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  1. Interactions between microbiome and lungs: Paving new paths for microbiome based bio-engineered drug delivery systems in chronic respiratory diseases
    Chellappan DK, Sze Ning QL, Su Min SK, Bin SY, Chern PJ, Shi TP, et al.
    Chem Biol Interact, 2019 Sep 01;310:108732.
    PMID: 31276660 DOI: 10.1016/j.cbi.2019.108732
    BACKGROUND: The human body is a home to thousands of microbiotas. It is defined as a community of symbiotic, commensal and pathogenic microorganisms that have existed in all exposed sites of the body, which have co-evolved with diet, lifestyle, genetic factors and immune factors. Human microbiotas have been studied for years on their effects with relation to health and diseases.

    METHODS: Relevant published studies, literature and reports were searched from accessible electronic databases and related institutional databases. We used keywords, viz; microbiome, microbiota, microbiome drug delivery and respiratory disease. Selected articles were carefully read through, clustered, segregated into subtopics and reviewed.

    FINDINGS: The traditional belief of sterile lungs was challenged by the emergence of culture-independent molecular techniques and the recently introduced invasive broncho-alveolar lavage (BAL) sampling method. The constitution of a lung microbiome mainly depends on three main ecological factors, which include; firstly, the immigration of microbes into airways, secondly, the removal of microbes from airways and lastly, the regional growth conditions. In healthy conditions, the microbial communities that co-exist in our lungs can build significant pulmonary immunity and could act as a barrier against diseases, whereas, in an adverse way, microbiomes may interact with other pathogenic bacteriomes and viromes, acting as a cofactor in inflammation and host immune responses, which may lead to the progression of a disease. Thus, the use of microbiota as a target, and as a drug delivery system in the possible modification of a disease state, has started to gain massive attention in recent years. Microbiota, owing to its unique characteristics, could serve as a potential drug delivery system, that could be bioengineered to suit the interest. The engineered microbiome-derived therapeutics can be delivered through BC, bacteriophage, bacteria-derived lipid vesicles and microbe-derived extracellular vesicles. This review highlights the relationships between microbiota and different types of respiratory diseases, the importance of microbiota towards human health and diseases, including the role of novel microbiome drug delivery systems in targeting various respiratory diseases.

    Matched MeSH terms: Drug Delivery Systems/methods*
  2. Fulltext The forgotten sub-regional COVID-19 response layer. The case of the WHO Eastern Mediterranean Region
    Ali Maher O, Elamein Boshara MA, Pichierri G, Cegolon L, Panu Napodano CM, Murgia P, et al.
    J Infect Dev Ctries, 2021 04 30;15(4):478-479.
    PMID: 33956646 DOI: 10.3855/jidc.14057
    The response to the COVID-19 pandemic have been driven by epidemiology, health system characteristics and control measures in form of social/physical distancing. Guidance, information and best practices have been characterized by territorial thinking with concentration on national health system and social contexts. Information was to a large extent provided from global entities such as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and others. This bipolar response mechanism came to the detriment of regional and sub-regional levels. The development of the global pandemic was evaluated in terms of the performance of single countries without trying to reflect on possible regional or sub-regional results of similar characteristics in health system and social contexts. To have a clearer view of the issue of sub-regional similarities, we examined the WHO, Eastern Mediterranean Region. When examining the development of confirmed cases for countries in the region, we identified four different sub-groups similar in the development of the pandemic and the social distancing measure implemented. Despite the complicated situation, these groups gave space for thinking outside the box of traditional outbreaks or pandemic response. We think that this sub-regional approach could be very effective in addressing more characteristics and not geographically based analysis. Furthermore, this can be an area of additional conceptual approaches, modelling and concrete platforms for information and lessons learned exchange.
    Matched MeSH terms: Infection Control/methods*
  3. Environmental Control of Vanadium Haloperoxidases and Halocarbon Emissions in Macroalgae
    Punitha T, Phang SM, Juan JC, Beardall J
    Mar Biotechnol (NY), 2018 Jun;20(3):282-303.
