Browse publications by year: 2019

  1. Al-Otaibi T, Gheith OA, Nagib AM, Nair P, Zakaria ZE, Halim MA, et al.
    Exp Clin Transplant, 2019 01;17(Suppl 1):99-104.
    PMID: 30777531 DOI: 10.6002/ect.MESOT2018.O42
    OBJECTIVES: Pregnancy after kidney transplant has a high risk for maternal and fetal complications; however, it can be successful if patients are properly selected. Here, we studied outcomes and complications of pregnancies in kidney transplant recipients who received calcineurin inhibitor-based immunosuppression.

    MATERIALS AND METHODS: In this case control study, we reviewed patients who became pregnant between 2004 and 2017. For this analysis, each pregnancy was considered an event. We divided pregnancies into 2 groups according to calcineurin inhibitor-based maintenance immunosuppression: group 1 (49 pregnancies) received cyclosporine, and group 2 (33 pregnancies) received tacrolimus. Patients also received steroids and azathioprine. Patients had regular antenatal follow-up at the Hamed Alessa Organ Transplant Center (Kuwait) and in the maternity hospital (monthly until month 7 and then weekly until delivery).

    RESULTS: Of 750 female kidney transplant recipients within childbearing potential, there were 82 pregnancies (10.9%) in 49 recipients (6.5%). Seventy-eight pregnancies were planned, and 4 pregnancies occurred while women were using contraception. There was 1 triple pregnancy, 5 double, and 76 single pregnancies. Two women had preeclampsia as maternal complication, 2 had uncontrolled hypertension, and 7 developed graft dysfunction. Forty-seven women (57.3%) had caesarean section, and the remaining had vaginal deliveries. Of 89 babies, 86 were viable (1 intrauterine fetal death and 2 abortions). Eight babies were delivered prematurely with low birth weight, and 2 needed incubators. Mean serum creatinine levels were 97.9 ± 24, 109 ± 38, 100 ± 39, 120 ± 46, and 115 ± 57 μmol/L at baseline, first, second, and third trimesters, and postpartum, respectively. Twelve patients showed high panel reactive antibodies but without donor-specific antibodies.

    CONCLUSIONS: Posttransplant pregnancy can be successful in most renal allograft recipients, but the increased risk of fetal and maternal complications, including low birth weight, spontaneous abortus, and preeclampsia, should be considered.

    MeSH terms: Drug Therapy, Combination; Female; Graft Survival; Humans; Immunosuppressive Agents/adverse effects; Immunosuppressive Agents/therapeutic use*; Kuwait; Pregnancy; Pregnancy Complications/etiology; Pregnancy Outcome; Risk Factors; Time Factors; Case-Control Studies; Tacrolimus/adverse effects; Tacrolimus/therapeutic use*; Cyclosporine/adverse effects; Cyclosporine/therapeutic use*; Treatment Outcome; Live Birth; Calcineurin Inhibitors/adverse effects; Calcineurin Inhibitors/therapeutic use*
  2. Nair P, Gheith O, Al-Otaibi T, Mostafa M, Rida S, Sobhy I, et al.
    Exp Clin Transplant, 2019 01;17(Suppl 1):113-119.
    PMID: 30777534 DOI: 10.6002/ect.MESOT2018.O58
    OBJECTIVES: Data on the management of chronic antibody-mediated rejection after kidney transplantation are limited. We aimed to assess the impact of treatment of biopsy-proven chronic active antibodymediated rejection with combined plasma exchange, intravenous immunoglobulin, and rituximab treatment versus intravenous immunoglobulin alone or conservative management on the evolution of renal function in renal transplant recipients.

    MATERIALS AND METHODS: In this retrospective study, we compared patients diagnosed with chronic active antibody-mediated rejection who were treated with standard of care steroids, intravenous immunoglobulin, plasma exchange, and rituximab (n = 40) at our center versus those who received intravenous immunoglobulin only or just intensified maintenance immunosuppression (n = 28). All patients were followed for 12 months clinically and by laboratory tests for graft and patient outcomes.

