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Fulltext Effect of postharvest storage of whole fruit on physico-chemical and microbial changes of fresh-cut cantaloupe (Cucumis melo L. reticulatus cv. Glamour)

Zainal Abidin, M., Shamsudin, R., Othman, Z., Abdul Rahman, R.

International Food Research Journal, 2013;20(2):953-960.
MyJurnal

Cantaloupes continue to ripen after harvesting which is caused by ethylene production due to climacteric behaviour during postharvest storage. In this study, the cantaloupe fruits harvested at commercial maturity were evaluated for quality attributes during three weeks of storage at 10°C and a relative humidity (RH) of 90±5%. In addition, fresh-cut samples were stored for a further 19 days at 2°C and 87% RH. The fresh-cut samples were prepared on a weekly basis by dipping into deionised water (control) at 2°C for 1 minute. The effect of postharvest storage of cantaloupe on the physico-chemical properties and microbial activity was observed prior to fresh-cut processing. It was found that firmness, luminosity (L*), and titratable acidity (TA) decreased, while total soluble solids (TSS), pH, TSS:TA ratio, microbial activity (total plate count (TPC) and yeast and mould (YM)) of the fresh-cut increased over the postharvest storage period of the fruit. Meanwhile, the orange colour and the intensity (hue angle, hab, and chromaticity) of the flesh did not differ significantly during storage. The cantaloupe stored for three weeks at a low temperature indicated a successful potential for fresh-cut processing due to good maintenance of the product quality.
Drone technology in maternal healthcare in Malaysia: A narrative review

Zailani MAH, Raja Sabudin RZA, Abdul Rahman R, Mohd Saiboon I, Ismail A, Mahdy ZA

Malays J Pathol, 2021 Aug;43(2):251-259.
PMID: 34448789

INTRODUCTION: The vast advancement of technology and breakthrough in high-tech disciplines created multiple areas of research activities, including the emergence of the medical drone. Malaysia, a rapidly developing country in Southeast Asia is on track to achieving high-income status. However, the stagnant growth of Malaysian maternal healthcare does not run parallel with the aspiration. This review paper assessed and reported narratively the current condition of maternal healthcare in Malaysia, the possible application of drones in improving the sector, exploring in detail several challenges, and providing recommendations for experts in studying the rising technological phenomena.
MATERIALS AND METHODS: A literature search was done from June 2019 to November 2019 with restrictions to the English language. The search was performed in ScienceDirect, PubMed, and EMBASE databases, using a combination of search terms related to drones, Unmanned Aerial Vehicles (UAV), Unmanned Aerial Systems (UAS), maternal, obstetric, healthcare, medical products transportation and Malaysia. A discourse analysis followed and a narrative review was provided on this subject.
RESULTS AND DISCUSSION: The validated ability of drones in the delivery of blood products is highlighted as a possible application in improving maternal healthcare in Malaysia, particularly in the state of Sabah. Five key challenges are identified: infrastructure, technicalities, regulations, expertise, and social acceptance. Future predictions of drone technology in healthcare were outlined with the suggestion of three principle arms of application.
CONCLUSION: The usage of the medical drone in medical products transportation supports the objectives of WHO MDG 5 for Malaysian maternal health. A study on the impact of drones in reducing the maternal mortality ratio is recommended for further exploration.
Effectiveness of P6 acupoint electrical stimulation in preventing postoperativenausea and vomiting following laparoscopic surgery

Yeoh AH, Tang SS, Abdul Manap N, Wan Mat WR, Said S, Che Hassan MR, et al.

