Methods: A completed clinical audit cycle was conducted in 2018 in the busy emergency department of a public hospital in Malaysia. Pre- and post-intervention antibiotic prescription data were collected, and changes were implemented through a multifaceted intervention similar to Thailand's Antibiotics Smart Use programme.
Results: Data from a total of 1,334 pre-intervention and 1,196 post-intervention patients were collected from the hospital's electronic medical records. The mean (SD) age of participants was 19.88 (17.994) years. The pre-intervention antibiotic prescription rate was 11.2% for acute diarrhoea and 29.1% for acute URI, both of which are above the average national rates. These antibiotic prescription rates significantly reduced post-intervention to 6.2% and 13.7%, respectively, falling below national averages. Antibiotic prescription rate was highest for young children. There were no significant changes in rates of re-attendance or hospital admission following the intervention.
Conclusion: The multifaceted intervention, which included continuing medical education, physician reminders and patient awareness, was effective in improving the antibiotic prescription rates for these two conditions.
METHODS: Three object detection networks of DL algorithms, namely SSD-MobileNetV2, EfficientDet, and YOLOv4, were developed to automatically detect Escherichia coli (E. coli) bacteria from microscopic images. The multi-task DL framework is developed to classify the bacteria according to their respective growth stages, which include rod-shaped cells, dividing cells, and microcolonies. Data preprocessing steps were carried out before training the object detection models, including image augmentation, image annotation, and data splitting. The performance of the DL techniques is evaluated using the quantitative assessment method based on mean average precision (mAP), precision, recall, and F1-score. The performance metrics of the models were compared and analysed. The best DL model was then selected to perform multi-task object detections in identifying rod-shaped cells, dividing cells, and microcolonies.
RESULTS: The output of the test images generated from the three proposed DL models displayed high detection accuracy, with YOLOv4 achieving the highest confidence score range of detection and being able to create different coloured bounding boxes for different growth stages of E. coli bacteria. In terms of statistical analysis, among the three proposed models, YOLOv4 demonstrates superior performance, achieving the highest mAP of 98% with the highest precision, recall, and F1-score of 86%, 97%, and 91%, respectively.
CONCLUSIONS: This study has demonstrated the effectiveness, potential, and applicability of DL approaches in multi-task bacterial image analysis, focusing on automating the detection and classification of bacteria from microscopic images. The proposed models can output images with bounding boxes surrounding each detected E. coli bacteria, labelled with their growth stage and confidence level of detection. All proposed object detection models have achieved promising results, with YOLOv4 outperforming the other models.
METHODS: We investigated the anti-proliferative efficacy of polar leaf extracts (LP), non-polar leaf extracts (LN), polar stem extract (SP) and non-polar stem extracts (SN) in human breast, colorectal, lung, endometrial, nasopharyngeal, and pancreatic cancer cells using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, MTT assay. The most potent extracts was tested along with gemcitabine using our established drug combination analysis. The effect of the combinatory treatment in apoptosis were quantified using enzyme-linked immunosorbent assay (ELISA), Annexin V assay, antibody array and immunoblotting. Statistical significance was analysed using one-way analysis of variance (ANOVA) and post hoc Dunnett's test. A p-value of less than 0.05 (p
CASES: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy.
DISCUSSION: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.