    PMID: 29691674 DOI: 10.1007/s10126-018-9820-x
    Vanadium-dependent haloperoxidases (V-HPO), able to catalyze the reaction of halide ions (Cl-, Br-, I-) with hydrogen peroxide, have a great influence on the production of halocarbons, which in turn are involved in atmospheric ozone destruction and global warming. The production of these haloperoxidases in macroalgae is influenced by changes in the surrounding environment. The first reported vanadium bromoperoxidase was discovered 40 years ago in the brown alga Ascophyllum nodosum. Since that discovery, more studies have been conducted on the structure and mechanism of the enzyme, mainly focused on three types of V-HPO, the chloro- and bromoperoxidases and, more recently, the iodoperoxidase. Since aspects of environmental regulation of haloperoxidases are less well known, the present paper will focus on reviewing the factors which influence the production of these enzymes in macroalgae, particularly their interactions with reactive oxygen species (ROS).
    Matched MeSH terms: Biotechnology/methods
  4. Recent advances in tau-directed immunotherapy against Alzheimer's disease: an overview of pre-clinical and clinical development
    Ng PY, Chang IS, Koh RY, Chye SM
    Metab Brain Dis, 2020 10;35(7):1049-1066.
    PMID: 32632666 DOI: 10.1007/s11011-020-00591-6
    Alzheimer's disease (AD) has been a worldwide concern for many years now. This is due to the fact that AD is an irreversible and progressive neurodegenerative disease that affects quality of life. Failure of some Phase II/III clinical trials in AD targeting accumulation of β-amyloid in the brain has led to an increase in interest in studying alternative treatments against tubulin-associated unit (Tau) pathology. These alternative treatments include active and passive immunisation. Based on numerous studies, Tau is reported as a potential immunotherapeutic target for tauopathy-related diseases including AD. Accumulation and aggregation of hyperphosphorylated Tau as neuropil threads and neurofibrillary tangles (NFT) are pathological hallmarks of AD. Both active and passive immunisation targeting Tau protein have shown the capabilities to decrease or prevent Tau pathology and improve either motor or cognitive impairment in various animal models. In this review, we summarise recent advances in active and passive immunisation targeting pathological Tau protein, and will discuss with data obtained from both animal and human trials. Together, we give a brief overview about problems being encountered in these immunotherapies.
    Matched MeSH terms: Immunotherapy/methods*
  5. A single-gene approach for the subspecies classification of Mycobacteroides abscessus
    Ng HF, Ngeow YF
    Pathog Dis, 2020 11 11;78(8).
    PMID: 32945880 DOI: 10.1093/femspd/ftaa055
    The subspecies classification of Mycobacteroides abscessus complex into M. abscessus, M. massiliense and M. bolletii requires the amplification and sequencing of multiple genes. The objective of this study was to evaluate the possibility of subspecies classification using a single PCR target. An in silico study was performed to classify 1613 strains deposited in a public database using 9 genes (partial gene sequences of hsp65, rpoB, sodA, argH, cya, glpK, gnd, and murC, and the full gene sequence of MAB_3542c). We found the housekeeping gene gnd to be able to classify the M. abscessus subspecies with high accuracy (99.94%). A single-gene PCR approach based on gnd would be a suitable replacement for the more expensive, labor-intensive and time-consuming multi-gene PCR analysis currently in use for the subspecies identification of M. abscessus.
    Matched MeSH terms: Bacterial Typing Techniques/methods*
  6. Fulltext Monitoring of three-phase variations in the mortality of COVID-19 pandemic using control charts: where does Pakistan stand?
    Mahmood Y, Ishtiaq S, Khoo MBC, Teh SY, Khan H
    Int J Qual Health Care, 2021 Apr 16;33(2).
