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Pyogenic meningitis in hospitalized children in Kelantan, Malaysia

Choo KE, Ariffin WA, Ahmad T, Lim WL, Gururaj AK

Ann Trop Paediatr, 1990 Mar;10(1):89-98.
PMID: 1694651

A 2.5-year retrospective study of pyogenic meningitis in hospitalized children in Kelantan was carried out with regard to aetiology, clinical features, investigation, treatment and outcome. There were 58 children with 43 cases (74.1%) occurring below the age of 1 year. Frequent presenting symptoms included fever (98.3%), fits (77.6%), anorexia (39.7%), vomiting (34.5%) and drowsiness (12.1%). On admission, 37 (63.7%) had neck stiffness, 10 (17.2%) had Kernig's sign and 32 (55.2%) had coma. CSF cultures were positive for Haemophilus influenzae in 29 (50%), Streptococcus pneumonia in 13 (22.4%) and Neisseria meningitidis in 3 (5.2%). The antibiotic sensitivity profiles showed that the three main organisms were 100% sensitive to Chloramphenicol, Streptococcus pneumoniae was 100% sensitive to penicillin, Neisseria meningitidis was 100% sensitive to penicillin and ampicillin, and Haemophilus influenzae was 90% sensitive to penicillin and ampicillin. The total hospital mortality was 18.9%. All but two of the eleven deaths occurred in children younger than 1 year. Nineteen of the 35 (54.3%) survivors attended for at least one follow-up after discharge from hospital. Of these 19 children, 47.4% had neurological sequelae.
Fulltext Intravenous urogram in acute renal failure

Md Ghazali AR, Suleiman AB, Md Alif AK, Thillakanu A

Med J Malaysia, 1981 Jun;36(2):104-7.
PMID: 7343817

Thirty-four case notes of patients in acute renal failure on whom intravenous urograms (IVU) were performed, were reviewed. All patients received high doses of Conray 420 or Urotrast. Delayed films up to 48 hours were routinely done in patients suspected of having obstruction. There were no side effects of the intravenous urogram examination. IVU with high dose contrast material and nephrogram are helpful in differentiating the cause of the acute renal failure, and in excluding outflow obstruction.
Fulltext Carcinoma of the vulva--a Malaysian experience

Sivanesaratnam V, Adlan A, Sinnathuray TA, Yusof K, Kulenthran A, Looi LM

Med J Malaysia, 1982 Jun;37(2):170-4.
PMID: 7132837

The technique of radical vulvectomy with lymphadenectomy in which primary skin. closure of the large defect is achieved is described. Experience with this operative technique at the University Hospital, Kuala Lurnpur from 1968 to 1980 is reviewed. The technique allows for wide clearance of the tumour and of regional lymphatic channels and nodes in continuity. We have been impressed by the good immediate results and at the primary skin closure achieved in all our cases.
Contamination of butyltin compounds in Malaysian marine environments

Sudaryanto A, Takahashi S, Iwata H, Tanabe S, Ismail A

Environ Pollut, 2004 Aug;130(3):347-58.
PMID: 15182968

Concentration of butyltin compounds (BTs), including tributyltin (TBT), dibutyltin (DBT) and monobutyltin (MBT) and total tin (SigmaSn) were determined in green mussel (Perna viridis), 10 species of muscle fish and sediment from coastal waters of Malaysia. BTs were detected in all these samples ranging from 3.6 to 900 ng/g wet wt., 3.6 to 210 ng/g wet wt., and 18 to 1400 ng/g dry wt. for mussels, fish and sediments, respectively. The concentrations of BTs in several locations of this study were comparable with the reported values from some developed countries and highest among Asian developing nations. Considerable concentration of BTs in several locations might have ecotoxicological consequences and may cause concern to human health. The parent compound TBT was found to be highest than those of its degradation compounds, DBT and MBT, suggesting recent input of TBT to the Malaysian marine environment. Significant positive correlation (Spearman rank correlation: r2=0.82, P<0.0001) was found between BTs and SigmaSn, implying considerable anthropogenic input of butyltin compounds to total tin contamination levels. Enormous boating activities may be a major source of BTs in this country, although aquaculture activities may not be ignored.
Fulltext Parametric evaluation of electrical discharge coatings on nickel-titanium shape memory alloy in deionized water

