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1. Fulltext Assessment of polymyxin B associated nephrotoxicity in ICU patients in a Malaysian tertiary teaching hospital

   Lim, M. Y., Nusaibah Abdul Rahim, Periyasamy, P., Lau, C. L.

   Malaysian Journal of Medicine and Health Sciences, 2019;15(102):4-4.

   MyJurnal

   Abstract

   Introduction: Polymyxins are used as the “last-line therapy” for multi drug resistant (MDR) Gram-negative bacterial infections. However, the development of nephrotoxicity is a major concern. The objectives of this study were to determine the incidence and severity of acute kidney injury (AKI) and to identify risk factors associated with AKI and mortality rate in Malaysian patients on polymyxin B (PMB) for MDR Gram-negative bacterial infections. Methods: A retrospective study was conducted in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Medical and
   medication charts were reviewed for all intensive care unit (ICU) patients who received intravenous (IV) PMB from 1st May 2008 to 1st May 2018. Simple and multiple logistic regression were performed to identify risk factors of PMB induced nephrotoxicity. Results: Among the total 572 patients identified, only 31 patients were eligible to be included. The incidence rate of AKI was 45.2% (14 of 31 patients). Univariate analysis showed that age was a significant risk factor of PMB associated nephrotoxicity [OR 1.074; 95% CI 1.002-1.151; P=0.045]. Other four variables (P

   MeSH terms: Critical Care; Humans; Intensive Care Units; Malaysia; Polymyxin B; Polymyxins; Retrospective Studies; Risk Factors; Incidence; Logistic Models; Gram-Negative Bacterial Infections; Acute Kidney Injury
2. Fulltext Effects of phenylpyruvate feeding with polymyxin B in Klebsiella pneumoniae

   Wong, A. S-L., Nusaibah Abdul Rahim

   Malaysian Journal of Medicine and Health Sciences, 2019;15(102):5-5.

   MyJurnal

   Abstract

   Introduction: Polymyxin B (PMB) is one of the remaining antibiotics that is effective against multidrug resistant (MDR) Gram-negative bacteria. However, PMB monotherapy is not able to achieve sustained killing hence, combination with other antibiotics are usually employed. Besides antibiotics, studies are now moving towards non-antibiotic alternatives such as metabolite feeding against MDR pathogens. This study aimed to investigate the susceptibility
   and bacterial killing of PMB in combination with metabolite phenylpyruvate against Klebsiella pneumoniae isolates. Methods: Broth microdilution was used to determine PMB minimum inhibitory concentration (MIC) alone and with phenylpyruvate against two Klebsiella pneumoniae isolates. Time kill studies were performed over 24 h (initial inoculum: ~106 CFU/mL), using PMB 2 mg/L and phenylpyruvate 2 mmol/L, alone and in combination, against the
   PMB-resistant isolate. Microbiological responses were examined using the log-change method. Results: The MIC of PMB was reduced by phenylpyruvate in both isolates. In the time kill studies, during the first hour, PMB monotherapy demonstrated the highest bacterial killing activity even compared to the combination. Phenylpyruvate monotherapy showed negligible activity against K. pneumoniae. A significant reduction in bacterial burden was seen at 1 h following PMB monotherapy and combination therapy but an equally rapid regrowth was seen at 4 h. Notably at 24 h, the regrowth following combination therapy was >1-log10 CFU/mL less than PMB monotherapy. Conclusion: Our results suggest that phenylpyruvate increased PMB susceptibility in K. pneumoniae and may minimise the emergence of resistance to PMB. Future studies investigating phenylpyruvate at higher concentrations against more isolates are
   warranted.

   MeSH terms: Anti-Bacterial Agents; Klebsiella pneumoniae; Microbial Sensitivity Tests; Phenylpyruvic Acids; Polymyxin B; Drug Resistance, Multiple, Bacterial
3. Fulltext The effect of different jubah dress’ materials on image quality using computed radiography (CR) on Knee X-Ray: a bovine study

   Umi Nadrah Amran, Nur Nadiah Mohd Rais

   International Journal of Allied Health Sciences, 2018;2(2):292-303.

   MyJurnal

   Abstract

   In medical imaging practice, the act of removing any clothes from the region of interest is justified as to prevent the presence of artefacts on radiographs. However, by doing so, the ‘aurah’ of the patients, especially for the Muslims, are not observed and can be considered as violating their privacy if they are not well-informed beforehand. Previous studies have proved that radiographs with the presence of some fabric materials on the region of interest are radiographically acceptable. Therefore, the aims of this study are to tackle the issue of exposing one’s ‘aurah’ for a knee x-ray examination to take place and also to add insufficiency from the previous studies.

