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1. Use of extracorporeal blood purification therapy (ECBPT) as an adjuvant to high-dose corticosteroids in a severely ill COVID-19 patient with concomitant bacterial infection

   Lim MX, Fong KK, Yeap TB

   BMJ Case Rep, 2021 Oct 13;14(10).

   PMID: 34645636 DOI: 10.1136/bcr-2021-245639

   Abstract

   COVID-19 presents with a spectrum of severity, ranging from asymptomatic or mild symptoms to those with acute respiratory distress syndrome. Corticosteroids are widely used for their efficacy in reducing inflammatory responses. However, its use may be limited to patients with immunosuppression. An adjunct therapy for cytokine storm in COVID-19 is extracorporeal blood purification therapies using high adsorptive filters, such as oXiris, to remove cytokines. We share our experience in using continuous renal replacement therapy with oXiris haemofilter as a temporising measure to high-dose corticosteroids in managing cytokine storm in a deteriorating COVID-19 patient with concomitant bacterial infection.

   MeSH terms: Adrenal Cortex Hormones; Bacterial Infections*; Humans; Respiratory Distress Syndrome, Adult*
2. Publisher Correction: The chloroplast-associated protein degradation pathway controls chromoplast development and fruit ripening in tomato

   Ling Q, Sadali NM, Soufi Z, Zhou Y, Huang B, Zeng Y, et al.

   Nat Plants, 2021 Oct;7(10):1433.

   PMID: 34646008 DOI: 10.1038/s41477-021-01018-5
3. Fulltext The Adverse Cardiovascular Effects and Cardiotoxicity of Kratom (Mitragyna speciosa Korth.): A Comprehensive Review

   Leong Bin Abdullah MFI, Singh D

   Front Pharmacol, 2021;12:726003.

   PMID: 34646135 DOI: 10.3389/fphar.2021.726003

   Abstract

   Background: Kratom or Mitragyna speciosa (Korth.) has received overwhelming attention recently due to its alleged pain-relieving effects. Despite its potential therapeutic value, kratom use has been linked to many occurrences of multiorgan toxicity and cardiotoxicity. Accordingly, the current narrative review aimed to provide a detailed account of kratom's adverse cardiovascular effects and cardiotoxicity risk, based on in vitro studies, poison center reports, coroner and autopsy reports, clinical case reports, and clinical studies. Methods: An electronic search was conducted to identify all research articles published in English from 1950 to 2021 using the major research databases, such as Google Scholar, Web of Science, PubMed, Scopus, Mendeley, EMBASE, Cochrane Library, and Medline. We then analyzed the literature's discussion of adverse cardiovascular effects, toxicity, and mortality related to kratom use. Results: Our findings revealed that, although in vitro studies have found kratom preparations' most abundant alkaloid-mitragynine-to cause a prolonged QTc interval and an increased risk of torsades de pointes, a clinical study examining humans' regular consumption of kratom did not report such a risk. However, this latter study did show that regular kratom use could induce an increased QTc interval in a dose-dependent manner. A few case reports also highlighted that kratom consumption is associated with ventricular arrhythmia and cardiopulmonary arrest, but this association could have ensued when kratom was co-administered with another substance. Similarly, analyses of national poison data showed that kratom's most common adverse acute cardiovascular effects include tachycardia and hypertension. Meanwhile, coroner and autopsy reports indicated that kratom's cardiovascular sequelae encompass coronary atherosclerosis, myocardial infarction, hypertensive cardiovascular disease, left ventricular hypertrophy, cardiac arrhythmia, cardiomegaly, cardiomyopathy, focal band necrosis in the myocardium, and myocarditis. Given the available data, we deduced that all cardiac eventualities reported in the literature could have been compounded by polysubstance use and unresolved underlying medical illnesses. Conclusion: Although kratom use has been associated with death and cardiotoxicity, especially at higher doses and when associated with other psychoactive drugs, the dearth of data and methodological limitations reported in existing studies do not allow a definitive conclusion, and further studies are still necessary to address this issue.
4. Fulltext The Rise of IGFBP4 in People with Obstructive Sleep Apnea and Multilevel Sleep Surgery Recovers Its Basal Levels

   Alterki A, Al Shawaf E, Al-Khairi I, Cherian P, Sriraman D, Hammad M, et al.

   Dis Markers, 2021;2021:1219593.