    PMID: 33822932 DOI: 10.1093/intqhc/mzab062
    BACKGROUND: At the end of December 2019, the world in general and Wuhan, the industrial hub of China, in particular, experienced the COVID-19 pandemic. Massive increment of cases and deaths occurred in China and 209 countries in Europe, America, Australia, Asia and Pakistan. Pakistan was first hit by COVID-19 when a case was reported in Karachi on 26 February 2020. Several methods were presented to model the death rate due to the COVID-19 pandemic and to forecast the pinnacle of reported deaths. Still, these methods were not used in identifying the first day when Pakistan enters or exits the early exponential growth phase.

    OBJECTIVE: The present study intends to monitor variations in deaths and identify the growth phases such as pre-growth, growth, and post-growth phases in Pakistan due to the COVID-19 pandemic.

    METHODS: New approaches are needed that display the death patterns and signal an alarming situation so that corrective actions can be taken before the condition worsens. To meet this purpose, secondary data on daily reported deaths due to the COVID-19 pandemic have been considered, and the $c$ and exponentially weighted moving average (EWMA) control charts are used To meet this purpose, secondary data on daily reported deaths in Pakistan due to the COVID-19 pandemic have been considered. The $ c$ and exponentially weighted moving average (EWMA) control charts have been used for monitoring variations.

    RESULTS: The chart shows that Pakistan switches from the pre-growth to the growth phase on 31 March 2020. The EWMA chart demonstrates that Pakistan remains in the growth phase from 31 March 2020 to 17 August 2020, with some indications signaling a decrease in deaths. It is found that Pakistan moved to a post-growth phase for a brief period from 27 July 2020 to 28 July 2020. Pakistan switches to re-growth phase with an alarm on 31/7/2020, right after the short-term post-growth phase. The number of deaths starts decreasing in August in that Pakistan may approach the post-growth phase shortly.

    CONCLUSION: This amalgamation of control charts illustrates a systematic implementation of the charts for government leaders and forefront medical teams to facilitate the rapid detection of daily reported deaths due to COVID-19. Besides government and public health officials, it is also the public's responsibility to follow the enforced standard operating procedures as a temporary remedy of this pandemic in ensuring public safety while awaiting a suitable vaccine to be discovered.

    Matched MeSH terms: Population Surveillance/methods*
  7. Whistle description of Irrawaddy dolphins (Orcaella brevirostris) in Bay of Brunei, Sarawak, Malaysia
    Muhamad HM, Xu X, Zhang X, Jaaman SA, Muda AM
    J Acoust Soc Am, 2018 05;143(5):2708.
    PMID: 29857727 DOI: 10.1121/1.5036926
    Studies of Irrawaddy dolphins' acoustics assist in understanding the behaviour of the species and thereby conservation of this species. Whistle signals emitted by Irrawaddy dolphin within the Bay of Brunei in Malaysian waters were characterized. A total of 199 whistles were analysed from seven sightings between January and April 2016. Six types of whistles contours named constant, upsweep, downsweep, concave, convex, and sine were detected when the dolphins engaged in traveling, foraging, and socializing activities. The whistle durations ranged between 0.06 and 3.86 s. The minimum frequency recorded was 443 Hz [Mean = 6000 Hz, standard deviation (SD) = 2320 Hz] and the maximum frequency recorded was 16 071 Hz (Mean = 7139 Hz, SD = 2522 Hz). The mean frequency range (F.R.) for the whistles was 1148 Hz (Minimum F.R. = 0 Hz, Maximum F.R. = 4446 Hz; SD = 876 Hz). Whistles in the Bay of Brunei were compared with population recorded from the waters of Matang and Kalimantan. The comparisons showed differences in whistle duration, minimum frequency, start frequency, and number of inflection point. Variation in whistle occurrence and frequency may be associated with surface behaviour, ambient noise, and recording limitation. This will be an important element when planning a monitoring program.
    Matched MeSH terms: Sound Spectrography/methods
  8. Whistles emitted by Indo-Pacific humpback dolphins (Sousa chinensis) in Zhanjiang waters, China
    Dong L, Caruso F, Lin M, Liu M, Gong Z, Dong J, et al.
