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Fulltext Rare late-presentation congenital diaphragmatic hernia mimicking a tension pneumothorax

Muien MZA, Jeyaprahasam K, Krisnan T, Ng CY, Teh YG

Radiol Case Rep, 2021 Sep;16(9):2542-2545.
PMID: 34276850 DOI: 10.1016/j.radcr.2021.06.024

Congenital Diaphragmatic Hernia (CDH) is due to a defect in the diaphragm and is usually detected soon after birth. However, in rare cases, asymptomatic CDHs can be missed and present later in life. Late-presentation CDH can be misdiagnosed as tension pneumothorax leading to iatrogenic complications. We report a case of a 10-year-old boy who presented with non-specific symptoms of vomiting and occasional breathlessness, but was subsequently diagnosed as late-presentation CDH. This case highlights the role of imaging in the diagnosis and management of late-presenting CDH. The role of CT imaging as an invaluable tool to further evaluate equivocal radiographic findings in CDH is discussed.
Fulltext The Relationship of Orofacial Pain and Dental Health Status and Oral Health Behaviours in Facial Burn Patients

Chaudhary FA, Ahmad B, Javed MQ, Yakub SS, Arjumand B, Khan AM, et al.

Pain Res Manag, 2021;2021:5512755.
PMID: 34055118 DOI: 10.1155/2021/5512755

This study aims to examine the association of orofacial pain and oral health status and oral health behaviours in facial burn patients. The participants in this cross-sectional study were randomly recruited from the Burn Care Center, Institute of Medical Sciences, Islamabad, Pakistan. An intraoral evaluation was carried out to record the DMFT and OHI-S. A self-administered questionnaire was used to collect information on sociodemographic status, brushing frequency, and dental visits. Orofacial pain during mandibular movement was assessed using the Visual Analogue Scale (VAS). Psychological status was assessed using the Generalized Anxiety Disorder Scale and Impact of Events Scale. ANOVA and simple and multiple linear regression tests were used to analyse the data. From the 90 facial burn patients included, the majority were below 34 years of age, female, single or divorced, and unemployed. The mean DMFT was 10.7, and 71% had poor oral hygiene. 56% of the participants had moderate-to-severe anxiety, and 68% had posttraumatic stress disorder. 53% of the participants had moderate-to-severe pain during mouth opening or moving the mandible with a mean score of 41.5. Analyses showed that orofacial pain was associated with less frequent brushing, irregular dental visits, greater DMFT score, and more plaque accumulation (OHI-S). It was also associated with employment status, the severity of a burn, anxiety, and stress. The treatment and management of dental and oral conditions in burn patients need judicious balance in controlling and accurate assessment of the pain and improving psychological problems in burn patients.
Unequal distribution of COVID-19 vaccine: A looming crisis

Sawal I, Ahmad S, Tariq W, Tahir MJ, Essar MY, Ahmed A

J Med Virol, 2021 09;93(9):5228-5230.
PMID: 33942326 DOI: 10.1002/jmv.27031
Chest Radiograph (CXR) Manifestations of the Novel Coronavirus Disease 2019 (COVID-19): A Mini-review

Chan WY, Hamid MTR, Gowdh NFM, Rahmat K, Yaakup NA, Chai CS

Curr Med Imaging, 2021;17(6):677-685.
PMID: 33390122 DOI: 10.2174/1573405616666201231103312

BACKGROUND: Coronavirus disease 2019 (COVID-19) is highly contagious and has claimed more than one million lives, besides causing hardship and disruptions. The Fleischner Society has recommended chest X-ray (CXR) in detecting cases at high risk of disease progression, for triaging suspected patients with moderate-to-severe illness, and for eliminating false negatives in areas with high pre-test probability or limited resources. Although CXR is less sensitive than real-- time reverse transcription-polymerase chain reaction (RT-PCR) in detecting mild COVID-19, it is nevertheless useful because of equipment portability, low cost and practicality in serial assessments of disease progression among hospitalized patients.
OBJECTIVE: This study aims to review the typical and relatively atypical CXR manifestations of COVID-19 pneumonia in a tertiary care hospital.
METHODS: The CXRs of 136 COVID-19 patients confirmed through real-time RT-PCR from March to May 2020 were reviewed. A literature search was performed using PubMed.
RESULTS: A total of 54 patients had abnormal CXR whilst the others were normal. Typical CXR findings included pulmonary consolidation or ground-glass opacities in a multifocal, bilateral peripheral, or lower zone distribution, whereas atypical CXR features comprised cavitation and pleural effusion.
CONCLUSION: Typical findings of COVID-19 infection in chest computed tomography studies can also be seen in CXR. The presence of atypical features associated with worse disease outcome. Recognition of these features on CXR will improve the accuracy and speed of diagnosing COVID-19 patients.
Fulltext The Effect of Bottom Profile Dimples on the Femoral Head on Wear in Metal-on-Metal Total Hip Arthroplasty

