Browse publications by year: 2021

  1. Hafizuddin Awang, Tengku Alina Tengku Ismail
    JUMMEC, 2021;24(1):15-22.
    MyJurnal
    Evidence-based recommendations on intrapartum care are important to ensure the safety of mothers and neonates. The objective of this study was to compare two established guidelines for intrapartum care to provide clinicians with more comprehensive recommendations on intrapartum management. We carried out a descriptive analysis of guidelines from the Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines published by the World Health Organization, and the Perinatal Care Manual published by the Ministry of Health Malaysia, on intrapartum care to determine differences, if any, with regards to management. Latent, active and the second phase of labour are defined differently in both guidelines. Both guidelines showed high similarity in the steps of clinical management for all phases of labour but differed in foetal monitoring methods, indications for episiotomy, mood and behavior assessment, universal precautions, pain management, and placental disposal. Both guidelines had similar managements for most of the problems encountered during the intrapartum period except for preterm labour and multiple births which have substantial differences. Malaysian guidelines highlight additional systems such as the red alert system, and referral and retrieval system, which would enhance the quality of intrapartum management. The IMPAC guidelines emphasize supportive care, birth companionship, maternal care and monitoring up to one hour after placental delivery; and home birth management; these are inadequately explained or lacking in Malaysian guidelines. From the comparison, it was seen that substantial variation exists in intrapartum management between both guidelines that indicates the need for better evidences to synthesize a more comprehensive set of guidelines for the improvement in intrapartum care.
  2. Lip, Henry Tan Chor, Huei, Tan Jih, Vellusamy, V Muthualhagi
    JUMMEC, 2021;24(1):11-14.
    MyJurnal
    In Malaysia, incidence of Wilms’ Tumor (WT) is rare, with only 8 cases reported over four years according to the Malaysia Cancer Registry Report (2012-2016). Reports of spontaneous rupture of WT are scarce and the commonest presentation of this entity is a palpable mass in the abdomen. Herein, we report on the unusual presentation of an 11-year-old boy with typical symptoms of acute appendicitis. The child was subjected to an initial open appendicectomy and diagnosed intra-operatively with a right sided ruptured renal mass. Subsequent investigation leading to the diagnosis of a ruptured Wilms’ tumor and its treatment is discussed in this case presentation.
  3. Chan, Siaw Leng, Fonny, Dameaty Hutagalung, Lau, Poh Li
    JUMMEC, 2021;24(1):1-10.
    MyJurnal
    An alarming increase in the prevalence of depression has been found among Malaysian young adults which necessitates responsiveness. This study sought to better understand the subjective personal growth experience in terms of the processes among young adults recovering from major depressive disorder (MDD). A qualitative, transcendental phenomenological design was adopted by collecting data through in-depth, semi-structured interviews, audio recordings, interview transcripts and documents. Nine Malaysian young adults with MDD (Mean age=28) who reported being in recovery from MDD for at least one year were recruited from local mental health settings through purposive sampling. Data analysis involved Colaizzi’s eight-step method. The findings revealed eight personal growth processes themes: revealing the struggles, self-discovery and personal strength, personal responsibility, readiness for change, hope, redefining the meaning, forgiveness, and acceptance. Noticeably, each theme was interconnected to facilitate personal growth among major depressive young adults. The implications for mental health psychotherapy practice and future research were discussed.
  4. Kassogue Y, Diakite B, Kassogue O, Konate I, Tamboura K, Diarra Z, et al.
    Medicine (Baltimore), 2021 Jul 23;100(29):e26614.
    PMID: 34398016 DOI: 10.1097/MD.0000000000026614
    Cytochrome P450 enzymes play a central role in the phase I biotransformation process of a wide range of compounds, including xenobiotics, drugs, hormones and vitamins. It is noteworthy that these enzymes are highly polymorphic and, depending on the genetic makeup, an individual may have impaired enzymatic activity. Therefore, the identification of genetic variants in these genes could facilitate the implementation of pharmacogenetic studies and genetic predisposition to multifactorial diseases. We have established the frequencies of CYP2B6 (rs3745274; rs2279343) and CYP3A4 (rs2740574) alleles and genotypes in 209 healthy Malian subjects using TaqMan drug metabolism genotyping assays for allelic discrimination. Allele frequencies were 37% for CYP2B6 rs3745274; 38% for CYP2B6 rs2279343; and 75% for CYP3A4 rs2740574 respectively. Overall, the frequencies observed in Mali are statistically comparable to those reported across Africa except North Africa. The major haplotypes in CYP2B6 rs3745274 and CYP2B6 rs2279343 were represented by GA (60.24%) followed by TG (35.36%). We noted a strong linkage disequilibrium between CYP2B6 rs3745274 and CYP2B6 rs2279343 with D' = 0.91 and r2 = 0.9. The frequencies of the genotypic combinations were 43.5% (GT/AG), 37.3% (GG/AA) and 11.5% (TT/GG) in the combination of CYP2B6-rs3745274 and CYP2B6-rs2279343; 26.8% (GT/CC), 25.4%, (GT/CT), 17.2% and GG/CT in the combination CYP2B6-rs3745274-CYP3A4-rs2740574; 26.8% (AG/CC), 23.9% (AA/CC), 19.1% (AG/CT), and 11% (AA/CT) in the combination CYP2B6-rs2279343-CYP3A4-rs2740574, respectively. The most common triple genotype was GT/AG/CC with 24.9%, followed by GG/AA/CC with 23.9%, GT/AG/CT with 16.7%, and GG/AA/CT with 10%. Our results provide new insights into the distribution of these pharmacogenetically relevant genes in the Malian population. Moreover, these data will be useful for studies of individual genetic variability to drugs and genetic predisposition to diseases.
    MeSH terms: Adolescent; Adult; Aged; Alleles*; Female; Genotype*; Haplotypes/genetics*; Humans; Malaysia/ethnology; Male; Middle Aged; Pharmacogenetics/methods; Cytochrome P-450 CYP3A/genetics; Cytochrome P-450 CYP2B6/genetics
  5. Muhammad AI, Dalia AM, Loh TC, Akit H, Samsudin AA
    BMC Vet Res, 2021 Aug 21;17(1):281.
    PMID: 34419016 DOI: 10.1186/s12917-021-02964-0
    BACKGROUND: The oviduct of a hen provides a conducive environment for egg formation, which needs a large amount of mineral elements from the blood via trans-epithelial permeability. Eggshell is the calcified layer on the outside of an egg that provides protection and is critical for egg quality. However, little is known about the genes or proteins involved in eggshell formation, and their relationship to dietary microminerals. We hypothesized that dietary selenium supplementation in chickens will influence genes involved in eggshell biomineralization, and improve laying hen antioxidant capacity. The objective of this research was to investigate how organic and inorganic dietary selenium supplementation affected mRNA expression of shell gland genes involved in eggshell biomineralization, and selenoproteins gene expression in Lohman Brown-Classic laying hens.