Turk J Med Sci, 2016 Apr 19;46(3):620-5.
PMID: 27513234 DOI: 10.3906/sag-1502-56

BACKGROUND/AIM: The effects of pericardium 6 (P6) electrical stimulation in patients at risk of postoperative nausea and vomiting (PONV) following laparoscopic surgery were evaluated.
MATERIALS AND METHODS: Eighty patients for laparoscopic surgery with at least one of the determined risks (nonsmoker, female, previous PONV/motion sickness, or postoperative opioid use) were randomized into either an active or sham group. At the end of surgery, Reletex electrical acustimulation was placed at the P6 acupoint. The active group had grade 3 strength and the sham group had inactivated electrodes covered by silicone. It was worn for 24 h following surgery. PONV scores were recorded.
RESULTS: The active group had significantly shorter durations of surgery and lower PONV incidence over 24 h (35.1% versus 64.9%, P = 0.024) and this was attributed to the lower incidence of nausea (31.4% versus 68.6%, P = 0.006). The overall incidence of vomiting was not significantly different between the groups, but it was higher in the sham group of patients with PONV risk score 3 (23.9%, P = 0.049).
CONCLUSION: In patients at high risk for PONV, P6 acupoint electrical stimulation lowers the PONV incidence by reducing the nausea component. However, this reduction in nausea is not related to increasing PONV risk scores.
Fulltext Sturge-Weber-Syndrome with extreme ocular manifestation and rare association of upper airway angioma with anticipated difficult airway

Wong HS, Abdul Rahman R, Choo SY, Yahya N

Med J Malaysia, 2012 Aug;67(4):435-7.
PMID: 23082461 MyJurnal

We report a rare case of an 18 year old girl with Sturge-Weber syndrome, she had extensive facial port wine stains, right bupthalmos and advanced glaucoma involving both eyes. She underwent right eye glaucoma drainage device surgery under general anaesthesia, and had a difficult intubation due to extensive angiomatous like soft tissue swelling at her upper airway. This report highlights the importance of being aware of the need for continuous follow-up in Sturge-Weber syndrome patients as this syndrome can lead to blindness due to advance glaucoma and the awareness of possible difficult intubation for this group of patients.
Near fatal error in management of postoperative epidural analgesia

Wan Mat WR, Yahya N, Izaham A, Abdul Rahman R, Abdul Manap N, Md Zain J

Int J Risk Saf Med, 2014;26(2):57-60.
PMID: 24902502 DOI: 10.3233/JRS-140611

Acute pain service (APS) ensures provision of effective and safe postoperative pain relief. The following cases describe a potentially fatal error in managing patients who receive epidural analgesia postoperatively.
Fulltext The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies

Wan Ismail WR, Abdul Rahman R, Rahman NAA, Atil A, Nawi AM

J Prev Med Public Health, 2019 Jul;52(4):205-213.
PMID: 31390683 DOI: 10.3961/jpmph.19.020

OBJECTIVES: Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer.
METHODS: A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review.
RESULTS: Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19).
CONCLUSIONS: Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.
Fulltext Pregnancy and COVID-19 Pandemic Perception in Malaysia: A Cross-Sectional Study

Syed Anwar Aly SA, Abdul Rahman R, Sharip S, Shah SA, Abdullah Mahdy Z, Kalok A

Int J Environ Res Public Health, 2021 May 27;18(11).
PMID: 34072017 DOI: 10.3390/ijerph18115762

Pregnant women are susceptible to COVID-19 complications due to gestation-related physiological changes. We aimed to evaluate the level of maternal knowledge, perception, and practice during the pandemic. A cross-sectional study was conducted during the Malaysian Movement Control Order (MCO) between April and June 2020. A self-administered electronic questionnaire that included the knowledge and practice domains was distributed. A newly designed set of questions was used to evaluate (1) women's perception of MCO and (2) maternal experience, which was subdivided into clinical care provision and maternal anxiety. The survey response rate was 93% with the final number for analysis of 415. The majority of women (95%) demonstrated an adequate level of knowledge on COVID-19, whilst 99% had a good practice. We found that tertiary education (p < 0.001), employment status (p = 0.03), higher household income (p < 0.001), and multiple sources of information (p < 0.001) were independent predictors of adequate maternal knowledge on COVID-19. Women with adequate knowledge also reported a more positive perception of MCO (p < 0.001) and better obstetric care experience (p = 0.037), as did those of Malay ethnicity. Younger (p < 0.001) and nulliparous (p = 0.01) women demonstrated greater anxiety levels. The majority of our women reported good practice and adequate knowledge, which contributed to a positive perception of MCO and better maternal obstetric experience. First-time mothers may benefit from extra support and reassurance during the pandemic to alleviate maternal anxiety.
Fulltext Microbial and quality attributes of thermally processed chili shrimp paste

Sobhi, B., Noranizan, M., Ab Karim, S., Abdul Rahman, R., Bakar, J., Ghazali, Z.

