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Induction of labor via Foley balloon catheter placement for 6 vs 12 hours in women with 1 previous cesarean delivery and unfavorable cervices: a randomized controlled trial

Yogamoorthy U, Saaid R, Gan F, Hong J, Hamdan M, Tan PC

Am J Obstet Gynecol MFM, 2023 Nov;5(11):101158.
PMID: 37734661 DOI: 10.1016/j.ajogmf.2023.101158

BACKGROUND: Induction of labor in women with 1 previous cesarean delivery and unripe cervices is a high-risk process, carrying an increased risk of uterine rupture and the need for cesarean delivery. Balloon ripening is often chosen as prostaglandin use is associated with an appreciable risk of uterine rupture in vaginal birth after cesarean delivery. A shorter duration of placement of the balloon typically expedites delivery; however, this has not been evaluated in induction of labor after 1 previous cesarean delivery.
OBJECTIVE: This study aimed to compare Foley balloon catheter placement for 6 vs 12 hours in induction of labor after 1 previous cesarean delivery.
STUDY DESIGN: A randomized controlled trial was conducted in a university hospital in Malaysia from January 2022 to February 2023. Eligible women with 1 previous cesarean delivery admitted for induction of labor were enrolled. Participants were randomized after balloon catheter insertion for 6 or 12 hours of passive ripening before balloon deflation and removal to check cervical status for amniotomy. The primary outcome was the induction of labor to delivery interval. The secondary outcomes were largely derived from the core outcome set for trials on induction of labor (Core Outcomes in Women's and Newborn Health [CROWN]). The Student t test, Mann-Whitney U test, chi-square test, and Fisher exact test were used as appropriate for the data.
RESULTS: Overall, 126 women were randomized, 63 to each intervention. The mean induction of labor to delivery intervals were 23.0 (standard deviation, ±8.9) in the 6-hour arm and 26.6 (standard deviation, ±7.1) in the 12-hour arm (mean difference, -3.5 hours; 95% confidence interval, -6.4 to -0.7; P=.02). The median induction of labor (Foley balloon catheter insertion) to Foley balloon catheter removal intervals were 6.0 hours (interquartile range, 6.0-6.3) in the 6-hour arm and 12.0 hours (interquartile range, 12.0-12.5) in the 12-hour arm (P
Fulltext A randomized controlled trial on the effect of smartphone-based mental health application among outpatients with depressive and anxiety symptoms: A pilot study in Malaysia

Tan S, Ismail MAB, Daud TIM, Hod R, Ahmad N

Indian J Psychiatry, 2023 Sep;65(9):934-940.
PMID: 37841542 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_240_23

INTRODUCTION: Despite the increasing number of mental health professionals in Malaysia, many have yet to receive adequate treatment for common mental illnesses such as depression and anxiety. Coupled with the increasing number of mobile phone users globally, smartphone-based intervention can be a promising mental health intervention. Thus, this study aims to investigate the efficacy of using a smartphone-based mental health application in addition to treatment-as-usual (TAU) in outpatients with depressive and/or anxiety symptoms.
METHODS: Psychiatric outpatients that fulfill the selection criteria were recruited and randomized into two groups, the intervention group (n = 24) and the control group (n = 24). Those in the intervention group received MoodMission in addition to TAU, while those in the control group received TAU. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores were assessed at baseline and after four weeks.
RESULTS: A total of 48 participants were recruited, randomized, and completed the study. Baseline characteristics for both groups were comparable. There is no significant mean difference between-group comparison of PHQ-9 (1.31, 95% CI -1.35, 3.98) and GAD-7 (0.02, 95% CI -2.01, 2.05) scores at four weeks. However, for the intervention group, there was a significant improvement in the PHQ-9 score at four weeks [mean difference 2.58 (95% CI 1.16, 4.01), P = 0.001)].
CONCLUSION: This study showed no significant improvement in anxiety symptoms after four weeks. Use of smartphone-based mental health applications led to significant reduction of depressive symptoms.
Fulltext The Effect of Material Fresh Properties and Process Parameters on Buildability and Interlayer Adhesion of 3D Printed Concrete

