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Fulltext Endogenous endophthalmitis as a septic complication postureteroscope candiduria

Inn FX, Md Noh UK, Jasman MH

Urol Ann, 2017 2 22;9(1):83-85.
PMID: 28216938 DOI: 10.4103/0974-7796.198902

Ureteroscopy (URS) is commonly used by urologists to treat ureteral stones. It is a relatively low-risk procedure. Both urinary tract obstruction and contamination of instrument can cause candiduria post-URS, and this infection can be treated with an antifungal medication. Candidemia is known as hematogenous dissemination, and ocular tissue is a common invasion. However, endogenous endophthalmitis, due to postureteroscope candiduria, has not been reported up to date. This is a devastating complication that may lead to visual loss. Here, we describe a case of endogenous endophthalmitis as a consequence of candiduria after URS.
Fulltext A case of anti-N-methyl-d-aspartate receptor encephalitis

Abdul Rashid AM, Mohamad Mokhtar E, Md Noh MSF

SAGE Open Med Case Rep, 2020;8:2050313X20926431.
PMID: 32547761 DOI: 10.1177/2050313X20926431

Anti-N-methyl-d-aspartate receptor encephalitis is characterized by the clinical manifestation of neuropsychiatric symptoms, predominantly affecting young adults, and frequently associated with neoplasms. It is the second most common cause of autoimmune and paraneoplastic encephalitis. Early diagnosis is often missed, as patients are commonly diagnosed with psychiatric illnesses and are treated with antipsychotics - which rarely gives complete resolution of symptoms. Herein, we discuss a patient with mixed clinical, imaging, electroencephalogram, and laboratory findings, with an eventual diagnosis of anti-N-methyl-d-aspartate receptor encephalitis requiring immunotherapy and operative intervention.
Fulltext Retinal vasculitis in systemic lupus erythematosus: an indication of active disease

Md Noh UK, Zahidin AZ, Yong TK

Clin Pract, 2012 Mar 30;2(2):e54.
PMID: 24765453 DOI: 10.4081/cp.2012.e54

A 26-year-old woman with a recent flare-up of systemic lupus erythematosus presented with peripheral retinal hemorrhages at a routine check-up. She is on a tapering dose of immunosuppressive agents. Her visual acuity was good. Fluorescein angiogram revealed vasculitic changes with capillary non-perfusion areas. A few weeks later, she developed cerebral lupus with advanced lupus nephritis. Immunosuppressive therapy was restarted and panretinal photocoagulation was delivered. Her visual acuity remained stable, despite development of a cataract from prednisolone therapy.
Fulltext Pediatric critical illness associated cerebral microhemorrhages

Abdul Rashid AM, Bahari N, Md Noh MSF

eNeurologicalSci, 2020 Mar;18:100221.
PMID: 31909229 DOI: 10.1016/j.ensci.2019.100221
Fulltext Important Metabolites in Maintaining Folate Cycle, Homocysteine, and Polyamine Metabolism Associated with Ranibizumab Treatment in Cultured Human Tenon's Fibroblasts

Munirah Md Noh S, Hamimah Sheikh Abdul Kadir S, Vasudevan S

Biomolecules, 2019 06 22;9(6).
PMID: 31234474 DOI: 10.3390/biom9060243

The anti-fibrotic properties of ranibizumab have been well documented. As an antagonist to vascular endothelial growth factor (VEGF), ranibizumab works by binding and neutralizing all active VEGF-A, thus limiting progressive cell growth and proliferation. Ranibizumab application in ocular diseases has shown remarkable desired effects; however, to date, its antifibrotic mechanism is not well understood. In this study, we identified metabolic changes in ranibizumab-treated human Tenon's fibroblasts (HTFs). Cultured HTFs were treated for 48 h with 0.5 mg/mL of ranibizumab and 0.5 mg/mL control IgG antibody which serves as a negative control. Samples from each group were injected into Agilent 6520 Q-TOF liquid chromatography/mass spectrometer (LC/MS) system to establish the metabolite expression in both ranibizumab treated cells and control group. Data obtained was analyzed using Agilent Mass Hunter Qualitative Analysis software to identify the most regulated metabolite following ranibizumab treatment. At p-value < 0.01 with the cut off value of two-fold change, 31 identified metabolites were found to be significantly upregulated in ranibizumab-treated group, with six of the mostly upregulated having insignificant role in fibroblast cell cycle and wound healing regulations. Meanwhile, 121 identified metabolites that were downregulated, and seven of the mostly downregulated are significantly involved in cell cycle and proliferation. Our findings suggest that ranibizumab abrogates the tissue scarring and wound healing process by regulating the expression of metabolites associated with fibrotic activity. In particular, we found that vitamin Bs are important in maintaining normal folate cycle, nucleotide synthesis, and homocysteine and spermidine metabolism. This study provides an insight into ranibizumab's mechanism of action in HTFs from the perspective of metabolomics.
Agro-Industrial Wastes as Potential Substrates for Rhamnolipid Production by Pseudomonas aeruginosa USM-AR2