International Food Research Journal, 2012;19(4):1705-1712.
MyJurnal

Chili shrimp paste (CSP) is a favorite condiment in Southeast Asia. Microbial spoilage makes CSP unsuitable for consumption within several days. Thermal treatment was applied to produce microbiologically safe CSP. The effect of heating process on physicochemical and sensorial properties of CSP was studied. Heating at the optimum condition (21.6 min, 80 ˚C) has been shown effective and reliable in controlling microorganisms in CSP. Complete inactivation of peroxidase activities could not be accomplished at the optimal point, and significant reduction of the total phenolic and capsaicinoids contents was observed. Sensorial evaluation indicated that thermally processed CSP was less preferred by panelists when compared to freshly prepared samples of dry weight respectively.
Fulltext Predictors of SLE relapse in pregnancy and post-partum among multi-ethnic patients in Malaysia

Shaharir SS, Mohamed Said MS, Mohd R, Abdul Cader R, Mustafar R, Abdul Rahman R

PLoS One, 2019;14(9):e0222343.
PMID: 31539383 DOI: 10.1371/journal.pone.0222343

Flare of Systemic Lupus Erythematosus (SLE) may occur during pregnancy and puerperium. We studied the prevalence and factors associated with SLE relapse during pregnancy and post-partum period in a multi-ethnic SLE cohort. Consecutive SLE patients who attended the outpatient clinic were reviewed for previous history of pregnancies in our institution. Patients who had a complete antenatal, delivery, and post-partum follow up were included. Their medical records were retrospectively analysed to assess the disease activity at pre-pregnancy/conception, during antenatal, and post-partum period. Presence of flare episodes during pregnancy and puerperium were recorded. The pregnancy outcomes recorded include live birth, foetal loss, prematurity and intra-uterine growth restrictions (IUGR). Univariate and multivariable logistic regression with generalized estimating equations (GEE) analyses were performed to determine the factors associated with disease relapse and the pregnancy outcomes. A total of 120 patients with 196 pregnancies were included, with a live birth rate of 78.6%. Four (2.0%) were diagnosed to have SLE during pregnancy. The flare rate in pregnancy was 40.1% while post-partum 17.4%. Majority of the relapse in pregnancy occurred in haematological system (62.3%) followed by renal (53.2%), musculoskeletal (22.1%), and mucocutaneous (14.3%). In GEE analyses, active disease at conception was the independent predictor of SLE relapse during and after pregnancy, whereas older maternal age and Malay ethnicity were associated with higher flare during post-partum. HCQ use was significantly associated with reduced risk of flare in univariate analysis but it was no longer significant in the GEE analyses. Presence of disease flare in pregnancy was significantly associated with prematurity. In conclusion, pregnancy in SLE need to be planned during quiescent state as pre-pregnant active disease was associated with disease relapse in both during and after pregnancy. Malay patients had an increased risk of post-partum flare but further larger prospective studies are needed to confirm the association between pregnancies in the different ancestral background.
Fulltext Cost analysis of facial injury treatment in two university hospitals in Malaysia: a prospective study

Saperi BS, Ramli R, Ahmed Z, Muhd Nur A, Ibrahim MI, Rashdi MF, et al.

Clinicoecon Outcomes Res, 2017;9:107-113.
PMID: 28223831 DOI: 10.2147/CEOR.S119910

OBJECTIVE: Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma.
MATERIALS AND METHODS: A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed.
RESULTS: A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia.
CONCLUSION: Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia.
A survey of perceived stress among undergraduate dental students in Universiti Kebangsaan Malaysia

Rosli TI, Abdul Rahman R, Abdul Rahman SR, Ramli R

Singapore Dent J, 2005 Dec;27(1):17-22.
PMID: 16438264

The objectives of this study were to determine the sources of stress among undergraduate dental students, and to compare the sources of stress among the 5 years of undergraduate study, between gender, and with other studies done elsewhere. A total of 325 students across the 5 academic years (88.8% response rate) of the Faculty of Dentistry, Universiti Kebangsaan Malaysia, completed the modified Dental Environment Stress questionnaire. All respondents reported that they experienced some form of stress. The preclinical students reported that examinations and fear of failure caused the most stress. The main stressor for clinical students was clinical training, particularly factors relating to meeting clinical requirements. Female students perceived more stress generally than male students. However, male students were more stressed when faced with factors related to clinical training.
Pattern of maxillofacial injuries in motorcyclists in Malaysia

Ramli R, Abdul Rahman R, Abdul Rahman N, Abdul Karim F, Krsna Rajandram R, Mohamad MS, et al.

