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Optimizing supercritical carbon dioxide in the inactivation of bacteria in clinical solid waste by using response surface methodology

Hossain MS, Nik Ab Rahman NN, Balakrishnan V, Alkarkhi AF, Ahmad Rajion Z, Ab Kadir MO

Waste Manag, 2015 Apr;38:462-73.
PMID: 25636860 DOI: 10.1016/j.wasman.2015.01.003

Clinical solid waste (CSW) poses a challenge to health care facilities because of the presence of pathogenic microorganisms, leading to concerns in the effective sterilization of the CSW for safe handling and elimination of infectious disease transmission. In the present study, supercritical carbon dioxide (SC-CO2) was applied to inactivate gram-positive Staphylococcus aureus, Enterococcus faecalis, Bacillus subtilis, and gram-negative Escherichia coli in CSW. The effects of SC-CO2 sterilization parameters such as pressure, temperature, and time were investigated and optimized by response surface methodology (RSM). Results showed that the data were adequately fitted into the second-order polynomial model. The linear quadratic terms and interaction between pressure and temperature had significant effects on the inactivation of S. aureus, E. coli, E. faecalis, and B. subtilis in CSW. Optimum conditions for the complete inactivation of bacteria within the experimental range of the studied variables were 20 MPa, 60 °C, and 60 min. The SC-CO2-treated bacterial cells, observed under a scanning electron microscope, showed morphological changes, including cell breakage and dislodged cell walls, which could have caused the inactivation. This espouses the inference that SC-CO2 exerts strong inactivating effects on the bacteria present in CSW, and has the potential to be used in CSW management for the safe handling and recycling-reuse of CSW materials.
Fulltext Implementation of Chatbot Technology in Health Care: Protocol for a Bibliometric Analysis

Ni Z, Peng ML, Balakrishnan V, Tee V, Azwa I, Saifi R, et al.

JMIR Res Protoc, 2024 Feb 15;13:e54349.
PMID: 38228575 DOI: 10.2196/54349

BACKGROUND: Chatbots have the potential to increase people's access to quality health care. However, the implementation of chatbot technology in the health care system is unclear due to the scarce analysis of publications on the adoption of chatbot in health and medical settings.
OBJECTIVE: This paper presents a protocol of a bibliometric analysis aimed at offering the public insights into the current state and emerging trends in research related to the use of chatbot technology for promoting health.
METHODS: In this bibliometric analysis, we will select published papers from the databases of CINAHL, IEEE Xplore, PubMed, Scopus, and Web of Science that pertain to chatbot technology and its applications in health care. Our search strategy includes keywords such as "chatbot," "virtual agent," "virtual assistant," "conversational agent," "conversational AI," "interactive agent," "health," and "healthcare." Five researchers who are AI engineers and clinicians will independently review the titles and abstracts of selected papers to determine their eligibility for a full-text review. The corresponding author (ZN) will serve as a mediator to address any discrepancies and disputes among the 5 reviewers. Our analysis will encompass various publication patterns of chatbot research, including the number of annual publications, their geographic or institutional distribution, and the number of annual grants supporting chatbot research, and further summarize the methodologies used in the development of health-related chatbots, along with their features and applications in health care settings. Software tool VOSViewer (version 1.6.19; Leiden University) will be used to construct and visualize bibliometric networks.
RESULTS: The preparation for the bibliometric analysis began on December 3, 2021, when the research team started the process of familiarizing themselves with the software tools that may be used in this analysis, VOSViewer and CiteSpace, during which they consulted 3 librarians at the Yale University regarding search terms and tentative results. Tentative searches on the aforementioned databases yielded a total of 2340 papers. The official search phase started on July 27, 2023. Our goal is to complete the screening of papers and the analysis by February 15, 2024.
CONCLUSIONS: Artificial intelligence chatbots, such as ChatGPT (OpenAI Inc), have sparked numerous discussions within the health care industry regarding their impact on human health. Chatbot technology holds substantial promise for advancing health care systems worldwide. However, developing a sophisticated chatbot capable of precise interaction with health care consumers, delivering personalized care, and providing accurate health-related information and knowledge remain considerable challenges. This bibliometric analysis seeks to fill the knowledge gap in the existing literature on health-related chatbots, entailing their applications, the software used in their development, and their preferred functionalities among users.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54349.
Fulltext Genotyping of Toxoplasma gondii isolates from wild boars in Peninsular Malaysia

