Browse publications by year: 2021

  1. Borzée A, Kielgast J, Wren S, Angulo A, Chen S, Magellan K, et al.
    Biol Conserv, 2021 Mar;255:108973.
    PMID: 35125500 DOI: 10.1016/j.biocon.2021.108973
    Emerging infectious diseases are on the rise in many different taxa, including, among others, the amphibian batrachochytrids, the snake fungal disease and the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) virus, responsible for Coronavirus disease 2019 (COVID-19) in mammals. Following the onset of the pandemic linked to COVID-19, eastern Asia has shown strong leadership, taking actions to regulate the trade of potential vector species in several regions. These actions were taken in response to an increase in public awareness, and the need for a quick reaction to mitigate against further pandemics. However, trade restrictions rarely affect amphibians, despite the risk of pathogen transmission, directly, or indirectly through habitat destruction and the loss of vector consumption. Thus, species that help alleviate the risk of zoonoses or provide biological control are not protected. Hence, in view of the global amphibian decline and the risk of zoonoses, we support the current wildlife trade regulations and support measures to safeguard wildlife from overexploitation. The current period of regulation overhaul should be used as a springboard for amphibian conservation. To mitigate risks, we suggest the following stipulations specifically for amphibians. I) Restrictions to amphibian farming in eastern Asia, in relation to pathogen transmission and the establishment of invasive species. II) Regulation of the amphibian pet trade, with a focus on potential vector species. III) Expansion of the wildlife trade ban, to limit the wildlife-human-pet interface. The resulting actions will benefit both human and wildlife populations, as they will lead to a decrease in the risk of zoonoses and better protection of the environment.

    SIGNIFICANCE STATEMENT: There is an increasing number of emerging infectious diseases impacting all species, including amphibians, reptiles and mammals. The latest threat to humans is the virus responsible for COVID-19, and the resulting pandemic. Countries in eastern Asia have taken steps to regulate wildlife trade and prevent further zoonoses thereby decreasing the risk of pathogens arising from wild species. However, as amphibians are generally excluded from regulations we support specific trade restrictions: I) Restrictions to amphibian farming; II) regulation of the amphibian pet trade; III) expansion of the wildlife trade ban. These restrictions will benefit both human and wildlife populations by decreasing the risks of zoonoses and better protecting the environment.