   PMID: 34646401 DOI: 10.1155/2021/1219593

   Abstract

   IGFBP4 is the smallest member of the insulin-like growth factor binding protein family (IGFBP). It is a hepatic protein that plays a role in modulating the activity and bioavailability of IGF-I. The expression of IGFBP4 was found to increase under conditions of hypoxia. Obstructive sleep apnea (OSA) is a common disorder, characterized by cyclic episodes of intermittent hypoxia and fragmented sleep. Our aim was to quantify levels of circulating IGFBP1, IGFBP2, IGFBP3, IGFBP4, and IGFBP7 in fasting plasma samples of 69 Kuwaiti participants and explore its correlation with indices of OSA. The quantification was performed using multiplexing assay. The study involved 28 controls and 41 patients with OSA. Levels of circulating IGFBP4 were significantly higher in people with OSA (289.74 ± 23.30 ng/ml) compared to the control group (217.60 ± 21.74 ng/ml, p = 0.028). The increase in IGFBP4 correlated significantly and positively with AHI (r = .574, p = .01) and AI (r = .794, p = .001) in people with moderate and severe OSA. There was a significant decline in circulating IGFBP4 after 3 months of surgery (225.89 ± 18.16 ng/ml, p = 0.012). This was accompanied by a prominent improvement in OSA (AHI 8.97 ± 2.37 events/h, p = 0.001). In this study, our data showed a significant increase in circulating IGFBP4 in people with OSA. We also report a significant positive correlation between IGFBP4 and indices of OSA at baseline, which suggests IGFBP4 as a potential diagnostic biomarker for OSA. There was a significant improvement in OSA after 3 months of surgical intervention, which concurred with a significant decline in IGFBP4 levels. Altogether, the detected change suggests a potential link between IGFBP4 and OSA or an OSA-related factor, whereby OSA might play a role in triggering the induction of IGFBP4 expression.
5. Fulltext Exogenous ethylene application on postharvest oil palm fruit bunches improves crude palm oil quality

   Chew CL, Tan BA, Low JYS, Mohd Hakimi NIN, Kua SF, Lim CM

   Food Sci Nutr, 2021 Oct;9(10):5335-5343.

   PMID: 34646505 DOI: 10.1002/fsn3.2423

   Abstract

   Quality and food safety are of paramount importance to the palm oil industry. In this work, we investigated the practicability of ethylene gas exogenous application on post-harvested oil palm fruit bunches to improve the crude palm oil (CPO) quality. The bunches were first exposed to ethylene gas for 24 hr to induce abscission of palm fruits from bunches. The detached fruits were then subjected to heat treatment, mechanical extraction, clarification and drying to produce CPO. Critical quality parameters of CPO produced, that is free fatty acid, deterioration of the bleachability index and triacylglycerol showed improvement with ethylene gas treatment. Contaminant content that is phosphorus, chloride, iron, and copper also showed a reduction in the CPO derived from ethylene-treated bunches. These findings corresponded with low levels of contaminants such as 3-monochloropropane-1,2-diol esters and glycidyl esters in refined oil. The implementation strategy and practicability of this method is herein proposed and discussed. Ethylene application not only improves the CPO quality, but could potentially enhance the process sustainability of palm oil mills.
6. Fulltext The effects of dual modification on functional, microstructural, and thermal properties of tapioca starch

   Javadian N, Mohammadi Nafchi A, Bolandi M

   Food Sci Nutr, 2021 Oct;9(10):5467-5476.

   PMID: 34646517 DOI: 10.1002/fsn3.2506

   Abstract

   The aim of this study was to investigate the effects of dual modification on the functional, microstructural, and thermal properties of tapioca starch. Tapioca starch was first hydrolyzed by 0.14 M HCl for 0, 6, 12, 18, and 24 hr and then hydroxypropylated by adding 0%, 10%, 20%, and 30% (v/w) propylene oxide. The degree of hydroxypropylation, solubility, water absorption, rheological, thermal, and microstructure characterization of dually modified tapioca starch was determined. Hydroxypropylation did not cause any considerable changes in the starch granular size and shape of tapioca starch. Acid hydrolysis disrupts the starch granules, and the starches with smaller sizes were produced. The degree of molar substitution (DS) of dual modified starches ranged from 0.118 to 0.270. The dual modified starches significantly had higher solubility than native starch (p 
7. Fulltext Review of proposed different irradiation methods to inactivate food-processing viruses and microorganisms

   Shahi S, Khorvash R, Goli M, Ranjbaran SM, Najarian A, Mohammadi Nafchi A

   Food Sci Nutr, 2021 Oct;9(10):5883-5896.