    J Acoust Soc Am, 2019 06;145(6):3289.
    PMID: 31255103 DOI: 10.1121/1.5110304
    Whistles emitted by Indo-Pacific humpback dolphins in Zhanjiang waters, China, were collected by using autonomous acoustic recorders. A total of 529 whistles with clear contours and signal-to-noise ratio higher than 10 dB were extracted for analysis. The fundamental frequencies and durations of analyzed whistles were in ranges of 1785-21 675 Hz and 30-1973 ms, respectively. Six tonal types were identified: constant, downsweep, upsweep, concave, convex, and sine whistles. Constant type was the most dominant tonal type, accounting for 32.51% of all whistles, followed by sine type, accounting for 19.66% of all whistles. This paper examined 17 whistle parameters, which showed significant differences among the six tonal types. Whistles without inflections, gaps, and stairs accounted for 62.6%, 80.6%, and 68.6% of all whistles, respectively. Significant intraspecific differences in all duration and frequency parameters of dolphin whistles were found between this study and the study in Malaysia. Except for start frequency, maximum frequency and the number of harmonics, all whistle parameters showed significant differences between this study and the study conducted in Sanniang Bay, China. The intraspecific differences in vocalizations for this species may be related to macro-geographic and/or environmental variations among waters, suggesting a potential geographic isolation among populations of Indo-Pacific humpback dolphins.
    Matched MeSH terms: Sound Spectrography/methods
  9. Fulltext COVID-19: Is herd immunity the only option for fragile Yemen?
    Noushad M, Al-Saqqaf IS
    Int J Infect Dis, 2021 May;106:79-82.
    PMID: 33737135 DOI: 10.1016/j.ijid.2021.03.030
    The first case of COVID-19 in Yemen was confirmed on 10 April 2020. Having faced with a six-year long conflict that has destroyed half of its healthcare facilities and displaced millions, predictions of infections and mortality in Yemen suggested a looming healthcare catastrophe. Difficulty in implementing coordinated lockdowns and preventive measures due to the daily labor working nature of the majority of the population, provided the perfect breeding ground for the SARS-CoV-2 virus. However, official figures of infections and mortality are very low and there have not been confirmed reports of excess mortality. This could indicate that Yemen is silently marching towards forced herd immunity. Seroprevalence studies will provide useful insight into the COVID-19 transmission trajectory in Yemen, which can serve as a guide in planning vaccine distribution strategies and allocating the limited funds wisely.
    Matched MeSH terms: Communicable Disease Control/methods
  10. Fulltext Initial testing of a pixelated silicon detector prototype in proton therapy
    Wroe AJ, McAuley G, Teran AV, Wong J, Petasecca M, Lerch M, et al.
    J Appl Clin Med Phys, 2017 Sep;18(5):315-324.
    PMID: 28719019 DOI: 10.1002/acm2.12120
    As technology continues to develop, external beam radiation therapy is being employed, with increased conformity, to treat smaller targets. As this occurs, the dosimetry methods and tools employed to quantify these fields for treatment also have to evolve to provide increased spatial resolution. The team at the University of Wollongong has developed a pixelated silicon detector prototype known as the dose magnifying glass (DMG) for real-time small-field metrology. This device has been tested in photon fields and IMRT. The purpose of this work was to conduct the initial performance tests with proton radiation, using beam energies and modulations typically associated with proton radiosurgery. Depth dose and lateral beam profiles were measured and compared with those collected using a PTW parallel-plate ionization chamber, a PTW proton-specific dosimetry diode, EBT3 Gafchromic film, and Monte Carlo simulations. Measurements of the depth dose profile yielded good agreement when compared with Monte Carlo, diode and ionization chamber. Bragg peak location was measured accurately by the DMG by scanning along the depth dose profile, and the relative response of the DMG at the center of modulation was within 2.5% of that for the PTW dosimetry diode for all energy and modulation combinations tested. Real-time beam profile measurements of a 5 mm 127 MeV proton beam also yielded FWHM and FW90 within ±1 channel (0.1 mm) of the Monte Carlo and EBT3 film data across all depths tested. The DMG tested here proved to be a useful device at measuring depth dose profiles in proton therapy with a stable response across the entire proton spread-out Bragg peak. In addition, the linear array of small sensitive volumes allowed for accurate point and high spatial resolution one-dimensional profile measurements of small radiation fields in real time to be completed with minimal impact from partial volume averaging.
