaysia and briefly discusses the challenging issues in this area.
  6. Chen X, Ong WJ, Kong Z, Zhao X, Li N
    Sci Bull (Beijing), 2020 Jan 15;65(1):45-54.
    PMID: 36659068 DOI: 10.1016/j.scib.2019.10.016
    The development of highly active and low-cost catalysts for electrochemical reactions is one of the most attractive topics in the renewable energy technology. Herein, the site-specific nitrogen doping of graphdiyne (GDY) including grap-N, sp-N(I) and sp-N(II) GDY is systematically investigated as metal-free oxygen reduction electrocatalysts via density functional theory (DFT). Our results indicate that the doped nitrogen atom can significantly improve the oxygen (O2) adsorption activity of GDY through activating its neighboring carbon atoms. The free-energy landscape is employed to describe the electrochemical oxygen reduction reaction (ORR) in both O2 dissociation and association mechanisms. It is revealed that the association mechanism can provide higher ORR onset potential than dissociation mechanism on most of the substrates. Especially, sp-N(II) GDY exhibits the highest ORR electrocatalytic activity through increasing the theoretical onset potential to 0.76 V. This work provides an atomic-level insight for the electrochemical ORR mechanism on metal-free N-doped GDY.
  7. Kurina I, Popenko A, Klimenko N, Koshechkin S, Chuprikova L, Filipenko M, et al.
    Mol Cell Probes, 2020 Aug;52:101570.
    PMID: 32304824 DOI: 10.1016/j.mcp.2020.101570
    Nowadays the advent of innovative high-throughput sequencing allows obtaining high-quality microbiome profiling. However, PCR-based tests are still considered the "golden standard" for many clinical applications. Here, we designed a qPCR-based platform with fluorescent-labeled oligonucleotide probes for assessing human gut microbiome composition. The system allows conducting qualitative and semiquantitative analysis for 12 prokaryotic taxa that are prevalent in the human gut and associated with diseases, diet, age and other factors. The platform was validated by comparing microbiome profile data obtained with two different methods - the platform and high-throughput 16S rRNA sequencing - across 42 stool samples. The test can form the basis for precise and cost-efficient microbiome assay for large-scale surveys including clinical trials with interventions related to diet and disease risks.
    MeSH terms: Gastrointestinal Microbiome/genetics*; Feces/microbiology; Phylogeny*; RNA, Ribosomal, 16S/genetics; DNA Probes/metabolism; Polymerase Chain Reaction/methods*; DNA Primers/metabolism; High-Throughput Nucleotide Sequencing
  8. Chakkarapani N, Murugan S, Ibrahim AR, Kavitha SJ, Hemamalini M, Rajakannan V
    IUCrdata, 2020 Sep;5(Pt 9):x201239.
    PMID: 36338912 DOI: 10.1107/S2414314620012390
    In the title 2:1 co-crystal, 2C4H5ClN4·C4H6O4 the complete succinic acid mol-ecule is generated by a crystallographic centre of symmetry. In the crystal, pairwise O-H⋯N and N-H⋯O hydrogen bonds link the pyrimidine and succinic acid mol-ecules, generating R 2 2(8) loops. The pyrimidine mol-ecules are linked by pairwise N-H⋯N hydrogen bonds, again generating R 2 2(8) loops. Collectively, the hydrogen bonds link the components into corrugated (100) sheets. The Hirshfeld surface is presented.
  9. Dallasta Pedroso S, Caracelli I, Zukerman-Schpector J, Soto-Monsalve M, De Almeida Santos RH, Correia CRD, et al.
    IUCrdata, 2020 Oct;5(Pt 10):x201228.
    PMID: 36339024 DOI: 10.1107/S2414314620012286
    The title pyrrolidine compound, C18H23NO7, is a tetra-substituted species in which the five-membered ring has a twisted conformation with the twist occurring in the C-C bond bearing the adjacent acet-yloxy substituents; the Cm-Ca-Ca-Cp torsion angle is -40.76 (18)° [m = methyl-ene, a = acet-yloxy and p = phen-yl]. The N atom, which is sp 2-hybridized [sum of bond angles = 359.4°], bears an ethyl-carboxyl-ate substitutent and is connected to a methyl-ene-C atom on one side and a carbon atom bearing a 4-meth-oxy-phenyl group on the other side. Minor disorder is noted in the ethyl-carboxyl-ate substituent as well as in one of the acet-yloxy groups; the major components of the disorder have site occupancies of 0.729 (9) and 0.62 (3), respectively. The most notable feature of the mol-ecular packing is the formation of helical, supra-molecular chains aligned along the b-axis direction whereby the carbonyl-O atom not involved in a disordered residue accepts C-H⋯O inter-actions from methyl-ene-H and two-C atom separated methine-H atoms to form a six-membered {⋯HCCCH⋯O} synthon.
  10. Shaharudin NA, Suriani I, Shariff Ghazali S, Juni MH, Hayati KS
    DOI: 10.32827/ijphcs.7.3.34
    Background: This study aims to determine the socio-demographic predictors of adequate health literacy among Type 2 Diabetes Mellitus (T2DM) patients attending two government health clinics in the district of Kuala Selangor.
    Methodology: A cross-sectional study using a validated self-administered questionnaire was performed with a total of 200 respondents with T2DM. The respondents were selected using systematic random sampling from a list of T2DM patients attending the two health clinics. The questionnaire consists of 2 sections on socio-demography characteristics and MY-TOFHLA. Significance level was set at p < 0.05. The predictors were then analysed using multiple logistic regression.