J Craniofac Surg, 2008 Mar;19(2):316-21.
PMID: 18362705 DOI: 10.1097/SCS.0b013e318163f94d

Motorcycle casualties represent significant number in road traffic accidents in Malaysia, and among all the injuries, facial injuries pose many significant problems physiologically, functionally, and aesthetically. The aim of this study was to analyze the pattern of maxillofacial as well as other injuries in motorcyclists who were seen at Hospital Universiti Kebangsaan Malaysia.Patients' records from January 2004 to December 2005 were reviewed. Data related to demographics, vehicle/object involved in collision, involvement as a rider or pillion, whether a helmet was worn or not, location of injuries on the face/facial bones, and other associated injuries were collected.A total of 113 cases of motorcycle accidents were recorded; 106 males and 7 females were involved. Mean age was 25.8 years. Among all the races, Malay had the highest involvement (72.3%), followed by Chinese (14.3%), Indians (8.9%), and others (5.4%). The types of collision were either a single-vehicle collision (i.e., skidded) or with another vehicle/s or object (e.g., tree, stone, or lamppost). The injuries were mainly seen on the lower face (46.9%) followed by midface (25.7%) and a combination of the midface and lower face (15%) and others (12.4%). The most frequent other associated injuries recorded were orthopedic and head injuries.
Minor oral surgery in anticoagulated patients: local measures alone are sufficient for haemostasis

Ramli R, Abdul Rahman R

Singapore Dent J, 2005 Dec;27(1):13-6.
PMID: 16438263

Minor oral surgery in warfarinized patients can be performed without stopping or altering the dose of the drug. Thirty patients underwent various types of oral surgical procedures without interruption of their anticoagulant therapy and their therapeutic international normalized ratio maintained. Local measures such as pressure, packing the sockets with oxidized regenerated cellulose, and suturing were applied. In some patients, tranexamic acid mouthwashes were prescribed to further enhance haemostasis. Four patients had minimal postoperative bleeding in the form of bloodstained saliva, which lasted for 24 hours. This study highlights the importance of local measures in controlling postoperative bleeding in warfarinized patients undergoing minor oral surgical procedures.
Indigenous use and trade of dugong (Dugong dugon) in Sabah, Malaysia

Rajamani L, Cabanban AS, Abdul Rahman R

Ambio, 2006 Aug;35(5):266-8.
PMID: 16989512
Fulltext Spatial distribution of Plasmodium knowlesi cases and their vectors in Johor, Malaysia: in light of human malaria elimination

Pramasivan S, Ngui R, Jeyaprakasam NK, Liew JWK, Low VL, Mohamed Hassan N, et al.

