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Fulltext Isolation and Characterization of Magnetic Oil Palm Empty Fruits Bunch Cellulose Nanofiber Composite as a Bio-Sorbent for Cu(II) and Cr(VI) Removal

Khalid AM, Hossain MS, Ismail N, Khalil NA, Balakrishnan V, Zulkifli M, et al.

Polymers (Basel), 2020 Dec 30;13(1).
PMID: 33396583 DOI: 10.3390/polym13010112

In the present study, magnetic oil palm empty fruits bunch cellulose nanofiber (M-OPEFB-CNF) composite was isolated by sol-gel method using cellulose nanofiber (CNF) obtained from oil palm empty fruits bunch (OPEFB) and Fe3O4 as magnetite. Several analytical methods were utilized to characterize the mechanical, chemical, thermal, and morphological properties of the isolated CNF and M-OPEFB-CNF. Subsequently, the isolated M-OPEFB-CNF composite was utilized for the adsorption of Cr(VI) and Cu(II) from aqueous solution with varying parameters, such as pH, adsorbent doses, treatment time, and temperature. Results showed that the M-OPEFB-CNF as an effective bio-sorbent for the removal of Cu(II) and Cr(VI) from aqueous solution. The adsorption isotherm modeling revealed that the Freundlich equation better describes the adsorption of Cu(II) and Cr(VI) on M-OPEFB-CNF composite. The kinetics studies revealed the pseudo-second-order kinetics model was a better-described kinetics model for the removal of Cu(II) and Cr(VI) using M-OPEFB-CNF composite as bio-sorbent. The findings of the present study showed that the M-OPEFB-CNF composite has the potential to be utilized as a bio-sorbent for heavy metals removal.
Fulltext Recycling Waste Cotton Cloths for the Isolation of Cellulose Nanocrystals: A Sustainable Approach

Mohamed SH, Hossain MS, Mohamad Kassim MH, Ahmad MI, Omar FM, Balakrishnan V, et al.

Polymers (Basel), 2021 Feb 19;13(4).
PMID: 33669623 DOI: 10.3390/polym13040626

There is an interest in the sustainable utilization of waste cotton cloths because of their enormous volume of generation and high cellulose content. Waste cotton cloths generated are disposed of in a landfill, which causes environmental pollution and leads to the waste of useful resources. In the present study, cellulose nanocrystals (CNCs) were isolated from waste cotton cloths collected from a landfill. The waste cotton cloths collected from the landfill were sterilized and cleaned using supercritical CO2 (scCO2) technology. The cellulose was extracted from scCO2-treated waste cotton cloths using alkaline pulping and bleaching processes. Subsequently, the CNCs were isolated using the H2SO4 hydrolysis of cellulose. The isolated CNCs were analyzed to determine the morphological, chemical, thermal, and physical properties with various analytical methods, including attenuated total reflection-Fourier transform-infrared spectroscopy (ATR-FTIR), field-emission scanning electron microscopy (FE-SEM), energy-filtered transmission electron microscopy (EF-TEM), X-ray diffraction (XRD), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). The results showed that the isolated CNCs had a needle-like structure with a length and diameter of 10-30 and 2-6 nm, respectively, and an aspect ratio of 5-15, respectively. Additionally, the isolated CNCs had a high crystallinity index with a good thermal stability. The findings of the present study revealed the potential of recycling waste cotton cloths to produce a value-added product.
Fulltext Influence of Fresh Palm Fruit Sterilization in the Production of Carotenoid-Rich Virgin Palm Oil

Hassan NSM, Hossain MS, Balakrishnan V, Zuknik MH, Mustaner M, Easa AM, et al.