    Matched MeSH terms: Radiosurgery/methods
  11. Metabolomic-guided discovery of Alzheimer's disease biomarkers from body fluid
    Enche Ady CNA, Lim SM, Teh LK, Salleh MZ, Chin AV, Tan MP, et al.
    J Neurosci Res, 2017 Oct;95(10):2005-2024.
    PMID: 28301062 DOI: 10.1002/jnr.24048
    The rapid increase in the older population has made age-related diseases like Alzheimer's disease (AD) a global concern. Given that there is still no cure for this neurodegenerative disease, the drastic growth in the number of susceptible individuals represents a major emerging threat to public health. The poor understanding of the mechanisms underlying AD is deemed the greatest stumbling block against progress in definitive diagnosis and management of this disease. There is a dire need for biomarkers that can facilitate early diagnosis, classification, prognosis, and treatment response. Efforts have been directed toward discovery of reliable and distinctive AD biomarkers but with very little success. With the recent emergence of high-throughput technology that is able to collect and catalogue vast datasets of small metabolites, metabolomics offers hope for a better understanding of AD and subsequent identification of biomarkers. This review article highlights the potential of using multiple metabolomics platforms as useful means in uncovering AD biomarkers from body fluids. © 2017 Wiley Periodicals, Inc.
    Matched MeSH terms: Metabolomics/methods*
  12. Morphology and magnetic characterisation of aluminium substituted yttrium-iron garnet nanoparticles prepared using sol gel technique
    Yahya N, Al Habashi RM, Koziol K, Borkowski RD, Akhtar MN, Kashif M, et al.
    J Nanosci Nanotechnol, 2011 Mar;11(3):2652-6.
    PMID: 21449447
    Aluminum substituted yttrium iron garnet nano particles with compositional variation of Y(3.0-x) A1(x)Fe5O12, where x = 0.0, 0.5, 1.0, 1.5, 2.0, 2.5 and 3.0 were prepared using sol gel technique. The X-ray diffraction results showed that the best garnet phase appeared when the sintering temperature was 800 degrees C. Nano-crystalline particles with high purity and sizes ranging from 20 to 100 nm were obtained. It was found that the aluminum substitution had resulted in a sharp fall of the d-spacing when x = 2, which we speculated is due to the preference of the aluminum atoms to the smaller tetrahedron and octahedron sites instead of the much larger dodecahedron site. High resolution transmission electron microscope (HRTEM) and electron diffraction (ED) patterns showed single crystal nanoparticles were obtained from this method. The magnetic measurement gave moderate values of initial permeability; the highest value of 5.3 was shown by sample Y3Fe5O12 at more than 100 MHz which was attributed to the morphology of the microstructure which appeared to be homogeneous. This had resulted in an easy movement of domain walls. The substitution of aluminum for yttrium is speculated to cause a cubic to rhombodedral structural change and had weakened the super-exchange interactions thus a fall of real permeability was observed. This might have created a strain in the sub-lattices and had subsequently caused a shift of resonance frequencies to more than 1.8 GHz when x > 0.5.
    Matched MeSH terms: Crystallization/methods
  13. Use of fungi to improve bioconversion of activated sludge
    Mannan S, Fakhru'l-Razi A, Alam MZ
    Water Res, 2005 Aug;39(13):2935-43.