    Results: The response rate was 86.9% and 85% of respondents had adequate health literacy. The odds of having adequate health literacy among those with secondary/tertiary education were 6 times higher compared to those with primary education [AOR = 5.990, 95% CI (1.301, 27.577), p = 0.022]. The odds of having adequate health literacy also increased by 5 times with 1 unit increase of household income [AOR = 4.836, 95% CI (1.152, 20.306), p = 0.031].
    Conclusion: The prevalence of adequate health literacy was high among the T2DM patients in this study population. The predictors of adequate health literacy are level of education and household income.
    Keywords: Health literacy, predictors, type 2 diabetes mellitus, sociodemographic
    MeSH terms: Adult; Ambulatory Care Facilities; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Humans; Malaysia; Primary Health Care; Prevalence; Health Literacy
  11. Sirunyan AM, Tumasyan A, Adam W, Ambrogi F, Asilar E, Bergauer T, et al.
    PMID: 31976986 DOI: 10.1140/epjc/s10052-019-7499-4
    New sets of CMS underlying-event parameters ("tunes") are presented for the pythia8 event generator. These tunes use the NNPDF3.1 parton distribution functions (PDFs) at leading (LO), next-to-leading (NLO), or next-to-next-to-leading (NNLO) orders in perturbative quantum chromodynamics, and the strong coupling evolution at LO or NLO. Measurements of charged-particle multiplicity and transverse momentum densities at various hadron collision energies are fit simultaneously to determine the parameters of the tunes. Comparisons of the predictions of the new tunes are provided for observables sensitive to the event shapes at LEP, global underlying event, soft multiparton interactions, and double-parton scattering contributions. In addition, comparisons are made for observables measured in various specific processes, such as multijet, Drell-Yan, and top quark-antiquark pair production including jet substructure observables. The simulation of the underlying event provided by the new tunes is interfaced to a higher-order matrix-element calculation. For the first time, predictions from pythia8 obtained with tunes based on NLO or NNLO PDFs are shown to reliably describe minimum-bias and underlying-event data with a similar level of agreement to predictions from tunes using LO PDF sets.
  12. Sirunyan AM, Tumasyan A, Adam W, Ambrogi F, Bergauer T, Brandstetter J, et al.
    PMID: 31976987 DOI: 10.1140/epjc/s10052-019-7493-x
    Two related searches for phenomena beyond the standard model (BSM) are performed using events with hadronic jets and significant transverse momentum imbalance. The results are based on a sample of proton-proton collisions at a center-of-mass energy of 13 Te , collected by the CMS experiment at the LHC in 2016-2018 and corresponding to an integrated luminosity of 137 fb - 1 . The first search is inclusive, based on signal regions defined by the hadronic energy in the event, the jet multiplicity, the number of jets identified as originating from bottom quarks, and the value of the kinematic variable M T 2 for events with at least two jets. For events with exactly one jet, the transverse momentum of the jet is used instead. The second search looks in addition for disappearing tracks produced by BSM long-lived charged particles that decay within the volume of the tracking detector. No excess event yield is observed above the predicted standard model background. This is used to constrain a range of BSM models that predict the following: the pair production of gluinos and squarks in the context of supersymmetry models conserving R-parity, with or without intermediate long-lived charginos produced in the decay chain; the resonant production of a colored scalar state decaying to a massive Dirac fermion and a quark; or the pair production of scalar and vector leptoquarks each decaying to a neutrino and a top, bottom, or light-flavor quark. In most of the cases, the results obtained are the most stringent constraints to date.
  13. Sirunyan AM, Tumasyan A, Adam W, Ambrogi F, Bergauer T, Brandstetter J, et al.
    Eur Phys J C Part Fields, 2020;80(3):237.
    PMID: 32215380 DOI: 10.1140/epjc/s10052-020-7773-5
    A search in an all-jet final state for new massive resonances decaying to W W , W Z , or Z Z boson pairs using a novel analysis method is presented. The analysis is performed on data corresponding to an integrated luminosity of 77.3 fb - 1 recorded with the CMS experiment at the LHC at a centre-of-mass energy of 13  Te . The search is focussed on potential narrow-width resonances with masses above 1.2  Te , where the decay products of each W or Z boson are expected to be collimated into a single, large-radius jet. The signal is extracted using a three-dimensional maximum likelihood fit of the two jet masses and the dijet invariant mass, yielding an improvement in sensitivity of up to 30% relative to previous search methods. No excess is observed above the estimated standard model background. In a heavy vector triplet model, spin-1 Z ' and W ' resonances with masses below 3.5 and 3.8   Te , respectively, are excluded at 95% confidence level. In a bulk graviton model, upper limits on cross sections are set between 27 and 0.2 fb for resonance masses between 1.2 and 5.2   Te , respectively. The limits presented in this paper are the best to date in the dijet final state.