    RESULTS: The two groups were matched regarding mean recipient age (41.9 ± 15.4 vs 37.8 ± 15.5 y in patients with conservative versus combined treatment), recipient sex, mean body weight, and the cause of end-stage kidney disease. Most patients and their donors were males. Glomerulonephritis represented the most common cause of end-stage kidney disease in both groups followed by diabetic nephropathy. The type of induction and pretransplant comorbidities were not different between groups (P > .05) except for the significantly higher number of chronic hepatitis C infections in patients who received conservative treatment (P = .007). Mean serum creatinine values before and after treatment of chronic active antibodymediated rejection were comparable between groups (P > .05). Active treatment with heavier immunosuppression (rituximab and plasma exchange) was associated with posttreatment viral (cytomegalovirus and BK virus) and bacterial infections that necessitated more hospitalization (P > .05). However, graft and patient outcomes were significantly better in the active treatment group than in patients with conservative treatment (P = .002 and .028, respectively).

    CONCLUSIONS: Combined treatment of chronic active antibody-mediated rejection with plasma exchange, intravenous immunoglobulin, and rituximab can significantly improve outcomes after renal transplant.

    MeSH terms: Rituximab/administration & dosage*; Rituximab/adverse effects; Adult; Biopsy; Chronic Disease; Combined Modality Therapy; Drug Therapy, Combination; Female; Graft Rejection/blood; Graft Rejection/immunology; Graft Rejection/therapy*; Graft Survival/drug effects*; Humans; Immunosuppressive Agents/administration & dosage*; Immunosuppressive Agents/adverse effects; Isoantibodies/blood; Isoantibodies/immunology*; Male; Middle Aged; Retrospective Studies; Risk Factors; Steroids/administration & dosage*; Steroids/adverse effects; Time Factors; Kidney Transplantation/adverse effects*; Immunoglobulins, Intravenous/administration & dosage*; Immunoglobulins, Intravenous/adverse effects; Treatment Outcome; Young Adult
  3. Abdeltawab K, Yagan J, Megahed M, Zahab MA, Gheith OA, Rida S, et al.
    Exp Clin Transplant, 2019 01;17(Suppl 1):142-144.
    PMID: 30777540 DOI: 10.6002/ect.MESOT2018.P9
    Organ transplant in patients with congenital bleeding disorders is a challenge requiring an integrated approach of various specialists. Inherited factor VII deficiency is the most common of the rare bleeding disorders, with a wide set of hemorrhagic features. Although a kidney allograft is the most frequent type of solid-organ transplant, it is rarely performed in individuals with congenital hemorrhagic disorders. Here, we highlight the course of a patient with coagulation factor VII deficiency who underwent successful kidney transplant without significant coagulopathy. Our patient was a 19-year-old man with end-stage kidney disease and congenital coagulation factor VII deficiency. Perioperative bleeding was successfully prevented by administration of recombinant factor VII, confirming its safety in solid-organ transplants. Success requires evaluation of doses and therapeutic schedules, as well as a multidisciplinary approach.
    MeSH terms: Blood Coagulation/drug effects; Coagulants/administration & dosage*; Factor VII Deficiency/blood; Factor VII Deficiency/complications; Factor VII Deficiency/diagnosis; Factor VII Deficiency/drug therapy*; Graft Survival/drug effects; Humans; Immunosuppressive Agents/administration & dosage; Kidney Failure, Chronic/complications; Kidney Failure, Chronic/diagnosis; Kidney Failure, Chronic/therapy*; Male; Recombinant Proteins/administration & dosage; Factor VIIa/administration & dosage*; Kidney Transplantation*; Blood Loss, Surgical/prevention & control*; Treatment Outcome; Drug Monitoring/methods; International Normalized Ratio; Young Adult
  4. Al-Otaibi T, Gheith O, Zahab MA, Abdul-Moneim M, Abdul-Tawab K, Halim MA, et al.
    Exp Clin Transplant, 2019 01;17(Suppl 1):220-222.
    PMID: 30777559 DOI: 10.6002/ect.MESOT2018.P75
    Although chronic kidney disease decreases fertility, kidney transplantation provides restoration of fertility in women, enabling them to get pregnant. Data available from registries have shown that pregnancy is feasible in solid-organ transplant recipients without significant impact on long-term graft function. Despite these reassuring data, some studies have reported that one-third of female transplant recipients are still actively being counseled against pregnancy. Here, we present a patient who received a simultaneous deceased-donor kidney and pancreas transplant and who had a favorably evolved pregnancy. The 36-yearold kidney-pancreas transplant recipient conceived 5 months after her marriage. The patient was closely followed during pregnancy by a multidisciplinary team that included a nephrologist, gynecologist, and endocrinologist. Renal function and blood glucose levels remained within normal limits. She delivered her baby normally at 31 weeks of pregnancy (1.3-kg male baby). Currently, both mother and baby are doing well. Pregnancy in combined kidney and pancreas transplant recipients with stable graft functions is feasible but remains risky. Proper planning, modification of immunosuppressive drugs, and close monitoring are the keys to optimized maternal, fetal, and graft outcomes.