Puvanesuaran VR, Noordin R, Balakrishnan V

PLoS One, 2013;8(4):e61730.
PMID: 23613920 DOI: 10.1371/journal.pone.0061730

Toxoplasma gondii is a parasitic protozoan that infects nearly one-third of the world population. The present study was done to isolate and genotype T. gondii from wild boar from forests of Pahang, Malaysia. A total of 30 wild boars' blood, heads and hearts were obtained for this study and 30 (100.0%) were found to be seropositive when assayed with modified agglutination test (MAT ≥ 6). The positive samples were inoculated into mice and T. gondii was only isolated from samples that had strong seropositivity (MAT ≥ 1:24).The isolates were subjected to PCR-RFLP analysis and all the Peninsular Malaysia isolates of T. gondii are of clonal type I.
Use of prednisolone to aid propagation of Toxoplasma gondii in mice

Puvanesuaran VR, Nowroji K, Sreenivasan S, Noordin R, Balakrishnan V

Eur Rev Med Pharmacol Sci, 2012 Aug;16(8):1028-32.
PMID: 22913152

AIM: To determine the usefulness of prednisolone in increasing the number of Toxoplasma (T.) gondii tachyzoites and bradyzoites in mice.
MATERIALS AND METHODS: The mice were water-fasted prior to being immunosuppressed with oral inoculation of prednisolone. Tachyzoites of 7T gondii RH strain were inoculated into mice and the number of the parasites in the intraperitoneal fluids was then determined at 96 hs post-infection. In addition, tachyzoites of T. gondii ME49 strains were orally introduced into mice and the number of brain cysts formed was observed by microscopic observation at 45 days post-infection.
RESULTS: T. gondii propagation was found to be significantly improved by introduction of the prednisolone (p = 0.0004); and the number of parasite showed positive correlation with the increment in dosage of prednisolone (r = 0.9051).
CONCLUSIONS: The use of prednisolone greatly improved the number of parasite formed in mice: both tachyzoite and cyst forms.
Isolation of viable Toxoplasma gondii cysts from brain samples for oral infection

Puvanesuaran VR, Ibrahim N, Noordin R, Balakrishnan V

Eur Rev Med Pharmacol Sci, 2012 Sep;16(9):1179-83.
PMID: 23047500

AIM: A method was developed to separate contaminant-free viable Toxoplasma gondii cysts from brain samples of infected mice for molecular biology studies and reinfection.
MATERIALS AND METHODS: The mice brains were homogenized and washed with phosphate buffered saline (PBS) Tween 80 prior to fractionation using 19-22% dextran solution. Finally, the supernatant was purified by two-step membrane filtration (100-160 microm and < 10 microm) to obtain pure T. gondii cyst. The isolates were analyzed through microscopic observation, qPCR and by reinfection of new batch of mice.
RESULTS: T. gondii cysts were best isolated with 21% dextran solution and two step filtration.
CONCLUSIONS: The method was observed not to disrupt the integrity of the cysts containing bradyzoites. In addition, the isolated cysts in the filtrate were found to be contaminant-free, viable and able to infect healthy mice when introduced orally; which, mimics the natural infectivity pathway.
Isolation and genotyping of Toxoplasma gondii from free-range ducks in Malaysia

Puvanesuaran VR, Noordin R, Balakrishnan V

Avian Dis, 2013 Mar;57(1):128-32.
PMID: 23678741

Toxoplasma gondii is a parasitic protozoan that infects nearly one-third of humans. The present study was performed to isolate and genotype T. gondii from free-range ducks in Malaysia. Sera, heads, and hearts from 205 ducks were obtained from four states in Peninsular Malaysia, and 30 (14.63%) sera were found to be seropositive when assayed with the modified agglutination test (MAT > or = 1:6). All the positive samples were inoculated into mice, and T. gondii was successfully isolated from four individual duck samples (1.95%), which were initially found to be strongly seropositive (MAT > or = 1:24). The isolates were subjected to PCR-RFLP analysis, and two T. gondii strains were identified: type I and type II. This is the first reported study on the genetic characterization of T. gondii isolates from free-range farm animals in Southeast Asia.
Indirect effect of management support on users' compliance behaviour towards information security policies