  14. Chow LC, Chew LP, Leong TS, Mohamad Tazuddin EE, Chua HH
    SN Compr Clin Med, 2020;2(11):2406-2410.
    PMID: 33043250 DOI: 10.1007/s42399-020-00537-0
    Coronavirus disease (COVID-19) has a wide spectrum of clinical manifestations. In this case report, we describe our first case of COVID-19 pneumonia that was complicated by cerebral venous thrombosis and bleeding in a patient with polycythemia vera. Madam A, a 72-year-old lady with polycythemia vera, ischemic stroke, hemorrhoids, diabetes mellitus, hypertension, and dyslipidemia was admitted to the hospital for COVID-19 pneumonia. She was treated with hydroxychloroquine and lopinavir/ritonavir as per hospital protocol. She continued taking hydroxyurea and aspirin for her treatment of polycythemia vera. Subsequently, she developed rectal bleeding when her platelet count was 1247 × 103/μl, even though she was not on an anticoagulant. Her aspirin was withheld. One week later, she was readmitted to the hospital for cerebral venous thrombosis and her D-dimer was 2.02 μg/ml. She was commenced on a therapeutic dose of low molecular weight heparin. Following that, her D-dimer level showed a decreasing trend and normalized upon her discharge. Patients with polycythemia vera are prone to develop thrombotic and bleeding complications. Management of this group of patients has become more complex with COVID-19 infection. It is crucial for us to decide when to start an anticoagulant especially when there is a history of recent bleeding. We need to balance the risks of further bleeding versus potentially fatal thrombotic events. Studies have shown that D-dimer can be used as a clinical marker to predict thrombotic events in COVID-19 infection. Patients with COVID-19 infection and polycythemia vera will benefit from both pharmacological thromboprophylaxis and close monitoring for bleeding.
  15. Nassr RM, Aborujilah A, Aldossary DA, Aldossary AAA
    IEEE Access, 2020;8:186939-186950.
    PMID: 35127298 DOI: 10.1109/ACCESS.2020.3029967
    The COVID-19 pandemic has struck the world and forced countries to go into lockdown including education sector. Students have been staying in hostels or houses, unable to go to university campuses. This situation has left university administrators no choice, but to have an online learning channel. Malaysian universities in particular have gone through many challenges to bring their online learning system up and ready to resume education process. However, students have found themselves caught in this situation (pure online learning) with no plan or readiness. Literature reviews showed that students encountered some challenges that could not be easily resolved. This study explored the challenges encountered by students of a government-linked university. This university is one of the largest in Malaysia with over 10 campuses across the country. This study collected 284 valid answers. The findings show that respondents lacked full readiness in this situation physically, environmentally, and psychologically with some differences in perspectives according to their gender, age, and residing state. Respondents were concerned about the implications of lockdown on their performance. The findings of this study indicate that a sudden switch to a pure online alternative creates considerable challenges to students who have no plans to be physically apart from classes. The findings also indicate that the current blended learning process which uses online learning as a support mechanism for face-to-face learning has faced a considerable challenge to replace it, particularly with unprepared students.
  16. Khaw SC, Wong ZZ, Anderson R, Martins da Silva S
    Reprod Fertil, 2020 Jul;1(1):67-81.
    PMID: 35128424 DOI: 10.1530/RAF-20-0037
    Fifteen percent of couples are globally estimated to be infertile, with up to half of these cases attributed to male infertility. Reactive oxidative species (ROS) are known to damage sperm leading to impaired quantity and quality. Although not routinely assessed, oxidative stress is a common underlying pathology in infertile men. Antioxidants have been shown to improve semen analysis parameters by reducing ROS and facilitating repair of damage caused by oxidative stress, but it remains unclear whether they improve fertility. Carnitines are naturally occurring antioxidants in mammals and are normally abundant in the epididymal luminal fluid of men. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of carnitine supplementation for idiopathic male infertility. We searched ClinicalKey, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDLINE, PubMed and ScienceDirect for relevant studies published from 1 January 2000 to 30 April 2020. Of the articles retrieved, only eight randomised controlled trials were identified and included. Analysis showed that carnitines significantly improve total sperm motility, progressive sperm motility and sperm morphology, but without effect on sperm concentration. There was no demonstrable effect on clinical pregnancy rate in the five studies that included that outcome, although patient numbers were limited. Therefore, the use of carnitines in male infertility appears to improve some sperm parameters but without evidence of an increase in the chance of natural conception.

