Prevalence of AmpC beta-lactamase and extended spectrum beta-lactamase co-producer in Escherichia coli and Klebsiella species in a teaching hospital.

INTRODUCTION: Beta-lactamase producing bacterial infection has been on surge due to selection pressure and injudicious antibiotics usage. Organisms that co-produced more than one beta lactamase enzyme posed diagnostic challenges which may result in inadequate treatment. To date, there is no standardised guideline offering phenotypic detection of AmpC ß-lactamase. The purpose of this study was to determine the prevalence of ESBLs, AmpC ß-lactamase and co-producer organisms in a teaching hospital. MATERIALS AND METHODS: Three hundred and four isolates of E. coli and Klebsiella sp. had been selected via convenient sampling. These isolates were identified using conventional laboratory methods and their antimicrobial susceptibilities were determined using disc diffusion method. Those isolates were then proceeded with ESBL confirmatory test, cloxacillin-containing Muller Hinton confirmatory test, modified double disk synergy test and AmpC disk test. RESULTS: Out of 304 isolates, 159 isolates were E. coli and 145 were Klebsiella sp. The prevalence of organisms which co-produced AmpC ß-lactamase and ESBL enzymes were 3.0%. Besides that, 39 cefoxitin resistant and three cefoxitin susceptible isolates (13.8%) were proven to produce AmpC ß-lactamase through AmpC disk test. Through the CLSI confirmatory test, 252 (82.9%) isolates were identified as ESBLs producers and the prevalence increased slightly when cloxacillin-containing Muller Hinton were used. Only three ESBLs positive organisms were positive for modified double disk synergy test. CONCLUSION: Distinguishing between AmpC ß-lactamase and ESBL-producing organisms has epidemiological significance as well as therapeutic importance. Moreover, AmpC ß-lactamase and ESBLs co-producing organisms can lead to false negative ESBL confirmatory test. Therefore, knowing the local prevalence can guide the clinician in navigating the treatment.

CTAD Task Force Paper: Neuropsychiatric Symptoms in AD: Clinical Trials Targeting Mild Behavioral Impairment: A Report from the International CTAD Task Force.

The International CTAD Task Force (TF) addressed challenges related to designing clinical trials for agitation in dementia, presenting accomplishments from the two previous TFs on neuropsychiatric symptoms (NPS). In addition, this TF proposed a paradigm shift in NPS assessment and management, presenting Mild Behavioral Impairment (MBI) as a clinical syndrome. MBI is marked by later-life emergent and persistent NPS in dementia-free older persons (ranging from cognitively unimpaired to subjective cognitive decline to mild cognitive impairment), which facilitates earlier detection and better prognostication of Alzheimer's disease (AD). The TF has made the following recommendations for incorporation of NPS into AD preventative trials: (1) clinical trials targeting improvement in MBI symptoms should be undertaken; (2) treatment trials for MBI should be disease specific and confirm the diagnosis of participants using biomarkers; trials should include measures sensitive to cognitive changes in preclinical AD, which can serve as outcome measures, in addition to changes in biomarker levels; (3) as a first step, pharmacotherapeutic trials should address the full MBI complex as well as the specific symptoms/domains that constitute MBI; (4) clinical trials using problem-adaptation psychotherapy to target affective MBI should be considered; and (5) MBI should be considered in AD trials of disease modifying therapies. The well-validated and widely-used MBI Checklist (MBI-C) is an appropriate symptom rating scale for these studies, as it was developed specifically to identify and measure MBI in dementia-free persons. Other scales such as the Neuropsychiatric Inventory (NPI) may be used, although administration at two timepoints may be necessary to operationalize the MBI criterion of symptom persistence.

Recent Improvements in Adult Wilms Tumor Diagnosis and Management: Review of Literature.

Wilms tumor, also denoted as nephroblastoma, an embryonal type of renal cancer, is the most common cancer that affects children in the first 5 years of life. Wilms tumor is very rarely seen in adults. Both adults and children showcase varied clinical symptoms. The metastasis of tumor in both adults and children are not uncommon. Though histological differences between children and adults are insignificant, the prognosis of adult Wilms tumors compared to children is abysmal. Despite remarkable advancements in oncology, no standard treatment protocol exists for Wilms tumor in adults. Children Wilms tumor treatment protocol is currently followed for adults with some changes. In this article, we reviewed the available treatment options for Wilms tumor in adults and protocols followed widely.