Nasir MS, Mohd Yahya AR, Md Noh NA

Trop Life Sci Res, 2024 Mar;35(1):33-47.
PMID: 39262861 DOI: 10.21315/tlsr2024.35.1.3

Rhamnolipid has gained much attention in various fields owing to its distinctive functional properties compared to conventional chemical surfactants, which are mostly derived from petroleum feedstock. Production cost is one of the main challenges in rhamnolipid production, particularly when using refined substrates. One possible solution is to use agro-industrial wastes as substrates for rhamnolipid production. This is a promising strategy due to their abundance and commercially low value, while simultaneously alleviating an agro-industrial waste management problem in the environment. This study aims to evaluate agro-industrial wastes from local crops as possible low-cost alternative substrates for rhamnolipid production by a local isolate, Pseudomonas aeruginosa USM-AR2. Various liquid wastes, namely sugarcane molasses, rice washing water, overly mature coconut (OMC) water, empty fruit bunch (EFB) steam effluent, palm sludge oil (PSO) and palm oil mill effluent (POME) were screened as the main carbon source supplementing mineral salt medium (MSM) in the fermentation of P. aeruginosa USM-AR2. Batch fermentation was carried out in a shake flask system, agitated at 200 rpm and incubated at room temperature, 27 ± 2°C for 120 h. Among the substrates tested, PSO exhibited the highest biomass at 20.78 g/L and rhamnolipid production at 1.07 g/L. This study has shown the potential of agro-industrial wastes in Malaysia as an alternative resource for rhamnolipid production, transforming them into value added products, while reducing the amount of wastes discharged into the environment.
Fulltext Bilateral idiopathic optic perineuritis in a young Malay woman: A case report

Ayesha Mohd Zain, Umi Kalthum Md Noh, Mushawiahti Mustapha, Norshamsiah Md. Din, Bastion, Mae Lynn Catherine

Neurology Asia, 2015;20(4):407-409.
MyJurnal

A 28-year-old Malay woman presented with severe loss of vision in both eyes associated with periocular pain on eye movement. She was completely blind at presentation and examination showed optic discs
swelling. Optic nerve imaging showed ‘doughnut sign’, characteristic of optic perineuritis. Steroid was
given over six months. Visual function improved gradually and was maintained at one year follow-up.
This case highlights the importance of differentiation between optic neuritis and optic perineuritis as
visual recovery depends on prolonged management with corticosteroid in optic perineuritis.
Fulltext Sugar content of selected Malaysian desserts, snacks and cooked foods commonly consumed by malaysian older adults

Suzana Shahar, Ching Phang Chong, Hasnah Haron, Mohd Fairulnizal Md Noh

Jurnal Sains Kesihatan Malaysia, 2018;16(101):235-236.
MyJurnal

Excess added sugar consumption is related to poor health outcomes in older adults. The sugar content of local food is limited. However, this information is imperative for understanding potential risks from overconsumption of sugars among older adults. This study was carried out to determine the type and total sugar contents in 70 types of local desserts, snacks and cooked foods, using high performance liquid chromatography. The type of food chosen was based on the highly consumed food by the older adults in Malaysia. The samples were collected in triplicates from local restaurants or stalls located in Selangor, Perak and Johor, stored at -20°C and freeze dried prior to analysis. Results showed that average sugar in each 100 g of local desserts, snacks and cooked foods were 13.69 ± 5.94 g, 8.41 ± 6.15 g and 2.1 ± 1.87 g respectively. The highest sugar content per 100 g samples was found to be in sweet potato donut (kuih keria), mashed banana fritter (cekodok pisang) and noodles with sweet potato gravy (mee rebus). The lowest sugar content per 100 g samples was found to be baked glutinous rice (pulut panggang), vadai and noodle soup (mee sup). Meanwhile, the highest sugar content per standard portion was found to be noodles with sweet potato gravy (mee rebus), peanut pancake (kuih apam balik) and banana savoury (pengat pisang). Percentage of recovery for the sugar analysis was 95.2 ± 6.8%. The main type of sugar found in this analysed food samples was sucrose followed by maltose, glucose, fructose and lactose. Sucrose was the most common added sugars in local desserts, snacks and cooked foods of this study. However, compliance with low added sugar recommendations may not be achievable for the general public. Thus, these findings can be utilised in raising public awareness and assist in better estimation of sugar contents and intake.
Discrete event simulation and data envelopment analysis models for selecting the best resource allocation alternative at an emergency department’s green zone