    Lay summary: Although male infertility affects 1:15 men, there is no obvious reason in the vast majority of cases. Reactive oxidative species (ROS) are highly active molecules containing oxygen and are natural byproducts of normal metabolism. However, high concentrations of ROS have been shown to damage sperm, which negatively impacts a couple's ability to conceive. Carnitines are natural antioxidants found in the body that counterbalance the damaging effects of ROS. We conducted a comprehensive review of published studies to assess whether carnitine supplements are safe and effective in improving sperm quality and pregnancy rates. Our analysis shows that carnitines improve sperm swimming and production of normal-shaped sperm cells but do not affect sperm count or pregnancy rates, although there are only a few studies and scientific evidence is limited. Whilst it is possible that carnitines may benefit male infertility, more evidence is required regarding chances of pregnancy after carnitine therapy.

  17. Sivakumar S, Gupta AA, Nik Mohd Rosdy NMM, Venkiteswaran A, Raj AT, Awan KH
    Transl Cancer Res, 2020 Apr;9(4):3092-3100.
    PMID: 35117672 DOI: 10.21037/tcr.2020.01.09
    BACKGROUND: This study aims to qualitatively and quantitatively review the association between Epstein-Barr virus (EBV) and oral squamous cell carcinoma (OSCC).

    METHODS: PubMed, Scopus, and Web of Science databases were searched using the keywords "EBV or Epstein Barr virus and Oral cancer or Oral squamous cell carcinoma" for published case-control studies in the English language upto August 2019.

    RESULTS: The search yielded 985 articles out of which 966 articles were excluded by screening their titles and abstracts as they were irrelevant or duplicates. Based on the full-text assessment of the remaining 19 articles, only 7 satisfied the inclusion criteria and were included in the qualitative analysis, out of which only 4 were compatible to be included in the meta-analysis. The diagnostic modalities used included immunohistochemistry, in situ hybridization and polymerase chain reaction. The diagnostic targets included latent membrane protein (LMP)-1, EBV determined nuclear antigen-1, EBV-encoded small non-polyadenylated RNA-2. The meta-analysis showed that there is an association between the EBV and OSCC.