  2. Liew KY, Kamise NI, Ong HM, Aw Yong PY, Islam F, Tan JW, et al.
    Front Pharmacol, 2021;12:785371.
    PMID: 35126124 DOI: 10.3389/fphar.2021.785371
    Allergic diseases are a global health burden with increasing prevalence. Side effects of available medications (antihistamines and steroids), lack of patients' perceived effectiveness and high cost of biologic therapies (omalizumab) are challenges to the clinical management of allergic diseases. As allergy symptoms persist for a long time, complementary and alternative medicine (CAM) such as propolis may be considered a potential prophylactic or therapeutic option to avoid long-term medication use. Propolis is a natural resinous substance produced by bees. Although propolis is well known to possess antioxidant, antimicrobial, and anticancer properties, its anti-allergic potential is not fully explored. Several preclinical studies demonstrated the therapeutic effects of propolis extracts against allergic inflammation, asthma, allergic rhinitis, atopic dermatitis, and food allergy, which may be partly attributed to their inhibitory effects on the activation of mast cells and basophils. Clinically, the consumption of propolis as a supplement or an adjunct therapy is safe and attenuates various pathological conditions in asthma. Such an approach may be adopted for atopic dermatitis and allergic rhinitis. Although flavonoids (chrysin, kaempferol, galangin, and pinocembrin) and cinnamic acid derivatives (artepillin C and caffeic acid phenethyl ester) can contribute to the anti-allergic activities, they may not be present in all propolis samples due to variations in the chemical composition. Future studies should relate the anti-allergic activity of propolis with its chemical contents. This mini-review summarizes and discusses existing preclinical and clinical studies reporting the anti-allergic activities of propolis to provide insights into its potential applications in allergic diseases.
  3. Anwar F, Saleem U, Rehman AU, Ahmad B, Ismail T, Mirza MU, et al.
    Front Pharmacol, 2021;12:810704.
    PMID: 35126145 DOI: 10.3389/fphar.2021.810704
    The U.S. National Research Council (NRC) introduced new approaches to report toxicity studies. The NRC vision is to explore the toxicity pathways leading to the adverse effects in intact organisms by the exposure of the chemicals. This study examines the toxicity profiling of the naphthalene-2-yl 2-chloro-5-dinitrobenzoate (SF5) by adopting the vision of NRC that moves from traditional animal studies to the cellular pathways. Acute, subacute, and developmental toxicity studies were assayed according to the Organization for Economic Cooperation and Development (OECD) guidelines. The stress response pathway, toxicity pathway, and adverse effects outcome parameters were analyzed by using their standard protocols. The results showed that the acute toxicity study increases the liver enzyme levels. In a subacute toxicity study, alkaline phosphatase (ALP) levels were raised in both male and female animals. SF5 significantly increases the normal sperm count in the male animals corresponding to a decrease in the abnormality count. Developmental toxicity showed the normal skeletal and morphological parameters, except little hydrocephalus was observed in developmental toxicity. Doses of 20 mg/kg in males and 4 mg/kg in females showed decreased glutathione (GSH) levels in the kidney and liver. MDA levels were also increased in the kidney and liver. However, histopathological studies did not show any cellular change in these organs. No statistical difference was observed in histamine levels, testosterone, nuclear factor erythroid two-related factor-2 (Nrf2), and nuclear factor-kappa B (NF-κB), which showed no initiation of the stress response, toxicity, and adverse effect pathways. Immunomodulation was observed at low doses in subacute toxicity studies. It was concluded that SF5 did not produce abrupt and high-toxicity levels in organs and biochemical parameters. So, it is safe for further studies.
  4. Klamar A, Horvath D, Keith N, Frese M
    Front Psychol, 2021;12:716915.
    PMID: 35126221 DOI: 10.3389/fpsyg.2021.716915