Nazhatul Sahima Mohd Yusoff, Choong-Yeun Liong, Wan Rosmanira Ismail, Abu Yazid Md Noh

Sains Malaysiana, 2018;47:2917-2925.

The Green Zone of Emergency Department Hospital Universiti Sains Malaysia (EDHUSM) which provides treatment for
non-critical cases contributes partly to the hustle and bustle in the emergency department. The imbalance of doctors
and nurses with the patient ratio which forms the resources’ bottleneck further results to the long patients’ waiting time
especially after the office hours and during weekends and public holidays. Collectively, this disproportion and bottlenecks
roots up the current problem faced by Green Zone EDHUSM which constantly fails to achieve the KPIs set by the hospital.
Henceforth, this study focuses on the best resource allocation of doctors and nurses for shifts during the weekdays and
for shifts during weekends and public holidays. The hybrid method of Discrete Event Simulation, and Data Envelopment
Analysis models such as BCC-input oriented and Super-Efficiency, were deployed to obtain the best resource allocation
for the two groups of shift. The method produced a series of resources allocation alternatives for doctors and nurses
with a total of 64 alternatives for weekdays and 729 alternatives for weekends and public holidays. The results show that
the best allocation for doctors and nurses during weekdays are three doctors and three nurses serving for every shift,
while during weekends and public holidays, a combination of four doctors and four nurses for every shift are the best.
The proposed combinations have reduced the average waiting time, optimized the utilization of doctors and nurses, and
managed to increase the number of patients served during weekdays, weekends and public holidays.
Fulltext A descriptive study of decompression illness among scuba divers treated with hyperbaric oxygen therapy at a military hospital-based recompression facility in Peninsular Malaysia

Fazriyati Jamharee, Abu Yazid Md Noh, Tuan Hairulnizam Tuan Kamauzaman, Ariff Arithra Abdullah, Junainah Nor

Malaysian Journal of Emergency Medicine, 2016;1(1):11-23.
MyJurnal

Background: Diving related illness has become a public health concern, as there isan increasing number of diversworldwide. However, the incidence of Decompression Illness (DCI), a medical disorder as a result of sudden reduction of ambient pressure, remainsgenerallylow. This paper describes the patternsof decompression illness treated in a military hospital-based recompression chamber facility in Peninsular Malaysiafrom year 2000 until 2010.Objective:The objective ofthis study is to determine the patternsof decompression illnesspatientstreated withHyperbaric Oxygen Therapy(HBOT)in a military hospital-based recompression chamber facility inPeninsular Malaysia.
Methodology:A retrospective descriptive study was carried out to utilizesecondary data from Hospital Angkatan Tentera Lumut, Perakfrom 1stJanuary 2000 to 31stDecember 2010. A total of 96 caseswere included in thisstudy.
Results:Most of the patients were male (94.8%), recreational divers (43.0%), non-smokers (56.3%),with no previous medical illness(85.4%), who had dived with compressed air (78.0%), had lessthan 5years divingexperience (56.3%), were non-instructors(75.0%),and had body mass index between 18.5 to 24.9kg/m2(59.4%). Interestingly,25% of the patients developing DCI dived to less than 10 meters depth, 35.4% of them went for a single dive and 71.9% performed safety stops.The majority of the patients had symptoms startingwithin 12 hours after surfacing (85.4%),mainly within the first 3 hours and many had neurological manifestation (61.5%).Only 16.7% of the patients treated withHBOThad therapycommenced within 6 hours from the onset of symptomsand 93.8% from this group had complete recovery. Overall,76.0% of patients had fullrecovery after HBOT.
Conclusion:Diving activities must be closely monitored. Medical surveillance as well as legislations related to diving activities in Malaysia areessential to improve SCUBA discipline and to reduce mortality and morbidity ofDCI in the future.
Macronutrients and sugar content in foods and beverages from three selected zones in peninsular Malaysia

Rosmawati Dora, Hasnah Haron, Muhamad Fikri Mohd Fauzi, Suzana Shahar, Chong CP, Mohd Fairulnizal Md Noh

Sains Malaysiana, 2018;47:1557-1562.