Humaidi N, Balakrishnan V

Health Inf Manag, 2018 Jan;47(1):17-27.
PMID: 28537207 DOI: 10.1177/1833358317700255

BACKGROUND: Health information systems are innovative products designed to improve the delivery of effective healthcare, but they are also vulnerable to breaches of information security, including unauthorised access, use, disclosure, disruption, modification or destruction, and duplication of passwords. Greater openness and multi-connectedness between heterogeneous stakeholders within health networks increase the security risk.
OBJECTIVE: The focus of this research was on the indirect effects of management support (MS) on user compliance behaviour (UCB) towards information security policies (ISPs) among health professionals in selected Malaysian public hospitals. The aim was to identify significant factors and provide a clearer understanding of the nature of compliance behaviour in the health sector environment.
METHOD: Using a survey design and stratified random sampling method, self-administered questionnaires were distributed to 454 healthcare professionals in three hospitals. Drawing on theories of planned behaviour, perceived behavioural control (self-efficacy (SE) and MS components) and the trust factor, an information system security policies compliance model was developed to test three related constructs (MS, SE and perceived trust (PT)) and their relationship to UCB towards ISPs.
RESULTS: Results showed a 52.8% variation in UCB through significant factors. Partial least squares structural equation modelling demonstrated that all factors were significant and that MS had an indirect effect on UCB through both PT and SE among respondents to this study.
CONCLUSION: The research model based on the theory of planned behaviour in combination with other human and organisational factors has made a useful contribution towards explaining compliance behaviour in relation to organisational ISPs, with trust being the most significant factor. In adopting a multidimensional approach to management-user interactions via multidisciplinary concepts and theories to evaluate the association between the integrated management-user values and the nature of compliance towards ISPs among selected health professionals, this study has made a unique contribution to the literature.
The potential applications of T cell receptor (TCR)-like antibody in cervical cancer immunotherapy

Dass SA, Selva Rajan R, Tye GJ, Balakrishnan V

Hum Vaccin Immunother, 2021 09 02;17(9):2981-2994.
PMID: 33989511 DOI: 10.1080/21645515.2021.1913960

Cervical cancer is ranked as the fourth most common cancer in women worldwide. Monoclonal antibody has created a new dimension in the immunotherapy of many diseases, including cervical cancer. The antibody's ability to target various aspects of cervical cancer (oncoviruses, oncoproteins, and signaling pathways) delivers a promising future for efficient immunotherapy. Besides, technologies such as hybridoma and phage display provide a fundamental platform for monoclonal antibody generation and create the opportunity to generate novel antibody classes including, T cell receptor (TCR)-like antibody. In this review, the current immunotherapy strategies for cervical cancer are presented. We have also proposed a novel concept of T cell receptor (TCR)-like antibody and its potential applications for enhancing cervical cancer therapeutics. Finally, the possible challenges in TCR-like antibody application for cervical cancer therapeutics have been addressed, and strategies to overcome the challenges have been highlighted to maximize the therapeutic benefits.
Fulltext Triple Negative Breast Cancer: A Review of Present and Future Diagnostic Modalities

Dass SA, Tan KL, Selva Rajan R, Mokhtar NF, Mohd Adzmi ER, Wan Abdul Rahman WF, et al.

Medicina (Kaunas), 2021 Jan 12;57(1).
PMID: 33445543 DOI: 10.3390/medicina57010062

Triple-negative breast cancer (TNBC) is an aggressive breast type of cancer with no expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2). It is a highly metastasized, heterogeneous disease that accounts for 10-15% of total breast cancer cases with a poor prognosis and high relapse rate within five years after treatment compared to non-TNBC cases. The diagnostic and subtyping of TNBC tumors are essential to determine the treatment alternatives and establish personalized, targeted medications for every TNBC individual. Currently, TNBC is diagnosed via a two-step procedure of imaging and immunohistochemistry (IHC), which are operator-dependent and potentially time-consuming. Therefore, there is a crucial need for the development of rapid and advanced technologies to enhance the diagnostic efficiency of TNBC. This review discusses the overview of breast cancer with emphasis on TNBC subtypes and the current diagnostic approaches of TNBC along with its challenges. Most importantly, we have presented several promising strategies that can be utilized as future TNBC diagnostic modalities and simultaneously enhance the efficacy of TNBC diagnostic.
Evidence for the Higgs Boson Decay to a Z Boson and a Photon at the LHC

Aad G, Abbott B, Abeling K, Abicht NJ, Abidi SH, Aboulhorma A, et al.