Panda B, Noor Mohamed NA, Paul SC, Bhagath Singh G, Tan MJ, Šavija B

Materials (Basel), 2019 Jul 04;12(13).
PMID: 31277393 DOI: 10.3390/ma12132149

The advent of digital concrete fabrication calls for advancing our understanding of the interaction of 3D printing with material rheology and print parameters, in addition to developing new measurement and control techniques. Thixotropy is the main challenge associated with printable material, which offers high yield strength and low viscosity. The higher the thixotropy, the better the shape stability and the higher buildability. However, exceeding a minimum value of thixotropy can cause high extrusion pressure and poor interface bond strength if the printing parameters are not optimized to the part design. This paper aims to investigate the effects of both material and process parameters on the buildability and inter-layer adhesion properties of 3D printed cementitious materials, produced with different thixotropy and print head standoff distances. Nano particles are used to increase the thixotropy and, in this context, a lower standoff distance is found to be useful for improving the bond strength. The low viscosity "control" sample is unaffected by the variation in standoff distances, which is attributed to its flowability and low yield stress characteristics that lead to strong interfacial bonding. This is supported by our microscopic observations.
Treatment of startle and related disorders

Lim TT, Por CY, Beh YY, Schee JP, Tan AH

Clin Park Relat Disord, 2023;9:100218.
PMID: 37808566 DOI: 10.1016/j.prdoa.2023.100218
Fulltext Device performances analysis of p-type doped silicene-based field effect transistor using SPICE-compatible model

Chuan MW, Riyadi MA, Hamzah A, Alias NE, Mohamed Sultan S, Lim CS, et al.

PLoS One, 2022;17(3):e0264483.
PMID: 35239699 DOI: 10.1371/journal.pone.0264483

Moore's Law is approaching its end as transistors are scaled down to tens or few atoms per device, researchers are actively seeking for alternative approaches to leverage more-than-Moore nanoelectronics. Substituting the channel material of a field-effect transistors (FET) with silicene is foreseen as a viable approach for future transistor applications. In this study, we proposed a SPICE-compatible model for p-type (Aluminium) uniformly doped silicene FET for digital switching applications. The performance of the proposed device is benchmarked with various low-dimensional FETs in terms of their on-to-off current ratio, subthreshold swing and drain-induced barrier lowering. The results show that the proposed p-type silicene FET is comparable to most of the selected low-dimensional FET models. With its decent performance, the proposed SPICE-compatible model should be extended to the circuit-level simulation and beyond in future work.
Innovation workshop using design thinking framework and involving stakeholders to co-create ideas for management of asthma

Leow MQH, Moosa AS, Salim H, Abdullah A, Lee YK, Ng CJ, et al.

NPJ Prim Care Respir Med, 2023 Nov 04;33(1):36.
PMID: 37925475 DOI: 10.1038/s41533-023-00357-4
Surgical Management of Cervical Ossification of Posterior Longitudinal Ligament: The Treatment Algorithm and Outcome