Viewpoint: Clinicians' Perspectives on How Disease Modifying Drugs for Alzheimer's Disease Impact Specialty Care.

Clinicians specialized in the diagnosis and management of persons living with early-stage Alzheimer's disease need to enable access, for those meeting criteria, to the new class of disease modifying drugs (DMDs). These drugs act on amyloid ß42 and delay progression of symptoms. Thus, there will be interest from patients and families. Over the short term, the use of antibodies administered intravenously with serial MRIs to detect amyloid-related imaging abnormalities (ARIA) may require participation in structured phase 4 studies or in registries with third party funding for support staff and MRI scans. In the mid term, the availability of oral anti-amyloid therapy, likely with lower risk of ARIA, may transform clinical practice to a model of screening suitable patients using plasma biomarkers, with a subsequent rapid referral to a specialized memory clinic. Eventually, the biological profile of patients for amyloid, tau, and inflammation will determine which type of DMD to use. We are optimistic that clinicians will gain confidence with the use DMDs and answer the increasing needs of our aging population.

High linoleic waste sunflower oil: A distinctive recycled source of self-healing agent for smart metal coatings.

High Linoleic Waste Sunflower Oil (HLWSO) is a new self-healing agent viable to be encapsulated. Meanwhile, the unique mechanism behind the synthesis of microcapsules is deeply illustrated; the emulsification process of HLWSO by anionic surfactant and microencapsulation of HLWSO. In addition, the application of microencapsulated HLWSO in the coating matrix by the layering method is presented followed by a detailed explanation of the self-healing mechanism of a smart coating incorporating the polymerization mechanism of HLWSO developed by the diene structure. Microencapsulation of high linoleic waste sunflower oil (HLWSO) is a wall formation process in which urea-formaldehyde (UF) is attached with emulsified HLWSO to form a microcapsule. In this study, the HLWSO from recycled cooking oil is uniquely bonded with a diene structure, thus possessing the ability to dry fast and be encapsulated via the in-situ polymerization method. The microencapsulated HLWSO was characterized using Field Emission Scanning Electron Microscopy (FESEM) and Fourier Transformation Infra-Red Spectroscopy (FTIR). The optimum microcapsules synthesized from HLWSO resulted in a smooth shell structure with 2.88 µm diameter microcapsules at 0.31 µm shell thickness and 66% core content. It was demonstrated that increased stirring speed decreases the size, shell thickness, and core content of the microcapsules. The FTIR results indicated that HLWSO as a core, while urea-formaldehyde acted as a shell of microcapsules. The scratch on the coating matrix embedded with HLWSO was healed after five days. The corrosion rate of optimum sample was 0.0574 mm/year, with an optimum reduction of 58% from the reference sample. This study revealed that the HLWSO from recycled sources is a viable self-healing agent to be microencapsulated. The smart coating embedded with HLWSO also displayed self-healing performance, reduced corrosion rate and beneficial for the advancement of corrosion control technology.

Cognitive profile of people with mild behavioral impairment in Brain Health Registry participants.