   PMID: 34646553 DOI: 10.1002/fsn3.2539

   Abstract

   Coronaviruses, which have been enveloped nonsegmented positive-sense RNA viruses, were first mentioned in the mid-1960s and can attack people as well as a wide range of animals (including mammals and birds). Three zoonotic coronaviruses have been identified as the cause of large-scale epidemics over the last two decades: Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and swine acute diarrhea syndrome (SADS). Epithelial cells in the respiratory and gastrointestinal tract are the principal targeted cells, and viral shedding occurs via these systems in diverse ways such as through fomites, air, or feces. Patients infected with the novel coronavirus (2019-nCoV) reported having visited the Wuhan seafood wholesale market shortly before disease onset. The clinical data on established 2019-nCoV cases reported so far indicate a milder disease course than that described for patients with SARS-CoV or MERS-CoV. This study aimed to review radiation inactivation of these viruses in the food industry in three sections: visible light, ionizing radiation (alpha ray, beta ray, X-ray, gamma ray, neutron, plasma, and ozone), and nonionizing radiation (microwave, ultraviolet, infrared, laser light, and radiofrequency). Due to the obvious possibility of human-to-human and animal-to-human transmission, using at least one of these three methods in food processing and packaging during coronavirus outbreaks will be critical for preventing further outbreaks at the community level.
8. Fulltext Isolated Traumatic Bitemporal Hemianopia

   Ahmad Fauzi S, Nor Sharina Y, Ibrahim M

   Cureus, 2021 Aug;13(8):e17593.

   PMID: 34646645 DOI: 10.7759/cureus.17593

   Abstract

   Bitemporal hemianopia is a rare presentation following severe head injury, which causes a delay in detection of the visual symptoms. This is a case of traumatic bitemporal hemianopia in a 20-year-old gentleman after an alleged motorbike accident. He was intubated following a severe head injury. The ophthalmologic assessment was performed after he regained consciousness and complained of acute blurring of vision in bilateral eyes. The visual acuity was 2/60 on the right eye and 4/60 on the left eye. Bilateral eyes anterior and posterior segments examination were unremarkable. Confrontation visual field testing discovered bitemporal hemianopia. Plain computed tomography (CT) scan of the brain showed right frontal bone fracture extending to the right orbital roof, superomedial wall of the right orbit, bilateral lamina papyracea, ethmoidal air cells, roof and bilateral walls of sphenoid sinus. He was treated conservatively by the ophthalmology team. Subsequent follow-ups showed improvement of visual acuity which were 6/6 on the right eye and 6/6 on the left eye. Humphrey visual field test confirmed the persistence of bitemporal hemianopia. His good visual acuity does not correlate with the severity of the field defect. Therefore, surveillance for bitemporal scotoma is necessary for all head injuries with severe midline facial bone fractures.
9. Fulltext Retinal Racemose Hemangioma With Optic Neuropathy in a Child

   Ahmad Tarmizi NN, Bastion MC, Abdul Aziz RA, Md Din N, Mohd Khialdin S

   Cureus, 2021 Aug;13(8):e17620.

   PMID: 34646671 DOI: 10.7759/cureus.17620

   Abstract

   The aim of this study is to report an unusual case of retinal racemose haemangioma (RRH) in a child resulting in optic neuropathy and its optical coherence tomography angiography (OCT-A) findings. This is a retrospective case report. For almost a year, a 13-year-old girl experienced gradual, painless, generalized blurred vision in her right eye. Visual acuity was 6/60 with a positive relative afferent pupillary defect (RAPD) in her right eye. The right-eye fundus showed enlarged and tortuous retinal vessels extending from the optic disc to all four quadrants, including the juxta foveal region. OCT analysis revealed distortion in the region of enlarged vessels with minimal retinal fluid while OCT-A of the macula area demonstrated dilated and tortuous vessels in the superficial layers of the retina. Right intra-orbital vascular channels surrounding the optic nerve with optic nerve atrophy and gliosis were detected on magnetic resonance imaging angiography/venography (MRA/MRV). The cerebral angiogram reported an abnormal tangle of small vessels within the right orbit that received supply from a dilated right ophthalmic artery indicating the presence of retro-orbital arteriovenous malformation (AVM). She was then referred to the neurosurgeon and a decision was made not to embolize or resect the dilated vessel as this might lead to occlusion of the ophthalmic artery and thus worsen her vision. RRH may present in the paediatric age group, and optic nerve atrophy is one of the disease manifestations. OCT-A is a less invasive diagnostic option compared to fundus fluorescein angiography (FFA) for diagnosis and monitoring of disease progression.
10. Fulltext Melioidosis-related mycotic aneurysm: Three cases

    Tong TK, Shan G, Sibangun FJ, Keung BLD

    IDCases, 2021;26:e01295.

    PMID: 34646734 DOI: 10.1016/j.idcr.2021.e01295

    Abstract

    Background: Melioidosis-related mycotic aneurysm (MA) is rare but a potentially life-threatening disease with high morbidity and mortality rate.

    Case presentation: We report a case series of mycotic aneurysm caused by Burkholderia pseudomallei and the subsequent outcomes. Here, we illustrate their clinical characteristics, laboratory results, radiological findings, mode of therapies and clinical outcomes.

    Conclusion: Melioidosis-associated MA may manifest in an atypical presentation. Its outcome is often lethal if antimicrobial therapy and surgical intervention are not offered promptly.