Ng BW, Tan JA, Sabri S, Baharuddin A, Muhamad Ariffin MH

Cureus, 2023 Mar;15(3):e36517.
PMID: 37090402 DOI: 10.7759/cureus.36517

Introduction Managing patients who present with symptoms of cervical myelopathy secondary to cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. Various factors such as the number of levels involved with OPLL, types of OPLL, canal occupying ratio, K-line characteristics, and C2-C7 lordosis angle were found to guide decision-making and surgical approaches in managing this condition. However, no clear treatment algorithm has been published. This study aims to investigate the outcome of the management of cervical OPLL using a treatment algorithm used in a tertiary university hospital. Methods This is a retrospective cross-sectional study. Patients with cervical myelopathy secondary to cervical OPLL who were treated surgically in our center from 2014 to 2020 were included in this study. Demographic data and preoperative parameters that determined the treatment given according to our treatment algorithm were analyzed. Result A total of 24 patients fit the inclusion and exclusion criteria of the study. The mean recovery rate for all groups is 61.8[Formula: see text]21.9% and the mean postoperative neck disability index (NDI) is 17.83[Formula: see text]16.67%. There was a statistically significant difference between preoperative and postoperative Japanese Orthopaedic Association (JOA) scores for both anterior and posterior surgery subgroups. Conclusion We believe that the treatment algorithm used in our center could benefit other surgeons as a guide in managing patients who suffer from cervical myelopathy secondary to cervical OPLL. Further study including newer techniques would increase the surgeon's arsenal in providing the best outcome in managing this condition.
Fulltext Factorial structure, reliability, and construct validity of the Generalized Anxiety Disorder 7-item (GAD-7): Evidence from Malaysia

Pheh KS, Tan CS, Lee KW, Tay KW, Ong HT, Yap SF

PLoS One, 2023;18(5):e0285435.
PMID: 37167230 DOI: 10.1371/journal.pone.0285435

Generalized anxiety disorder (GAD) is one of the most common mental disorders in Malaysia. Psychometrically sound measurements are urgently needed to assess anxiety symptoms. The extensively used Generalized Anxiety Disorder 7-item (GAD-7) is a promising candidate. However, studies on its factorial validity show mixed findings. While the one-factor solution has been replicated in different cultural contexts, some studies found different factorial structures instead. This study aimed to clarify the factorial validity of the English version of the GAD-7 in the Malaysian context. The responses collected from 1272 emerging to older adults in Malaysia were randomly divided into two halves and submitted to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) respectively. Four acceptable models were explored in EFA ranging from unidimensional factor with 7 items to 3-factor models with 6 items. The four models revealed in EFA and the other competing models found in past studies were then examined and compared using CFA. The 6-item second-order model with a general factor of anxiety and three first-order factors with two items respectively (i.e., GAD-6) showed a more harmonic result and hence, is preferable. Moreover, the GAD-6 and its three subscales also showed satisfactory internal consistency and construct validity. This study uncovers a new and unique factorial structure of the GAD screening tool that fits in the Malaysian context. The scale may reveal GAD symptomatic dimensions that guide clinical interventions.
Preoperative assessment of blood supply and its role in predicting anastomotic leak

Khan SM, Wells C, Christou N, Tan CY, Mathur P, El-Hussuna A

Surgery, 2023 Jul;174(1):46-51.
PMID: 37156647 DOI: 10.1016/j.surg.2023.04.001

BACKGROUND: Anastomosis leak is one of the significant postoperative complications after colorectal surgery. The aim of this systematic review was to synthesize the evidence relative to the preoperative assessment of the colon and rectum blood supply and to investigate its role in predicting anastomosis leak.
METHOD: This systematic review was conducted according to the recommendations of the Cochrane Handbook for Reviews of Interventions and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Embase, and the Cochrane Library were searched to identify eligible studies. The main outcome variable was the preoperative assessment of patterns of blood supply to the colon and the impact of these patterns on anastomosis leak. The quality of bias control in the studies was assessed using the Newcastle-Ottawa Scale. Due to the heterogeneous nature of the included studies, no meta-analysis was conducted.
RESULTS: Fourteen studies were included. The study covered a period from 1978 to 2021. A significant degree of variation in the arterial and/or venous supply of the colon and rectum might influence anastomosis leak rates. Calcification in great blood vessels can be assessed with a preoperative computed tomography scan, which may predict anastomosis leak rates. This is supported by many experimental studies that showed increased rates of anastomosis leak after preoperative ischemia, but the extent of this impact is not well established.
CONCLUSION: Preoperative assessment of blood supply to the colon and rectum might help in planning the surgical intervention to reduce anastomosis leak rates. Calcium scoring of major arteries might predict anastomosis leak and thus play a crucial role in intraoperative decision-making.
Metabolites characterisation of endophytic Phyllosticta fallopiae L67 isolated from Aloe vera with antimicrobial activity on diabetic wound microorganisms