   MeSH terms: Diagnostic Tests, Routine; Humans; Islam; Radiography; Textiles; X-Rays; Artifacts; Privacy
4. Fulltext Synthesis, characterization and biological properties of copper(II) and zinc(II) complexes against blood-stage Plasmodium falciparum

   Lai, Jing-Wei, Ng, Chew-Hee, Lim, Yvonne Ai-Lian, Mohd Jamil Maah

   Malaysian Journal of Medicine and Health Sciences, 2019;15(102):1-1.

   MyJurnal

   Abstract

   Introduction: The spread of multidrug-resistant malaria parasite – Plasmodium sp. to commercially available antimalarial drugs, i.e. artemisinin-based combination therapies (ACTs) and chloroquine (CQ), has become a global treat to eliminate malaria. To limit the impact of antimalarial drug resistance, a new potent and affordable alternative is urgently needed. A number of metal-based compounds (metallodrugs) have been found active against Plasmodium falciparum, the species that causes potentially fatal cerebral malaria, as they are ease in ligand grafting of multi-functional groups. Ferroquine (FQ) is one of the metalloantimalarial drugs that is currently undergoing clinical trials. Methods: In this study, a series of ternary copper(II) and zinc(II) complexes – Cu(phen)(edda) 1, Zn(phen)(edda) 2, [Cu(phen)(cdmg)] NO3 3 and [Zn(phen)(c-dmg)]NO3 4 were synthesized and characterized by the following tests: Fourier transformed infrared (FTIR), CHN elemental analysis, UV-Vis spectroscopy, molar conductivity and magnetic susceptibility measurements. Results: In vitro hemolytic and antimalarial assays using SYBR Green I dye were done to determine the biological properties of these complexes. Preliminary biological evaluation demonstrated that all the complexes 1, 2, 3 and 4 exhibit toxicity against the sensitive blood-stage Plasmodium falciparum 3D7 with IC50 in μM range. Conclusion: Thus, metal complex is a potentially viable candidate as antimalarial drug to overcome the emergence of drug resistance.

   MeSH terms: Aminoquinolines; Animals; Antimalarials; Chloroquine; Copper; Ferrous Compounds; Parasites; Plasmodium falciparum; Zinc; Malaria, Cerebral; Inhibitory Concentration 50; Artemisinins
5. Fulltext Biofilm architecture of Candida rugosa and effect of amphotericin b, caspofungin, fluconazole and voriconazole on its structure

   Sri Raja Rajeswari Mahalingam, Priya Madhavan, Chong, Pei Pei

   Malaysian Journal of Medicine and Health Sciences, 2019;15(102):2-2.

   MyJurnal

   Abstract

   Introduction: One of the most common aetiology of opportunistic fungal infections in humans is Candida species. The virulence of Candida species is due to repertoire of factors, specifically, the ability to form biofilms. Medical devices such as intravenous catheters, prosthetic heart valves and surgical interventions provide pathogenic microorganisms with a surface to adhere to form biofilm. Fungi present as biofilms are often resistant to antifungal treatment because these biofilms offer a protective barrier that prohibits the drugs to get to the active site of the fungi. The objective of this study is to investigate the biofilm architecture of Candida rugosa (C.rugosa) at different developmental phases and to identify Sessile Minimum Inhibition Concentrations (SMICs) of amphotericin B, caspofungin, fluconazole, and voriconazole for the biofilm of C. rugosa. Methods: Confocal scanning laser microscopy (CSLM) and scanning electron microscopy (SEM) were used to visualize C. rugosa biofilms at different developmental phases. The antifungal susceptibility test was performed using serial doubling dilution. The growth kinetics of Candida biofilms was quantified using XTT reduction assay and crystal violet assay. Results: From the antifungal susceptibility test, the biofilms had SMIC of >16μg/mL for amphotericin B, 6µg/mL for caspofungin, >64μg/mL for fluconazole and >16μg/ mL for voriconazole. From the SEM micrographs, C. rugosa biofilm have a structure composed of an adherent yeast cells and blastopores with hyphal elements. There were significant alterations in the morphology after exposure to antifungal agents. The quantitative measurement of the matrix thickness of embedded yeast cells were obtained from CLSM micrographs. Conclusion: In conclusion, the ability of C. rugosa to form biofilms may attribute to one of the virulence factors that causes reduced susceptibility to antifungal agents.