OBJECTIVES: Dementia assessment includes cognitive and behavioral testing with informant verification. Conventional testing is resource-intensive, with uneven access. Online unsupervised assessments could reduce barriers to risk assessment. The aim of this study was to assess the relationship between informant-rated behavioral changes and participant-completed neuropsychological test performance in older adults, both measured remotely via an online unsupervised platform, the Brain Health Registry (BHR). DESIGN: Observational cohort study. SETTING: Community-dwelling older adults participating in the online BHR. Informant reports were obtained using the BHR Study Partner Portal. PARTICIPANTS: The final sample included 499 participant-informant dyads. MEASUREMENTS: Participants completed online unsupervised neuropsychological assessment including Forward Memory Span, Reverse Memory Span, Trail Making B, and Go/No-Go tests. Informants completed the Mild Behavioral Impairment Checklist (MBI-C) via the BHR Study Partner portal. Cognitive performance was evaluated in MBI+/- individuals, as was the association between cognitive scores and MBI symptom severity. RESULTS: Mean age of the 499 participants was 67, of which 308/499 were females (61%). MBI + status was associated with significantly lower memory and executive function test scores, measured using Forward and Reverse Memory Span, Trail Making Errors and Trail Making Speed. Further, significant associations were found between poorer objectively measured cognitive performance, in the domains of memory and executive function, and MBI symptom severity. CONCLUSION: These findings support the feasibility of remote, informant-reported behavioral assessment utilizing the MBI-C, supporting its validity by demonstrating a relationship to online unsupervised neuropsychological test performance, using a previously validated platform capable of assessing early dementia risk markers.

Effects of Zinc Oxide Nanoparticle Supplementation on Performance, Digestibility, and Blood Biochemistry of Californian Male Rabbits Under Hot Climatic Conditions.

This study aims to investigate the effects of nanoparticles of zinc oxide (Nano-ZnO) supplementation on productive performance, nutrient digestibility, mineral retention, and blood biochemistry of Californian male rabbits under hot climatic conditions. A total of 100 Californian male rabbits 90 days of age (BW: 1790 ± 13 g) were randomly assigned to one of five treatment diets: Nano-ZnO at 0, 25, 50, 75, or 100 mg/kg, respectively, for 90 days. The rabbits were raised in an open house system (average ambient temperature of 39 °C, relative humidity of 30-35%, and temperature-humidity index of 33.6-34.0). Each treatment had 20 rabbits, and each rabbit was considered as a replicate. During the entire study period, there were no significant differences (P > 0.05) in BW, BW gain, feed intake, or feed conversion ratio between the treatment groups. Nano-ZnO supplementation at 25, 50, 75, and 100 mg/kg enhanced the digestibility coefficient of crude protein (CP) and ether extract (EE) considerably (quadratically, P < 0.05) when compared to the control group. In addition, when Nano-ZnO was supplemented at 25, 50, 75, and 100 mg/kg, serum levels of creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were considerably lower than the non-supplemented control group. Furthermore, when comparing the control and Nano-ZnO-fed rabbits, serum testosterone concentrations increased significantly (P < 0.05) in the treated groups. In addition, compared to the other groups, the 50 mg/kg Nano-ZnO group had the highest cecal Lactobacilli spp. count. These findings suggest that supplementing Californian male rabbits with 50 mg/kg dietary Nano-ZnO enhanced CP and EE digestibility, cecal Lactobacilli spp., as well as serum testosterone levels, and decreased serum ALT and AST levels under hot climatic conditions.

Sociodemographic Factors of Depression During the COVID-19 Pandemic in Malaysia: the COVID-19 Mental Health International Study.

OBJECTIVES: To determine the prevalence of depression and the sociodemographic factors associated with depression in Malaysia during the COVID-19 pandemic METHODS. This study is part of the COVID-19 Mental Health International Study to collect data on the impact of the pandemic on mental health through an online survey. People who were aged ≥18 years, able to read Malay or English, had access to the internet, and consented to participate were asked to complete a pro forma questionnaire to collect their sociodemographic data. The presence of distress and depression was assessed using the English or Malay version of the Center for Epidemiologic Studies Depression Scale. RESULTS: Of 963 participants, 451 (46.8%) had depression and 512 (53.2%) had no depression who were either normal (n = 169, 17.5%) or had distress (n = 343, 35.6%). Participants had higher odds of having depression when living with two people (adjusted odds ratio [AOR] = 3.896, p = 0.001), three people (AOR = 2.622, p < 0.001) or four people (AOR = 3.135, p < 0.001). Participants with three children had higher odds of having depression (AOR = 2.084, p = 0.008), whereas having only one child was a protective factor for depression (AOR = 0.481, p = 0.01). Participants had higher odds of having depression when self-employed (AOR = 3.825, p = 0.003), retired (AOR = 4.526, p = 0.001), being housekeeper (AOR = 7.478, p = 0.004), not working by choice (AOR = 5.511, p < 0.001), or unemployed (AOR = 3.883, p = 0.009). Participants had higher odds of depression when living in a small town (AOR = 3.193, p < 0.001) or rural area (AOR = 3.467, p < 0.001). Participants with no chronic medical illness had lower odds of having depression (AOR = 0.589, p = 0.008). CONCLUSION: In Malaysia during the COVID-19 pandemic, people who are living with two, three, or four people, having three children, living in a small town or rural areas, and having unstable income have higher odds of having depression. Urgent intervention for those at risk of depression is recommended.