    Field studies indicate that error management culture can be beneficial for organizational performance. The question of whether and how error management culture can be induced remained unanswered. We conducted two experiments with newly formed teams, in which we aimed to induce error management culture and to explore whether we would also find beneficial effects of error management culture on performance in an experimental setting. Furthermore, we tested whether culture strength moderates the relationship between error management culture and performance. In Study 1, we used two tasks that require rational problem solving. In Study 2, we used a task that requires creative problem solving. We successfully manipulated error management culture in terms of an effect on perceived error management culture within the teams. While we did not find a direct effect of error management culture on performance, Study 2 revealed an indirect effect via communication in the teams. To our surprise, culture strength did not influence the hypothesized relationship. We discuss potential theoretical and alternative explanations for our results, and provide an outlook for future studies.
  5. Wang S, Ye Y, Ning B, Cheah JH, Lim XJ
    Front Psychol, 2021;12:829696.
    PMID: 35126270 DOI: 10.3389/fpsyg.2021.829696
    Shopping cart abandonment remains a challenge for many e-retailers despite the continued growth of the e-commerce industry worldwide. However, the issue of online shopping cart abandonment (OSCA) has not been explored extensively in the literature. Grounded by the stimulus-organism-response (S-O-R) model, this study explores a sequential mediation model comprising consumers' wait for lower prices as an antecedent, hesitation at checkout and OSCA as mediators, perceived transaction inconvenience as a moderator, and decision to buy from a land-based retailer (DBLR) as an outcome. An online questionnaire was designed and distributed to 883 online consumers in Mainland China. Partial least squares-structural equation modeling (PLS-SEM) was employed to analyze the survey data. The results show that waiting for lower prices positively influences hesitation at checkout, and subsequently, impacts both OSCA and DBLR. Hesitation at checkout and OSCA play sequential mediating roles in the framework path. In addition, perceived transaction inconvenience strengthens the relationship between waiting for lower prices and hesitation at checkout. Overall, this study contributes to theory and serves as a guideline for e-retailers in reducing the OSCA rate.
  6. Austin CM, Croft LJ, Grandjean F, Gan HM
    Front Genet, 2021;12:695763.
    PMID: 35126445 DOI: 10.3389/fgene.2021.695763
    Cherax destructor, the yabby, is an iconic Australian freshwater crayfish species, which, similar to other major invertebrate groups, is grossly under-represented in genomic databases. The yabby is also the principal commercial freshwater crustacean species in Australia subject to explotation via inland fisheries and aquaculture. To address the genomics knowledge gap for this species and explore cost effective and efficient methods for genome assembly, we generated 106.8 gb of Nanopore reads and performed a long-read only assembly of the Cherax destructor genome. On a mini-server configured with an ultra-fast swap space, the de novo assembly took 131 h (∼5.5 days). Genome polishing with 126.3 gb of PCR-Free Illumina reads generated an assembled genome size of 3.3 gb (74.6% BUSCO completeness) with a contig N50 of 80,900 bp, making it the most contiguous for freshwater crayfish genome assemblies. We found an unusually large number of cellulase genes within the yabby genome which is relevant to understanding the nutritional biology, commercial feed development, and ecological role of this species and crayfish more generally. These resources will be useful for genomic research on freshwater crayfish and our methods for rapid and super-efficient genome assembly will have wide application.
  7. Chai MH, Sukiman MZ, Liew YW, Shapawi MS, Roslan FS, Hashim SN, et al.
    Iran J Vet Res, 2021;22(4):277-287.
    PMID: 35126535 DOI: 10.22099/ijvr.2021.39586.5752
    Background: The emergence of multidrug-resistant strains such as methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Staphylococcus aureus (MDRSA) in animals and humans with continuous contact are a great zoonotic concern.