   MeSH terms: Amphotericin B; Antifungal Agents; Candida; Gastrula; Gentian Violet; Humans; Kinetics; Microbial Sensitivity Tests; Microscopy, Electron, Scanning; Saccharomyces cerevisiae; Virulence; Fluconazole; Catalytic Domain; Virulence Factors; Voriconazole
6. Fulltext Usage and completeness of antimicrobial prescribing form within general intensive care unit in a tertiary hospital

   Nordin N. N., Lau, C. L., Wan Mat W. R., Yow, H. Y.

   Malaysian Journal of Medicine and Health Sciences, 2019;15(102):3-3.

   MyJurnal

   Abstract

   Introduction: The incidence of antimicrobial resistance (AMR) has increased worldwide including Malaysia, which may be attributed partly to inappropriate prescribing of antimicrobials. Antimicrobial prescribing form has been introduced to mandate appropriate antimicrobial prescription including documented indication as a key standard of antimicrobial stewardship practice. Hence, this current study aimed to determine the usage and completeness of the designated antimicrobial prescribing form that had been implemented in the General Intensive Care Unit (GICU), Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Methods: This prospective observational study was carried out in GICU UKMMC from 30 August 2018 to 30 November 2018 by convenience sampling. The information that was recorded in the antimicrobial prescribing form was collected by using the designated data collection form. A total of 68 patients were included and 205 antimicrobial prescribing forms were evaluated. Results: There were 100% usage of antimicrobial prescribing forms found in this study. However, only 81 ± 8 % of these forms were completely filled. Indication for the antimicrobial prescription was not filled in 47% of the forms. Almost two thirds of the antimicrobial prescriptions were empirically indicated and one percent de-escalation of antimicrobial therapy was filled in the forms. These prescriptions comprised of 91.7% antibiotics, 7.8% antifungals and 0.5% antivirals. The suspected site of infections were primarily from the lungs (27%), gastrointestinal (16%), blood (16%) and central nervous system (14%). Piperacillin/Tazobactam was the most frequent antibiotic prescribed (21%), followed by third and fourth generation cephalosporins (20%). Conclusion: This study provided an overview of the uptake of the antimicrobial prescribing form implementation and highlighted the requirement for supplementary efforts to maximize the compliance of this form.

   MeSH terms: Anti-Infective Agents; Anti-Bacterial Agents; Antifungal Agents; Antiviral Agents; Cephalosporins; Data Collection; Humans; Intensive Care Units; Malaysia; Prospective Studies; Incidence; Drug Resistance, Bacterial; Prescriptions; Inappropriate Prescribing
7. Functional Outcomes and Health-Related Quality of Life After Severe Traumatic Brain Injury: A Review

   Mohamed Ludin S, Abdul Rashid N

   Clin Nurs Res, 2020 Sep;29(7):433-439.

   PMID: 30079766 DOI: 10.1177/1054773818792459

   Abstract

   Throughout recovery, patients with severe traumatic brain injury (TBI) show physical and functional improvement, but continue to have cognitive and psychosocial problems. The aim of this article was to review the literature regarding the functional and health-related quality of life (HRQOL) outcomes in severe TBI. There were 15 articles reviewed, 13 of them were quantitative studies and two were narrative review. Most of the articles showed an improvement occurs rapidly at 6 months post-injury. There were several factors that influence the outcome after TBI, most of it was the Glasgow Coma Scale (GCS) on admission, age, educational level, duration of posttraumatic amnesia (PTA), and length of stay (LOS) in the Intensive Care Unit (ICU). Thus, health care workers should help the survivors of severe TBI in the recovery process to ensure the latter can attain maximum function and quality of life.

   MeSH terms: Amnesia; Cognition; Health Personnel; Hospitalization; Humans; Intensive Care Units; Length of Stay; Quality of Life; Glasgow Coma Scale; Survivors; Brain Injuries, Traumatic
8. A revisit to the effects of zinc salt on skin burn wound healing to reflect the risks in current pharmaceutical care

   Osman MAH, Wong TW, Anuar NK

   J Dermatolog Treat, 2020 Sep;31(6):651-654.