Taher MA, Tan WN, Chear NJ, Leong CR, Rashid SA, Tong WY

Nat Prod Res, 2023 May;37(10):1674-1679.
PMID: 35879820 DOI: 10.1080/14786419.2022.2103127

This study aimed to assess the antimicrobial activity of endophytic Phyllosticta fallopiae L67 isolated from Aloe vera against diabetic wound microorganisms and characterise their active fraction for biologically important metabolites. The dichloromethane (DCM) extract exhibited the most significant activity with inhibition zones ranging from 11.33 to 38.33 mm. The minimal inhibitory and lethality concentrations of DCM extract ranged from 78.13 to 2500.00 µg/ml and 625.00 to 5000.00 µg/ml, respectively. The extract showed teratogenicity and lethality in the zebrafish model, where peritoneal and hepatic oedema occurred at 62.50 µg/ml, and no abnormality appeared at 31.25 µg/ml. The extract also inhibited more than 82% biofilm formation. Bioassay-guided fractionation on DCM extract yielded 18 fractions and the most active fraction was subjected to UPLC-QTOF-MS/MS analysis. Flavones, stilbenes, flavanonols, isoflavonoids, phenolic glycosides and phenol derivatives were detected. In conclusion, endophytic P. fallopiae possessed bioactive metabolites with significant antimicrobial activity against diabetic wound microorganisms.
Fulltext Impact of multicomponent integrated care on mortality and hospitalization after acute coronary syndrome: a systematic review and meta-analysis

Hoo JX, Yang YF, Tan JY, Yang J, Yang A, Lim LL

Eur Heart J Qual Care Clin Outcomes, 2023 Apr 26;9(3):258-267.
PMID: 35687013 DOI: 10.1093/ehjqcco/qcac032

AIMS: Multicomponent integrated care is associated with sustained control of multiple cardiometabolic risk factors among patients with type 2 diabetes. There is a lack of data in patients with acute coronary syndrome (ACS). We aimed to examine its efficacy on mortality and hospitalization outcomes among patients with ACS in outpatient settings.
METHODS AND RESULTS: A literature search was conducted on PubMed, EMBASE, Ovid, and Cochrane library databases for randomized controlled trials, published in English language between January 1980 and November 2020. Multicomponent integrated care defined as two or more quality improvement strategies targeting different domains (the healthcare system, healthcare providers, and patients) for one month or more. The study outcomes were all-cause and cardiovascular-related mortality, hospitalization, and emergency department visits. We pooled the risk ratio (RR) with 95% confidence interval (CI) for the association between multicomponent integrated care and study outcomes using the Mantel-Haenszel test. 74 trials (n = 93 278 patients with ACS) were eligible. The most common quality improvement strategies were team change (83.8%), patient education (62.2%), and facilitated patient-provider relay (54.1%). Compared with usual care, multicomponent integrated care was associated with reduced risks for all-cause mortality (RR 0.83, 95% CI 0.77-0.90; P
Real-time imaging as visual biofeedback in active second stage of labor among nulliparas: a randomized controlled trial

Hamid NA, Hong JGS, Hamdan M, Vallikkannu N, Adlan AS, Tan PC

Am J Obstet Gynecol, 2023 Oct;229(4):443.e1-443.e9.
PMID: 37207931 DOI: 10.1016/j.ajog.2023.04.049