Jamari J, Ammarullah MI, Saad APM, Syahrom A, Uddin M, van der Heide E, et al.

J Funct Biomater, 2021 Jun 06;12(2).
PMID: 34204138 DOI: 10.3390/jfb12020038

Wear and wear-induced debris is a significant factor in causing failure in implants. Reducing contact pressure by using a textured surface between the femoral head and acetabular cup is crucial to improving the implant's life. This study presented the effect of surface texturing as dimples on the wear evolution of total hip arthroplasty. It was implemented by developing finite element analysis from the prediction model without dimples and with bottom profile dimples of flat, drill, and ball types. Simulations were carried out by performing 3D physiological loading of the hip joint under normal walking conditions. A geometry update was initiated based on the patient's daily routine activities. Our results showed that the addition of dimples reduced contact pressure and wear. The bottom profile dimples of the ball type had the best ability to reduce wear relative to the other types, reducing cumulative linear wear by 24.3% and cumulative volumetric wear by 31% compared to no dimples. The findings demonstrated that surface texturing with appropriate dimple bottom geometry on a bearing surface is able to extend the lifetime of hip implants.
Systematic Optimisation of Microtiter Plate Lectin Assay to Improve Sialic Acid Linkage Detection

Khairol Mokhtar NHI, Hussin A, Hamid AA, Zainal Ariffin SH, Shahidan MA

Comb Chem High Throughput Screen, 2021 Aug 02.
PMID: 34342257 DOI: 10.2174/1386207324666210802122538

AIMS: We aimed to develop a high-throughput lectin assay with minimized background signals to investigate the interactions of lectins and sialic acid glycans, focusing on prostate-specific antigen (PSA).
BACKGROUND: High background signals resulting from nonspecific binding are a significant concern for microtiter plate-based enzyme-linked lectin sorbent assays (ELLSAs), as they can mask specific binding signals and cause false-positive results.
METHODS: In this study, we constructed an ELLSA based on different washing step parameters, including the number of washing cycles, NaCl and Tween-20 concentrations, and the type of blocking agent and evaluated the effects on both specific and nonspecific binding signals. Furthermore, we performed a PSA binding assay using the optimized ELLSA.
RESULTS: The optimal washing parameters based on the highest specific binding signal proposed four cycles of washing steps using a washing buffer containing a high salt concentration (0.5 M NaCl) and mild detergent (0.05% Tween-20). The utilization of the optimized washing parameters in this assay was shown to be sufficient to obtain the optimal binding signals without the use of any blocking agent. Binding assays performed using the optimized ELLSA revealed that the glycan of the PSA sample used in this study mainly consists of terminal α2,6-linked sialic acid, as strongly recognized by Sambucus nigra agglutinin (SNA) with a KD value of 12.38 nM.
CONCLUSION: The ELLSA reported in this study provides a simple yet sensitive assay for sialic acid linkage recognition.
Fulltext SNG and DNG meta-absorber with fractional absorption band for sensing application