    MeSH terms: Adult; Diabetes Mellitus, Type 1/complications; Diabetes Mellitus, Type 1/diagnosis; Diabetes Mellitus, Type 1/surgery*; Diabetic Nephropathies/diagnosis; Diabetic Nephropathies/etiology; Diabetic Nephropathies/surgery*; Female; Graft Survival; Humans; Immunosuppressive Agents/administration & dosage; Infant, Newborn; Male; Obesity/complications; Obesity/diagnosis; Obesity/surgery*; Pregnancy; Risk Factors; Treatment Outcome; Live Birth
  5. Alagan A, Jantan I, Kumolosasi E, Ogawa S, Abdullah MA, Azmi N
    Front Pharmacol, 2019;10:632.
    PMID: 31231221 DOI: 10.3389/fphar.2019.00632
    Background:Phyllanthus amarus (PA) is widely studied for its hepatoprotective properties but has recently received increasing attention due to its diverse anti-inflammatory effects. However, the effects of PA in modulating immune responses in the central nervous system leading to protection against functional changes remain unexplored. Therefore, we sought to examine the protective effects of 80% v/v ethanol extract of PA on lipopolysaccharide (LPS)-induced non-spatial memory impairment and neuroinflammation. Methods: Selected major phytoconstituents of PA extract were identified and quantified using high-performance liquid chromatography. Subchronic neurotoxicity was performed in male Wistar rats given daily oral administration of 100, 200, and 400 mg/kg of the PA extract. Their neurobehavioral activities (functional observation battery and locomotor activity) were scored, and the extracted brains were examined for neuropathological changes. Rats were treated orally with vehicle (5% Tween 20), PA extract (100, 200, and 400 mg/kg), or ibuprofen (IBF; 40 mg/kg) for 14 and 28 days before being subjected to novel object discrimination test. All groups were challenged with LPS (1 mg/kg) given intraperitoneally a day prior to the behavioral tests except for the negative control group. At the end of the behavioral tests, the levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, nitric oxide (NO), inducible nitric oxide synthase (iNOS), CD11b/c integrin expression, and synaptophysin immunoreactivity were determined in the brain tissues. Results: Gallic acid, ellagic acid, corilagin, geraniin, niranthin, phyllanthin, hypophyllanthin, phyltetralin, and isonirtetralin were identified in the PA extract. Subchronic administration of PA extract (100, 200, and 400 mg/kg) showed no abnormalities in neurobehavior and brain histology. PA extract administered at 200 and 400 mg/kg for 14 and 28 days effectively protected the rodents from LPS-induced memory impairment. Similar doses significantly (p < 0.05) decreased the release of proteins like TNF-α, IL-1β, and iNOS in the brain tissue. NO levels, CD11b/c integrin expression, and synaptophysin immunoreactivity were also reduced as compared with those in the LPS-challenged group. Conclusion: Pre-treatment with PA extract for 14 and 28 days was comparable with pre-treatment with IBF in prevention of memory impairment and alleviation of neuroinflammatory responses induced by LPS. Further studies are essential to identify the bioactive phytochemicals and the precise underlying mechanisms.
  6. Naqvi AA, AlShayban DM, Ghori SA, Mahmoud MA, Haseeb A, Faidah HS, et al.
    Front Pharmacol, 2019;10:633.
    PMID: 31231222 DOI: 10.3389/fphar.2019.00633
    Objective: The aim was to validate the General Medication Adherence Scale (GMAS) (English version) in Saudi patients with chronic disease. Methods: A month-long study was conducted in the out-patient department of tertiary care hospitals in three cities of Saudi Arabia that collected data from a randomized sample of Saudi patients with chronic disease. The study aimed to achieve an item-to-subject ratio greater than 1:10. Factor analyses were conducted and fit indices calculated. Convergent, discriminant, known group, and concurrent validities were analysed. Internal consistency was determined using test-retest reliability using Cronbach's alpha (α), McDonald's coefficient omega (ω
    ), and Pearson's correlation coefficient (ρ). Sensitivity analysis was conducted. Data were analysed through Statistical Package for Social Sciences (SPSS) version 23. The study was ethically approved (i.e., IRB-129-26/6/1439). Results: The survey gathered responses from 171 patients with a response rate of 85.5%. An item-to-subject ratio of 1:15 was achieved. Factor analysis revealed a three-factor structure with acceptable fit indices (i.e., normed fit index (NFI) = 0.93, Tucker-Lewis index (TLI) = 0.99, and comparative fit index (CFI) = 0.99), i.e., greater than 0.9. The value of root mean square error of approximation (RMSEA) was 0.01, i.e., less than 0.08. The tool established construct validity, i.e., convergent and discriminant validities. Known group and concurrent validities were also established. An α value of 0.74 and ω