BACKGROUND: A prolonged second stage of labor increases the risk of severe perineal laceration, postpartum hemorrhage, operative delivery, and poor Apgar score. The second stage is longer in nulliparas. Maternal pushing during the second stage of labor is an important contributor to the involuntary expulsive force developed by uterine contraction to deliver the fetus. Preliminary data indicate that visual biofeedback during the active second stage hastens birth.
OBJECTIVE: This study aimed to evaluate if visual feedback focusing on the perineum reduced the length of the active second stage of labor in comparison with the control.
STUDY DESIGN: A randomized controlled trial was conducted in the University Malaya Medical Centre from December 2021 to August 2022. Nulliparous women about to commence the active second stage, at term, with singleton gestation, reassuring fetal status, and no contraindication for vaginal delivery were randomized to live viewing of the maternal introitus (intervention) or maternal face (sham/placebo control) as visual biofeedback during their pushing. A video camera Bluetooth-linked to a tablet computer display screen was used; in the intervention arm, the camera was focused on the introitus, and in the control arm, on the maternal face. Participants were instructed to watch the display screen during their pushing. The primary outcomes were the intervention-to-delivery interval and maternal satisfaction with the pushing experience assessed using a 0-to-10 visual numerical rating scale. Secondary outcomes included mode of delivery, perineal injury, delivery blood loss, birthweight, umbilical cord arterial blood pH and base excess at birth, Apgar score at 1 and 5 minutes, and neonatal intensive care unit admission. Data were analyzed with the t test, Mann-Whitney U test, chi-square test, and Fisher exact test, as appropriate.
RESULTS: A total of 230 women were randomized (115 to intervention and 115 to control arm). The active second stage duration (intervention-to-delivery interval) was a median (interquartile range) of 16 (11-23) and 17 (12-31) minutes (P=.289), and maternal satisfaction with the pushing experience was 9 (8-10) and 7 (6-7) (P
Fulltext Biocomputational Identification of sRNAs in Leptospira interrogans Serovar Lai

Tan XY, Citartan M, Chinni SV, Ahmed SA, Tang TH

Indian J Microbiol, 2023 Mar;63(1):33-41.
PMID: 37188232 DOI: 10.1007/s12088-022-01050-9

Regulatory small RNAs (sRNA) are RNA transcripts that are not translated into proteins but act as functional RNAs. Pathogenic Leptospira cause an epidemic spirochaetal zoonosis, Leptospirosis. It is speculated that Leptospiral sRNAs are involved in orchestrating their pathogenicity. In this study, biocomputational approach was adopted to identify Leptospiral sRNAs. In this study, two sRNA prediction programs, i.e., RNAz and nocoRNAc, were employed to screen the reference genome of Leptospira interrogans serovar Lai. Out of 126 predicted sRNAs, there are 96 cis-antisense sRNAs, 28 trans-encoded sRNAs and 2 sRNAs that partially overlap with protein-coding genes in a sense orientation. To determine whether these candidates are expressed in the pathogen, they were compared with the coverage files generated from our RNA-seq datasets. It was found out that 7 predicted sRNAs are expressed in mid-log phase, stationary phase, serum stress, temperature stress and iron stress while 2 sRNAs are expressed in mid-log phase, stationary phase, serum stress, and temperature stress. Besides, their expressions were also confirmed experimentally via RT-PCR. These experimentally validated candidates were also subjected to mRNA target prediction using TargetRNA2. Taken together, our study demonstrated that biocomputational strategy can serve as an alternative or as a complementary strategy to the laborious and expensive deep sequencing methods not only to uncover putative sRNAs but also to predict their targets in bacteria. In fact, this is the first study that integrates computational approach to predict putative sRNAs in L. interrogans serovar Lai.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12088-022-01050-9.
Effects of R-salbutamol on the inflammatory response and acute lung injury in endotoxemic mice

Beng H, Hu J, Wang S, Liang X, Qin H, Tan W

Int Immunopharmacol, 2023 Aug;121:110482.
PMID: 37364330 DOI: 10.1016/j.intimp.2023.110482