    RESULTS: Shell gland (Uterus) and liver tissue samples were collected from hens during the active growth phase of calcification (15-20 h post-ovulation) for RT-PCR analysis. In the oviduct (shell gland and magnum) and liver of laying hens, the relative expression of functional eggshell and hepatic selenoproteins genes was investigated. Results of qPCR confirmed the higher (p 

    MeSH terms: Animals; Animal Feed/analysis; Antioxidants/analysis; Chickens; Diet/veterinary*; Egg Shell/chemistry; Female; Liver; Oviducts/metabolism*; Selenium/administration & dosage*; Selenium/chemistry; Gene Expression; Selenoproteins/metabolism
  6. Liu J, Chen X, Liu Y, Lin J, Shen J, Zhang H, et al.
    Infect Dis Poverty, 2021 Aug 21;10(1):112.
    PMID: 34419160 DOI: 10.1186/s40249-021-00895-4
    BACKGROUND: The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) is pandemic. However, the origins and global transmission pattern of SARS-CoV-2 remain largely unknown. We aimed to characterize the origination and transmission of SARS-CoV-2 based on evolutionary dynamics.

    METHODS: Using the full-length sequences of SARS-CoV-2 with intact geographic, demographic, and temporal information worldwide from the GISAID database during 26 December 2019 and 30 November 2020, we constructed the transmission tree to depict the evolutionary process by the R package "outbreaker". The affinity of the mutated receptor-binding region of the spike protein to angiotensin-converting enzyme 2 (ACE2) was predicted using mCSM-PPI2 software. Viral infectivity and antigenicity were tested in ACE2-transfected HEK293T cells by pseudovirus transfection and neutralizing antibody test.

    RESULTS: From 26 December 2019 to 8 March 2020, early stage of the COVID-19 pandemic, SARS-CoV-2 strains identified worldwide were mainly composed of three clusters: the Europe-based cluster including two USA-based sub-clusters; the Asia-based cluster including isolates in China, Japan, the USA, Singapore, Australia, Malaysia, and Italy; and the USA-based cluster. The SARS-CoV-2 strains identified in the USA formed four independent clades while those identified in China formed one clade. After 8 March 2020, the clusters of SARS-CoV-2 strains tended to be independent and became "pure" in each of the major countries. Twenty-two of 60 mutations in the receptor-binding domain of the spike protein were predicted to increase the binding affinity of SARS-CoV-2 to ACE2. Of all predicted mutants, the number of E484K was the largest one with 86 585 sequences, followed by S477N with 55 442 sequences worldwide. In more than ten countries, the frequencies of the isolates with E484K and S477N increased significantly. V367F and N354D mutations increased the infectivity of SARS-CoV-2 pseudoviruses (P 

    MeSH terms: Antibodies, Viral/immunology; Humans; Mutation; Evolution, Molecular*; Antibodies, Neutralizing/immunology; HEK293 Cells; Pandemics; Spike Glycoprotein, Coronavirus/genetics*
  7. Simon PD, Adams C, Goh MCW, Suhaimi AF, Hassem T
    Asian J Psychiatr, 2021 Nov;65:102813.
    PMID: 34419720 DOI: 10.1016/j.ajp.2021.102813
    MeSH terms: Humans; Mental Health; Mental Health Services*
  8. Yong CH, Muhammad SA, Aziz FA, Nasir FI, Mustafa MZ, Ibrahim B, et al.
    Food Chem, 2021 Aug 09;368:130808.
    PMID: 34419793 DOI: 10.1016/j.foodchem.2021.130808