    value of 0.92 were reported. Test-retest reliability ρ = 0.82, p < 0.001. The tool had high sensitivity (>75%) and specificity (>80%). Conclusion: The GMAS-English was successfully validated in Saudi patients with chronic disease.
  7. Bernardo ABI, Salanga MGC, Tjipto S, Hutapea B, Khan A, Yeung SS
    Front Psychol, 2019;10:1335.
    PMID: 31231289 DOI: 10.3389/fpsyg.2019.01335
    Polyculturalism is the lay belief that cultures are dynamically interconnected and mutually influencing each other historically and in contemporary times. Belief in polyculturalism is associated with various positive intergroup outcomes in intercultural social contexts, but it has never been studied in relation to intergroup attitudes in postcolonial societies. Two studies with participants from four postcolonial Asian societies (total N = 1,126) explore whether polyculturalism will also be associated with positive attitudes toward the continuing presence of former colonizers. The historical colonial experience may be socially represented positively or negatively in different societies, and in this context, the studies inquire into whether current attitudes toward former colonizers are positively associated with the belief in polyculturalism. In two studies (after controlling for belief in multiculturalism, genetic and social constructivist lay theories of race, and national identity) polyculturalism was positively associated with favorable attitudes toward continuing presence of former colonizers in Hong Kong, Macau, and Jakarta, but not in Johor Bahru, Malaysia and Wonosobo, Indonesia. The positive association with polyculturalism was found only in the three societies with a high degree of intercultural contact, where the core beliefs of polyculturalism may be more meaningful. The results are discussed in terms of how intergroup relations between former colonizers and colonized peoples are forms of between-society intercultural contact that are also influenced by intergroup lay theories.
  8. Kamarudin MNA, Parhar I
    Oncotarget, 2019 Jun 11;10(39):3952-3977.
    PMID: 31231472 DOI: 10.18632/oncotarget.26994
    Despite numerous advancements in the last decade, human gliomas such as astrocytoma and glioblastoma multiforme have the worst prognoses among all cancers. Anti-psychotic drugs are commonly prescribed to treat mental disorders among cancer patients, and growing empirical evidence has revealed their antitumor, anti-metastatic, anti-angiogenic, anti-proliferative, chemo-preventive, and neo-adjuvant efficacies in various in vitro, in vivo, and clinical glioma models. Anti-psychotic drugs have drawn the attention of physicians and researchers owing to their beneficial effects in the prevention and treatment of gliomas. This review highlights data on the therapeutic potential of various anti-psychotic drugs as anti-proliferative, chemopreventive, and anti-angiogenic agents in various glioma models via the modulation of upstream and downstream molecular targets involved in apoptosis, autophagy, oxidative stress, inflammation, and the cell cycle in in vitro and in vivo preclinical and clinical stages among glioma patients. The ability of anti-psychotic drugs to modulate various signaling pathways and multidrug resistance-conferring proteins that enhance the efficacy of chemotherapeutic drugs with low side-effects exemplifies their great potential as neo-adjuvants and potential chemotherapeutics in single or multimodal treatment approach. Moreover, anti-psychotic drugs confer the ability to induce glioma into oligodendrocyte-like cells and neuronal-like phenotype cells with reversal of epigenetic alterations through inhibition of histone deacetylase further rationalize their use in glioma treatment. The improved understanding of anti-psychotic drugs as potential chemotherapeutic drugs or as neo-adjuvants will provide better information for their use globally as affordable, well-tolerated, and effective anticancer agents for human glioma.
  9. Li CK, Dalvi R, Yonemori K, Ariffin H, Lyu CJ, Farid M, et al.
    ESMO Open, 2019;4(3):e000467.
    PMID: 31231565 DOI: 10.1136/esmoopen-2018-000467
    Background: Adolescents and young adults (AYAs) with cancer require dedicated management encompassing both adult and paediatric cancer services. Following a European survey, the European Society for Medical Oncology, the European Society for Paediatric Oncology and the Asian continental branch of International Society of Paediatric Oncology undertook a similar survey to assess AYA cancer care across Asia.