Sex Moderates the Association between Frailty and Mild Behavioral Impairment.

BACKGROUND: Frailty has been associated with cognitive markers of dementia but its relationship with behavioral markers of dementia are poorly understood. OBJECTIVES: To investigate the association between frailty and mild behavioral impairment (MBI), and whether this association is moderated by sex. DESIGN: Cross-sectional observational study. PARTICIPANTS/SETTING: 219 non-dementia participants (cognitively normal and mild cognitive impairment) from the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) study. MEASUREMENTS: Frailty was measured using the frailty index (FI) with higher scores indicating more health deficits/greater frailty. MBI symptoms were derived from Neuropsychiatric Inventory Questionnaire scores using a published algorithm with a cut-off of >0 indicating MBI symptom presence and higher scores indicating greater severity. Multivariable logistic and linear regressions adjusted for age, sex, education, and cognitive diagnosis were used to test the association between FI and MBI symptom presence and severity, respectively, with MBI as the outcome variable. An FI-by-sex interaction term was included to test for sex-dependent effects. RESULTS: The FI mean and SD across the entire cohort was 0.14 ± 0.06 (median = 0.14, IQR = 0.09-0.17, range = 0.02-0.38). Higher FI scores were associated with the presence of MBI symptoms both globally and in the domains of decreased motivation, affective dysregulation, and psychosis. Higher FI scores were also associated with more severe MBI symptoms in a sex-dependent manner: both sexes reported similarly low MBI symptom severity at low (-1 SD) levels of FI but males reported 1.9x higher MBI symptom severity relative to females at high (+1 SD) levels of FI. CONCLUSIONS: The FI is associated with both the presence and severity of MBI, especially for males. This suggests that screening for early dementia risk should incorporate assessments of MBI for patients with frailty, and assessments of frailty for patients with MBI.

Alkali treatment-acid leaching of rare earth elements from phosphogypsum fertilizer: insight for additional resource of valuable components.

Phosphogypsum (PG) is the main by-product of phosphoric acid, which is produced by the sulfuric acid attack of phosphate rocks, wet process. This by-product, which contains around 2.0% phosphoric acid, is used as a low-cost soil fertilizer, PGF. PGF consists mainly of gypsum (CaSO4·2H2O), P2O5, SiO2, and other impurities, including a minor amount of rare earth elements, REEs. In general, phosphate rocks contain from about 0.04 to 1.0% REE, which are precipitated with PG. Now, REEs are considered as strategic elements. Therefore, PG is now regarded as a secondary source of REE. This paper address a process for the separation of REEs and sodium sulphate as a product from PGF. This paper is based on the metathesis of the bulk of PGF with sodium carbonate to obtain calcium carbonate precipitated contain REEs. Furthermore, sodium sulphate was obtained as a product. Calcium carbonate containing REEs was leached out by citric acid as a green acid or nitric acid. At optimum conditions, maximum leaching of REEs from CaCO3 after one cycle of leaching by 3.0 mol/L nitric acid at L/S = 3/1, agitation time of 180.0 min., and at a temperature of 25 °C is 75.1%, 361.10 mg/kg from the total REEs present in PGF. While, the maximum leaching of 87.4%, 420.2 mg/kg of REEs from CaCO3 after one cycle of leaching by 1.0 mol/L citric acid, L/S = 5/1, agitation time of 15.0 min., and 85 °C. The REEs that were obtained in the leaching citrate solutions were purified by solvent extraction using 10% of di-2-ethyl hexyl phosphoric acid, HDEHP, in kerosene. The extracted REEs were stripped by 0.5 mol/L H2SO4. The stripped solutions were further treated with 10.0% oxalic acid to precipitate the REEs. The developed procedure can recover REEs from PGF with an efficiency of 85.2% and a purity of 97.7%.