Mansor AF, Azmi AI, Zain MZM, Jamaluddin R

Heliyon, 2020 Aug;6(8):e04812.
PMID: 32913911 DOI: 10.1016/j.heliyon.2020.e04812

Nickel-titanium shape memory alloy (NiTi) has a unique capacity to restore its initial shape after deformation, which is highly applicable to orthopaedic implantations, especially for the minimization of invasive surgeries. The high nickel content of this alloy can lead to unfavourable effects on the human body upon dissolution; thus, a reliable barrier of coatings on the NiTi surface is required to alleviate the nickel migration and increase its biocompatibility. In this paper, analyses of a titanium oxide layer development on NiTi surface using electrical discharge coating (EDC) process is presented. The recast layer thickness, crater sizes, and surface roughness were characterized based on five parameters; polarity, discharge duration, pulse interval, peak current, and gap voltage. The results show that the discharge duration is the most significant parameter to influence all responses, followed by peak current. The surface characteristics of the EDC substrate is depending on the crater formations and is highly correlated with the discharge energy intensity. As a result, appropriate parametric conditions of the electrical discharge coating process can enhance the NiTi surface for future medical applications, without compromising the shape memory effect.
Fulltext COVID-19 exit strategy: Transitioning towards a new normal

Jamaludin S, Azmir NA, Mohamad Ayob AF, Zainal N

Ann Med Surg (Lond), 2020 Nov;59:165-170.
PMID: 33024558 DOI: 10.1016/j.amsu.2020.09.046

The COVID-19 outbreak from the SARS-CoV-2 virus has shocking us with its fast transmission and deadly complication. Due to that, the movement restriction has been enforced to contain this pandemic. Recently, there is an increasing pressure to restart and resurrect social and economic sectors, and to allow people to get back to work. This must be well planned before the movement restriction is lifted. Because of that, this paper aims to review and make recommendations on the new normal for our daily activities and works. Firstly, the social and economic sectors must be opening in phases by emphasizing safety and health than an economic recovery. In the meantime, the WHO recommendations on social distancing and personal hygiene must be adapted and become a new normal. Because of that, the government and local authorities should develop a soft landing approach based on the WHO recommendations. Next, the community must be engaged and empowered to do their parts in preventing the spread of COVID-19. From the new normal recommendations, the people can continue their daily routines, and at the same time can reduce COVID-19 transmission. However, medical possibilities are not considered while compiling these new normals and procedures. The population must adapt and embrace the new normal to control, reduce and prevent the spreading of COVID-19, as it could be with us for a long time.
Tap water contamination: Multiclass endocrine disrupting compounds in different housing types in an urban settlement

Wee SY, Aris AZ, Yusoff FM, Praveena SM

Chemosphere, 2021 Feb;264(Pt 1):128488.
PMID: 33045559 DOI: 10.1016/j.chemosphere.2020.128488

Contamination of endocrine disrupting compounds (EDCs) in tap water is an emerging global issue, and there are abundant influencing factors that have an ambivalent eﬀect on their transportation and fate. Different housing types vary in terms of water distribution system operation and design, water consumption choices, and other hydraulic factors, which potentially affect the dynamics, loadings, and partitioning of pollutants in tap water. Thus, this study analyzed 18 multiclass EDCs in tap water from different housing types (i.e., landed and high-rise) and the associated health risks. Sample analyses revealed the presence of 16 EDCs, namely hormones (5), pharmaceuticals (8), a pesticide (1), and plasticizers (2) in tap water, with the prevalent occurrence of bisphenol A up to 66.40 ng/L in high-rise housing. The presence of caffeine and sulfamethoxazole distribution in tap water was significantly different between landed and high-rise housings (t(152) = -2.298, p = 0.023 and t(109) = 2.135, p = 0.035). Moreover, the salinity and conductivity of tap water in high-rise housings were significantly higher compared to those in landed housings (t(122) = 2.411, p = 0.017 and t(94) = 2.997, p = 0.003, respectively). Furthermore, there were no potential health risks of EDCs (risk quotient
Fulltext Effects of touch-screen technology usage on the hand skills dataset