    As stingless bee honey (SBH) is gaining in popularity in the Malaysian market, it is now prone to adulteration. The higher price of SBH compared to floral honey has led to the use of unusual adulterants such as vinegar and even floral honey to mimic the unique taste and appearance of SBH. Since the current AOAC 998.12 method fails to detect these adulterants as their δ13C values are in the range for C3 plants, untargeted 1H NMR metabolomics was proposed. Principal component analysis of SBH 1H NMR fingerprints was able to distinguish authentic SBHs from adulterated ones down to 1% adulteration level for selected adulterants. Discriminant analysis showed promising results in distinguishing the preliminary datasets of authentic SBHs from the adulterated ones, including discriminating SBHs adulterated with different adulterants derived from C3 and C4 plants. Hence, to assure any emerging adulterant can be detected, all 1H NMR regions should be considered.
  9. Ramli UIS, Muhd US, Mohd Yusof MYP
    J Forensic Odontostomatol, 2021 Aug 30;2(39):38-44.
    PMID: 34419944
    The use of teeth to estimate the age of unknown bodies provides much help especially in skeletal remains with no soft tissues left for identification. However, dental age estimation utilizing degenerative changes in teeth like dentinal translucency is often hampered with large margin of error. This study aims to compare the accuracy of Kvaal's radiographic method (intraoral periapical radiograph) with modified Bang-Ramm dentinal root translucency method in estimating dental age in Malay adults. One-hundred teeth of maxillary and mandibular incisors and canine were collected following dental extraction. Date of birth, date of extraction, gender and ethnicity were documented prior to extraction. All teeth were assessed using two methods of dental age estimation: 1) The equation from Kvaal's radiographic method and 2) Formula from modified Bang-Ramm dentinal root translucency method. The results from the age estimation were compared to the chronological age of the persons from whom the teeth were extracted. The average dental age estimated using both methods significantly correlated with the chronological age for both men and women. Overestimation and underestimation with mean absolute error up to 13 years and 15 years was observed in modified Bang-Ramm and Kvaal, respectively. The estimated age calculated from both methods also showed increasing standard deviation as the patient gets older. From the obtained results it is reasonable to conclude that modified Bang-Ramm method gives better accuracy for dental age estimation in Malay adults.
    MeSH terms: Adult; Age Determination by Teeth*; Female; Humans; Malaysia; Male; Body Remains
  10. Poh CL, Lalani S
    Vitam Horm, 2021;117:17-46.
    PMID: 34420580 DOI: 10.1016/bs.vh.2021.06.008
    The emergence and re-emergence of viral pathogens capable of causing epidemics or pandemics pose a serious healthcare burden. Small molecule antivirals used in conventional therapy have given rise to the severe problem of viral resistance against them. Peptides are generally considered safe, effective and are less likely to induce viral resistance. Antiviral peptides can be identified from screening of phage display of combinational peptide libraries, peptide array libraries or designed against viral targets. Limitations of peptides such as bioavailability can be improved with chemical modifications. Nanotechnology can further improve the stability of peptides in systemic circulation and enhance the antiviral activity of peptides, making them an appealing therapeutic option.
  11. Daood U, Bapat RA, Sidhu P, Ilyas MS, Khan AS, Mak KK, et al.
    Dent Mater, 2021 10;37(10):1511-1528.
    PMID: 34420798 DOI: 10.1016/j.dental.2021.08.001
    OBJECTIVES: The aim of the current project was to study the antimicrobial efficacy of a newly developed irrigant, k21/E against E. faecalis biofilm.