Foods, 2021 Nov 17;10(11).
PMID: 34829117 DOI: 10.3390/foods10112838

Palm oil is known to be rich in carotenoids and other phytonutrients. However, the carotenoids and phytonutrients degrade due to high heat sterilization of oil palm fruits. The present study was conducted to produce carotenoid-rich virgin palm oil (VPO) using cold-press extraction. Herein, the influence of sterilization of oil palm fresh fruits in the production of cold-pressed VPO was determined with varying sterilization temperatures, times, and amounts of palm fruits in sterilization. The experimental sterilization conditions were optimized using response surface methodology (RSM) based on the maximum VPO yield and minimum FFAs in cold-pressed VPO. The optimal sterilization experimental conditions of oil palm fruits were determined to be a sterilization temperature of 62 °C, a time of 90 min, and an amount of oil palm fruits of 8 kg. Under these experimental conditions, the maximum cold-pressed VPO yield and the minimal content of free fatty acids (FFAs) obtained were 27.94 wt.% and 1.32 wt.%, respectively. Several analytic methods were employed to determine cold-pressed VPO quality and fatty acids compositions and compared with the crude palm oil. It was found that cold-pressed VPO contains higher carotenoids (708 mg/g) and unsaturated fatty acids compared with the carotenoid (343 mg/g) and fatty acid compositions in CPO. The findings of the present study reveal that the sterilization temperature potentially influences the carotenoid and nutrient contents in VPO; therefore, the optimization of the sterilization conditions is crucial to producing carotenoid- and phytonutrient-rich VPO.
Fulltext Effectiveness of Booster Vaccinations on the Control of COVID-19 during the Spread of Omicron Variant in Malaysia

Wong MTJ, Dhaliwal SS, Balakrishnan V, Nordin F, Norazmi MN, Tye GJ

Int J Environ Res Public Health, 2023 Jan 16;20(2).
PMID: 36674401 DOI: 10.3390/ijerph20021647

(1) Background: The assessment of vaccine effectiveness against the Omicron variant is vital in the fight against COVID-19, but research on booster vaccine efficacy using nationwide data was lacking at the time of writing. This study investigates the effectiveness of booster doses on the Omicron wave in Malaysia against COVID-19 infections and deaths; (2) Methods: This study uses nationally representative data on COVID-19 from 1 January to 31 March 2022, when the Omicron variant was predominant in Malaysia. Daily new infections, deaths, ICU utilization and Rt values were compared. A screening method was used to predict the vaccine effectiveness against COVID-19 infections, whereas logistic regression was used to estimate vaccine effectiveness against COVID-19-related deaths, with efficacy comparison between AZD1222, BNT162b2 and CoronaVac; (3) Results: Malaysia's Omicron wave started at the end of January 2022, peaking on 5 March 2022. At the time of writing, statistics for daily new deaths, ICU utilization, and effective reproductive values (Rt) were showing a downtrend. Boosted vaccination is 95.4% (95% CI: 95.4, 95.4) effective in curbing COVID-19 infection, compared to non-boosted vaccination, which is 87.2% (95% CI: 87.2, 87.2). For symptomatic infection, boosted vaccination is 97.4% (95% CI: 97.4, 97.4) effective, and a non-boosted vaccination is 90.9% (95% CI: 90.9, 90.9). Against COVID-19-related death, boosted vaccination yields a vaccine effectiveness (VE) of 91.7 (95% CI: 90.6, 92.7) and full vaccination yields a VE of 65.7% (95% CI: 61.9, 69.1). Looking into the different vaccines as boosters, AZD1222 is 95.2% (CI 95%: 92.7, 96.8) effective, BNT162b2 is 91.8% (CI 95%: 90.7, 92.8) effective and CoronaVac is 88.8% (CI 95%: 84.9, 91.7) effective against COVID-19 deaths. (4) Conclusions: Boosters are effective in increasing protection against COVID-19, including the Omicron variant. Given that the VE observed was lower, CoronaVac recipients are encouraged to take boosters due to its lower VE.
Fulltext The COVID-19/Tuberculosis Syndemic and Potential Antibody Therapy for TB Based on the Lessons Learnt From the Pandemic