Hoque A, Islam MT, Almutairi AF, Chowdhury MEH, Samsuzzaman M

Sci Rep, 2020 Aug 04;10(1):13086.
PMID: 32753600 DOI: 10.1038/s41598-020-69792-4

This paper reports on a tunable transmission frequency characteristics-based metamaterial absorber of an X band sensing application with a fractional bandwidth. Tunable resonator metamaterial absorbers fabricated with dielectric surface have been the subject of growing attention of late. Absorbers possess electromagnetic properties and range modification capacity, and they have yet to be studied in detail. The proposed microstructure resonator inspired absorber with triple fractional band absorption consists of two balanced symmetrical vertical patches at the outer periphery and a tiny drop hole at two edges. Experimental verification depicted two absorption bands with single negative (SNG) characteristics for two resonances, but double negative (DNG) for single resonance frequency. The mechanism of sensing and absorption was analyzed using the transmission line principle with useful parameter analysis. Cotton, a hygroscopic fiber with moisture content, was chosen to characterize the proposed absorber for the X band application. The electrical properties of the cotton changed depending on the moisture absorption level. The simulation and the measured absorption approximately justified the result; the simulated absorption was above 90% (at 10.62, 11.64, and 12.8 GHz), although the steady level was 80%. The moisture content of the cotton (at different levels from 0 to 32.13%) was simulated, and the transmission resonance frequency changed its point in two significant ranges. However, comparing the two adopted measurement method and algorithm applied to the S parameter showed a closer variation between the two resonances (11.64 and 12.8 GHz) which signified that a much more accurate measurement of the cotton dielectric constant was possible up to a moisture content of 16.1%. However, certain unwanted changes were noted at 8.4-8.9 GHz and 10.6-12.4 GHz. The proposed triple-band absorber has potential applications in the X band sensing of moisture in capsules or tablet bottles.
Functionally graded biomimetic biomaterials in dentistry: an evidence-based update

Qasim SSB, Zafar MS, Niazi FH, Alshahwan M, Omar H, Daood U

J Biomater Sci Polym Ed, 2020 06;31(9):1144-1162.
PMID: 32202207 DOI: 10.1080/09205063.2020.1744289

Design and development of novel therapeutic strategies to regenerate lost tissue structure and function is a serious clinical hurdle for researchers. Traditionally, much of the research is dedicated in optimising properties of scaffolds. Current synthetic biomaterials remain rudimentary in comparison to their natural counterparts. The ability to incorporate biologically inspired elements into the design of synthetic materials has advanced with time. Recent reports suggest that functionally graded material mimicking the natural tissue morphology can have a more exaggerated response on the targeted tissue. The aim of this review is to deliver an overview of the functionally graded concept with respect to applications in clinical dentistry. A comprehensive understanding of spatiotemporal arrangement in fields of restorative, prosthodontics, periodontics, orthodontics and oral surgery is presented. Different processing techniques have been adapted to achieve such gradients ranging from additive manufacturing (three dimensional printing/rapid prototyping) to conventional techniques of freeze gelation, freeze drying, electrospinning and particulate leaching. The scope of employing additive manufacturing technique as a reliable and predictable tool for the design and accurate reproduction of biomimetic templates is vast by any measure. Further research in the materials used and refinement of the synthesis techniques will continue to expand the frontiers of functionally graded membrane based biomaterials application in the clinical domain.
In Silico Docking of Vitamin E Isomers on Transport Proteins

Zulkiflee NS, Awang SA, Ming WX, Kamilan MFW, Mariappan MY, Kit TJ

Curr Comput Aided Drug Des, 2020;16(4):467-472.
PMID: 31203808 DOI: 10.2174/1573409915666190614113733

BACKGROUND: Vitamin E is comprised of α, β, γ and δ-tocopherols (Ts) and α, β, γ and δ- tocotrienols (T3s). Vitamin E has neuroprotective antioxidant, anti-cancer, and cholesterol-lowering effects. Intracellular trafficking of these isomers remains largely unknown, except for αT which is selectively transported by αT transfer protein (αTTP).
OBJECTIVE: This study aimed to determine the binding of vitamin E isomers on transport proteins using in silico docking.
METHODS: Transport proteins were selected using AmiGo Gene Ontology tool based on the same molecular function annotation as αTTP. Protein structures were obtained from the Protein Data Bank. Ligands structures were obtained from ZINC database. In silico docking was performed using SwissDock.
RESULTS AND DISCUSSION: A total of 6 transport proteins were found: SEC14-like protein 2, glycolipid transfer protein (GLTP), pleckstrin homology domain-containing family A member 8, collagen type IV alpha-3-binding protein, ceramide-1-phosphate transfer protein and afamin. Compared with other transport proteins, αTTP had the highest affinities for all isomers except βT3. Binding order of vitamin E isomers toward αTTP was γT > βT > αT > δT > αT3 > γT3 > δT3 > βT3. GLTP had a higher affinity for tocotrienols than tocopherols. βT3 bound stronger to GLTP than αTTP.
CONCLUSION: αTTP remained as the most preferred transport protein for most of the isomers. The binding affinity of αT toward αTTP was not the highest than other isomers suggested that other intracellular trafficking mechanisms of these isomers may exist. GLTP may mediate the intracellular transport of tocotrienols, especially βT3. Improving the bioavailability of these isomers may enhance their beneficial effects to human.
Brown/Beige adipose tissues and the emerging role of their secretory factors in improving metabolic health: The batokines