    METHODS: Root canals were instrumented and randomly divided into the following groups: irrigation with saline, 6% NaOCl (sodium hypochlorite), 6% NaOCl+2% CHX (Chlorhexidine), 2% CHX, 0.5% k21/E (k21 - quaternary ammonium silane) and 1% k21/E. E. faecalis were grown (3-days) (1×107CFU mL-1), treated, and further cultured for 11-days. Specimens were subjected to SEM, confocal and Raman analysis and macrophage vesicles characterized along with effect of lipopolysaccharide treatment. 3T3 mouse-fibroblasts were cultured for alizarin-red with Sortase-A active sites and Schrödinger docking was performed. TEM analysis of root dentin substrate with matrix metalloproteinases profilometry was also included. A cytotoxic test analysis for cell viability was measured by absorbance of human dental pulp cells after exposure to different irrigant solutions for 24h. The test percentages have been highlighted in Table 1.

    RESULTS: Among experimental groups, irrigation with 0.5% k21/E showed phase separation revealing significant bacterial reduction and lower phenylalanine 1003cm-1 and Amide III 1245cm-1 intensities. Damage was observed on bacterial cell membrane after use of k21/E. No difference in exosomes distribution between control and 0.5%k21/E was observed with less TNFα (*p<0.05) and preferential binding of SrtA. TEM images demonstrated integrated collagen fibers in control and 0.5%k21/E specimens and inner bacterial membrane damage after k21/E treatment. The k21 groups appeared to be biocompatible to the dental pulpal cells grown for 24h.

    SIGNIFICANCE: Current investigations highlight potential advantages of 0.5% k21/E as irrigation solution for root canal disinfection.