Malar J, 2021 Oct 29;20(1):426.
PMID: 34715864 DOI: 10.1186/s12936-021-03963-0

BACKGROUND: Plasmodium knowlesi, a simian malaria parasite infection, increases as Plasmodium falciparum and Plasmodium vivax infections decrease in Johor, Malaysia. Therefore, this study aimed to identify the distribution of vectors involved in knowlesi malaria transmission in Johor. This finding is vital in estimating hotspot areas for targeted control strategies.
METHODS: Anopheles mosquitoes were collected from the location where P. knowlesi cases were reported. Cases of knowlesi malaria from 2011 to 2019 in Johor were analyzed. Internal transcribed spacers 2 (ITS2) and cytochrome c oxidase subunit I (COI) genes were used to identify the Leucosphyrus Group of Anopheles mosquitoes. In addition, spatial analysis was carried out on the knowlesi cases and vectors in Johor.
RESULTS: One hundred and eighty-nine cases of P. knowlesi were reported in Johor over 10 years. Young adults between the ages of 20-39 years comprised 65% of the cases. Most infected individuals were involved in agriculture and army-related occupations (22% and 32%, respectively). Four hundred and eighteen Leucosphyrus Group Anopheles mosquitoes were captured during the study. Anopheles introlatus was the predominant species, followed by Anopheles latens. Spatial analysis by Kriging interpolation found that hotspot regions of P. knowlesi overlapped or were close to the areas where An. introlatus and An. latens were found. A significantly high number of vectors and P. knowlesi cases were found near the road within 0-5 km.
CONCLUSIONS: This study describes the distribution of P. knowlesi cases and Anopheles species in malaria-endemic transmission areas in Johor. Geospatial analysis is a valuable tool for studying the relationship between vectors and P. knowlesi cases. This study further supports that the Leucosphyrus Group of mosquitoes might be involved in transmitting knowlesi malaria cases in Johor. These findings may provide initial evidence to prioritize diseases and vector surveillance.
Multicentre evaluations of two new rapid IgG4 tests (WB rapid and panLF rapid) for detection of lymphatic filariasis

Noordin R, Itoh M, Kimura E, Abdul Rahman R, Ravindran B, Mahmud R, et al.

Filaria journal, 2007;6:9.
PMID: 17961262

In the global effort to eliminate lymphatic filariasis (LF), rapid field-applicable tests are useful tools that will allow on-site testing to be performed in remote places and the results to be obtained rapidly. Exclusive reliance on the few existing tests may jeopardize the progress of the LF elimination program, thus the introduction of other rapid tests would be useful to address this issue. Two new rapid immunochromatographic IgG4 cassette tests have been produced, namely WB rapid and panLF rapid, for detection of bancroftian filariasis and all three species of lymphatic filaria respectively. WB rapid was developed using BmSXP recombinant antigen, while PanLF rapid was developed using BmR1 and BmSXP recombinant antigens. A total of 165 WB rapid and 276 panLF rapid tests respectively were evaluated at USM and the rest were couriered to another university in Malaysia (98 WB rapid, 129 panLF rapid) and to universities in Indonesia (56 WB rapid, 62 panLF rapid), Japan (152 of each test) and India (18 of each test) where each of the tests underwent independent evaluations in a blinded manner. The average sensitivities of WB rapid and panLF rapid were found to be 97.6% (94%-100%) and 96.5% (94%-100%) respectively; while their average specificities were both 99.6% (99%-100%). Thus this study demonstrated that both the IgG4 rapid tests were highly sensitive and specific, and would be useful additional tests to facilitate the global drive to eliminate this disease.
Fulltext Pain assessment using self-reported, nurse-reported, and observational pain assessment tools among older individuals with cognitive impairment

Ngu SS, Tan MP, Subramanian P, Abdul Rahman R, Kamaruzzaman S, Chin AV, et al.

Pain Manag Nurs, 2015 Aug;16(4):595-601.
PMID: 26088939 DOI: 10.1016/j.pmn.2014.12.002

Pain assessment in older individuals with cognitive impairment is challenging. Evidence on the performance of pain assessment tools in this population remains limited. The aim of this study was to evaluate the performance of self-reported pain, nurse-reported pain, and observational pain tools among older patients with cognitive impairment using a prospective observational design. In all, 152 older individuals admitted to the acute geriatric ward were recruited through convenience sampling. Three methods of pain assessment were compared: self-reported pain (SRP), observational pain using the Pain Assessment in Advanced Dementia (PAINAD) tool, and nurse-reported pain (NRP). Cognition and mood were assessed with the Mini-Mental State Examination (MMSE) and the 15-item Geriatric Depression Scale (GDS-15). There was moderate agreement between SRP and PAINAD (k = 0.438) and fair agreement between SRP and NRP (k = 0.263). There was statistically significant correlation between SRP and GDS-15 (r = 0.382, p r = 0.018, p = .824). These results suggest that the use of an observational pain scale would be helpful in pain assessment among older individuals when the ability to report pain is not possible. However, self-reported assessments should be attempted first for cognitively impaired patients.
Fulltext Survivability of Salmonella and shiga-toxigenic Escherichia coli (STEC) O157 in microwave heated ready-to-eat (RTE) foods

New, C.Y., Abdul Rahman, R., Son, R., Mohammed, A.S.