Ahmad B, Vohra MS, Saleemi MA, Serpell CJ, Fong IL, Wong EH

Biochimie, 2021 May;184:26-39.
PMID: 33548390 DOI: 10.1016/j.biochi.2021.01.015

Brown and beige adipose tissues are the primary sites for adaptive non-shivering thermogenesis. Although they have been known principally for their thermogenic effects, in recent years, it has emerged that, just like white adipose tissue (WAT), brown and beige adipose tissues also play an important role in the regulation of metabolic health through secretion of various brown adipokines (batokines) in response to various physiological cues. These secreted batokines target distant organs and tissues such as the liver, heart, skeletal muscles, brain, WAT, and perform various local and systemic functions in an autocrine, paracrine, or endocrine manner. Brown and beige adipose tissues are therefore now receiving increasing levels of attention with respect to their effects on various other organs and tissues. Identification of novel secreted factors by these tissues may help in the discovery of drug candidates for the treatment of various metabolic disorders such as obesity, type-2 diabetes, skeletal deformities, cardiovascular diseases, dyslipidemia. In this review, we comprehensively describe the emerging secretory role of brown/beige adipose tissues and the metabolic effects of various brown/beige adipose tissues secreted factors on other organs and tissues in endocrine/paracrine manners, and as well as on brown/beige adipose tissue itself in an autocrine manner. This will provide insights into understanding the potential secretory role of brown/beige adipose tissues in improving metabolic health.
Ionic liquid-biosurfactant blends as effective dispersants for oil spills: Effect of carbon chain length and degree of saturation

Hassan Shah MU, Bhaskar Reddy AV, Yusup S, Goto M, Moniruzzaman M

Environ Pollut, 2021 Sep 01;284:117119.
PMID: 33906032 DOI: 10.1016/j.envpol.2021.117119

The well-known toxicity of conventional chemical oil spill dispersants demands the development of alternative and environmentally friendly dispersant formulations. Therefore, in the present study we have developed a pair of less toxic and green dispersants by combining lactonic sophorolipid (LS) biosurfactant individually with choline myristate and choline oleate ionic liquid surfactants. The aggregation behavior of resulted surfactant blends and their dispersion effectiveness was investigated using the baffled flask test. The introduction of long hydrophobic alkyl chain with unsaturation (attached to choline cation) provided synergistic interactions between the binary surfactant mixtures. The maximum dispersion effectiveness was found to be 78.23% for 80:20 (w/w) lactonic sophorolipid-choline myristate blends, and 81.15% for 70:30 (w/w) lactonic sophorolipid-choline oleate blends at the dispersant-to-oil ratio of 1:25 (v/v). The high dispersion effectiveness of lactonic sophorolipid-choline oleate between two developed blends is attributed to the stronger synergistic interactions between surfactants and slower desorption rate of blend from oil-water interface. The distribution of dispersed oil droplets at several DOR were evaluated and it was observed that oil droplets become smaller with increasing DOR. In addition, the acute toxicity analysis of developed formulations against zebra fish (Danio rerio) confirmed their non-toxic behavior with LC50 values higher than 400 ppm after 96 h. Overall, the proposed new blends/formulations could effectively substitute the toxic and unsafe chemical dispersants.
Fulltext The In Vitro α-Glucosidase Inhibition Activity of Various Solvent Fractions of Tamarix dioica and 1H-NMR Based Metabolite Identification and Molecular Docking Analysis

Niaz A, Adnan A, Bashir R, Mumtaz MW, Raza SA, Rashid U, et al.