Phys Rev Lett, 2024 Jan 12;132(2):021803.
PMID: 38277607 DOI: 10.1103/PhysRevLett.132.021803

The first evidence for the Higgs boson decay to a Z boson and a photon is presented, with a statistical significance of 3.4 standard deviations. The result is derived from a combined analysis of the searches performed by the ATLAS and CMS Collaborations with proton-proton collision datasets collected at the CERN Large Hadron Collider (LHC) from 2015 to 2018. These correspond to integrated luminosities of around 140 fb^{-1} for each experiment, at a center-of-mass energy of 13 TeV. The measured signal yield is 2.2±0.7 times the standard model prediction, and agrees with the theoretical expectation within 1.9 standard deviations.
Fulltext The Relationship between Dark Triad Personality Traits and Sexting Behaviors among Adolescents and Young Adults across 11 Countries

Morelli M, Urbini F, Bianchi D, Baiocco R, Cattelino E, Laghi F, et al.

Int J Environ Res Public Health, 2021 03 04;18(5).
PMID: 33806314 DOI: 10.3390/ijerph18052526

BACKGROUND: Sexting is an increasingly common phenomenon among adolescents and young adults. Some studies have investigated the role of personality traits in different sexting behaviors within mainstream personality taxonomies like Big Five and HEXACO. However, very few studies have investigated the role of maladaptive personality factors in sexting. Therefore, the present study investigated the relationship between Dark Triad Personality Traits and experimental (i.e., sharing own sexts), risky (i.e., sexting under substance use and with strangers), and aggravated sexting (i.e., non-consensual sexting and sexting under pressure) across 11 countries.
METHODS: An online survey was completed by 6093 participants (Mage = 20.35; SDage = 3.63) from 11 different countries which covered four continents (Europe, Asia, Africa, and America). Participants completed the Sexting Behaviors Questionnaire and the 12-item Dark Triad Dirty Dozen scale.
RESULTS: Hierarchical regression analyses showed that sharing own sexts was positively predicted by Machiavellianism and Narcissism. Both risky and aggravated sexting were positively predicted by Machiavellianism and Psychopathy.
CONCLUSIONS: The present study provided empirical evidence that different sexting behaviors were predicted by Dark Triad Personality Traits, showing a relevant role of Machiavellianism in all kinds of investigated sexting behaviors. Research, clinical, and education implications for prevention programs are discussed.
Fulltext A deep learning approach in predicting products' sentiment ratings: a comparative analysis

Balakrishnan V, Shi Z, Law CL, Lim R, Teh LL, Fan Y

J Supercomput, 2021 Nov 05.
PMID: 34754140 DOI: 10.1007/s11227-021-04169-6

We present a benchmark comparison of several deep learning models including Convolutional Neural Networks, Recurrent Neural Network and Bi-directional Long Short Term Memory, assessed based on various word embedding approaches, including the Bi-directional Encoder Representations from Transformers (BERT) and its variants, FastText and Word2Vec. Data augmentation was administered using the Easy Data Augmentation approach resulting in two datasets (original versus augmented). All the models were assessed in two setups, namely 5-class versus 3-class (i.e., compressed version). Findings show the best prediction models were Neural Network-based using Word2Vec, with CNN-RNN-Bi-LSTM producing the highest accuracy (96%) and F-score (91.1%). Individually, RNN was the best model with an accuracy of 87.5% and F-score of 83.5%, while RoBERTa had the best F-score of 73.1%. The study shows that deep learning is better for analyzing the sentiments within the text compared to supervised machine learning and provides a direction for future work and research.
Fulltext Effect of Supporting Background Electrolytes on the Nanostructure Morphologies and Electrochemical Behaviors of Electrodeposited Gold Nanoparticles on Glassy Carbon Electrode Surfaces

Zakaria ND, Omar MH, Ahmad Kamal NN, Abdul Razak K, Sönmez T, Balakrishnan V, et al.