Dass SA, Balakrishnan V, Arifin N, Lim CSY, Nordin F, Tye GJ

Front Immunol, 2022;13:833715.
PMID: 35242137 DOI: 10.3389/fimmu.2022.833715

2020 will be marked in history for the dreadful implications of the COVID-19 pandemic that shook the world globally. The pandemic has reshaped the normality of life and affected mankind in the aspects of mental and physical health, financial, economy, growth, and development. The focus shift to COVID-19 has indirectly impacted an existing air-borne disease, Tuberculosis. In addition to the decrease in TB diagnosis, the emergence of the TB/COVID-19 syndemic and its serious implications (possible reactivation of latent TB post-COVID-19, aggravation of an existing active TB condition, or escalation of the severity of a COVID-19 during TB-COVID-19 coinfection), serve as primary reasons to equally prioritize TB. On a different note, the valuable lessons learnt for the COVID-19 pandemic provide useful knowledge for enhancing TB diagnostics and therapeutics. In this review, the crucial need to focus on TB amid the COVID-19 pandemic has been discussed. Besides, a general comparison between COVID-19 and TB in the aspects of pathogenesis, diagnostics, symptoms, and treatment options with importance given to antibody therapy were presented. Lastly, the lessons learnt from the COVID-19 pandemic and how it is applicable to enhance the antibody-based immunotherapy for TB have been presented.
Machine learning approaches in diagnosing tuberculosis through biomarkers - A systematic review

Balakrishnan V, Kherabi Y, Ramanathan G, Paul SA, Tiong CK

Prog Biophys Mol Biol, 2023 May;179:16-25.
PMID: 36931609 DOI: 10.1016/j.pbiomolbio.2023.03.001

Biomarker-based tests may facilitate Tuberculosis (TB) diagnosis, accelerate treatment initiation, and thus improve outcomes. This review synthesizes the literature on biomarker-based detection for TB diagnosis using machine learning. The systematic review approach follows the PRISMA guideline. Articles were sought using relevant keywords from Web of Science, PubMed, and Scopus, resulting in 19 eligible studies after a meticulous screening. All the studies were found to have focused on the supervised learning approach, with Support Vector Machine (SVM) and Random Forest emerging as the top two algorithms, with the highest accuracy, sensitivity and specificity reported to be 97.0%, 99.2%, and 98.0%, respectively. Further, protein-based biomarkers were widely explored, followed by gene-based such as RNA sequence and, Spoligotypes. Publicly available datasets were observed to be popularly used by the studies reviewed whilst studies targeting specific cohorts such as HIV patients or children gathering their own data from healthcare facilities, leading to smaller datasets. Of these, most studies used the leave one out cross validation technique to mitigate overfitting. The review shows that machine learning is increasingly assessed in research to improve TB diagnosis through biomarkers, as promising results were shown in terms of model's detection performance. This provides insights on the possible application of machine learning approaches to diagnose TB using biomarkers as opposed to the traditional methods that can be time consuming. Low-middle income settings, where access to basic biomarkers could be provided as compared to sputum-based tests that are not always available, could be a major application of such models.
Fulltext Gestational diabetes: what size the problem?

Wang KW, Balakrishnan V, Liauw PC, Chua EK, Vengadasalam D, Tan YT

Singapore Med J, 1988 Feb;29(1):53-5.
PMID: 3406769

Diabetes mellitus is a common chronic disease in Singapore. Its occurrence in pregnant women was 1.3% in a previous report. In a survey of 145 consecutive pregnant women registered at Alexandra Hospital the incidence of gestational diabetes was 13.1% when a total screen with 75 gm oral glucose challenge was used. The mean age of this sample was 27 years and the mean gestation at screening 33 weeks. There was an excess of Malay and Indian patients. Fifty percent had traditional risk factors tor gestational diabetes. Whether this higher incidence is a result of more stringent screening and/or increased occurrence remains to be confirmed.
Fulltext Critical product features' identification using an opinion analyzer

Shamim A, Balakrishnan V, Tahir M, Shiraz M

ScientificWorldJournal, 2014;2014:340583.
PMID: 25506612 DOI: 10.1155/2014/340583

The increasing use and ubiquity of the Internet facilitate dissemination of word-of-mouth through blogs, online forums, newsgroups, and consumer's reviews. Online consumer's reviews present tremendous opportunities and challenges for consumers and marketers. One of the challenges is to develop interactive marketing practices for making connections with target consumers that capitalize consumer-to-consumer communications for generating product adoption. Opinion mining is employed in marketing to help consumers and enterprises in the analysis of online consumers' reviews by highlighting the strengths and weaknesses of the products. This paper describes an opinion mining system based on novel review and feature ranking methods to empower consumers and enterprises for identifying critical product features from enormous consumers' reviews. Consumers and business analysts are the main target group for the proposed system who want to explore consumers' feedback for determining purchase decisions and enterprise strategies. We evaluate the proposed system on real dataset. Results show that integration of review and feature-ranking methods improves the decision making processes significantly.
Fulltext Ringed Seal Search for Global Optimization via a Sensitive Search Model