Plants (Basel), 2021 Jun 02;10(6).
PMID: 34199333 DOI: 10.3390/plants10061128

The Tamarix dioica (T. dioica) is widely used medicinal plant to cure many chronic ailments. T. dioica is being used to manage diabetes mellitus in traditional medicinal system; however, very little scientific evidence is available on this plant in this context. The current study involves the fractionation of crude methanolic extract of T. dioica using n-hexane, ethyl acetate, chloroform, and n-butanol. The screening for antioxidant activity using 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay was carried out. The in vitro antidiabetic potential was assessed by measuring α-glucosidase inhibition. Total phenolic and flavonoid contents were also determined for each fraction. The metabolites were identified using highly sensitive and emerging 1H-NMR technique. The results revealed the ethyl acetate fraction as the most potent with DPPH scavenging activity of 84.44 ± 0.21% and α-glucosidase inhibition with IC50 value of 122.81 ± 2.05 µg/mL. The total phenolic and flavonoid content values of 205.45 ± 1.36 mg gallic acid equivalent per gram dried extract and 156.85 ± 1.33 mg quercetin equivalent per gram dried extract were obtained for ethyl acetate fraction. The bucketing of 1H-NMR spectra identified 22 metabolites including some pharmacologically important like tamarixetin, tamaridone, quercetin, rutin, apigenin, catechin, kaempferol, myricetin and isorhamnetin. Leucine, lysine, glutamic acid, aspartic acid, serine, and tyrosine were the major amino acids identified in ethyl acetate fraction. The molecular docking analysis provided significant information on the binding affinity among secondary metabolites and α-glucosidase. These metabolites were most probably responsible for the antioxidant activity and α-glucosidase inhibitory potential of ethyl acetate fraction. The study ascertained the ethnomedicinal use of T. dioica to manage diabetes mellitus and may be a helpful lead towards naturopathic mode for anti-hyperglycemia.
Microwave-assisted catalysis of water-glycerol solutions for hydrogen production over NiO/zeolite catalyst

Husin H, Mahidin M, Pontas K, Ahmadi A, Ridho M, Erdiwansyah E, et al.

Heliyon, 2021 Jul;7(7):e07557.
PMID: 34355081 DOI: 10.1016/j.heliyon.2021.e07557

In this study, glycerol as an abundant green feedstock was used as a hydrogen source to investigate the reaction of water-glycerol solution decomposition by microwave-assisted catalytic to produce hydrogen over NiO/zeolite catalyst. The catalyst was prepared by inception wetness and then characterized through X-ray diffraction (XRD), scanning electron microscopy (SEM), Energy diffraction X-ray (EDX), and transmission electron microscope (TEM) measurements. The conversion process of glycerol into hydrogen was performed in a fixed-bed microwave-assisted reactor. Effect of microwave power, NiO content, and feed flow rate (FFR) on glycerol conversion and hydrogen selectivity were studied. The results of XRD and EDX measurement showed that NiO crystalline exists on the catalyst sample. The particle size of NiO/zeolite was determined in the range of 30-300 nm, and the particle was found well dispersed on the zeolite surface as confirmed by TEM. Furthermore, the maximum conversion rate can achieve about 96.67 %, while the highest hydrogen production was found up to 73.5 % with the condition of 20% of NiO as an active site on natural zeolite. It was found that the NiO content of 20% gave the best glycerol conversion at the microwave power of 600 W and FFR 0.5 ml/min. Microwave-assisted catalytic irradiation of glycerol appears to be a promising candidate for the production of H2 from an aqueous glycerol solution.
Fulltext Hypothetical Protein BPSL3393 of Burkholderia pseudomallei is Involved in Ethanolamine Catabolism

Luan OG, Yam H, Samian R, Wajidi MFF, Mahadi NM, Mohamad S, et al.