    Methods: A link to the online survey was sent to healthcare professionals (HCPs) in Asia interested in AYA cancer care. Questions covered the demographics and training of HCPs, their understanding of AYA definition, availability and access to specialised AYA services, the support and advice offered during and after treatment, and factors of treatment non-compliance.

    Results: We received 268 responses from 22 Asian countries. There was a striking variation in the definition of AYA (median lower age 15 years, median higher age 29 years). The majority of the respondents (78%) did not have access to specialised cancer services and 73% were not aware of any research initiatives for AYA. Over two-thirds (69%) had the option to refer their patients for psychological and/or nutritional support and most advised their patients on a healthy lifestyle. Even so, 46% did not ask about smokeless tobacco habits and only half referred smokers to a smoking cessation service. Furthermore, 29% did not promote human papillomavirus vaccination for girls and 17% did not promote hepatitis B virus vaccination for high-risk individuals. In terms of funding, 69% reported governmental insurance coverage, although 65% reported that patients self-paid, at least partially. Almost half (47%) reported treatment non-compliance or abandonment as an issue, attributed to financial and family problems (72%), loss of follow-up (74%) and seeking of alternative treatments (77%).

    Conclusions: Lack of access to and suboptimal delivery of AYA-specialised cancer care services across Asia pose major challenges and require specific interventions.

  10. Mohd Zain MR, Shamsuddin AM, Mamat AZ, Mokhtar AM, Ali S, Chen YC, et al.
    Front Pediatr, 2019;7:230.
    PMID: 31231625 DOI: 10.3389/fped.2019.00230
    Introduction: Pediatric cardiac surgical mission programs are deemed as common practice, especially in developing nations funded by international non-governmental organizations (NGOs). This article presents and discusses the results and strategies implemented by this partnership, aiming at achieving the autonomy of the local center by this collaboration. Materials and Methods: A retrospective review was conducted on patients with congenital heart disease who underwent surgical intervention from the beginning of the NGO collaboration (September 2015) until November 2018 in an existing cardiac center. In between those visits, any congenital heart disease patient with Risk Adjustment Congenital Heart Surgery (RACHS)-1 Category 1-3 would be discussed in a local multi-disciplinary meeting with regards to the feasibility of the surgery being performed by the local members. Results: A total of 60 operations were performed during the trips. Throughout the visit, 46% (28) of the operations were performed by the local surgeon, with or without assistance from the visiting surgeon. Between September 2015 and November 2018, 27 cases were also performed by the local team independently. For the 27 cases performed by the local team independently, the median age of the patient was 42 days (ranging from 14 days to 20 years old), with median body weight of 3.2 kg (ranging from 2.8 to 64 kg). Conclusion: Humanitarian pediatric cardiac surgical missions are safe to be done for the population in need. In order to achieve autonomy, continuous efforts by both teams are crucial, as the cooperation by the two parties ensures that the objectives are achieved.
  11. Chan CYW, Naing KS, Chiu CK, Mohamad SM, Kwan MK
    J Orthop Surg (Hong Kong), 2019 6 25;27(2):2309499019857250.
    PMID: 31232161 DOI: 10.1177/2309499019857250
    PURPOSE: To analyze the incidence, pattern, and contributing factors of pelvic obliquity among Adolescent Idiopathic Scoliosis (AIS) patients who will undergo surgery.