Aman NA, Chien CW, Judd J, Daud AZC

Data Brief, 2020 Dec;33:106358.
PMID: 33083507 DOI: 10.1016/j.dib.2020.106358

This data article describes the hand skills of pre-school children between five and six years old from five schools under the Ministry of Education Malaysia. These data may be used in a journal article later to show the effects of touch-screen technology usage on hand skills of pre-school children. Demographic characteristics, hand skills ability and frequency of touch-screen technology usage data that was collected from August to September 2019. These data may be used in a future systematic review, meta-analysis and meta-regression analysis to conclude the effects of touch-screen technology usage on children's hand skills. Parents, teachers and health practitioners may refer to these data to note the effects of touch-screen technology usage on hand skills of pre-school children.
Modifiable risk factors and overall cardiovascular mortality: Moderation of urbanization

Sajid MR, Muhammad N, Zakaria R, Bukhari SAC

J Public Health Res, 2020 Oct 14;9(4):1893.
PMID: 33244464 DOI: 10.4081/jphr.2020.1893

Background: Modifiable risk factors are associated with cardiovascular mortality (CVM) which is a leading form of global mortality. However, diverse nature of urbanization and its objective measurement can modify their relationship. This study aims to investigate the moderating role of urbanization in the relationship of combined exposure (CE) of modifiable risk factors and CVM. Design and Methods: This is the first comprehensive study which considers different forms of urbanization to gauge its manifold impact. Therefore, in addition to existing original quantitative form and traditional two categories of urbanization, a new form consisted of four levels of urbanization was duly introduced. This study used data of 129 countries mainly retrieved from a WHO report, Non-Communicable Diseases Country Profile 2014. Factor scores obtained through confirmatory factor analysis were used to compute the CE. Age-income adjusted regression model for CVM was tested as a baseline with three bootstrap regression models developed for the three forms of urbanization. Results: Results revealed that the CE and CVM baseline relationship was significantly moderated through the original quantitative form of urbanization. Contrarily, the two traditional categories of urbanization could not capture the moderating impact. However, the four levels of urbanization were objectively estimated the urbanization impact and subsequently indicated that the CE was more alarming in causing the CVM in levels 2 and 3 urbanized countries, mainly from low-middle-income countries. Conclusion: This study concluded that the urbanization is a strong moderator and it could be gauged effectively through four levels whereas sufficiency of two traditional categories of urbanization is questionable.
Fulltext Factors Affecting Cell Biomass and Flavonoid Production of Ficus deltoidea var. kunstleri in Cell Suspension Culture System

Haida Z, Syahida A, Ariff SM, Maziah M, Hakiman M

Sci Rep, 2019 07 02;9(1):9533.
PMID: 31267036 DOI: 10.1038/s41598-019-46042-w

A study was conducted to establish in vitro culture conditions for maximum production of biomass and flavonoid content for Ficus deltoidea var. kunstleri, locally named as Mas Cotek, known to have a wide variety of potential beneficial attributes for human health. Size of initial inoculum, cell aggregate and initial pH value have been suggested to influent content of biomass and flavonoid for cell suspension culture in several plant species. In the present study, leaf explants were cultured by cell suspension culture procedures in MSB5 basal medium supplemented with predetermined supplements of 30 g/L sucrose, 2.75 g/L gelrite, 2 mg/L picloram and 1 mg/L kinetin with continuous agitation of 120 rpm in a standard laboratory environment. Establishment of cell suspension culture was accomplished by culturing resulting callus in different initial fresh weight of cells (0.10, 0.25, 0.50, 1.0, and 2.0 g/25 mL of media) using similar basal medium. The results showed that the highest production of biomass (0.65 g/25 mL of media) was recorded from an initial inoculum size of 2.0 g/25 mL media, whereas the highest flavonoid (3.3 mg RE/g DW) was found in 0.5 g/25 mL of media. Cell suspension fractions classified according to their sizes (500-750 µm, 250-500 µm, and <250 µm). Large cell aggregate size (500-750 µm) cultured at pH 5.75 produced the highest cell biomass (0.28 g/25 mL media) and flavonoid content (3.3 mg RE/g DW). The study had established the optimum conditions for the production of total antioxidant and flavonoid content using DPPH and FRAP assays in cell suspension culture of F. deltoidea var. kunstleri.
Fulltext Streamlining Natural Products Biomanufacturing With Omics and Machine Learning Driven Microbial Engineering