Salbutamol, which consists of an R-isomer and S-isomer, is an effective and widely used β2 adrenoreceptor agonist that may possess anti-inflammatory properties in addition to its bronchodilator activity. Whether the salbutamol R-isomer has advantages over its racemic mixture and effectiveness in treating endotoxemia and endotoxin-induced lung injury has not been well studied. In this study, we investigated the preventive and therapeutic effects of R-salbutamol (R-sal), S-salbutamol (S-sal), and their racemic mixture (Rac-sal) on a mouse model of lipopolysaccharide (LPS)-induced endotoxemia. Dexamethasone (Dex) was used for comparison. The results showed that R-sal markedly improved the 7-day survival rate of endotoxic mice when administered before and after LPS treatment. Dex was toxic and accelerated the death of endotoxic mice when administered before LPS injection. Histological examination of the lungs revealed that the LPS challenge resulted in acute lung damage, including inflammatory cell infiltration, thickened alveolar septa, and congestion. R-sal pre-treatment effectively inhibited these changes, accompanied by markedly reduced lung myeloperoxidase levels, serum cytokine levels, and lactate release, significant restoration of lymphocyte count, and reduction of monocyte count. This may have occurred through inhibition of M1 macrophage inflammatory responses by enhancement of β-arrestin2 expression and suppression of NF-κB activation. Rac-sal exhibited diminished effects compared to that of R-sal, while S-sal showed enhanced release of some inflammatory cytokines. In addition, R-sal pre-treatment showed a better improvement in prognostic pulmonary function on day 4 compared to that by Rac-sal. Collectively, our results indicate the potential benefits of R-sal in regulating inflammatory responses to endotoxemia and endotoxin-induced lung injury.
Fulltext Kratom use disorder and unfolded protein response: Evaluating their relationship in a case control study

Yang B, Tan ML, Zhang R, Singh D, Leong Bin Abdullah MFI

PLoS One, 2023;18(6):e0287466.
PMID: 37352311 DOI: 10.1371/journal.pone.0287466

BACKGROUND AND AIMS: Kratom (Mitragyna speciosa Korth.) is widely use worldwide despite its addictive potential. Although psychostimulant use has been linked to occurrence of endoplasmic reticulum (ER) stress, data is lacking on how regular kratom use affects ER stress. This case-control study first determined differences in ER stress sensor protein expression (BiP, sXBP1, ATF4, CHOP, JNK, and p-JNK) between regular kratom users and healthy controls. Second, it evaluated the association between kratom use characteristics, targeted ER stress sensor protein expression, and "kratom use disorder" diagnosed with Diagnostic and Statistical Manual for Mental Disorders 5th Edition (DSM-5) among regular kratom users.
METHODS: In total, 60 regular kratom users and 50 healthy control-group participants were recruited and administered a sociodemographic and clinical characteristics questionnaire. While participants who used kratom were also administered a kratom use characteristics questionnaire. Blood samples were collected from all participants, and targeted ER stress sensor protein expression was determined via Western blot analysis.
RESULTS: The study's findings revealed first that kratom users registered significantly higher protein expression in all targeted ER stress sensors compared to the control group. Second, higher protein expression of CHOP (B = 5.061, standard error [SE] = 2.547, Wald = 3.948, adjusted odds ratio [AOR] = 5.382, 95% confidence interval [CI] = 1.071 to 9.656, p = 0.047) and p-JNK (B = 5.795, SE = 2.635, Wald = 4.544, AOR = 17.025, 95% CI = 1.395 to 24.123, p = 0.017) increased the odds of kratom use disorder occurrence. Kratom use characteristics and other ER stress sensor protein expression were not associated with kratom use disorder.
CONCLUSION: Regular kratom use may induce protracted ER stress, leading to the decompensation of the unfolded protein response to maintain ER homeostasis. This effect may be linked to kratom use disorder occurrence.
Immediate vs on-demand maternal oral full feeding after unplanned cesarean section during labor: a randomized controlled trial

Asmary A, Nurulhuda AS, Hong JGS, Gan F, Adlan AS, Hamdan M, et al.