    Aims: This cross-sectional study was performed to investigate the carriage rate, genotypic characteristics, and to determine the antibiogram of S. aureus isolated from pets and pet owners in Malaysia.

    Methods: Nasal and oral swab samples from 40 cats, 30 dogs, and 70 pet owners were collected through convenient sampling. Presumptive colonies on mannitol salt agar were subjected to biochemical identification. S. aureus and MRSA were confirmed by PCR detection of nuc and mecA genes, respectively. Molecular profiles for antimicrobial resistance and virulence genes in S. aureus were also determined. The antibiogram was carried out via Kirby-Bauer test using 18 antibiotics.

    Results: 17.5% of cats, 20% of dogs, and 27% of pet owners were S. aureus positive. MRSA was also detected in dogs, and pet owners. S. aureus isolates displayed high resistance against penicillin (72.7%), and amoxicillin/clavulanate (66.7%). 39.4% of S. aureus isolates showed multidrug-resistance traits, phenotypically. Molecular characterization of S. aureus revealed the presence of mecA, tetk, tetL, ermA, ermB, ermC, msrA, scn, chp, sak, sep, and sea genes.

    Conclusion: This study showed the emergence of MRSA and MDRSA in pets and pet owners in Malaysia. The antibiogram findings showed resistance of S. aureus to multiple antibiotics. Furthermore, molecular analysis of immune evasion cluster (IEC) strongly suggests the spread of animal-adapted S. aureus lineages among pets and pet owners.

  8. Oglat AA, Dheyab MA
    J Med Ultrasound, 2021 05 14;29(4):258-263.
    PMID: 35127405 DOI: 10.4103/JMU.JMU_166_20
    Background: Diagnostic ultrasound or sonography is an image which can provide valuable information for diagnosing and treating a variety of diseases and conditions. This experiment was done to check the performance and evaluate the ultrasonic imaging system. There were three tests performed in this experiment: dead zone (transducer ring-down), vertical measurement calibration, and horizontal measurement calibration.

    Methods: The evaluation was made by performed all the tests with different depth on two different multipurpose phantom model #539. The tests were also performed by two different probes which were curved and flat (linear probe). The images were taken, and the measurements were made by electronic calipers on the ultrasound machine system. Observations and evaluations were done via all images and measurements taken.

    Results: The images formed by two various probes were different. The penetration settings were different since the depths were different. The depth influenced the penetrations to the formed image. From the comparison of all results and measurements recorded were all under the accepted value of the standard that was given by the manufacture of the phantom.