Saadi Y, Yanto IT, Herawan T, Balakrishnan V, Chiroma H, Risnumawan A

PLoS One, 2016;11(1):e0144371.
PMID: 26790131 DOI: 10.1371/journal.pone.0144371

The efficiency of a metaheuristic algorithm for global optimization is based on its ability to search and find the global optimum. However, a good search often requires to be balanced between exploration and exploitation of the search space. In this paper, a new metaheuristic algorithm called Ringed Seal Search (RSS) is introduced. It is inspired by the natural behavior of the seal pup. This algorithm mimics the seal pup movement behavior and its ability to search and choose the best lair to escape predators. The scenario starts once the seal mother gives birth to a new pup in a birthing lair that is constructed for this purpose. The seal pup strategy consists of searching and selecting the best lair by performing a random walk to find a new lair. Affected by the sensitive nature of seals against external noise emitted by predators, the random walk of the seal pup takes two different search states, normal state and urgent state. In the normal state, the pup performs an intensive search between closely adjacent lairs; this movement is modeled via a Brownian walk. In an urgent state, the pup leaves the proximity area and performs an extensive search to find a new lair from sparse targets; this movement is modeled via a Levy walk. The switch between these two states is realized by the random noise emitted by predators. The algorithm keeps switching between normal and urgent states until the global optimum is reached. Tests and validations were performed using fifteen benchmark test functions to compare the performance of RSS with other baseline algorithms. The results show that RSS is more efficient than Genetic Algorithm, Particles Swarm Optimization and Cuckoo Search in terms of convergence rate to the global optimum. The RSS shows an improvement in terms of balance between exploration (extensive) and exploitation (intensive) of the search space. The RSS can efficiently mimic seal pups behavior to find best lair and provide a new algorithm to be used in global optimization problems.
Fulltext To share or not to share - The underlying motives of sharing fake news amidst the COVID-19 pandemic in Malaysia

Balakrishnan V, Ng KS, Rahim HA

Technol Soc, 2021 Aug;66:101676.
PMID: 36540782 DOI: 10.1016/j.techsoc.2021.101676

This study investigates the underlying motives for online fake news sharing during the COVID-19 pandemic, an unprecedented time that witnessed a spike in the spread of false content. Motives were identified based on a fake news sharing model developed using the SocioCultural-Psychological-Technology (SCulPT) model, Uses and Gratification (U&G) theory and Self-Determination Theory (SDT), and further extended using fake news predictors/gratifications from past studies. A self-administered survey resulted in 869 online Malaysian respondents aged between 18 and 59 years old (Mean = 22.6, Standard deviation = 6.13). Structured equation modelling revealed the fake news sharing model to collectively account for 49.2 % of the variance, with Altruism (β = 0.333; p
Fulltext A Review on Plant Cellulose Nanofibre-Based Aerogels for Biomedical Applications

Abdul Khalil HPS, Adnan AS, Yahya EB, Olaiya NG, Safrida S, Hossain MS, et al.