  12. Katiri R, Hall DA, Hoare DJ, Fackrell K, Horobin A, Buggy N, et al.
    JMIR Form Res, 2021 Aug 19;5(8):e28878.
    PMID: 34420915 DOI: 10.2196/28878
    BACKGROUND: Clinical trials that assess the benefits and harms of an intervention do so by measuring and reporting outcomes. Inconsistent selection and diversity in the choice of outcomes make it challenging to directly compare interventions. To achieve an agreed core set of outcomes, a consensus methodology is recommended, comprising a web-based Delphi survey and a face-to-face consensus meeting. However, UK government regulations to control the pandemic prohibited plans for a face-to-face consensus meeting as part of the Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study.

    OBJECTIVE: This study aims to evaluate the modifications made by the CROSSSD study team to achieve consensus using web-based methods, but with minimal deviation from the original study protocol.

    METHODS: The study team worked with health care users and professionals to translate the planned face-to-face consensus meeting in a web-based format, preserving the key elements of the nominal group technique. A follow-up survey gathered evaluation feedback on the experiences of the 22 participating members. Feedback covered premeeting preparation, the process of facilitated discussions and voting, ability to contribute, and perceived fairness of the outcome.

    RESULTS: Overall, 98% (53/54) of feedback responses agreed or strongly agreed with the statements given, indicating that the web-based meeting achieved its original goals of open discussion, debate, and voting to agree with a core outcome set for single-sided deafness. Hearing-impaired participants were fully engaged, but there were some methodological challenges. For the participants, challenges included building rapport, understanding, and delivering the tasks in hand. For the study team, challenges included the need for thorough preparation and management of the unpredictability of tasks on the day.

    CONCLUSIONS: Sharing our experiences and lessons learned can benefit future core outcome set developers. Overcoming the challenges of delivering a web-based consensus exercise in the face of the pandemic can be applied more generally to maximize inclusiveness, enhance geographical access, and reduce research costs.