    PMID: 16000208
    The present study was designed to evaluate the potential of microbial adaptation and its affinity to biodegradation as well as bioconversion of soluble/insoluble (organic) substances of domestic wastewater treatment plant (DWTP) sludge (activated domestic sludge) under natural/non-sterilized conditions. The two filamentous fungi, Penicillium corylophilum (WWZP1003) and Aspergillus niger (SCahmA103) were used to achieve the objectives. It was observed that P. corylophilum (WWZP1003) was the better strain compared to A. niger (SCahmA103) for the bioconversion of domestic activated sludge through adaptation. The visual observation in plate culture showed that about 95-98% of cultured microbes (P. corylophilum and A. niger) dominated in treated sludge after 2 days of treatment. In this study, it was also found that the P. corylophilum was capable of removing 94.40% of COD and 98.95% of turbidity of filtrate with minimum dose of inoculum of 10% v/v in DWTP sludge (1% w/w). The pH level was lower (acidic condition) in the fungal treatment and maximum reduction of COD and turbidity was observed (at lower pH). The results for specific resistance to filtration (SRF) showed that the fungi played a great role in enhancing the dewaterability and filterability. In particular, the strain Penicillium had a more significant capability (than A. niger) of reducing 93.20% of SRF compared to the uninoculated sample. Effective results were observed by using fungal inoculum after 2 days of treatment. The developed LSB process is a new biotechnological approach for sludge management strategy.
    Matched MeSH terms: Waste Disposal, Fluid/methods*
  14. Enhanced settleability and dewaterability of fungal treated domestic wastewater sludge by liquid state bioconversion process
    Alam MZ, Fakhru'l-Razi A
    Water Res, 2003 Mar;37(5):1118-24.
    PMID: 12553987
    A study was conducted to evaluate the settleability and dewaterability of fungal treated and untreated sludge using liquid state bioconversion process. The fungal mixed culture of Aspergillus niger and Penicillium corylophilum was used for fungal pretreatment of wastewater sludge. The fungal strains immobilized/entrapped on sludge particles with the formation of pellets and enhanced the separation process. The results presented in this study showed that the sludge particles (pellets) size of 2-5mm of diameter were formed with the microbial treatment of sludge after 2 days of fermentation that contained maximum 33.7% of total particles with 3-3.5mm of diameter. The settling rate (measured as total suspended solids (TSS) concentration, 130 mg/l) was faster in treated sludge than untreated sludge (TSS concentration, 440 mg/l) after 1 min of settling time. In 1 min of settling operation, 86.45% of TSS was settled in treated sludge while 4.35% of TSS settled in raw sludge. Lower turbidity was observed in treated sludge as compared to untreated sludge. The results to specific resistance to filtration (SRF) revealed that the fungal inoculum had significant potentiality to reduce SRF by 99.8% and 98.7% for 1% w/w and 4% w/w of TSS sludge, respectively. The optimum fermentation period recorded was 3 days for 1% w/w sludge and 6 days for 4% w/w sludge, respectively, for dewaterability test.
    Matched MeSH terms: Waste Disposal, Fluid/methods*
  15. Mouse embryo co-culture with autologous cumulus cells and fetal development post-embryo transfer
    Omar Farouk FN, Stott D, Vlad M
    Anim Sci J, 2011 Jun;82(3):420-7.
    PMID: 21615835 DOI: 10.1111/j.1740-0929.2010.00869.x
    This study was conducted to examine the potential for implantation and sustainable fetal development of mouse embryos cultured from the pronuclear to blastocyst stage. Pronuclear embryos from ICR mice (Harlan Sprague-Dawley) were cultured in Sydney IVF sequential media (Cook) to the blastocyst stage in medium only or co-cultured with autologous cumulus cells. We also experimented with co-culture in 100 µL drops. Drop co-culture produced blastocyst formation rates with a mean of 47.0%, which was significantly higher (P < 0.05) compared to embryos cultured in identical culture conditions except without cumulus cells at 27.3%. Blastocysts obtained in vitro in Cook medium only and co-cultured in Cook medium with cumulus cells were transferred to pseudopregnant females of ICR strain. The day of blastocyst transfer into surrogate females was designated as post-transfer of blastocyst day 1 (PT 1). The implantation and fetal development was compared to embryo transfer of in vivo derived blastocysts, which served as controls. There were no statistical differences for implantation and fetal development rates for blastocysts cultured in vitro in either Cook medium only or co-culture in Cook medium with cumulus cells compared to in vivo-derived blastocysts. The advantage of the co-culture system is in generating more blastocysts available for transfer.