Polymers (Basel), 2020 Aug 06;12(8).
PMID: 32781602 DOI: 10.3390/polym12081759

Cellulose nanomaterials from plant fibre provide various potential applications (i.e., biomedical, automotive, packaging, etc.). The biomedical application of nanocellulose isolated from plant fibre, which is a carbohydrate-based source, is very viable in the 21st century. The essential characteristics of plant fibre-based nanocellulose, which include its molecular, tensile and mechanical properties, as well as its biodegradability potential, have been widely explored for functional materials in the preparation of aerogel. Plant cellulose nano fibre (CNF)-based aerogels are novel functional materials that have attracted remarkable interest. In recent years, CNF aerogel has been extensively used in the biomedical field due to its biocompatibility, renewability and biodegradability. The effective surface area of CNFs influences broad applications in biological and medical studies such as sustainable antibiotic delivery for wound healing, the preparation of scaffolds for tissue cultures, the development of drug delivery systems, biosensing and an antimicrobial film for wound healing. Many researchers have a growing interest in using CNF-based aerogels in the mentioned applications. The application of cellulose-based materials is widely reported in the literature. However, only a few studies discuss the potential of cellulose nanofibre aerogel in detail. The potential applications of CNF aerogel include composites, organic-inorganic hybrids, gels, foams, aerogels/xerogels, coatings and nano-paper, bioactive and wound dressing materials and bioconversion. The potential applications of CNF have rarely been a subject of extensive review. Thus, extensive studies to develop materials with cheaper and better properties, high prospects and effectiveness for many applications are the focus of the present work. The present review focuses on the evolution of aerogels via characterisation studies on the isolation of CNF-based aerogels. The study concludes with a description of the potential and challenges of developing sustainable materials for biomedical applications.
Fulltext Minichromosome Maintenance Complex (MCM) Genes Profiling and MCM2 Protein Expression in Cervical Cancer Development

Kaur G, Balasubramaniam SD, Lee YJ, Balakrishnan V, Oon CE

Asian Pac J Cancer Prev, 2019 Oct 01;20(10):3043-3049.
PMID: 31653153 DOI: 10.31557/APJCP.2019.20.10.3043

OBJECTIVE: Minichromosome maintenance complex (MCM) proteins are essential for the process of DNA replication and cell division. This study aimed to evaluate MCM genes expression profiles and MCM2 protein in HPV-associated cervical carcinogenesis.
METHODOLOGY: MCM2, 4, 5 and 7 genes expression profiles were evaluated in three cervical tissue samples each of normal cervix, human papillomavirus (HPV)-infected low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma (SCC), using Human Transcriptome Array 2.0 and validated by nCounter® PanCancer Pathway NanoString Array. Immunohistochemical expression of MCM2 protein was semi-quantitatively assessed by histoscore in tissue microarrays containing 9 cases of normal cervix, 10 LSIL, 10 HSIL and 42 cases of SCC.
RESULTS: MCM2, 4, 5 and 7 genes expressions were upregulated with increasing fold change during the progression from LSIL to HSIL and the highest in SCC. MCM2 gene had the highest fold change in SCC compared to normal cervix. Immunohistochemically, MCM2 protein was localised in the nuclei of basal cells of normal cervical epithelium and dysplastic-neoplastic cells of CIN and SCC. There was a significant difference in MCM2 protein expression between the histological groups (P = 0.039), and histoscore was the highest in HSIL compared to normal cervix (P = 0.010).
CONCLUSION: The upregulation of MCM genes expressions in cervical carcinogenesis reaffirms MCM as a proliferative marker in DNA replication pathway, whereby proliferation of dysplastic and cancer cells become increasingly dysregulated and uncontrolled. A strong expression of MCM2 protein in HSIL may aid as a concatenated screening tool in detecting pre-cancerous cervical lesions.
Fulltext Testing the Feasibility and Acceptability of Using an Artificial Intelligence Chatbot to Promote HIV Testing and Pre-Exposure Prophylaxis in Malaysia: Mixed Methods Study

Cheah MH, Gan YN, Altice FL, Wickersham JA, Shrestha R, Salleh NAM, et al.