    Conclusion: Therefore, it can be concluded that the measurements were all not exceeding 2% of the standard value given based on the result that we get.

  9. Ab Rahman S, Matic T, Yordanova M, Ariffin H
    Front Pediatr, 2021;9:758680.
    PMID: 35127585 DOI: 10.3389/fped.2021.758680
    Allogeneic haematopoietic stem cell transplantation (HSCT) is indicated in children with high-risk, relapsed or refractory acute lymphoblastic leukaemia (ALL). HLA-matched grafts from cord blood and stem cell repositories have allowed patients without suitable sibling donors to undergo HSCT. However, challenges in procuring matched unrelated donor (MUD) grafts due to high cost, ethnic disparity and time constraints have led to the exponential rise in the use of stem cells from human leukocyte antigen (HLA)-haploidentical family donors. Whilst HLA-haploidentical HSCT (hHSCT) performed in adult patients with acute leukaemia has produced outcomes similar to MUD transplants, experience in children is limited. Over the last 5 years, more data have emerged on hHSCT in the childhood ALL setting, allowing comparisons with matched donor transplants. The feasibility of hHSCT using adult family donors in childhood ALL may also address the ethical issues related to selection of minor siblings in matched sibling donor transplants. Here, we review hHSCT in paediatric recipients with ALL and highlight the emergence of hHSCT as a promising therapeutic option for patients lacking a suitable matched donor. Recent issues related to conditioning regimens, donor selection and graft-vs.-host disease prophylaxis are discussed. We also identify areas for future research to address transplant-related complications and improve post-transplant disease-free survival.
  10. R S, M S, Hasan MK, Saeed RA, Alsuhibany SA, Abdel-Khalek S
    Front Public Health, 2021;9:792124.
    PMID: 35127623 DOI: 10.3389/fpubh.2021.792124
    Today, disease detection automation is widespread in healthcare systems. The diabetic disease is a significant problem that has spread widely all over the world. It is a genetic disease that causes trouble for human life throughout the lifespan. Every year the number of people with diabetes rises by millions, and this affects children too. The disease identification involves manual checking so far, and automation is a current trend in the medical field. Existing methods use a single algorithm for the prediction of diabetes. For complex problems, a single model is not enough because it may not be suitable for the input data or the parameters used in the approach. To solve complex problems, multiple algorithms are used. These multiple algorithms follow a homogeneous model or heterogeneous model. The homogeneous model means the same algorithm, but the model has been used multiple times. In the heterogeneous model, different algorithms are used. This paper adopts a heterogeneous ensemble model called the stacked ensemble model to predict whether a person has diabetes positively or negatively. This stacked ensemble model is advantageous in the prediction. Compared to other existing models such as logistic regression Naïve Bayes (72), (74.4), and LDA (81%), the proposed stacked ensemble model has achieved 93.1% accuracy in predicting blood sugar disease.
  11. Ahmad Kuthi N, Chandren S, Basar N, Jamil MSS
    Front Chem, 2021;9:800145.
    PMID: 35127648 DOI: 10.3389/fchem.2021.800145
    The past decade has observed a significant surge in efforts to discover biological systems for the fabrication of metal nanoparticles. Among these methods, plant-mediated synthesis has garnered sizeable attention due to its rapid, cost-effective, environmentally benign single-step procedure. This study explores a step-wise, room-temperature protocol for the synthesis of gold nanoparticles (AuNPs) using Carallia brachiata, a mangrove species from the west coast of Peninsular Malaysia. The effects of various reaction parameters, such as incubation time, metal ion concentration, amount of extract and pH, on the formation of stable colloids were monitored using UV-visible (UV-Vis) absorption spectrophotometry. Our findings revealed that the physicochemical properties of the AuNPs were significantly dependent on the pH. Changing the pH of the plant extract from acidic to basic appears to have resulted in a blue-shift in the main characteristic feature of the surface plasmon resonance (SPR) band, from 535 to 511 nm. The high-resolution-transmission electron microscopy (HR-TEM) and field emission scanning electron microscopy (FESEM) images revealed the morphologies of the AuNPs synthesized at the inherent pH, varying from isodiametric spheres to exotic polygons and prisms, with sizes ranging from 10 to 120 nm. Contrarily, an optimum pH of 10 generated primarily spherical-shaped AuNPs with narrower size distribution (8-13 nm). The X-ray diffraction (XRD) analysis verified the formation of AuNPs as the diffraction patterns matched well with the standard value of a face-centered cubic (FCC) Au lattice structure. The Fourier-transform infrared (FTIR) spectra suggested that different functional groups are involved in the biosynthetic process, while the phytochemical test revealed a clear role of the phenolic compounds. The reduction of 4-nitrophenol (4-NP) was selected as the model reaction for evaluating the catalytic performance of the green-synthesized AuNPs. The catalytic activity of the small, isotropic AuNPs prepared using basic aqueous extract was more effective than the nanoanisotrops, with more than 90% of 4-NP conversion achieved in under an hour with just 3 mg of the nanocatalyst.
  12. Ahmad NA, Mohd MH, Musa KI, Abdullah JM, Othman NA
    Malays J Med Sci, 2021 Oct;28(5):1-9.
    PMID: 35115883 DOI: 10.21315/mjms2021.28.5.1
    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 disease, which has become pandemic since December 2019. In the recent months, among five countries in the Southeast Asia, Malaysia has the highest per-capita daily new cases and daily new deaths. A mathematical modelling approach using a Singular Spectrum Analysis (SSA) technique was used to generate data-driven 30-days ahead forecasts for the number of daily cases in the states and federal territories in Malaysia at four consecutive time points between 27 July 2021 and 26 August 2021. Each forecast was produced using SSA prediction model of the current major trend at each time point. The objective is to understand the transition dynamics of COVID-19 in each state by analysing the direction of change of the major trends during the period of study. The states and federal territories in Malaysia were grouped in four categories based on the nature of the transition. Overall, it was found that the COVID-19 spread has progressed unevenly across states and federal territories. Major regions like Selangor, Kuala Lumpur, Putrajaya and Negeri Sembilan were in Group 3 (fast decrease in infectivity) and Labuan was in Group 4 (possible eradication of infectivity). Other states e.g. Pulau Pinang, Sabah, Sarawak, Kelantan and Johor were categorised in Group 1 (very high infectivity levels) with Perak, Kedah, Pahang, Terengganu and Melaka were classified in Group 2 (high infectivity levels). It is also cautioned that SSA provides a promising avenue for forecasting the transition dynamics of COVID-19; however, the reliability of this technique depends on the availability of good quality data.
  13. Long GC, Umat C, Din NC
    Malays J Med Sci, 2021 Oct;28(5):10-33.
    PMID: 35115884 DOI: 10.21315/mjms2021.28.5.2
    Background: Attaining socio-emotional competence is challenging for children with hearing impairment. There is wide recognition of children with cochlear implant (CI) indicating significant improvement in their speech and language abilities, however many factors may restrict their chance of having reciprocal social interactions. A significant improvement in speech and language does not automatically affirm the quality of social interactions. This present observation on social-emotional development addressed a more current representative population of children with hearing loss who have benefitted from cochlear implantation.