    METHODS: In total, 311 patients underwent erect whole spine anteroposterior, lateral and lower limb axis films. Radiographic measurements included Transilium Pelvic Height Difference (TPHD; mm), Hip Abduction-Adduction angle (H/Abd-Add; °), Lower limb Length Discrepancy (LLD; mm), and Pelvic Hypoplasia (PH angle; °). The incidence and severity of pelvic obliquity were stratified to Lenke curve subtypes in 311 patients. The causes of pelvic obliquity were analyzed in 57 patients with TPHD ≥10 mm.

    RESULTS: The mean Cobb angle was 64.0 ± 17.2°. Sixty-nine patients had a TPHD of 0 mm (22.2%). The TPHD was <5 mm in 134 (43.0%) patients, 5-9 mm in 104 (33.4%) patients, 10-14 mm in 52 (16.7%) patients, 15-19 mm in 19 (6.1%) patients, and ≥20 mm in only 2 (0.6%) patients. There was a significant difference between the Lenke curve types in terms of TPHD (p = 0.002). L6 curve types had the highest TPHD of 9.0 ± 6.3 mm followed by L5 curves, which had a TPHD of 7.1 ± 4.8 mm. In all, 44.2% of L1 curves and 50.0% of L2 curves had positive TPHD compared to 66.7% of L5 curves and 74.1% of L6 curves which had negative TPHD. 33.3% and 24.6% of pelvic obliquity were attributed to PH and LLD, respectively, whereas 10.5% of cases were attributed to H/Abd-Add positioning.

    CONCLUSIONS: 76.4% of AIS cases had pelvic obliquity <10 mm; 44.2% of L1 curves and 50.0% of L2 curves had a lower right hemipelvis compared to 66.7% of L5 curves and 74.1% of L6 curves, which had a higher right hemipelvis. Among patients with pelvic obliquity ≥10 mm, 33.3% were attributed to PH, whereas 24.6% were attributed to LLD.

  12. Nazimi AJ, Khoo SC, Nabil S, Nordin R, Lan TH, Rajandram RK, et al.
    J Craniofac Surg, 2019 Jun 20.
    PMID: 31232997 DOI: 10.1097/SCS.0000000000005667
    Orbital fractures pose specific challenge in its surgical management. One of the greatest challenges is to obtain satisfactory reconstruction by correct positioning of orbital implant. Intraoperative computed tomography (CT) scan may facilitate this procedure. The aim of this study was to describe the early use of intraoperative CT in orbital fractures repair in our center. The authors assessed the revision types and rates that have occurred with this technique. With the use of pre-surgical planning, optical intraoperative navigation, and intraoperative CT, the impact of intraoperative CT on the management of 5 cases involving a total number of 14 orbital wall fractures were described. There were 6 pure orbital blowout wall fractures reconstructed, involving both medial and inferior wall of the orbit fracturing the transition zone and 8 impure orbital wall fractures in orbitozygomaticomaxillary complex fracture. 4 patients underwent primary and 1 had delayed orbital reconstruction. Intraoperative CT resulted in intraoperative orbital implant revision, following final navigation planning position, in 40% (2/5) of patients or 14% (2/14) of the fractures. In revised cases, both implant repositioning was conducted at posterior ledge of orbit. Intraoperative CT confirmed true to original reconstruction of medial wall, inferior wall and transition zone of the orbit. Two selected cases were illustrated. In conclusion, intraoperative CT allows real-time assessment of fracture reduction and immediate orbital implant revision, especially at posterior ledge. As a result, no postoperative imaging was indicated in any of the patients. Long-term follow-ups for orbital fracture patients managed with intraoperative CT is suggested.
  13. Kow RY, Yuen JC, Ahmad Alwi AA, Abas MF, Low CL
    JBJS Case Connect, 2019 Jun 21.
    PMID: 31233428 DOI: 10.2106/JBJS.CC.18.00163
    CASE: A 17-year-old male sustained an open fracture of the right medial malleolus (MM) with significant bone and soft tissue loss following a motor-vehicle accident. Following serial wound debridement, his ankle was effectively reconstructed with MM antiglide plate stabilization, iliac autogenous bone graft, and a free radial forearm soft tissue flap.

    CONCLUSIONS: Open MM fracture with bone and soft tissue loss is rare. It is feasible to treat this injury with a novel surgical reconstruction technique involving autogenous bicortical iliac bone graft and radial forearm free flap.