ACS Omega, 2021 Sep 28;6(38):24419-24431.
PMID: 34604624 DOI: 10.1021/acsomega.1c02670

Electrodeposition is an electrochemical method employed to deposit stable and robust gold nanoparticles (AuNPs) on electrode surfaces for creating chemically modified electrodes (CMEs). The use of several electrodeposition techniques with different experimental parameters allow in obtaining various surface morphologies of AuNPs deposited on the electrode surface. By considering the electrodeposition of AuNPs in various background electrolytes could play an important strategy in finding the most suitable formation of the electrodeposited AuNP films on the electrode surface. This is because different electrode roughnesses can have different effects on the electrochemical activities of the modified electrodes. Thus, in this study, the electrodeposition of AuNPs onto the glassy carbon (GC) electrode surfaces in various aqueous neutral and acidic electrolytes was achieved by using the cyclic voltammetry (CV) technique with no adjustable CV parameters. Then, surface morphologies and electrochemical activities of the electrodeposited AuNPs were investigated using scanning electron microscopy (SEM), atomic force microscopy (AFM), CV, and electrochemical impedance spectroscopy (EIS). The obtained SEM and 3D-AFM images show that AuNPs deposited at the GC electrode prepared in NaNO3 solution form a significantly better, uniform, and homogeneous electrodeposited AuNP film on the GC electrode surface with nanoparticle sizes ranging from ∼36 to 60 nm. Meanwhile, from the electrochemical performances of the AuNP-modified GC electrodes, characterized by using a mixture of ferricyanide and ferrocyanide ions [Fe(CN6)3-/4-], there is no significant difference observed in the case of charge-transfer resistances (R ct) and heterogeneous electron-transfer rate constants (k o), although there are differences in the surface morphologies of the electrodeposited AuNP films. Remarkably, the R ct values of the AuNP-modified GC electrodes are lower than those of the bare GC electrode by 18-fold, as the R ct values were found to be ∼6 Ω (p < 0.001, n = 3). This has resulted in obtaining k o values of AuNP-modified GC electrodes between the magnitude of 10-2 and 10-3 cm s-1, giving a faster electron-transfer rate than that of the bare GC electrode (10-4 cm s-1). This study confirms that using an appropriate supporting background electrolyte plays a critical role in preparing electrodeposited AuNP films. This approach could lead to nanostructures with a more densely, uniformly, and homogeneously electrodeposited AuNP film on the electrode surfaces, albeit utilizing an easy and simple preparation method.
Fulltext Treatment of clinical solid waste using a steam autoclave as a possible alternative technology to incineration

Hossain MS, Balakrishnan V, Rahman NN, Sarker MZ, Kadir MO

Int J Environ Res Public Health, 2012 Mar;9(3):855-67.
PMID: 22690168 DOI: 10.3390/ijerph9030855

A steam autoclave was used to sterilize bacteria in clinical solid waste in order to determine an alternative to incineration technology in clinical solid waste management. The influence of contact time (0, 5, 15, 30 and 60 min) and temperature (111 °C, 121 °C and 131 °C) at automated saturated steam pressure was investigated. Results showed that with increasing contact time and temperature, the number of surviving bacteria decreased. The optimum experimental conditions as measured by degree of inactivation of bacteria were 121 °C for 15 minutes (min) for Gram negative bacteria, 121 °C and 131 °C for 60 and 30 min for Gram positive bacteria, respectively. The re-growth of bacteria in sterilized waste was also evaluated in the present study. It was found that bacterial re-growth started two days after the inactivation. The present study recommends that the steam autoclave cannot be considered as an alternative technology to incineration in clinical solid waste management.
Fulltext Infectious risk assessment of unsafe handling practices and management of clinical solid waste

Hossain MS, Rahman NN, Balakrishnan V, Puvanesuaran VR, Sarker MZ, Kadir MO

Int J Environ Res Public Health, 2013 Jan 31;10(2):556-67.
PMID: 23435587 DOI: 10.3390/ijerph10020556