    CONCLUSIONS: Determining the association of EBV with OSCC is highly tedious due to the contrasting data obtained from individuals' studies which in turn is due to the wide variations in the sensitivity and specificity of the diagnostic modalities used and diagnostic targets selected. Although the meta-analysis revealed an association between EBV and OSCC, the number and the quality of the studies included in the meta-analysis are limited, thus the association requires further validation for any conclusive inference.

  18. Al-Rudayni AHM, Gopinath D, Maharajan MK, Menon RK
    Transl Cancer Res, 2020 Apr;9(4):3126-3134.
    PMID: 35117676 DOI: 10.21037/tcr.2020.02.77
    Oral mucositis (OM) is one of the most prominent side effects of cancer treatment and is believed to have a significant impact on the quality of life (QoL) of the affected patients. However, measurements for the investigation of OM is plagued by heterogeneity in symptoms that varies with the type of cancer or the treatment. We aimed to carry out a qualitative assessment of the current evidence on the impact of OM on QoL in patients undergoing oncologic treatment. A systematic search for studies evaluating the impact of OM on QoL was performed in MEDLINE and Embase databases from inception to December 2018 using the MeSH terms for the keywords "Antineoplastic", "Stomatitis", and "Quality of life". Studies were initially assessed based on the selection criteria and underwent a selection process based on the title and abstract followed by a full text review. Data extraction was performed into a standardized data collection form to collect data pertaining to the author/year, study design, study characteristics, mucositis assessment, QoL assessment and results. A qualitative assessment was performed. A total of 459 articles were selected after removal of duplicates. Following the full text review, only ten articles qualified for the systematic review based on the selection criteria. Several studies have identified a correlation between the severity of mucositis and reduction in QoL. The impact of OM on QoL extend beyond the local oral complications and has been shown to affect the physical, emotional, and psychological functional domains. However, heterogeneity in the study parameters and evaluation (cancer types, treatment regimens, chosen time points (during or after therapy) and the instruments used for QoL measurements) does not permit a robust assessment of the impact of OM on QoL. A standardized approach to the measurement of oral mucositis and evaluation of QoL is required to enhance the utility of QoL data in patients afflicted with oral mucositis following cancer treatment.
  19. Tseng M, Vellayappan B, Choong R, Appalanaido GK, Soon YY
    Transl Cancer Res, 2020 Jan;9(Suppl 1):S23-S28.
    PMID: 35117945 DOI: 10.21037/tcr.2019.07.23
    Background: To determine if PMRT for elderly patients (>65 years old) with intermediate risk breast cancer (T1-2N1, T3N0) improves outcomes.

    Methods: We performed a systematic review and meta-analysis to compare the effects of PMRT to no PMRT for elderly patients with intermediate-risk breast cancer. We searched PubMed for eligible studies from Jan 2008 to Dec 2018. We assessed the methodological quality of the included studies using the ROBINS-I tool and performed the meta-analysis with random effects model. The primary outcome of interest was overall survival (OS); secondary outcomes were breast cancer specific survival (BCSS), loco-regional (LRR) and distant disease recurrence (DDR).

    Results: We found 2 retrospective cohort studies with 743 patients directly comparing PMRT to no PMRT. Both studies were judged to have serious risk of bias in their methodological quality. The pooled results suggest that PMRT was associated with a 20% relative reduction in the hazard in death, ranging from 41% relative reduction, a substantial negative association to 10% relative increase, a small positive association (HR 0.80, 95% CI: 0.59-1.1, P=0.62, I2=0%). PMRT was also associated with a 17% relative reduction in the hazard for breast cancer related death, ranging from 52% relative reduction, a substantial negative association to 41% relative increase, a substantial positive association (HR 0.83, 95% CI: 0.48-1.41, P=0.48, I2=0%). One study did not observe any significant differences in LRR and DDR between the two groups.

    Conclusions: The survival benefits from PMRT in unselected elderly patients with intermediate risk breast cancer is unclear. Further research to better select elderly patients who may benefit from PMRT is warranted. Patients with a multiple pathological risk factors suggestive of high risk of loco-regional recurrence post-mastectomy should consider PMRT.

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