This study was conducted to determine the content of macronutrients and sugar in 30 types of food selected from three
zones in Peninsular Malaysia. The food samples consisted of 14 types of processed foods and beverages, 8 types of
fruits and 10 types ready to eat food. Each type of food and drink were purchased from selected restaurants, stores and
supermarkets from three different zones which were North zone (Perak), Central zone (Selangor) and South Zone (Johor).
Methods used for proximate analysis were based on the standard methods of AOAC (1997) while the total carbohydrate
was calculated by difference method. Total calories were calculated using Atwater method. Total sugar content were
analysed using high performace liquid chromatography (HPLC). Dietary fibre contents were determined by using a
combination of enzyme-gravimetric methods (AOAC 985.29 and AACC 32-05). The results showed that peanut butter has
the highest value of fat (44.75 ± 7.59 g/100 g), total calorie (611 ± 38 kcal /100 g) and dietary fibre contents (8.07 ± 0.98
g/100 g). Highest protein content (21.98 ± 2.57 g/100 g) was found in low-fat milk powder. The highest carbohydrate
(97.48 ± 1.47 g/100 g) and total sugar (86.7 ± 2.9 g/100 g) contents were found in palm sugar. The results of this study
will update and add up to the data for the Malaysian Food Composition Table and can provide useful information in
choosing healthy foods based on the nutrient contents of the food.
An 11-Year Analysis of Emergency Presentations of Melioidosis in Northeastern Malaysia

Yazid MB, Fauzi MH, Hasan H, Md Noh AY, Deris ZZ

J Immigr Minor Health, 2017 Jun;19(3):774-777.
PMID: 27160769 DOI: 10.1007/s10903-016-0429-8

A neglected tropical disease, melioidosis is known to have variability in clinical presentations. Here, we described clinical features that should alert the physicians on the possibility of melioidosis. In this review of 86 cases from 2001 to 2011, the common presentations of melioidosis in the Emergency Department (ED), Hospital Universiti Sains Malaysia were; male gender (79.1 %), in working age group (47.8 ± 15.2 year-old), worked in contact with soil (73.3 %), presented with fever (91.9 %), in rainy season (55.8 %), have underlying diabetes mellitus (79.1 %), have leukocytosis (67.4 %) and high blood glucose (62.8 %) during presentation. In 34.9 % of cases, the antimicrobials were initiated at the ED and only 10.5 % include antimelioid drugs. Thirty-one patients (36.0 %) died due to melioidosis and 51.6 % of this were within 48 h of admission. Despite high mortality rate, the clinical awareness on the possibility of melioidosis among emergency physicians is still low and need to be strengthened.
Fulltext Supraclinoid direct carotid-cavernous sinus fistula

Che Ani MF, Kumar R, Md Noh MSF, Muda AS

BJR Case Rep, 2018 Mar;4(3):20170058.
PMID: 31489208 DOI: 10.1259/bjrcr.20170058

Carotid-cavernous fistulas (CCFs) are vascular shunts between the carotid arterial system with direct drainage into the cerebral venous system, mainly to the cavernous sinus. Direct CCF is a well-recognised complication following head trauma. Classically in direct or traumatic CCF, vessel wall tear occurs at the cavernous segment of the internal carotid artery, between the fixed and free segment. Tears at the supraclinoid segment are rare. We report a case of an internal carotid artery supraclinoid segment pseudoaneurysm, with a direct communication with the cavernous sinus, draining into the superior ophthalmic vein.
The Relationship Between Long-term Use of Intranasal Corticosteroid and Intraocular Pressure

Mohd Zain A, Md Noh UK, Hussein S, Che Hamzah J, Mohd Khialdin S, Md Din N

J Glaucoma, 2019 04;28(4):321-324.
PMID: 30585941 DOI: 10.1097/IJG.0000000000001164