    Methods: The research conducted a systematic review of selected articles from Scopus and PubMed databases, retrieved through three search-process keywords, namely socio-emotional, children and CI. The inclusion criteria only included journal articles published in English with empirical data from the year 2010-2019. The initial search had identified 189 potential abstracts and after removal of duplicates, only 38 eligible studies met the inclusion criteria.

    Results: Among 38 studies reviewed, 19 studies showed comparable socio-emotional skills with peers in social interaction, empathy, emotion theory of mind and comprehension skills. Conversely, the other 19 studies presented underprivileged results in socio-emotional functioning mainly in identifying facial expression, regulating emotion and emotional cues in the auditory domain.

    Conclusion: This review concluded that the socio-emotional development among children with CI, both at preschool-age and school-age, was not justified due to the heterogeneity in studies across measurement and small sample size. Also, the conclusion recommended extensive cross-referencing, mixed-mode research design, detailed distinguishing of socio-emotional functioning and identification of diverse groups of the population with impaired hearing as an approach to provide empirical evidence on socio-emotional functioning among children with CI in the future.

  14. Abdul Karim AK, Azrai Abu M, Ahmad MF, Mat Jin N, Suharjono HN
    Malays J Med Sci, 2021 Oct;28(5):34-41.
    PMID: 35115885 DOI: 10.21315/mjms2021.28.5.3
    The novel coronavirus (COVID-19) pandemic has affected the community at large. It has affected almost everyone and every aspect of social, economic and educational activities. Training in reproductive medicine has not been spared, as training in this field requires a combination of clinical interaction with patients, procedural experience, constant discussions and the element of research. The changes to numbers of new infections or active cases dictate the restrictions placed on the community and health care services alike. At the beginning of the pandemic, both the patients' fear of going to a health care facility and movement restrictions had caused a significant reduction in the number of COVID-19 cases. Furthermore, the Ministry of Health (MOH) Malaysia's recommendation to withhold all non-essential medical services, including those related to reproductive medicine, falls under this category. Therefore, it could negatively impact the quality of training and lead to an extension of training duration in reproductive medicine. Thus, the procedural experience could be supplemented with simulator training, teleconsultation could replace standard clinic sessions and online meeting platforms could replace routine academic meetings. Any modifications must be adaptable or flexible, as similar infectious pandemics and restrictions could recur from time to time.
  15. Darwis I, Hidayat H, Wisnu GNPP, Mentari S
    Malays J Med Sci, 2021 Oct;28(5):42-53.
    PMID: 35115886 DOI: 10.21315/mjms2021.28.5.4
    Background: Diabetic foot infection (DFI) is a serious complication of diabetes mellitus and identification of the causative bacteria is an essential step in selecting the appropriate antibiotic therapy. This study aimed to evaluate the bacterial pattern and antibiotic susceptibility of the bacteria causing DFI in Lampung Province in Indonesia.

    Methods: This study is a retrospective study reviewing the medical records of DFI patients admitted to the Dr Hi Abdul Moeloek Regional General Hospital in 2017-2019. DFI patients with complete medical record data were included in this study. Demographic, clinical, laboratory, wound culture and antibiotic susceptibility data were collected from the medical records using a short structural chart. The data obtained then reviewed.

    Results: In this study, 131 DFI patients met the study criteria and were included. Based on the wound culture results, Gram-negative bacteria were obtained in 112 (85.5%) subjects with Enterobacter spp. as the predominant bacteria. Gram-positive bacteria were found in 19 (14.5%) subjects with Staphylococcus spp. as the predominant bacteria. Gram-negative bacteria found in this study showed high susceptibility to amikacin, meropenem and sulbactam/cefoperazone. Meanwhile, the Gram-positive bacteria showed high susceptibility to meropenem, sulbactam/cefoperazone and amikacin.

    Conclusion: The findings of the study revealed Enterobacter spp. as the most predominant bacteria causing DFI in the studied population. The highest antibiotic susceptibility was seen for amikacin, meropenem and sulbactam/cefoperazone.

  16. Al-Nwany NT, Ahmad N, Mohammed Nawi A, Hassan MR, Hod R, Baharom M
    Malays J Med Sci, 2021 Oct;28(5):54-63.
    PMID: 35115887 DOI: 10.21315/mjms2021.28.5.5
    Background: In limited-resource countries, the prevalence of hepatitis B virus (HBV) infection can be measured using data taken from blood donors. This study aimed to determine the HBV infection seroprevalence and its associated factors among blood donors in Sana'a Governorate, Yemen.

    Methods: A cross-sectional study was conducted on 500 people who donated blood at hospitals located in Sana'a between August and October 2016. The volunteers were aged 18-65 years old and were recruited using convenience sampling. A set of questionnaires was administered through face-to-face interviews. Blood samples from each donor were tested for hepatitis B surface antigens using enzyme-linked immunosorbent assay.