   PMID: 31264929 DOI: 10.1080/09546634.2019.1639607

   Abstract

   The lower limit of soluble zinc content that can possibly be applied onto a wounded skin as a healing promoter was not known. This study examined skin wound healing process of rats inflicted by partial thickness thermal burn wound as a function of applied soluble zinc contents (0.1 ml of zinc chloride solution 0.01% (w/w) or 5.0% (w/w)). The size, surface morphology and histological profiles of wound beds of untreated rats and those treated with zinc chloride solutions were characterized. A soluble zinc content as low as 10.5 μg/cm2 of skin negated skin wound healing when compared to the untreated rats. This was alarming as the commercial products currently in the market are formulated with a high level of zinc content. Albeit the zinc salt employed was water-insoluble, a minute fraction of soluble zinc might be available to the treatment sites. This could be partially responsible for the late adverse effects such as pruritis and inflammation reported with calamine/diphenhydramine lotion, medicated shampoo, Olay Complete defense moisturizing lotion and Zineryt® topical solution. The skin irritation was likely a resultant oxidative stress action of soluble zinc, where a small fraction could be adequate to negate the skin homeostasis.[Figure: see text]Key messagesZinc is essentially a cofactor for skin collagen formation.Soluble zinc content as low as 10.5 μg/cm2 of skin irritates skin and negates burn wound healing.Skin irritation of commercial products relates to minute soluble zinc content availability.

   MeSH terms: Animals; Burns; Chlorides; Decanoic Acids; Diphenhydramine; Drug Combinations; Erythromycin; Inflammation; Pruritus; Water; Wound Healing; Zinc; Zinc Compounds; Zinc Acetate; Rats
9. Oleic Acid Coated Silver Nanoparticles Showed Better in Vitro Amoebicidal Effects against Naegleria fowleri than Amphotericin B

   Rajendran K, Anwar A, Khan NA, Aslam Z, Raza Shah M, Siddiqui R

   ACS Chem Neurosci, 2019 Aug 08.

   PMID: 31347828 DOI: 10.1021/acschemneuro.9b00289

   Abstract

   Naegleria fowleri (N. fowleri) causes primary amoebic meningoencephalitis (PAM) which almost always results in death. N. fowleri is also known as "brain-eating amoeba" due to its literal infestation of the brain leading to an inflammatory response in the brain tissues. Currently, there is no single drug that is available to treat PAM, and most treatments are combinations of antifungal, anticancer, and anti-inflammatory drugs. Recently nanotechnology has gained attention in chemotherapeutic research converging on drug delivery, while oleic acid (OA) has shown positive effects on the human immune system and inflammatory processes. In continuation of our recent research in which we reported the effects of oleic acid conjugated with silver nanoparticles (OA-AgNPs) against free-living amoeba Acanthamoeba castellanii, in this report, we show their antiamoebic effects against N. fowleri. OA alone and its nanoconjugates were tested against the amoeba by using amoebicidal and host cell cytopathogenicity assays. Trypan blue exclusion assay was used to determine cell viability. The results revealed that OA-AgNPs exhibited significantly enhanced antiamoebic effects (P < 0.05) against N. fowleri as compared to OA alone. Evidently, lactate dehydrogenase release shows reduced N. fowleri-mediated host cell cytotoxicity. Based on our study, we anticipate that further studies on OA-AgNPs could potentially provide an alternative treatment of PAM.

   MeSH terms: Amebicides; Amoeba; Anti-Inflammatory Agents; Antifungal Agents; Cell Survival; Humans; L-Lactate Dehydrogenase; Silver; Trypan Blue; Naegleria fowleri; Oleic Acid; Central Nervous System Protozoal Infections; Nanotechnology; Acanthamoeba castellanii; Metal Nanoparticles; Nanoconjugates
10. Fulltext White Light Emission from a Simple Mixture of Fluorescent Organic Compounds

    Muhamad Sarih N, Myers P, Slater A, Slater B, Abdullah Z, Tajuddin HA, et al.

    Sci Rep, 2019 08 14;9(1):11834.

    PMID: 31413269 DOI: 10.1038/s41598-019-47847-5

    Abstract

    Three fluorescent organic compounds-furocoumarin (FC), dansyl aniline (DA), and 7-hydroxycoumarin-3-carboxylic acid (CC)-are mixed to produce almost pure white light emission (WLE). This novel mixture is immobilised in silica aerogel and applied as a coating to a UV LED to demonstrate its applicability as a low-cost, organic coating for WLE via simultaneous emission. In ethanol solution and when immobilised in silica aerogel, the mixture exhibits a Commission Internationale d'Eclairage (CIE) chromaticity index of (0.27, 0.33). It was observed that a broadband and simultaneous emission involving coumarin carboxylic acid, furocoumarin and dansyl aniline played a vital role in obtaining a CIE index close to that of pure white light.

    MeSH terms: Ethanol; Aniline Compounds; Carboxylic Acids; Coumarins; Furocoumarins; Silicon Dioxide; Umbelliferones