Ramzi AB, Baharum SN, Bunawan H, Scrutton NS

Front Bioeng Biotechnol, 2020;8:608918.
PMID: 33409270 DOI: 10.3389/fbioe.2020.608918

Increasing demands for the supply of biopharmaceuticals have propelled the advancement of metabolic engineering and synthetic biology strategies for biomanufacturing of bioactive natural products. Using metabolically engineered microbes as the bioproduction hosts, a variety of natural products including terpenes, flavonoids, alkaloids, and cannabinoids have been synthesized through the construction and expression of known and newly found biosynthetic genes primarily from model and non-model plants. The employment of omics technology and machine learning (ML) platforms as high throughput analytical tools has been increasingly leveraged in promoting data-guided optimization of targeted biosynthetic pathways and enhancement of the microbial production capacity, thereby representing a critical debottlenecking approach in improving and streamlining natural products biomanufacturing. To this end, this mini review summarizes recent efforts that utilize omics platforms and ML tools in strain optimization and prototyping and discusses the beneficial uses of omics-enabled discovery of plant biosynthetic genes in the production of complex plant-based natural products by bioengineered microbes.
Fulltext Ruptured sinus of Valsalva aneurysm with ventricular septal defect complicated by preoperative cardiogenic shock, cardiac arrest, and multiple organ dysfunction: a rare survivor and review of contemporary literature

Furui M, Dillon J, Akhtar KMA, Bin Ja'apar AN

J Surg Case Rep, 2020 Dec;2020(12):rjaa567.
PMID: 33425326 DOI: 10.1093/jscr/rjaa567

Sinus of Valsalva aneurysm (SVA) is a relatively rare cardiac condition, in which the patient is usually asymptomatic. However, once this aneurysm ruptures, patients present with acute symptoms of heart failure. Timely surgical intervention is essential. We present the case of a 27-year-old woman, who had a ruptured SVA with a ventricular septal defect (VSD). The patient collapsed before the emergency operation and needed cardiopulmonary resuscitation. The patient required preoperative high inotoropic support and postoperative management was difficult because of multiple organ dysfunction. However, the patient recovered after using inhaled nitric oxide and veno-venous hemofiltration and tracheostomy, and was discharged with no further complications. To the best of our knowledge, no such case of a ruptured SVA with VSD, complicated by preoperative cardiac arrest and multiple organ dysfunction that culminated in a successful recovery, has been reported to date.
Palm tocotrienol-rich fraction reduced plasma homocysteine and heart oxidative stress in rats fed with a high-methionine diet

Norsidah KZ, Asmadi AY, Azizi A, Faizah O, Kamisah Y

J Physiol Biochem, 2013 Sep;69(3):441-9.
PMID: 23208529 DOI: 10.1007/s13105-012-0226-3