    Matched MeSH terms: Embryo Transfer/methods*
  16. Hybrid Organizations in Health Systems: The Corporatization of Malaysia's National Heart Institute
    Virk A, Croke K, Mohd Yusoff M, Mokhtaruddin K, Abdullah Z, Nadziha Mohd Hanafiah A, et al.
    Health Syst Reform, 2020 12 01;6(1):e1833639.
    PMID: 33314988 DOI: 10.1080/23288604.2020.1833639
    Health system reforms across high- and middle-income countries often involve changes to public hospital governance. Corporatization is one such reform, in which public sector hospitals are granted greater functional independence while remaining publicly owned. In theory, this can improve public hospital efficiency, while retaining a public service ethos. However, the extent to which efficiency gains are realized and public purpose is maintained depends on policy choices about governance and payment systems. We present a case study of Malaysia's National Heart Institute (IJN), which was created in 1992 by corporatization of one department in a large public hospital. The aim of the paper is to examine whether IJN has achieved the goals for which it was created, and if so, whether it provides a potential model for further reforms in Malaysia and other similar health systems. Using a combination of document analysis and key informant interviews, we examine key governance, health financing and payment, and equity issues. For governance, we highlight the choice to have IJN owned by and answerable to a Ministry of Finance (MOF) holding company and MOF-appointed board, rather than the Ministry of Health (MOH). On financing and payment, we analyze the implications of IJN's combined role as fee-for-service provider to MOH as well as provider of care to private patients. For equity, we analyze the targeting of IJN care across publicly-referred and private patients. These issues demonstrate unresolved tensions between IJN's objectives and public service goals. As an institutional innovation that has endured for 28 years and grown dramatically in size and revenue, IJN's trajectory offers critical insights on the relevance of the hybrid public-private models for hospitals in Malaysia as well as in other middle-income countries. While IJN appears to have achieved its goal of establishing itself as a commercially viable, publicly owned center of clinical excellence in Malaysia, the value for money and equity of the services it provides to the Ministry of Health remain unclear. IJN is accountable to a small Ministry of Finance holding company, which means that detailed information required to evaluate these critical questions is not published. The case of IJN highlights that corporatization cannot achieve its stated goals of efficiency, innovation, and equity in isolation; rather it must be supported by broader reforms, including of health financing, payment, governance, and transparency, in order to ensure that autonomous hospitals improve quality and provide efficient care in an equitable way.
    Matched MeSH terms: Government Programs/methods
  17. Fulltext Sex Chromosome Turnover in Bent-Toed Geckos (Cyrtodactylus)
    Keating SE, Blumer M, Grismer LL, Lin A, Nielsen SV, Thura MK, et al.
    Genes (Basel), 2021 01 19;12(1).
    PMID: 33477871 DOI: 10.3390/genes12010116
    Lizards and snakes (squamates) are known for their varied sex determining systems, and gecko lizards are especially diverse, having evolved sex chromosomes independently multiple times. While sex chromosomes frequently turnover among gecko genera, intrageneric turnovers are known only from Gekko and Hemidactylus. Here, we used RADseq to identify sex-specific markers in two species of Burmese bent-toed geckos. We uncovered XX/XY sex chromosomes in Cyrtodactylus chaunghanakwaensis and ZZ/ZW sex chromosomes in Cyrtodactylus pharbaungensis. This is the third instance of intrageneric turnover of sex chromosomes in geckos. Additionally, Cyrtodactylus are closely related to another genus with intrageneric turnover, Hemidactylus. Together, these data suggest that sex chromosome turnover may be common in this clade, setting them apart as exceptionally diverse in a group already known for diverse sex determination systems.