PURPOSE: The purpose of this study was to investigate the association between long-term intranasal steroid use and intraocular pressure (IOP) elevation.
PATIENTS AND METHODS: In total, 100 eyes from 50 patients on long-term intranasal steroids (>2 y) for allergic rhinitis and 90 eyes from 45 controls were included in this study. Patients on other forms of steroids and risk factors for glaucoma were excluded. IOP was measured and nonmydriatic stereoscopic optic disc photos were taken for each eye. The vertical cup-to-disc ratio and the status of the optic disc were evaluated.
RESULTS: The mean IOP for intranasal steroids group was significantly higher (15.24±2.31 mm Hg) compared to the control group (13.91±1.86 mm Hg; P=0.000). However, there were no significant differences in the vertical cup-to-disc ratio and the status of glaucomatous optic disc changes between the groups.
CONCLUSIONS: Prolonged use of intranasal steroids cause statistical significant increase in IOP in patients with allergic rhinitis although no significant glaucomatous disc changes were seen. We suggest patients on long-term use of intranasal steroid have a yearly eye examination to be monitored for IOP elevation and those with additional risk factors for glaucoma is closely monitored for glaucoma.
Rhamnolipid produced by Pseudomonas aeruginosa USM-AR2 facilitates crude oil distillation

Asshifa Md Noh N, Al-Ashraf Abdullah A, Nasir Mohamad Ibrahim M, Ramli Mohd Yahya A

J Gen Appl Microbiol, 2012;58(2):153-61.
PMID: 22688247

A biosurfactant-producing and hydrocarbon-utilizing bacterium, Pseudomonas aeruginosa USM-AR2, was used to assist conventional distillation. Batch cultivation in a bioreactor gave a biomass of 9.4 g L(-1) and rhamnolipid concentration of 2.4 g L(-1) achieved after 72 h. Biosurfactant activity (rhamnolipid) was detected by the orcinol assay, emulsification index and drop collapse test. Pretreatment of crude oil TK-1 and AG-2 with a culture of P. aeruginosa USM-AR2 that contains rhamnolipid was proven to facilitate the distillation process by reducing the duration without reducing the quality of petroleum distillate. It showed a potential in reducing the duration of the distillation process, with at least 2- to 3-fold decreases in distillation time. This is supported by GC-MS analysis of the distillate where there was no difference between compounds detected in distillate obtained from treated or untreated crude oil. Calorimetric tests showed the calorie value of the distillate remained the same with or without treatment. These two factors confirmed that the quality of the distillate was not compromised and the incubation process by the microbial culture did not over-degrade the oil. The rhamnolipid produced by this culture was the main factor that enhanced the distillation performance, which is related to the emulsification of hydrocarbon chains in the crude oil. This biotreatment may play an important role to improve the existing conventional refinery and distillation process. Reducing the distillation times by pretreating the crude oil with a natural biosynthetic product translates to energy and cost savings in producing petroleum products.
Fulltext Recent Techniques in Nutrient Analysis for Food Composition Database

Md Noh MF, Gunasegavan RD, Mustafa Khalid N, Balasubramaniam V, Mustar S, Abd Rashed A

Molecules, 2020 Oct 06;25(19).
PMID: 33036314 DOI: 10.3390/molecules25194567

Food composition database (FCD) provides the nutritional composition of foods. Reliable and up-to date FCD is important in many aspects of nutrition, dietetics, health, food science, biodiversity, plant breeding, food industry, trade and food regulation. FCD has been used extensively in nutrition labelling, nutritional analysis, research, regulation, national food and nutrition policy. The choice of method for the analysis of samples for FCD often depends on detection capability, along with ease of use, speed of analysis and low cost. Sample preparation is the most critical stage in analytical method development. Samples can be prepared using numerous techniques; however it should be applicable for a wide range of analytes and sample matrices. There are quite a number of significant improvements on sample preparation techniques in various food matrices for specific analytes highlighted in the literatures. Improvements on the technology used for the analysis of samples by specific instrumentation could provide an alternative to the analyst to choose for their laboratory requirement. This review provides the reader with an overview of recent techniques that can be used for sample preparation and instrumentation for food analysis which can provide wide options to the analysts in providing data to their FCD.
Fulltext Prognostic predictors of early mortality from exsanguination in adult trauma: a Malaysian trauma center experience

Huei TJ, Mohamad Y, Lip HTC, Md Noh N, Imran Alwi R

Trauma Surg Acute Care Open, 2017;2(1):e000070.
PMID: 29766083 DOI: 10.1136/tsaco-2016-000070