JMIR Hum Factors, 2024 Jan 26;11:e52055.
PMID: 38277206 DOI: 10.2196/52055

BACKGROUND: The HIV epidemic continues to grow fastest among men who have sex with men (MSM) in Malaysia in the presence of stigma and discrimination. Engaging MSM on the internet using chatbots supported through artificial intelligence (AI) can potentially help HIV prevention efforts. We previously identified the benefits, limitations, and preferred features of HIV prevention AI chatbots and developed an AI chatbot prototype that is now tested for feasibility and acceptability.
OBJECTIVE: This study aims to test the feasibility and acceptability of an AI chatbot in promoting the uptake of HIV testing and pre-exposure prophylaxis (PrEP) in MSM.
METHODS: We conducted beta testing with 14 MSM from February to April 2022 using Zoom (Zoom Video Communications, Inc). Beta testing involved 3 steps: a 45-minute human-chatbot interaction using the think-aloud method, a 35-minute semistructured interview, and a 10-minute web-based survey. The first 2 steps were recorded, transcribed verbatim, and analyzed using the Unified Theory of Acceptance and Use of Technology. Emerging themes from the qualitative data were mapped on the 4 domains of the Unified Theory of Acceptance and Use of Technology: performance expectancy, effort expectancy, facilitating conditions, and social influence.
RESULTS: Most participants (13/14, 93%) perceived the chatbot to be useful because it provided comprehensive information on HIV testing and PrEP (performance expectancy). All participants indicated that the chatbot was easy to use because of its simple, straightforward design and quick, friendly responses (effort expectancy). Moreover, 93% (13/14) of the participants rated the overall chatbot quality as high, and all participants perceived the chatbot as a helpful tool and would refer it to others. Approximately 79% (11/14) of the participants agreed they would continue using the chatbot. They suggested adding a local language (ie, Bahasa Malaysia) to customize the chatbot to the Malaysian context (facilitating condition) and suggested that the chatbot should also incorporate more information on mental health, HIV risk assessment, and consequences of HIV. In terms of social influence, all participants perceived the chatbot as helpful in avoiding stigma-inducing interactions and thus could increase the frequency of HIV testing and PrEP uptake among MSM.
CONCLUSIONS: The current AI chatbot is feasible and acceptable to promote the uptake of HIV testing and PrEP. To ensure the successful implementation and dissemination of AI chatbots in Malaysia, they should be customized to communicate in Bahasa Malaysia and upgraded to provide other HIV-related information to improve usability, such as mental health support, risk assessment for sexually transmitted infections, AIDS treatment, and the consequences of contracting HIV.
Prognostic prospect of soluble programmed cell death ligand-1 in cancer management

Khairil Anwar NA, Mohd Nazri MN, Murtadha AH, Mohd Adzemi ER, Balakrishnan V, Mustaffa KMF, et al.

Acta Biochim Biophys Sin (Shanghai), 2021 Jul 28;53(8):961-978.
PMID: 34180502 DOI: 10.1093/abbs/gmab077

Aggressive tissue biopsy is commonly unavoidable in the management of most suspected tumor cases to conclusively verify the presence of cancerous cells through histological assessment. The extracted tissue is also immunostained for detection of antigens (tissue tumor markers) of potential prognostic or therapeutic importance to assist in treatment decision. Although liquid biopsies can be a powerful tool for monitoring treatment response, they are still excluded from standard cancer diagnostics, and their utility is still being debated in the scientific community. With a myriad of soluble tissue tumor markers now being discovered, liquid biopsies could completely change the current paradigms of cancer management. Recently, soluble programmed cell death ligand-1 (sPD-L1), which is found in the peripheral blood, i.e. serum and plasma, has shown potential as a pre-therapeutic predictive marker as well as a prognostic biomarker to monitor treatment efficacy. Thus, this review focuses on the emergence of sPD-L1 and promising technologies for its detection in order to support liquid biopsies for future cancer management.
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.
Fulltext Breast milk from healthy women has higher anti-Candida properties than women with vaginal infections during pregnancy

Nisaa AA, Oon CE, Sreenivasan S, Balakrishnan V, Tan JJ, Teh CS, et al.

Food Sci Biotechnol, 2023 Mar;32(4):471-480.
PMID: 36911325 DOI: 10.1007/s10068-022-01088-x

The aim of this study was to investigate the different immunological and antimicrobial properties of breast milk from women with (W) or without (WO) vaginal yeast infections during pregnancy in 85 lactating women (W, n = 43; WO, n = 42). Concentrations of IL-10, IgA, IgM, IgG, EGF, and TGF-α were similar in both groups. However, breast milk of women aged below 31 years old from the W-group showed higher concentration of EGF than the WO-group (p = 0.031). Breast milk from WO-group exhibited higher anti-Candida properties than W-group, both via growth inhibition and aggregation of yeast cells (p
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.
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.

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