  14. Lu N, Pahang J, Zhang G, Loengard A, Wong LL, Biffl WL
    PMID: 31233439 DOI: 10.1097/TA.0000000000002415
    BACKGROUND: In bowel obstruction and biliary pancreatitis, patients receive more expedient surgical care when admitted to surgical compared with medical services. This has not been studied in acute cholecystitis.

    METHODS: Retrospective analysis of clinical and cost data from July 2013 to September 2015 for patients with cholecystitis who underwent laparoscopic cholecystectomy in a tertiary care inpatient hospital. 190 lower-risk (Charlson-Deyo) patients were included. We assessed admitting service, length of stay, time from admission to surgery, time from surgery to discharge, number of imaging studies, and total cost.

    RESULTS: Patients admitted to surgical (n=106) versus medical (n=84) service had shorter mean LOS (1.4 vs 2.6 days), shorter time from admission to surgery (0.4 vs 0.8 days), and shorter time from surgery to discharge (0.8 vs 1.1 days). Surgical service patients had fewer CT (38% vs 56%) and MRI (5% vs 16%) studies. Cholangiography (30 vs 25%) and ERCP (3 vs 8%) rates were similar. Surgical service patients had 39% lower median total costs ($7787 vs $12572).

    CONCLUSIONS: Nonsurgical admissions of patients with cholecystitis are common, even among lower-risk patients. Routine admission to the surgical service should decrease LOS, resource utilization and costs.

  15. Woon FC, Chin YS, Ismail IH, Batterham M, Abdul Latiff AH, Gan WY, et al.
    PLoS ONE, 2019;14(6):e0216439.
    PMID: 31233513 DOI: 10.1371/journal.pone.0216439
    BACKGROUND: Despite perennial sunshine, vitamin D deficiency is prevalent among Malaysians especially pregnant women. This study determines the vitamin D status and its associated factors among third trimester pregnant women attending government health clinics in Selangor and Kuala Lumpur, Malaysia.

    METHODS: Information on socio-demographic characteristics, obstetrical history, and sun exposure were obtained through face-to-face interviews. Vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Serum 25-hydroxyvitamin D concentration was measured and classified as deficient (< 30 nmol/L), insufficient (30-50 nmol/L), and sufficient (≥ 50 nmol/L).

    RESULTS: Of the 535 pregnant women recruited, 42.6% were vitamin D deficient. They consumed an average of 8.7 ± 6.7 μg of vitamin D daily. A total of 80.4% of the vitamin D were obtained from the food sources, while 19.6% were from dietary supplements. Fish and fish products showed the highest contribution to vitamin D intake (35.8%). The multivariable generalized linear mixed models, with clinic as a random effect, indicates that higher intake of vitamin D is associated with lower odds of vitamin D deficiency among pregnant women (OR = 0.96; 95% CI = 0.93-0.99). The odds of having vitamin D deficiency was reduced by 87% in non-Malays (OR = 0.14; 95% CI = 0.05-0.41) compared to Malays. No associations were found between age, educational level, monthly household income, work status, gravidity, parity, pre-pregnancy body mass index, total hours of sun exposure, total percentage of body surface area, and sun exposure index per day with vitamin D deficiency.

    CONCLUSION: Vitamin D deficiency is prevalent among Malaysian pregnant women. Considering the possible adverse obstetric and fetal outcomes of vitamin D deficiency during pregnancy, future nutrition education should emphasise on vitamin D-fortified foods consumption among pregnant women by taking into consideration ethnic differences.