Oxidative stress contributes to cardiovascular diseases. We aimed to study the effects of palm tocotrienol-rich fraction (TRF) on plasma homocysteine and cardiac oxidative stress in rats fed with a high-methionine diet. Forty-two male Wistar rats were divided into six groups. The first group was the control. Groups 2-6 were fed 1% methionine diet for 10 weeks. From week 6 onward, folate (8 mg/kg diet) or palm TRF (30, 60 and 150 mg/kg diet) was added into the diet of groups 3, 4, 5 and 6. The rats were then killed. Palm TRF at 150 mg/kg and folate supplementation prevented the increase in plasma total homocysteine (4.14 ± 0.33 and 4.30 ± 0.26 vs 5.49 ± 0.25 mmol/L, p < 0.05) induced by a high-methionine diet. The increased heart thiobarbituric acid reactive substance in rats fed with high-methionine diet was also prevented by the supplementations of palm TRF (60 and 150 mg/kg) and folate. The high-methionine group had a lower glutathione peroxidase activity (49 ± 3 vs 69 ± 4 pmol/mg protein/min) than the control group. This reduction was reversed by palm TRF at 60 and 150 mg/kg diet (p < 0.05), but not by folate. Catalase and superoxide dismutase activities were unaffected by both methionine and vitamin supplementations. In conclusion, palm TRF was comparable to folate in reducing high-methionine diet-induced hyperhomocysteinemia and oxidative stress in the rats' hearts. However, palm TRF was more effective than folate in preserving the heart glutathione peroxidase enzyme activity.
Fulltext Evaluation of Adsorptive Characteristics of Cow Dung and Rice Husk Ash for Removal of Aqueous Glyphosate and Aminomethylphoshonic Acid

Garba J, Samsuri WA, Othman R, Hamdani MSA

Sci Rep, 2019 11 27;9(1):17689.
PMID: 31776374 DOI: 10.1038/s41598-019-54079-0

Glyphosate (GLY) is a major herbicide used throughout the world, and its continuous application has become an environmental issue. Adsorption is an important mechanism for removing organic contaminant in water. The present study characterized cow dung (CD) and rice husk ash (RHA), and determined the adsorption-desorption of GLY and its metabolite, aminomethylphoshonic acid (AMPA), on to them. The results revealed that both CD and RHA were alkaline and had no or low content of arsenic, cadmium, chromium and lead. The CD had lower surface area (13.104 mg2g-1) than RHA (21.500 m2g-1). The CD contained amines, phenol, ethers and carboxylic functional groups, while in addition to carboxylic and ether, RHA contains siloxane. Both CD and RHA had high affinities for GLY and AMPA. The Freundlich sorption coefficient (Kf) on AMPA were 2.915 and 2.660 for CD and RHA, respectively, while the values on GLY were 1.168 and 1.166 (mg g-1) for CD and RHA, respectively. Desorption of GLY only occurred at lower concentrations, while no desorption of AMPA was recorded, indicating their strong adsorption on CD and RHA. Considering their availabilities and affordable prices, both CD and RHA can be recommended as economical adsorbent for the removal of GLY and AMPA.
Quantification of multi-classes of endocrine-disrupting compounds in estuarine water

Ismail NAH, Wee SY, Kamarulzaman NH, Aris AZ

Environ Pollut, 2019 Jun;249:1019-1028.
PMID: 31146308 DOI: 10.1016/j.envpol.2019.03.089

Emerging pollutants known as endocrine-disrupting compounds (EDCs) are a contemporary global issue, especially in aquatic ecosystems. As aquaculture production through mariculture activities in Malaysia supports food production, the concentration and distribution of EDCs in estuarine water ecosystems may have changed. Therefore, this current study aims to prepare a suitable and reliable method for application on environmental samples. Besides, this study also presented the occurrence of EDCs pollutant in Pulau Kukup, Johor, where the biggest and most active mariculture site in Malaysia takes place. Analytical methods based on a combination of solid-phase extraction with liquid chromatography tandem mass spectrometry (Solid-phase extraction (SPE)-LC-MS/MS) have been modified and optimised to examine the level of targeted EDCs contaminant. In the current study, this method displays high extraction recovery for targeted EDCs, ranging from 92.02% to 132.32%. The highest concentration detected is diclofenac (<0.47-79.89 ng/L) followed by 17β-estradiol (E2) (<5.28-31.43 ng/L) and 17α-ethynylestradiol (EE2) (<0.30-7.67 ng/L). The highest percentage distribution for the targeted EDCs in the current study is diclofenac, followed by EE2 and dexamethasone with the percentages of 99.44%, 89.53% and 73.23%, respectively. This current study can be a baseline assessment to understand the pollution profile of EDCs and their distribution in the estuarine water of the mariculture site throughout the world, especially in Malaysia. Owing to the significant concentration of targeted EDCs detected in water samples, the need for further monitoring in the future is required.
Amblyomma cordiferum Neumann, 1899 (Acari: Ixodidae) parasitizing reticulated pythons, Malayopython reticulatus (Schneider, 1801) (Reptilia: Pythonidae) in Peninsular Malaysia