Trop Life Sci Res, 2017 Jul;28(2):57-74.
PMID: 28890761 MyJurnal DOI: 10.21315/tlsr2017.28.2.5

Burkholderia pseudomallei is a soil-dwelling bacterium that causes a globally emerging disease called melioidosis. Approximately one third of the in silico annotated genes in its genome are classified as hypothetical genes. This group of genes is difficult to be functionally characterised partly due to the absence of noticeable phenotypes under conventional laboratory settings. A bioinformatic survey of hypothetical genes revealed a gene designated as BPSL3393 that putatively encodes a small protein of 11 kDA with a CoA binding domain. BPSL3393 is conserved in all the B. pseudomallei genomes as well as various in other species within the genus Burkholderia. Taking into consideration that CoA plays a ubiquitous metabolic role in all life forms, characterisation of BPSL3393 may uncover a previously over-looked metabolic feature of B. pseudomallei. The gene was deleted from the genome using a double homologous recombination approach yielding a null mutant. The BPSL3393 mutant showed no difference in growth rate with the wild type under rich and minimal growth conditions. An extensive metabolic phenotyping test was performed involving 95 metabolic substrates. The deletion mutant of BPSL3393 was severely impaired in its ethanolamine metabolism. The growth rate of the mutant was attenuated when ethanolamine was used as the sole carbon source. A transcriptional analysis of the ethanolamine metabolism genes showed that they were down-regulated in the BPSL3393 mutant. This seemed to suggest that BPSL3393 functions as a positive regulator for ethanolamine metabolism.
Fulltext Early Development of Fig (Ficus carica L.) Root and Shoot Using Different Propagation Medium and Cutting Types

Shamsuddin MS, Shahari R, Amri CNAC, Tajudin NS, Mispan MR, Salleh MS

Trop Life Sci Res, 2021 Mar;32(1):83-90.
PMID: 33936552 DOI: 10.21315/tlsr2021.32.1.5

This study aimed at determining the effects of propagation medium and cutting types on the early growth performance of fig (Ficus carica L.) root and shoot. The experiment was conducted at the Glasshouse and Nursery Complex (GNC), International Islamic University Malaysia (IIUM). The split-plot design was employed with the main plot (propagation medium) and sub-plot (types of cutting). The propagation medium were sand:topsoil (1:3) (M1), topsoil:peat:sawdust (1:1:1) (M2) and peat:perlite (1:1) (M3). Two types of cutting were semi-hardwood (C1) and hardwood (C2). As a result, there were a significant effect of propagation medium on measured parameters. This study revealed that the most effective propagation medium and cutting types for the propagation of fig were a combination of peat and perlite at 1:1 ratio (M3) and hardwood cutting (C2), respectively as evidenced by significantly higher root and shoot growth quality as compared to other treatments.
Fulltext Fatty Acid Composition of Hepatopancreas and Gonads in Both Sexes of Orange Mud Crab, Scylla olivacea Cultured at Various Water Flow Velocities

Taufik M, Shahrul I, Mohd Nordin AR, Ikhwanuddin M, Abol-Munafi AB

Trop Life Sci Res, 2020 Jul;31(2):79-105.
PMID: 32922670 DOI: 10.21315/tlsr2020.31.2.5

Nutritional quality of the hepatopancreas and gonads of orange portunid mud crab, Scylla olivacea was evaluated for each gender under four treatment of different water velocities (0, 20, 40 and 60 cm s-1), in terms of nutrient reserve and nutrient for reproduction. About 56 crabs were used in this study in which fatty acids composition was analysed using gas chromatography mass-spectrometry (GC-MS). For hepatopancreas analysis, monounsaturated fatty acids (MUFAs) were present in the highest fatty acids concentration, followed by polyunsaturated fatty acids (PUFAs) and, saturated fatty acids (SFAs). However, long-chain polyunsaturated fatty acids (LC-PUFAs) were displayed in low concentration in the hepatopancreas. Total fatty acid (TFAs) composition was significantly higher at moderate velocity of 20 cm s-1 compared to other water velocity treatments. For gonad analysis, 20 cm s-1 showed the highest TFA concentration of 93.34 mg g-1 while, the lowest concentration of 3.90 mg g-1 occurred at 0 cm s-1. There were significant differences in male and female crab's fatty acids contents of gonads at all flow velocities challenged (p < 0.05). PUFAs and MUFAs were dominant while, SFAs were observed at low concentration. This study revealed that, concentration of PUFAs increased as gonad maturation increased. The decreasing concentration of hepatopancreas fatty acids over the culture period indicated that nutrient was shifted from the hepatopancreas, to be used as energy reserved to gonads for further growth of eggs and offspring. The linkages between water flow strength, hepatopancreas, and gonad fatty acids concentrations, is fundamental knowledge useful in establishing efficient habitat velocities selection which will improve aquaculture production of mud crabs with high quality broodstock.
Bacterial microbiome of Coptotermes curvignathus (Isoptera: Rhinotermitidae) reflects the coevolution of species and dietary pattern