  13. Ting RS, Aw Yong YY, Tan MM, Yap CK
    Front Psychol, 2021;12:634863.
    PMID: 34421700 DOI: 10.3389/fpsyg.2021.634863
    Many psychological researchers have proven the deteriorating effects of the coronavirus disease 2019 (Covid-19) pandemic on public mental health. In Malaysia, various Covid-19 clusters were associated with religious gatherings. From a cultural psychology perspective, how ethno-religious groups respond to this crisis originating from their unique rationality and ecological systems. Therefore, this study aimed to explore the illness perceptions of major religious groups (Christian, Muslim, and Buddhist) in Malaysia toward the Covid-19 pandemic, their stress levels, and the relationship between illness perception, stress, and forms of religious expression during the lockdown period. Through an online survey method, 608 Malaysian religious believers were included in this mixed-method empirical study, which adapted standardized instruments [Duke University Religion Index (DUREL), Brief Illness Perception Questionnaire (BIPQ), and Perceived Stress Scale (PSS)]. Statistical analysis showed that all three groups reported moderate levels of stress in average without any significant difference after controlling for age. Both internal and external forms of religious expression had a significant negative relationship with stress levels. Personal control, comprehension, and emotions domains of illness perception accounted for a significant variance in the stress level. Furthermore, religious expression significantly moderated the relationship between some illness perception domains and stress. Qualitative coding revealed that most participants perceived human behavior and attitudes, sociopolitical, and sociological factors as causal factors to the current pandemic. These findings confirmed the relationship between religious expression, illness belief, and stress regulation during the pandemic lockdown. Incidental findings of age as a potential protective factor for Malaysian believers warrants further study. In the conclusion, implications for public health policymakers and religious communities on pandemic prevention and well-being promotion were discussed.
  14. Islam A, Haque S
    Front Psychol, 2021;12:703237.
    PMID: 34421755 DOI: 10.3389/fpsyg.2021.703237
    There is a lack of a psychometric tool for generational identity. We have conducted two studies involving Bangladeshi older adults who have witnessed the Bangladesh liberation war in 1971 to develop a new generational identity scale (GIS). The first study (N = 300) prepared an initial pool of 31 items and got them vetted by expert judges, which retained 21 items to form the provisional GIS (GIS-21). An exploratory factor analysis on GIS-21 excluded eight items and offered a two-factor solution: (i) identification with the generation and (ii) awareness of the generational importance. The second study (N = 176) ran a confirmatory factor analysis on the resulting GIS-13 and dropped another item to achieve a better model fit (SRMR =0.058, GFI = 0.986, AGFI = 0.980, and NFI = 0.980). The remaining 12-item GIS (GIS-12) showed excellent reliability (Mc Donald's omega = 0.898) and satisfactory temporal stability (ICC = 0.59, 95% CI = 0.27-0.77) over a 4-week interval. The scale's moderate correlation with another measure for generational identification demonstrates its convergent validity. Participants' transitional experience caused by the Bangladesh independence war in 1971 was also moderately correlated with the GIS-12 supporting further theoretical convergence of this scale. We recommend that researchers could use this scale on different populations and age groups upon appropriate validation.
  15. Foo JB, Looi QH, Chong PP, Hassan NH, Yeo GEC, Ng CY, et al.
    Stem Cells Int, 2021;2021:2616807.
    PMID: 34422061 DOI: 10.1155/2021/2616807
    Cell therapy involves the transplantation of human cells to replace or repair the damaged tissues and modulate the mechanisms underlying disease initiation and progression in the body. Nowadays, many different types of cell-based therapy are developed and used to treat a variety of diseases. In the past decade, cell-free therapy has emerged as a novel approach in regenerative medicine after the discovery that the transplanted cells exerted their therapeutic effect mainly through the secretion of paracrine factors. More and more evidence showed that stem cell-derived secretome, i.e., growth factors, cytokines, and extracellular vesicles, can repair the injured tissues as effectively as the cells. This finding has spurred a new idea to employ secretome in regenerative medicine. Despite that, will cell-free therapy slowly replace cell therapy in the future? Or are these two modes of treatment still needed to address different diseases and conditions? This review provides an indepth discussion about the values of stem cells and secretome in regenerative medicine. In addition, the safety, efficacy, advantages, and disadvantages of using these two modes of treatment in regenerative medicine are also critically reviewed.
  16. Tan MY, Kwong HC, Crouse KA, Ravoof TBSA, Tiekink ERT
    Acta Crystallogr E Crystallogr Commun, 2021 Aug 01;77(Pt 8):788-794.
    PMID: 34422302 DOI: 10.1107/S2056989021006666