Tan LP, Choong SS, Samsuddin AS, Lee SH

Ticks Tick Borne Dis, 2019 10;10(6):101285.
PMID: 31494069 DOI: 10.1016/j.ttbdis.2019.101285

Two ticks were collected from a reticulated python (Malayopython reticulatus) caught in Tumpat District, Kelantan, Peninsular Malaysia. The ticks were first identified as Ambylomma sp. through morphological comparison with identification keys. Determination of the tick species was made through PCR and sequencing. However, BLAST analysis revealed 85-88% sequence nucleotide identity with Amblyomma nitidum and Amblyomma geoemydae. Additionally, the morphological features of the ticks collected in this study did not match either A. nitidum or A. geoemydae. Further examination of the ticks confirmed the species as Amblyomma cordiferum. This is the first record of A. cordiferum DNA sequence with morphological support of colour illustrations for adult A. cordiferum. This is also the most recent record of this host association in Peninsular Malaysia. Information from this report can serve as a reference for species identification using the described morphology or molecular sequences.
Toxic heavy metal (Pb and Cd) content in tobacco cigarette brands in Selangor state, Peninsular Malaysia

Janaydeh M, Ismail A, Zulkifli SZ, Omar H

Environ Monit Assess, 2019 Sep 16;191(10):637.
PMID: 31529162 DOI: 10.1007/s10661-019-7755-y

Cadmium (Cd) and lead (Pb) are ubiquitous metals widely distributed in the environment, resulting in toxic health effects. This project aims to evaluate Pb and Cd as toxic elements in 15 different tobacco cigarette brands produced and/or sold in Selangor state, Peninsular Malaysia. The concentrations of Pb and Cd in all tobacco brands tested in this study were determined using the air-acetylene flame atomic absorption spectrophotometer (AAS). On average, the concentrations of Pb and Cd in different tobacco brand samples ranged from 3.05 and 0.80 μg/g dw, respectively. The results indicate that assessment mean values of Pb inhaled from smoking one packet of 20 cigarettes were in the range of 1.55-3.51 μg. Furthermore, the concentration of Cd inhaled per packet of cigarettes (20 sticks) is estimated to be 0.04-0.36 μg. However, there was a significant difference in the concentrations of Pb and Cd between the different brands of tobacco cigarettes, among cigarette prices (cheap versus expensive) of tobacco brands. In conclusion, cigarette smokers in Selangor, Malaysia, are heavily exposed to Pb and Cd, and such exposure could adversely affect their health in the long term. The impact of toxic heavy metals on smokers in this state would be an area for future research.
Evaluating the quality of antenatal care and pregnancy outcomes using content and utilization assessment

Yeoh PL, Hornetz K, Shauki NIA, Dahlui M

Int J Qual Health Care, 2018 Jul 01;30(6):466-471.
PMID: 29590356 DOI: 10.1093/intqhc/mzy041

Objective: To assess the adequacy of antenatal care (ANC) and its association with pregnancy outcomes using an approach that includes adequacy of both utilization and content.

Design: Retrospective cohort study.

Setting and Participants: Women attending ANC at public-funded primary health clinics where data were extracted from individual records.

Methods: Adequacy of utilization assessment was based on the concept of Adequacy of Prenatal Care Utilization index; adequacy of content assessed the recommended routine care received by the women according to local guidelines. Association between adequacy and pregnancy outcomes was examined using binary logistic regression.