    Matched MeSH terms: Sequence Analysis, DNA/methods
  18. Uniportal video assisted thoracoscopic surgery right upper sleeve lobectomy- The first experience in Hospital Kuala Lumpur
    Diong NC, Dharmaraj B, Sathiamurthy N
    Med J Malaysia, 2020 07;75(4):445-446.
    PMID: 32724014
    Sleeve lobectomy is a lung sparing surgery and is the preferred alternative to pneumonectomy for centrally located tumours, which has less postoperative morbidity and mortality. Surgical approach for the technically demanding sleeve lobectomy evolved over the decades from conventional thoracotomy to video assisted thoracoscopic surgery (VATS) to uniportal VATS (uVATS) which allows for quicker recovery and less pain postoperatively. We report our very first successful uVATS sleeve right upper lobectomy performed in the Hospital Kuala Lumpur, Malaysia.
    Matched MeSH terms: Thoracic Surgery, Video-Assisted/methods*
  19. Priorities for primary health care policy implementation: recommendations from the combined experience of six countries in the Asia-Pacific
    Kassai R, van Weel C, Flegg K, Tong SF, Han TM, Noknoy S, et al.
    Aust J Prim Health, 2020 Oct;26(5):351-357.
    PMID: 32746962 DOI: 10.1071/PY19194
    Primary health care is essential for equitable, cost-effective and sustainable health care. It is the cornerstone to achieving universal health coverage against a backdrop of rising health expenditure and aging populations. Implementing strong primary health care requires grassroots understanding of health system performance. Comparing successes and barriers between countries may help identify mutual challenges and possible solutions. This paper compares and analyses primary health care policy in Australia, Malaysia, Mongolia, Myanmar, Thailand and Vietnam. Data were collected at the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Asia-Pacific regional conference in November 2017 using a predetermined framework. The six countries varied in maturity of their primary health care systems, including the extent to which family doctors contribute to care delivery. Challenges included an insufficient trained and competent workforce, particularly in rural and remote communities, and deficits in coordination within primary health care, as well as between primary and secondary care. Asia-Pacific regional policy needs to: (1) focus on better collaboration between public and private sectors; (2) take a structured approach to information sharing by bridging gaps in technology, health literacy and interprofessional working; (3) build systems that can evaluate and improve quality of care; and (4) promote community-based, high-quality training programs.
    Matched MeSH terms: Primary Health Care/methods*
  20. Blood exchange transfusion in viral hepatitis in a small infant: a case report
    Pham TS, Reda A, Ngan Nguyen TT, Ng SJ, Huan VT, Viet DC, et al.
    Transfus Apher Sci, 2020 Dec;59(6):102907.
    PMID: 32883595 DOI: 10.1016/j.transci.2020.102907
    We report a case of blood exchange transfusion to treat acute liver failure following hepatitis B infection at the Infectious Disease Department of Children's Hospital No.2 in Ho Chi Minh City, Vietnam. A 3.5-month old baby boy was admitted to the hospital with a presentation of progressively worsening jaundice for the past one month. The patient was diagnosed with hepatitis B infection with a positive HBV DNA quantitative assay. Plasma exchange was indicated in view of progressive liver failure and gradually increasing hepatic coma. However, it was impossible to perform plasmapheresis in this case because the patient was small (in terms of age and weight) and there was no suitable plasma exchange filter. Accordingly, the patient was treated with 3 times of blood exchange transfusion in combination with an antiviral drug, lamivudine. After each blood exchange transfusion, the biochemical values (bilirubin, liver enzymes, and coagulation profile) gradually improved and he was discharged after 1 month of treatment. Blood exchange transfusion is an effective procedure for managing acute liver failure, where plasma exchange is not possible while waiting for the recovery of liver functions or liver transplantation.
    Matched MeSH terms: Exchange Transfusion, Whole Blood/methods*
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