    Results: The overall seroprevalence of HBV infection in the blood donors was 2.6%. Participants with a history of dental treatment had 7.80 higher odds (95% confidence interval [CI]: 2.26, 26.71; P = 0.002) for HBV infection. Respectively, blood donors who had history of malaria infection or cupping therapy had 7.48 (95% CI: 1.75, 31.82; P = 0.010) and 7.32 (95% CI: 1.72, 30.83; P = 0.010) greater odds of HBV infection.

    Conclusion: The seroprevalence of HBV infection in Sana'a is lower than in other governorates in Yemen. Stakeholders could focus on a history of dental procedure, malaria infection and cupping treatment when strategising about HBV infection prevention and control among blood donors.

  17. Wan Nur Aimi WMZ, Noorazliyana S, Tuan Salwani TI, Adlin Zafrulan Z, Najib Majdi Y, Noor Azlin Azraini CS
    Malays J Med Sci, 2021 Oct;28(5):64-71.
    PMID: 35115888 DOI: 10.21315/mjms2021.28.5.6
    Background: In end-stage renal disease (ESRD), troponin T concentrations can be elevated even without cardiac ischaemia, which hampers the diagnosis of acute myocardial infarction (AMI). The objectives of our study were to determine the proportion of dialysisdependent ESRD patients without acute coronary syndrome (ACS) but with highly sensitive cardiac troponin T (hs-cTnT) levels above the 99th percentile upper reference limit and to evaluate the range of hs-cTnT among this population.

    Methods: A cross-sectional study was conducted at the haemodialysis (HD) unit of a tertiary hospital in Malaysia from January 2018 to February 2019. Dialysis-dependent ESRD patients were included and those with a recent history of ACS (within 30 days) were excluded. Pre-dialysed serum hs-cTnT levels were measured using Cobas e411. The upper limit of the 99th percentile value for troponin T was 14 ng/L.

    Results: A total of 150 patients were recruited as study participants. The majority were female (62%) and of Malay ethnicity (94%), and the mean (SD) age was 45.19 (16.36) years old. The hs-cTnT range (min, max) was 11.39-738.30 ng/L and the median (interquartile range [IQR]) of hs-cTnT was 59.20 (83.41) ng/L. Elevated hs-cTnT levels were observed in 149/150 (99%) of the study participants (54/55 [98.2%] of the patients were on HD, and 95/95 [100.0%] of the patients were on continuous ambulatory peritoneal dialysis).

    Conclusion: This study supports prior research showing that even without ACS, most ESRD patients have elevated concentrations of cardiac troponin. Furthermore, our study illustrates the need to revisit the use of absolute troponin values when making a diagnosis of ACS in ESRD patients.

  18. Fattahi-Saravi Z, Jouybar R, Haghighat R, Asmarian N
    Malays J Med Sci, 2021 Oct;28(5):72-81.
    PMID: 35115889 DOI: 10.21315/mjms2021.28.5.7
    Background: Emergence agitation (EA) in children is one of the most common complications following anaesthesia. We aimed to compare the effect of ketamine, ketamine-midazolam and ketamine-propofol on EA after tonsillectomy.

    Methods: This study was a randomised, double-blind clinical trial conducted on 162 children undergoing adenotonsillectomy surgery. The participants were randomly divided into three groups of receiving ketamine (0.5 mg/kg) (N = 54), ketamine (0.5 mg/kg) + propofol (1 mg/kg) (N = 54) and ketamine (0.5 mg/kg) + midazolam (0.01 mg/kg) (N = 54) 10 min before the end of the operation. At the time of the patients' entry into the post-anaesthesia care unit (PACU) and at intervals of 5 min, 10 min and 20 min after that, consciousness, mobility, breathing, circulation and SpO2 were recorded. Modified Aldrete recovery score (MARS), the objective pain score (OPS) and Richmond agitation-sedation scale (RASS) were also evaluated.

    Results: At the time of entrance to the PACU and 5 min later, the ketamine-midazolam and ketamine-propofol groups had lower RASS scores than the ketamine group (P < 0.001); after 10 min and 20 min, the ketamine-propofol group showed the lowest RASS score (P < 0.001). Ketamine-propofol group had a significantly lower MARS score at all-time points (P < 0.001). Recovery time was the longest for the ketamine-propofol group (P = 0.008).

    Conclusion: The ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.

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