Am J Obstet Gynecol MFM, 2023 Aug;5(8):101031.
PMID: 37244640 DOI: 10.1016/j.ajogmf.2023.101031

BACKGROUND: The adoption of Enhanced Recovery After Cesarean is increasing, but evidence supporting individual interventions having a specific benefit to Enhanced Recovery After Cesarean is lacking. A key element in Enhanced Recovery After Cesarean is early oral intake. Maternal complications are more frequent in unplanned cesarean delivery. In planned cesarean delivery, immediate full feeding enhances recovery, but the effect of unplanned cesarean delivery during labor is not known.
OBJECTIVE: This study aimed to evaluate immediate oral full feeding vs on-demand oral full feeding after unplanned cesarean delivery in labor on vomiting and maternal satisfaction.
STUDY DESIGN: A randomized controlled trial was conducted in a university hospital. The first participant was enrolled on October 20, 2021, the last participant was enrolled on January 14, 2023, and follow-up was completed on January 16, 2023. Women were assessed for full eligibility on arrival at the postnatal ward after their unplanned cesarean delivery. The primary outcomes were vomiting in the first 24 hours (noninferiority hypothesis and 5% noninferiority margin) and maternal satisfaction with their feeding regimen (superiority hypothesis). The secondary outcomes were time to first feed; food and beverage quantum consumed at first feed; nausea, vomiting, and bloating at 30 minutes after first feed, at 8, 16, and 24 hours after the operation, and at hospital discharge; parenteral antiemetic and opiate analgesia use; first breastfeeding and satisfactory breastfeeding, bowel sound, and flatus; second meal; cessation of intravenous fluid; removal of a urinary catheter; urination; ambulation; vomiting during the rest of hospital stay; and serious maternal complications. Data were analyzed using the t test, Mann-Whitney U test, chi-square test, Fisher exact test, and repeated measures analysis of variance as appropriate.
RESULTS: Overall, 501 participants were randomized into immediate or on-demand oral full feeding (sandwich and beverage). Vomiting in the first 24 hours were reported by 5 of 248 participants (2.0%) in the immediate feeding group and 3 of 249 participants (1.2%) in the on-demand feeding group (relative risk, 1.7; 95% confidence interval, 0.4-6.9 [0.48%-8.28%]; P=.50), and the maternal satisfaction scores from 0 to 10 were 8 (6-9) for the immediate feeding group and 8 (6-9) for the on-demand feeding groups (P=.97). The times from cesarean delivery to the first meal were 1.9 hours (1.4-2.7) vs 4.3 hours (2.8-5.6) (P
Fulltext A Rare Occurrence of Opportunistic Infection by Streptococcus mitis Due to Antibiotic-Induced Neutropenia in Prosthetic Joint Infection

Tan EK, Ahmad Hanif KA, Jebasingam Issace SJ, Che-Hamzah F

Cureus, 2023 Feb;15(2):e35583.
PMID: 37007355 DOI: 10.7759/cureus.35583

Prosthetic joint infection (PJI) is a devastating complication in arthroplasty surgery. Although the prevalence is less than 2%, its functional and financial implications are significant. Part of its treatment involves the usage of prolonged and high-dose systemic antibiotics. Ironically, this predisposes the patient to unwanted adverse effects caused by the drugs. We report a case of cefazolin-induced neutropenia that led to Streptococcus mitis (S. mitis) bacteraemia in a patient with Staphylococcus aureus PJI. There have been no previous reports on cefazolin-induced neutropenic bacteraemia complicating the treatment of PJI. This case report aims to create awareness among the attending physicians on the possibility of cefazolin-induced neutropenia, which led to bacteraemia from an opportunistic microorganism. The reversal was as simple as cessation of the antibiotic itself. However, if not recognized, it could be fatal.
Fulltext Critical Inhaler Administration Errors of Patients on Pressurized Meter Dose Inhaler (pMDI): A Hospital-Based Cross-Sectional Study in Malaysia

Rajah R, Tang YW, Ho SC, Tan JL, Mat Said MS, Ooi LH

Hosp Pharm, 2022 Apr;57(2):217-222.
PMID: 35601709 DOI: 10.1177/00185787211010164