Main Outcome Measures: Pregnancy outcomes included preterm birth and low birth weight.

Results: Sixty-three percent of women showed higher than recommended ANC utilization; 52% had <80% of recommended routine care content. Although not statistically significant, the odds of preterm birth was lower among women with adequate level of utilization compared with inadequate (adjusted odds ratios (aOR) = 2.34, 95% confidence interval (CI) 0.45-12.16) and intensive levels (aOR = 3.27, 95% CI 0.73-14.60). Regarding adequacy of content, women who received inadequate level of care content were associated with higher prevalence of preterm birth (aOR = 3.69, 95% CI 1.60-8.55).

Conclusion: The study shows inadequate content is associated with higher prevalence of preterm birth and suggests that inadequate utilization increases the risk of preterm birth. It demonstrates the relevance of using both utilization and content assessment in evaluating quality of ANC. Further studies are encouraged to review the methods used.
Fulltext Developing and validating a checklist for accreditation in leadership and management of hospitals in Iran

Jafari H, Raeisi AR, Yarmohammadian MH, Heidari M, Niknam N

J Educ Health Promot, 2018;7:136.
PMID: 30505864 DOI: 10.4103/jehp.jehp_54_18

INTRODUCTION: In the Iranian Accreditation System, leadership and management standards have been almost ignored and not paid enough and necessary attention to the structural components and the infrastructures standards in management and leadership sections. Governing body, medical staff, chief executive officer (CEO), and nursing management standards are inadequate and lack accountability. These standards could lead to reform and finally provide the context for accomplishment of an appropriate accreditation program.
MATERIALS AND METHODS: This is a descriptive, comparative, and qualitative study. It was done in two phases. The first phase included literature review of the standards of the selected countries followed by comparison of the standards of the board of trustees, medical staff, CEOs, and nursing management standards to develop the primary framework for Iranian hospitals. In phase two, the primary framework was validated true three rounds of Delphi technique.
RESULTS: Surveying the accreditation system standards in selected countries included the USA, Egypt, Malaysia, and Iran. It was found that the management and leadership standards were classify as governing body, medical staff, CEOs, and nursing management standards. The result of this study provides a framework for improvement of the Iranian national accreditation program.
CONCLUSION: In regarded to the importance of the leadership and management standards in reform and change and promotion of the health services quality, efficiency, and effectiveness, the results of this study showed that the present standards of the Iranian accreditation assessment system and guidelines lack the necessary infrastructures for implementing a successful national accreditation program.
Gibberellin Promotes Cell Growth and Induces Changes in Fatty Acid Biosynthesis and Upregulates Fatty Acid Biosynthetic Genes in Chlorella vulgaris UMT-M1

Jusoh M, Loh SH, Aziz A, Cha TS

Appl Biochem Biotechnol, 2019 Jun;188(2):450-459.
PMID: 30536033 DOI: 10.1007/s12010-018-02937-4

Microalgae lipids and oils are potential candidates for renewable biofuels and nutritional inventions. Recent studies from our lab have shown that two plant hormones, auxin and jasmonic acid, influence microalgae growth and fatty acid accumulation. Therefore, in this study, a high oil-producing strain Chlorella vulgaris UMT-M1 was selected for hormonal study using gibberellin (GA). Exogenous GA3 was applied to early stationary culture of C. vulgaris UMT-M1. Results showed that GA3 gradually increases the cell density of C. vulgaris to up to 42% on days after treatment (DAT)-8 and also capable of delaying the algal senescence. However, the increment in cell density did not enhance the total oil production albeit transient modification of fatty acid compositions was observed for saturated (SFA) and polyunsaturated (PUFA) fatty acids. This illustrates that GA3 only promotes cell division and growth but not the oil accumulation. In addition, application of GA3 in culture medium was shown to promote transient increment of palmitic (C16:0) and stearic (C18:0) acids from DAT-4 to DAT-6 and these changes are correlated with the expression of β-ketoacyl ACP synthase I (KAS I) gene.

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