King JH, Mahadi NM, Bong CF, Ong KH, Hassan O

Insect Sci, 2014 Oct;21(5):584-96.
PMID: 24123989 DOI: 10.1111/1744-7917.12061

Coptotermes curvignathus Holmgren is capable of feeding on living trees. This ability is attributed to their effective digestive system that is furnished by the termite's own cellulolytic enzymes and cooperative enzymes produced by their gut microbes. In this study, the identity of an array of diverse microbes residing in the gut of C. curvignathus was revealed by sequencing the near-full-length 16S rRNA genes. A total of 154 bacterial phylotypes were found. The Bacteroidetes was the most abundant phylum and accounted for about 65% of the gut microbial profile. This is followed by Firmicutes, Actinobacteria, Spirochetes, Proteobacteria, TM7, Deferribacteres, Planctomycetes, Verrucomicrobia, and Termite Group 1. Based on the phylogenetic study, this symbiosis can be a result of long coevolution of gut enterotypes with the phylogenic distribution, strong selection pressure in the gut, and other speculative pressures that determine bacterial biome to follow. The phylogenetic distribution of cloned rRNA genes in the bacterial domain that was considerably different from other termite reflects the strong selection pressures in the gut where a proportional composition of gut microbiome of C. curvignathus has established. The selection pressures could be linked to the unique diet preference of C. curvignathus that profoundly feeds on living trees. The delicate gut microbiome composition may provide available nutrients to the host as well as potential protection against opportunistic pathogen.
Fulltext Tibia vara in Asians: Myth or fact? Verification with three-dimensional computed tomography

Ho JPY, Merican AM, Ayob KA, Sulaiman SH, Hashim MS

J Orthop Surg (Hong Kong), 2021 2 27;29(1):2309499021992618.
PMID: 33632009 DOI: 10.1177/2309499021992618

BACKGROUND: There is a common perception among surgeons that Asian tibiae are significantly more varus compared to non-Asians, contributed both by an acute medial tibial proximal angle (MPTA) and diaphyseal bowing. Insight into the normative morphology of the tibia allows generation of knowledge towards disease processes and subsequently planning for corrective surgeries.
METHODS: Computed tomography (CT) scans of 100 normal adult knees, aged 18 years and above, were analysed using a 3-dimensional (3D) analysis software. All tibiae were first aligned to a standard frame of reference and then rotationally aligned to the tibial centroid axis (TCAx) and the transmalleolar axis (tmAx). MPTA was measured from best-fit planes on the surface of the proximal tibia for each rotational alignment. Diaphyseal bowing was assessed by dividing the shaft to three equal portions and establishing the angle between the proximal and distal segments.
RESULTS: The mean MPTA was 87.0° ± 2.2° (mean ± SD) when rotationally aligned to TCAx and 91.6° ± 2.7° when aligned to tmAx. The mean diaphyseal bowing was 0.1° ± 1.9° varus when rotationally aligned to TCAx and 0.3° ± 1.6° valgus when aligned to tmAx. The mean difference when the MPTA was measured with two different rotational alignments (TCAx and tmAx) was 4.6° ± 2.3°. No statistically significant differences were observed between males and females. Post hoc tests revealed statistically significant difference in MPTA between different ethnic sub-groups.
CONCLUSION: The morphology of the proximal tibiae in the disease-free Asian knee is inherently varus but not more so than other reported populations. The varus profile is contributed by the MPTA, with negligible diaphyseal bowing. These implications are relevant to surgical planning and prosthesis design.
Fulltext Perception and practices of public hospital pharmacists towards the antimicrobial stewardship programme in the State of Selangor, Malaysia

Saleh MS, Hong YH, Muda MR, Dali AF, Hassali MA, Khan TM, et al.