Background: Inhaler technique errors can affect the disease outcome through reduced deposition of medication in the lungs with certain errors were more likely to deter the optimum drug from reaching the lung. The objective of this study was to evaluate the pressurized metered-dose inhaler (pMDI) critical technique errors among asthma and COPD patients, and to investigate the predictors of those errors. Methods: A cross-sectional, observational, and multi-centered study conducted in 3 major hospitals in the state of Penang, Malaysia. Asthma and COPD patients aged 18 years or older consented to the study were consecutively recruited if they were at least on 1 pMDI without mouthpiece spacer or facemask space. Direct observation of the patient's technique was recorded using a standard checklist and certain steps in the checklist were pre-determined as critical steps. The number of patients missed or incorrectly performed the steps including the critical steps were documented. Using logistic regression, the factors associated with the critical errors were determined, and the correlation was evaluated between age and pMDI knowledge score with critical inhalation steps score. Results: Of 209 patients observed, only less than half (40.7%) could perform all the critical pMDI steps correctly. Low education level was the only factor associated with critical inhaler errors. The increased knowledge of their inhaled medication was found to positively correlate with the correct critical inhalation steps. The critical errors also increase with the increased age of patients. Conclusion: The majority of the study population make inhalation error particularly in critical steps. Training and education intervention programs may help patients with lower education level, as well as those of advanced age and lack of knowledge of their inhaled medication because those populations are at a greater risk of committing critical errors in their use of pMDI.
Prospects of microalgae in nutraceuticals production with nanotechnology applications

Tan KY, Low SS, Manickam S, Ma Z, Banat F, Munawaroh HSH, et al.

Food Res Int, 2023 Jul;169:112870.
PMID: 37254319 DOI: 10.1016/j.foodres.2023.112870

Nutraceutical supplements provide health benefits, such as fulfilling the lack of nutrients in the human body or being utilized to treat or cure certain diseases. As the world population is growing, certain countries are experiencing food crisis challenges, causing natural foods are not sustainable to be used for nutraceutical production because it will require large-scale of food supply to produce enriched nutraceutics. The high demand for abundant nutritional compounds has made microalgae a reliable source as they can synthesize high-value molecules through photosynthetic activities. However, some microalgae species are limited in growth and unable to accumulate a significant amount of biomass due to several factors related to environmental conditions. Therefore, adding nanoparticles (NPs) as a photocatalyst is considered to enhance the yield rate of microalgae in an energy-saving and economical way. This review focuses on the composition of microalgal biomass for nutraceutical production, the health perspectives of nutritional compounds on humans, and the application of nanotechnology on microalgae for improved production and harvesting. The results obtained show that microalgal-based compounds indeed have better nutrients content than natural foods. However, nanotechnology must be further comprehended to make them non-hazardous and sustainable.
Fulltext Gastrointestinal Dysfunction in Parkinson's Disease: Neuro-Gastroenterology Perspectives on a Multifaceted Problem

Tan AH, Chuah KH, Beh YY, Schee JP, Mahadeva S, Lim SY

J Mov Disord, 2023 May;16(2):138-151.
PMID: 37258277 DOI: 10.14802/jmd.22220

Patients with Parkinson's disease (PD) face a multitude of gastrointestinal (GI) symptoms, including nausea, bloating, reduced bowel movements, and difficulties with defecation. These symptoms are common and may accumulate during the course of PD but are often under-recognized and challenging to manage. Objective testing can be burdensome to patients and does not correlate well with symptoms. Effective treatment options are limited. Evidence is often based on studies in the general population, and specific evidence in PD is scarce. Upper GI dysfunction may also interfere with the pharmacological treatment of PD motor symptoms, which poses significant management challenges. Several new less invasive assessment tools and novel treatment options have emerged in recent years. The current review provides an overview and a practical approach to recognizing and diagnosing common upper and lower GI problems in PD, e.g., dyspepsia, gastroparesis, small bowel dysfunction, chronic constipation, and defecatory dysfunction. Management aspects are discussed based on the latest evidence from the PD and general populations, with insights for future research pertaining to GI dysfunction in PD.

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