The present study was undertaken to determine the bacterial agents present in various clinical solid wastes, general waste and clinical sharp waste. The waste was collected from different wards/units in a healthcare facility in Penang Island, Malaysia. The presence of bacterial agents in clinical and general waste was determined using the conventional bacteria identification methods. Several pathogenic bacteria including opportunistic bacterial agent such as Pseudomonas aeruginosa, Salmonella spp., Klebsiella pneumoniae, Serratia marcescens, Acinetobacter baumannii, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pyogenes were detected in clinical solid wastes. The presence of specific pathogenic bacterial strains in clinical sharp waste was determined using 16s rDNA analysis. In this study, several nosocomial pathogenic bacteria strains of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Lysinibacillus sphaericus, Serratia marcescens, and Staphylococcus aureus were detected in clinical sharp waste. The present study suggests that waste generated from healthcare facilities should be sterilized at the point of generation in order to eliminate nosocomial infections from the general waste or either of the clinical wastes.
Comparative transcriptomic profiling in HPV-associated cervical carcinogenesis: Implication of MHC class II and immunoglobulin heavy chain genes

Balasubramaniam SD, Wong KK, Oon CE, Balakrishnan V, Kaur G

Life Sci, 2020 Sep 01;256:118026.
PMID: 32615187 DOI: 10.1016/j.lfs.2020.118026

AIM: We aimed to determine the biological processes and pathways involved in cervical carcinogenesis associated with high-risk human papillomavirus (HPV) infection.
MATERIALS AND METHODS: Total RNA was extracted from three formalin-fixed paraffin-embedded (FFPE) samples each of normal cervix, HPV-infected low-grade squamous intraepithelial lesion (LSIL), high-grade SIL (HSIL) and squamous cell carcinoma (SCC). Transcriptomic profiling by microarrays was conducted followed by downstream Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses.
RESULTS: We examined the difference in GOs enriched for each transition stage from normal cervix to LSIL, HSIL, and SCC, and found 307 genes to be differentially expressed. In the transition from normal cervix to LSIL, the extracellular matrix (ECM) genes were significantly downregulated. The MHC class II genes were significantly upregulated in the LSIL to HSIL transition. In the final transition from HSIL to SCC, the immunoglobulin heavy locus genes were significantly upregulated and the ECM pathway was implicated.
CONCLUSION: Deregulation of the immune-related genes including MHC II and immunoglobulin heavy chain genes were involved in the transitions from LSIL to HSIL and SCC, suggesting immune escape from host anti-tumour response. The extracellular matrix plays an important role during the early and late stages of cervical carcinogenesis.
Fulltext Key Molecular Events in Cervical Cancer Development

Balasubramaniam SD, Balakrishnan V, Oon CE, Kaur G

Medicina (Kaunas), 2019 Jul 17;55(7).
PMID: 31319555 DOI: 10.3390/medicina55070384

Cervical cancer is the fourth most common cancer among women. Infection by high-risk human papillomavirus (HPV) is the main aetiology for the development of cervical cancer. Infection by high-risk human papillomavirus (HPV) and the integration of the HPV genome into the host chromosome of cervical epithelial cells are key early events in the neoplastic progression of cervical lesions. The viral oncoproteins, mainly E6 and E7, are responsible for the initial changes in epithelial cells. The viral proteins inactivate two main tumour suppressor proteins, p53, and retinoblastoma (pRb). Inactivation of these host proteins disrupts both the DNA repair mechanisms and apoptosis, leading to rapid cell proliferation. Multiple genes involved in DNA repair, cell proliferation, growth factor activity, angiogenesis, as well as mitogenesis genes become highly expressed in cervical intraepithelial neoplasia (CIN) and cancer. This genomic instability encourages HPV-infected cells to progress towards invasive carcinoma. The key molecular events involved in cervical carcinogenesis will be discussed in this review.
Fulltext COVID-19 depression and its risk factors in Asia Pacific - A systematic review and meta-analysis

Balakrishnan V, Ng KS, Kaur W, Govaichelvan K, Lee ZL

J Affect Disord, 2022 Feb 01;298(Pt B):47-56.
PMID: 34801606 DOI: 10.1016/j.jad.2021.11.048