    The title thio-urea derivative, C17H19N3OS, adopts a U-shaped conformation with the dihedral angle between the terminal aromatic rings being 73.64 (5)°. The major twist in the mol-ecule occurs about the ethane bond with the Ci-Ce-Ce-Cb torsion angle being -78.12 (18)°; i = imine, e = ethane and b = benzene. The configuration about the imine bond is E, the N-bound H atoms lie on opposite sides of the mol-ecule and an intra-molecular amine-N-H⋯N(imine) hydrogen bond is evident. In the mol-ecular packing, hydroxyl-O-H⋯S(thione) and amine-N-H⋯O hydrogen bonding feature within a linear, supra-molecular chain. The chains are connected into a layer in the ab plane by a combination of methyl-ene-C-H⋯S(thione), methyl-ene-C-H⋯O(hydrox-yl), methyl-C-H⋯π(phen-yl) and phenyl-C-H⋯π(hy-droxy-benzene) inter-actions. The layers stack without directional inter-actions between them. The analysis of the calculated Hirshfeld surface highlights the presence of weak methyl-C-H⋯O(hydrox-yl) and H⋯H inter-actions in the inter-layer region. Computational chemistry indicates that dispersion energy is the major contributor to the overall stabilization of the mol-ecular packing.
  17. Tan MY, Kwong HC, Crouse KA, Ravoof TBSA, Tiekink ERT
    Acta Crystallogr E Crystallogr Commun, 2021 Aug 01;77(Pt 8):839-846.
    PMID: 34422312 DOI: 10.1107/S2056989021007398
    The title zinc bis-(thio-semicarbazone) complex, [Zn(C22H17N4O2S)2], comprises two N,S-donor anions, leading to a distorted tetra-hedral N2S2 donor set. The resultant five-membered chelate rings are nearly planar and form a dihedral angle of 73.28 (3)°. The configurations about the endocyclic- and exocyclic-imine bonds are Z and E, respectively, and that about the ethyl-ene bond is E. The major differences in the conformations of the ligands are seen in the dihedral angles between the chelate ring and nitro-benzene rings [40.48 (6) cf. 13.18 (4)°] and the N-bound phenyl and nitro-benzene ring [43.23 (8) and 22.64 (4)°]. In the crystal, a linear supra-molecular chain along the b-axis direction features amine-N-H⋯O(nitro) hydrogen bonding. The chains assemble along the 21-screw axis through a combination of phenyl-C-H⋯O(nitro) and π(chelate ring)-π(phen-yl) contacts. The double chains are linked into a three-dimensional architecture through phenyl-C-H⋯O(nitro) and nitro-O⋯π(phen-yl) inter-actions.
  18. Ahmad F, Gandre P, Nguekam J, Wall A, Ong S, Karuppamakkantakath AN, et al.
    Case Rep Crit Care, 2021;2021:9955466.
    PMID: 34422417 DOI: 10.1155/2021/9955466
    Background. Novel coronavirus-19 disease (COVID-19) is associated with significant cardiovascular morbidity and mortality. However, there have been very few reports on complete heart block (CHB) associated with COVID-19. This case series describes clinical characteristics, potential mechanisms, and short-term outcomes of critically ill COVID-19 patients complicated by CHB. Case Summary. We present three cases of new-onset CHB in critically ill COVID-19 patients. Patient 1 is a 41-year-old male with well-documented history of Familial Mediterranean Fever (FMF) who required mechanical ventilator support for acute hypoxic respiratory failure from severe COVID-19 pneumonia. He developed new-onset CHB without a hemodynamic derangement but subsequently had acute coronary syndrome complicated by cardiogenic shock. Patient 2 is a 77-year-old male with no past medical history who required intubation for severe COVID-19 pneumonia acute hypoxic respiratory failure. He developed CHB with sinus pause requiring temporary pacing but subsequently developed multiorgan failure. Patient 3 is 36-year-old lady 38 + 2 weeks pregnant, gravida 2 para 1 with no other medical history, who had an emergency Lower Section Caesarean Section (LSCS) as she required intubation for acute hypoxic respiratory failure. She exhibited new-onset CHB without hemodynamic compromise. The CHB resolved spontaneously after 24 hours. Discussion. COVID-19-associated CHB is a very rare clinical manifestation. The potential mechanisms for CHB in patients with COVID-19 include myocardial inflammation or direct viral infiltration as well as other causes such as metabolic derangements or use of sedatives. Patients diagnosed with COVID-19 should be monitored closely for the development of bradyarrhythmia and hemodynamic instability.
  19. Teo K, Yong CW, Chuah JH, Hum YC, Tee YK, Xia K, et al.
    Arab J Sci Eng, 2021 Aug 16.
    PMID: 34422543 DOI: 10.1007/s13369-021-06040-5
    Hospital readmission shortly after discharge threatens the quality of patient care and leads to increased medical care costs. In the United States, hospitals with high readmission rates are subject to federal financial penalties. This concern calls for incentives for healthcare facilities to reduce their readmission rates by predicting patients who are at high risk of readmission. Conventional practices involve the use of rule-based assessment scores and traditional statistical methods, such as logistic regression, in developing risk prediction models. The recent advancements in machine learning driven by improved computing power and sophisticated algorithms have the potential to produce highly accurate predictions. However, the value of such models could be overrated. Meanwhile, the use of other flexible models that leverage simple algorithms offer great transparency in terms of feature interpretation, which is beneficial in clinical settings. This work presents an overview of the current trends in risk prediction models developed in the field of readmission. The various techniques adopted by researchers in recent years are described, and the topic of whether complex models outperform simple ones in readmission risk stratification is investigated.
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