Eur J Hosp Pharm, 2020 05;27(3):173-177.
PMID: 32419939 DOI: 10.1136/ejhpharm-2018-001679

Objective: The increase in antimicrobial resistance and the lack of new antimicrobial agents in drug discovery pipelines have called for global attention to mitigate the problem of antimicrobial misuse. While an antimicrobial stewardship (AMS) programme has been implemented in Malaysia, the perception and practices of public hospital pharmacists remain unknown. The aim of this study was to determine the perception and practices of Malaysian public hospital pharmacists towards the AMS programme in the state of Selangor, Malaysia.
Methods: A cross-sectional study, using a validated 23-item self-administered questionnaire, was conducted among pharmacists from 11 public hospitals in the State of Selangor, Malaysia, from December 2016 to January 2017. All public hospital pharmacists (n=432) were invited to participate in the survey. A 5-point Likert scale was employed in the questionnaire; the perception section was scored from 1 (strongly disagree) to 5 (strongly agree) while the practice section was scored from 1 (never) to 5 (always). Both descriptive and inferential statistical analyses were used to analyse data.
Results: Of the 432 pharmacists surveyed, 199 responded, giving a response rate of 46.0%. The majority of the respondents agreed (n=190, 95.5%) that the AMS programme improves patient care at their hospitals (median=5; IQR=1). Slightly less than half of the respondents indicated that a local antibiotic guideline was established in their hospitals (median=3, IQR=2.5), and had taken part in antimicrobial awareness campaigns to promote optimal use of antimicrobials in hospitals (median=3, IQR=1).
Conclusions: Overall, the perception and practices of the surveyed hospital pharmacists towards AMS programme were positive. National antibiotic guidelines, which take into consideration local antimicrobial resistance patterns, should be used fully to improve antimicrobial usage and to reduce practice variation. Collaboration among healthcare professionals should be strengthened to minimise the unfavourable consequences of unintended use of antimicrobial agents while optimising clinical outcomes.
Fulltext Norepinephrine in Septic Shock: A Systematic Review and Meta-analysis

Ruslan MA, Baharuddin KA, Noor NM, Yazid MB, Noh AYM, Rahman A

West J Emerg Med, 2021 Feb 16;22(2):196-203.
PMID: 33856300 DOI: 10.5811/westjem.2020.10.47825

INTRODUCTION: Most experts recommend norepinephrine as the first-line agent in septic shock. Our objective was to determine the effectiveness and safety of norepinephrine in patients with septic shock.
METHODS: We searched the Cochrane Central Register of Controlled Trials and Epistemonikos, as well as MEDLINE from 1966 till August 2019. Screening of full texts, evaluation for eligibility, and data extraction were done by four independent reviewers. We estimated risk ratios (RR) and mean differences (MD) using a random-effects model with 95% confidence intervals (CI). The primary outcomes included the number of participants who achieved the target mean arterial pressure (MAP), time to achieve the target MAP, and number of participants with all-cause 28-day mortality. The secondary outcomes included the length of stay in the intensive care unit, length of hospital stay, incidence of arrhythmia and myocardial infarction, vasopressor-free days, and number of participants with all-cause 90-day mortality.
RESULTS: We identified 11 randomized controlled trials with a total of 4,803 participants. There was no difference in the number of participants who achieved the target MAP between those patients receiving norepinephrine and other vasopressors (RR 1.44; 95% CI, 0.32 to 6.54; P = 0.640; I2 = 94%; two trials, 116 participants). There was no significant difference in time to achieve the target MAP (MD -0.05; 95%, CI, -0.32 to 0.21; P = 0.690; I2 = 26%; two trials, 1763 participants) and all-cause 28-day mortality (RR 0.95; 95% CI, 0.89 to 1.02; P = 0.160; I2 = 0%; seven trials, 4,139 participants). Regarding the secondary outcome, norepinephrine may significantly reduce the incidence of arrhythmia as compared to other vasopressors (RR 0.64; 95% CI, 0.42 to 0.97; P = 0.030; I2 = 64%; six trials, 3974 participants). There was no difference in the incidence of myocardial infarction (RR 1.28; 95% CI, 0.79 to 2.09), vasopressor-free day (RR 0.46; 95% CI, -1.82 to 2.74) and all-cause 90-day mortality (RR 1.08; 95% CI, 0.96 to 1.21) between norepinephrine and vasopressors.
CONCLUSION: In minimizing the occurrence of an arrhythmia, norepinephrine is superior to other vasopressors, making it safe to be used in septic shock. However, there was insufficient evidence concerning mortality and achievement of the target MAP outcomes.

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