  16. Neoh HM, Tan XE, Sapri HF, Tan TL
    Infect. Genet. Evol., 2019 Jun 21.
    PMID: 31233781 DOI: 10.1016/j.meegid.2019.103935
    Pulsed-field gel electrophoresis (PFGE) is considered the "gold standard" for bacteria typing. The method involves enzyme restriction of bacteria DNA, separation of the restricted DNA bands using a pulsed-field electrophoresis chamber, followed by clonal assignment of bacteria based on PFGE banding patterns. Various PFGE protocols have been developed for typing different bacteria, leading it to be one of the most widely used methods for phylogenetic studies, food safety surveillance, infection control and outbreak investigations. On the other hand, as PFGE is lengthy and labourious, several PCR-based typing methods can be used as alternatives for research purposes. Recently, matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) and whole genome sequencing (WGS) have also been proposed for bacteria typing. In fact, as WGS provides more information, such as antimicrobial resistance and virulence of the tested bacteria in comparison to PFGE, more and more laboratories are currently transitioning from PFGE to WGS for bacteria typing. Nevertheless, PFGE will remain an affordable and relevant technique for small laboratories and hospitals in years to come.
  17. Paudel YN, Angelopoulou E, Piperi C, Balasubramaniam VRMT, Othman I, Shaikh MF
    Eur. J. Pharmacol., 2019 Jun 20.
    PMID: 31229535 DOI: 10.1016/j.ejphar.2019.172487
    High mobility group box 1 (HMGB1) is a ubiquitous protein, released passively by necrotic tissues or secreted actively by stressed cells. Extracellular HMGB1 is a typical damage-associated molecular pattern (DAMP) molecule which generates different redox types through binding with several receptors and signalling molecules, aggravating a range of cellular responses, including inflammation. HMGB1 is reported to participate in the pathogenesis of inflammatory diseases, through the interaction with pivotal transmembrane receptors, including the receptor for advanced glycation end products (RAGE) and toll-like receptor-4 (TLR-4). This review aims to highlight the role of HMGB1 in the innate inflammatory response describing its interaction with several cofactors and receptors that coordinate its downstream effects. Novel and underexplored HMGB1 binding molecules that have been actively involved in HMGB1-mediated inflammatory diseases/conditions with therapeutic potential are further discussed.
    MeSH terms: Alarmins; Inflammation; Oxidation-Reduction; HMGB1 Protein; Toll-Like Receptor 4
  18. Rhatomy S, Purnama H, Singh C, Setyawan R, Utomo DN
    Int J Surg Case Rep, 2019 Jun 16;60:175-182.
    PMID: 31229772 DOI: 10.1016/j.ijscr.2019.06.018
    INTRODUCTION: The high rate of recurrence in patellar dislocation treatment, requires a more comprehensive action, this is due to causes not only single but often multifactorial, including problems with static stability, dynamic stability or both.

    PRESENTATION OF CASE: 1st case: A-39-years-old male, complain of irreducible right patella dislocation with valgus knee and already done soft tissue procedure for patella dislocation. Long-leg radiographs of the right leg showed 18° valgus mechanical angle. 2nd case: A-26-years-old obese female, complain of dislocation of left patella and history of surgery for dislocation at 5 years old. Long-leg radiographs of the right leg showed 11° valgus mechanical angle.

    DISCUSSION: After knowing the cause of the patellar dislocation from history taking, physical and supporting examination, we performed lateral open wedge distal femoral osteotomy also MPFL and MCL reconstruction, and tibial tuberosity medialization osteotomy. There is improvement mean score in Tegner Lysholm Knee Scoring system and IKDC Scoring at 6 months after surgery.

    CONCLUSION: Lateral open wedge distal femur osteotomy combine with MPFL and MCL reconstruction and tibial tuberosity medialization realignment procedure can be successfully done for improve irreducible patellar dislocation in valgus knee, from clinical and radiological evaluation have good outcome after surgery.

  19. Chong YY, Thangalazhy-Gopakumar S, Ng HK, Lee LY, Gan S
    J. Environ. Manage., 2019 Jun 20;247:38-45.
    PMID: 31229784 DOI: 10.1016/j.jenvman.2019.06.049
    Fast pyrolysis is a potential technology for converting lignocellulosic biomass into bio-oil. Nevertheless, the high amounts of acid, oxygenated compounds, and water content diminish the energy density of the bio-oil and cause it to be unsuitable for direct usage. Catalytic fast pyrolysis (CFP) is able to improve bio-oil properties so that downstream upgrading processes can be economically feasible. Here, calcium oxide (CaO), magnesium oxide (MgO), and zinc oxide (ZnO) were employed due to their potential in enhancing bio-oil properties. The results showed that overall, all three catalysts positively impacted the empty fruit bunch fibre-derived bio-oil properties. Among the catalysts, CaO showed the most favorable effects in terms of reducing the acidity of the bio-oil and anhydrosugar. Thermal stability of bio-oils produced in the presence of CaO was studied as well.
    MeSH terms: Fruit; Magnesium Oxide; Oxides; Plant Oils; Water; Zinc Oxide; Calcium Compounds; Biomass; Polyphenols
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