Food Research, 2018;2(4):378-390.
MyJurnal

The safety level of microwaved foods remains at vague as this subject was less addressed
scientifically. A study was initiated to address the matter by investigating on the
survivability of Salmonella and Shiga-toxigenic Escherichia coli (STEC) O157 in
microwave heated ready-to-eat (RTE) foods using the Most Probable Number coupled
Polymerase Chain Reaction (MPN-PCR) technique. A total of 329 samples of various
ready-to-eat (RTE) convenience meals were collected around Wilayah Persekutuan Kuala
Lumpur and Selangor regions. Salmonella was positively identified in 66 samples (20.1%,
Application of response surface methodology (RSM) for optimisation of COD, NH3-N and 2,4-DCP removal from recycled paper wastewater in a pilot-scale granular activated carbon sequencing batch biofilm reactor (GAC-SBBR)

Muhamad MH, Sheikh Abdullah SR, Mohamad AB, Abdul Rahman R, Hasan Kadhum AA

J Environ Manage, 2013 May 30;121:179-90.
PMID: 23542216 DOI: 10.1016/j.jenvman.2013.02.016

In this study, the potential of a pilot-scale granular activated carbon sequencing batch biofilm reactor (GAC-SBBR) for removing chemical oxygen demand (COD), ammoniacal nitrogen (NH3-N) and 2,4-dichlorophenol (2,4-DCP) from recycled paper wastewater was assessed. For this purpose, the response surface methodology (RSM) was employed, using a central composite face-centred design (CCFD), to optimise three of the most important operating variables, i.e., hydraulic retention time (HRT), aeration rate (AR) and influent feed concentration (IFC), in the pilot-scale GAC-SBBR process for recycled paper wastewater treatment. Quadratic models were developed for the response variables, i.e., COD, NH3-N and 2,4-DCP removal, based on the high value (>0.9) of the coefficient of determination (R(2)) obtained from the analysis of variance (ANOVA). The optimal conditions were established at 750 mg COD/L IFC, 3.2 m(3)/min AR and 1 day HRT, corresponding to predicted COD, NH3-N and 2,4-DCP removal percentages of 94.8, 100 and 80.9%, respectively.
Fulltext A rare case of Pseudomonas putida ventriculitis in intensive care unit: A case report

Mokhtar MN, Azaharuddin I, Abdullah FH, Izaham A, Abdul Rahman R

Front Med (Lausanne), 2022;9:1058121.
PMID: 36569164 DOI: 10.3389/fmed.2022.1058121

Pseudomonas putida is a rare pathogen leading to nosocomial and central nervous system infections. Despite having a low virulence and being a rare organism to cause bacteremia, it can evolve into a multidrug-resistant organism and lead to mortality and morbidity in the intensive care setting. A 64-year-old male gardener was presented with extensive acute subarachnoid hemorrhage with intraventricular extension causing hydrocephalus requiring embolization and coiling following a cerebral angiogram, which showed bilateral posterior circulation aneurysm and left anterior circulation aneurysm. External ventricular drain (EVD) was inserted given the worsening hydrocephalus. During his stay in the intensive care unit (ICU), he was becoming more septic and a full septic workup including a cerebral spinal fluid culture taken from the indwelling catheter of the EVD and was found to be positive for a ceftazidime-sensitive strain of P. putida. Following the treatment with intravenous ceftazidime for 1 week and a revision of the EVD on day 32 of admission, he continued to recover well and showed an improvement in his Glasgow Coma Scale (GCS) and septic parameters. Eventually, he was able to wean off mechanical ventilation. He was discharged from ICU care to the neurosurgical ward with supplemental oxygen on day 42 of admission. It is necessary to be aware of the possibility of nosocomial P. putida infection, especially in patients with indwelling catheters, and to consider the early initiation of appropriate antibiotic regimens once detected as well as strict precautions in hygiene during the management of these patients to avoid further development of multi-drug resistant (MDR) strains.

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