BACKGROUND: This systematic review and meta-analysis aim to synthesize the extant literature reporting the effects of COVID-19 pandemic based on the pooled prevalence of depression among affected populations in Asia Pacific, as well as its risk factors.
METHOD: A systematic review and meta-analysis approach was adopted as per the PRISMA guidelines, targeting articles published in PubMed, Google Scholar and Scopus from January 2021 to March 30, 2021. The screening resulted in 82 papers.
RESULTS: The overall pooled depression prevalence among 201,953 respondents was 34% (95%CI, 29-38, 99.7%), with no significant differences observed between the cohorts, timelines, and regions (p > 0.05). Dominant risk factors found were fear of COVID-19 infection (13%), gender (i.e., females; 12%) and deterioration of underlying medical conditions (8.3%), regardless of the sub-groups. Specifically, fear of COVID-19 infection was the most reported risk factor among general population (k = 14) and healthcare workers (k = 8). Gender (k = 7) and increased workload (k = 7) were reported among healthcare workers whereas education disruption among students (k = 7).
LIMITATION: The review is limited to articles published in three electronic databases. Conclusion The pandemic has caused depression among the populations across Asia Pacific, specifically among the general population, healthcare workers and students. Immediate attention and interventions from the concerned authorities are needed in addressing this issue.
Fulltext COVID-19 mental health prevalence and its risk factors in South East Asia

Balakrishnan V, Ng KS, Kaur W, Lee ZL

Curr Psychol, 2022 Jan 12.
PMID: 35035200 DOI: 10.1007/s12144-021-02556-z

With the record surge of positive cases in Southeast Asia, there is a need to examine the adverse mental effects of COVID-19 among the under-researched countries. This study aims to synthesize the extant literature reporting the effects of COVID-19 pandemic on the psychological outcomes of people in Southeast Asia, and its risk factors. A scoping review was adopted targeting articles published in PubMed, Google Scholar and Scopus from January 2020 to March 30, 2021. Articles were screened using predetermined eligibility criteria, resulting in 26 papers. Elevated prevalence of adverse mental effects was noted in most of the countries as the pandemic progressed over time, with Malaysia and Philippines reporting higher prevalence rates. Mental decline was found to be more profound among the general population compared to healthcare workers and students. Dominant risk factors reported were age (younger), sex (females), education (higher), low coping skill and social/family support, and poor reliability in COVID-19 related information. Adverse mental effects were noted among population, healthcare workers and students in most of the Southeast Asian countries. Intervention and prevention efforts should be based at community-level and prioritize young adults, females, and individuals with dire financial constraints.
Fulltext Vaginal Infections during Pregnancy Increase Breast Milk Microbiome Alpha Diversity and Alter Taxonomic Composition

Nisaa AA, Oon CE, Sreenivasan S, Balakrishnan V, Rajendran D, Tan JJ, et al.

Prev Nutr Food Sci, 2023 Mar 31;28(1):1-9.
PMID: 37066035 DOI: 10.3746/pnf.2023.28.1.1

We previously reported that breast milk from women with (W) or without (WO) vaginal yeast infection during pregnancy differs in its immunological and antimicrobial properties, especially against pathogenic vaginal Candida sp.. Here, we investigated the differences in microbiota profiles of breast milk from these groups. Seventy-two breast milk samples were collected from lactating mothers (W, n=37; WO, n=35). The DNA of bacteria was extracted from each breast milk sample for microbiota profiling by 16S rRNA gene sequencing. Breast milk from the W-group exhibited higher alpha diversity than that from the WO-group across different taxonomic levels of class (P=0.015), order (P=0.011), family (P=0.020), and genus (P=0.030). Compositional differences between groups as determined via beta diversity showed marginal differences at taxonomic levels of phylum (P=0.087), family (P=0.064), and genus (P=0.067). The W-group showed higher abundances of families Moraxellaceae (P=0.010) and Xanthomonadaceae (P=0.008), and their genera Acinetobacter (P=0.015), Enhydrobacter (P=0.015), and Stenotrophomonas (P=0.007). Meanwhile, the WO-group showed higher abundances of genus Staphylococcus (P=0.046) and species Streptococcus infantis (P=0.025). This study shows that, although breast milk composition is affected by vaginal infection during pregnancy, this may not pose a threat to infant growth and development.

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