METHODS: This is a cross-sectional study performed at 28 hospitals under the Ministry of Health, Malaysia, involved in the National Surveillance of Multidrug-Resistant Organism, which surveys 6 MDROs (Acinetobacter baumanii, extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae, carbapenem-resistant Entrobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE)).
RESULTS: In terms of mortality, 9.6% (n = 951) of the patients died overall, whereas 90.4% (n = 8931) of the patients survived. Healthcare-acquired infection (HCAI) poses a high risk of mortality, with an adjusted odds ratio (aOR) of 2.91 (95% CI: 2.15-3.94). The presence of sterile specimens was significantly associated with increased mortality risk (aOR: 2.33, 95% CI: 2.02-2.68). Gram-negative bacteria had a greater mortality risk (aOR 1.63 95% CI: 1.37-1.93), whereas Acinetobacter baumanii had the highest prevalence of 30.7% (3033) among the 6 MDRO organisms isolated. Patients in medical-based departments had a greater mortality risk (aOR: 1.47, 95% CI: 1.22-1.75).
CONCLUSION: HCAIs, Gram-negative bacteria, sterile specimens, medical-based departments and state hospitals have been shown to be associated with increased mortality risk in patients with MDRO infections. Improved surveillance and reporting mechanisms are necessary to better understand the burden of MDRO infections and guide research funding allocation.
STUDY DESIGN: The research was designed as a crossover, randomized control trial.
MATERIALS AND METHODS: Subjects comprised patients receiving fixed appliances at a teaching institution and indicated for VFRs. Post-treatment stone models were scanned with a structured-light scanner. A fused deposition modelling machine was used to construct acrylonitrile-butadiene-styrene (ABS)-based replicas from the 3D scanned images. VFRs were fabricated on the original stone and printed models. Analysis comprised independent t-tests and repeated measures analysis of variance.
RANDOMIZATION: Subjects were allocated to two groups using Latin squares methods and simple randomization. A week after debond, subjects received either VFR-CV first (group A) or VFR-3D first (group B) for 3 months, then the interventions were crossed over for another 3 months.
BLINDING: In this single-blinded study, subjects were assigned a blinding code for data entry; data were analysed by a third party.
OUTCOME MEASURES: The primary outcome measured was oral health-related quality of life (OHRQoL) based on Oral Health Impact Profile-14 (OHIP-14). Secondary outcome was post-treatment stability measured using Little's Irregularity Index (LII).
RESULTS: A total of 30 subjects (15 in each group) were recruited but 3 dropped out. Analysis included 13 subjects from group A and 14 subjects from group B. Group A showed an increase in LII (P < 0.05) after wearing VFR-CV and VFR-3D, whereas group B had no significant increase in LII after wearing both VFRs. Both groups reported significant improvement in OHRQoL after the first intervention but no significant differences after the second intervention. LII changes and OHIP-14 scores at T2 and T3 between groups, and overall between the retainers were not significantly different. No harm was reported during the study.
CONCLUSION: VFRs made on ABS-based 3D printed models showed no differences in terms of patients' OHRQoL and stability compared with conventionally made retainers.
REGISTRATION: NCT02866617 (ClinicalTrials.gov).
Objective: To develop and validate an high-performance liquid chromatography (HPLC)-diode array detector (DAD) method combined with solid-phase extraction that involves precolumn derivatization with O-phthaladehyde for simultaneous analysis of free amino acids in OS leaves extracts.
Materials and Methods: OS leaves were extracted with water (OS-W), ethanol (OS-E), methanol (OS-M), 50% ethanol (OS-EW), and 50% methanol (OS-MW). The extracts were treated by C18 cartridge before derivatization, resulting in great improvement of separation by Zorbox Eclipse XDB-C18 column.
Results: The HPLC-DAD method was successfully developed and validated for analyzing the contents of free amino acids in OS extracts. The results showed that l-aspartic acid with 0.93 ± 0.01 nmol/mg was the major free amino acid in OS-W extract. However, in OS-E, OS-M, OS-EW, and OS-MW, l-glutamic acid with 3.53 ± 0.16, 2.17 ± 0.10, 4.01 ± 0.12, and 2.49 ± 0.12 nmol/mg, respectively, was the major free amino acid. Subsequently, l-serine, which was detected in OS-W, OS-E, and OS-M, was the minor free amino acid with 0.33 ± 0.02, 0.12 ± 0.01, and 0.06 ± 0.01 nmol/mg, respectively. However, l-threonine with 0.26 ± 0.02 and 0.19 ± 0.08 nmol/mL in OS-EW and OS-MW, respectively, had the lowest concentration compared with other amino acid components.
Conclusion: All validation parameters of the developed method indicate that the method is reliable and efficient to simultaneously determine the free amino acids content for routine analysis of OS extracts.
SUMMARY: The HPLC-DAD method combined with solid phase extraction was successfully developed and validated for simultaneous determination and quantification of 17 free amino acids in Orthosiphon stamineus (OS) Benth extractsOS extracts were found to be rich in free amino acid contentL-aspartic acid was the major free amino acid in OS water extract while, in OS ethanol, methanol, 50% ethanol and 50% methanol extracts, L-glutamic acid was the major free amino acidL-serine was the minor free amino acid in OS water, ethanol and methanol extracts while, in OS 50% ethanol and 50% methanol extracts, L-threonine had the lowest concentration compared to other amino acid components. Abbreviations used: HPLC-DAD: High-Performance Liquid Chromatography with Diode-Array Detection, OS: Orthosiphon stamineus, OS-W: Orthosiphon stamineus water extract, OS-E: Orthosiphon stamineus ethanol extract, OS-M: Orthosiphon stamineus methanol extract, OS-EW: Orthosiphon stamineus 50% ethanol extract, OS-MW: Orthosiphon stamineus 50% methanol extract, OPA: O-phthaladehyde, SPE: Solid Phase Extraction, UV: Ultraviolet, LOD: Limit of Detection, LOQ: Limit of Quantification, RSD: Relative Standard Deviation.