Background: Trauma mortality due to exsanguination is the second most common cause of death. The objective of this study is to investigate the predictors for early death from exsanguination.
Methods: A prognostic study was done to identify predictors of early mortality due to exsanguination. Data were extracted from our Trauma Surgery Registry database of Sultanah Aminah Hospital, Johor Bahru, Malaysia. All patients who were treated from May 1, 2011 to April 31, 2014 by the trauma team were included. Adult trauma patients included from the Trauma Surgery Registry were divided into two groups for analysis: early death from exsanguination and death from non-exsanguination/survivors. Univariate and multivariate analysis was performed to look for significant predictors of death from exsanguination. Variables analyzed were demography, mechanism of injury, organ injury scale, physiological parameters (systolic blood pressure (SBP), respiratory rate, heart rate, temperature), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS) and cause of death.
Results: A total of 2208 patients with an average age of 36 (±16) years were included. Blunt trauma was the majority with 90.5%, followed by penetrating injuries (9.2%). The overall mortality is 239 out of 2208 (10.8%). Seventy-eight patients (32.6%) died due to central nervous system injury, 69 due to sepsis (28.9%) and 58 due to exsanguination (24.3%). After multivariate analysis, age (OR 1.026 (1.009 to 1.044), p=0.002), SBP (OR 0.985 (0.975 to 0.995), p=0.003) and temperature (OR 0.203 (0.076 to 0.543), p=0.001) were found to be the significant physiological parameters. Intra-abdominal injury and NISS were significant anatomic mortality predictors from exsanguination (p<0.001). Patients with intra-abdominal injury had four times higher risk of mortality from exsanguination (OR 3.948 (2.331 to 6.686), p<0.001).
Discussion: In a Malaysian trauma center, age, SBP, core body temperature, intra-abdominal injury and NISS were significant predictors of early death from exsanguination.
Level of evidence: II.
Fulltext Emphysematous aortitis: report of two cases and CT imaging findings

Md Noh MSF, Abdul Rashid AM, Ar A, B N, Mohammed Y, A R E

BJR Case Rep, 2017;3(3):20170006.
PMID: 30363220 DOI: 10.1259/bjrcr.20170006

Emphysematous aortitis is a rare condition that manifests through the presence of air within or surrounding the inflamed aorta. Aortic inflammation may result from either an infective or a non-infective cause. Recognition of this rare condition is important as the resultant clinical deterioration may be rapid and lead to inevitable death. Cross-sectional imaging, with its relatively wide availability, proves an important tool in the diagnosis and subsequent management of this condition. We report two such cases encountered in our centre, with particular focus on the imaging findings on CT.
Production of lipopeptide biosurfactant in batch and fed-batch Streptomyces sp. PBD-410L cultures growing on palm oil

Zambry NS, Rusly NS, Awang MS, Md Noh NA, Yahya ARM

Bioprocess Biosyst Eng, 2021 Jul;44(7):1577-1592.
PMID: 33687550 DOI: 10.1007/s00449-021-02543-5

The present study focused on lipopeptide biosurfactant production by Streptomyces sp. PBD-410L in batch and fed-batch fermentation in a 3-L stirred-tank reactor (STR) using palm oil as a sole carbon source. In batch cultivation, the impact of bioprocessing parameters, namely aeration rate and agitation speed, was studied to improve biomass growth and lipopeptide biosurfactant production. The maximum oil spreading technique (OST) result (45 mm) which corresponds to 3.74 g/L of biosurfactant produced, was attained when the culture was agitated at 200 rpm and aeration rate of 0.5 vvm. The best aeration rate and agitation speed obtained from the batch cultivation was adopted in the fed-batch cultivation using DO-stat feeding strategy to further improve the lipopeptide biosurfactant production. The lipopeptide biosurfactant production was enhanced from 3.74 to 5.32 g/L via fed-batch fermentation mode at an initial feed rate of 0.6 mL/h compared to that in batch cultivation. This is the first report on the employment of fed-batch cultivation on the production of biosurfactant by genus Streptomyces.
Fulltext Successful febuxostat desensitization in a patient with febuxostat hypersensitivity: A Malaysian experience

Sulaiman N, Othman AZ, Shahril NS, Abdul Rashid AM, Md Noh MSF

SAGE Open Med Case Rep, 2017;5:2050313X17749080.
PMID: 29318019 DOI: 10.1177/2050313X17749080

Over the years, allopurinol has been widely used as the preferred choice of urate lowering therapy in patients with gout. However, its role in patients with renal impairment is limited; and adverse reactions are well documented. Febuxostat, a newer oral non-purine xanthine oxidase inhibitor has been proven in several trials to be more effective and tolerable compared to allopurinol and may be used in patients with renal impairment. Here, we describe a case of successful febuxostat desensitization in a patient with a history of allopurinol- and febuxostat-induced adverse cutaneous reaction, as well as the protocol utilized.

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