Network analysis of impulse dyscontrol in mild cognitive impairment and subjective cognitive decline.

OBJECTIVES: To investigate conditional dependence relationships of impulse dyscontrol symptoms in mild cognitive impairment (MCI) and subjective cognitive decline (SCD). DESIGN: A prospective, observational study. PARTICIPANTS: Two hundred and thirty-five patients with MCI (n = 159) or SCD (n = 76) from the Prospective Study for Persons with Memory Symptoms dataset. MEASUREMENTS: Items of the Mild Behavioral Impairment Checklist impulse dyscontrol subscale. RESULTS: Stubbornness/rigidity, agitation/aggressiveness, and argumentativeness were frequent and the most central symptoms in the network. Impulsivity, the fourth most central symptom in the network, served as the bridge between these common symptoms and less central and rare symptoms. CONCLUSIONS: Impulse dyscontrol in at-risk states for dementia is characterized by closely connected symptoms of irritability, agitation, and rigidity. Compulsions and difficulties in regulating rewarding behaviors are relatively isolated symptoms.

Self-sampling in Human Papillomavirus screening during and post-COVID-19 pandemic.

INTRODUCTION: Cervical cancer is the third most common cancer among Malaysian women. Sarawak, the largest state in Malaysia has consistently recorded the highest cervical cancer rate in the country where nearly half of its population still live in the rural areas and is at increased risk of the disease due to inequitable access to healthcare. The countrywide lockdown due to the COVID-19 pandemic had halted the accessibility to cervical cancer screening programme. The aim of the study is to determine the feasibility of providing primary HPV DNA test using the selfsampling method to the hard-to-reach population in the interior of Sarawak during the COVID-19 pandemic. MATERIALS AND METHODS: This is a cross-sectional study where women aged between 20-80 years were recruited via convenient sampling from villages in Long Banga, Sarawak over a five-day outreach programme. Cervicovaginal selfsamples were obtained and screened for the presence of high-risk human papillomavirus DNA (HR-HPV) using the careHPVTM Test. A self-administered questionnaire was also administered to determine the sociodemographic and perception towards the self-sampling method. RESULTS: The 55 women recruited consist of ethnic backgrounds of Penan (58.18%), Kenyah (25.45%), Iban (5.45%), Saban (3.64%), Kelabit (3.64%), Malay (1.82%) and Chinese (1.82%). The prevalence of HR-HPV was 1.85% (n=1/55). Nearly 80% of the women were unemployed, and more than half have had attended primary education. Nine (16.4%) have heard about HPV, and seven (13%) knew HPV infection could cause cervical cancer. Three of them had HPV vaccination, and only one (1.85%) knew the brand of the HPV vaccine. Although 40% preferred self-sampling over clinician-collection, only ten (18.2%) women have completed the self-collection perception questionnaire. CONCLUSION: Primary HPV DNA screening using the selfsampling method can be carried out in the remote areas during the COVID-19 pandemic without compromising mobility restriction.

Dataset relating self-control and hope among participants in Malaysian rehabilitation centers.

Current research trends are moving towards acknowledging the significance and contributions of positive psychology in understanding the potential of individuals coping with problems. The shared data were used to explore the relations between self-control and hope among drug addicts in drug rehabilitation centers in Malaysia. Self-control was conceptualized by six dimensions: impulsivity, simple tasks, risk seeking, physical activities, self-centeredness, and temper. The measurement of hope included three dimensions: cognitive-temporal, affiliative-contextual, and affective-behavioral. A total of 244 clients from drug rehabilitation centers in Peninsular Malaysia were randomly selected to participate in the data collection. Significant correlations were observed between the self-control dimensions of impulsivity, simple tasks, self-centeredness and temper with hope. No significant correlation was observed between risk seeking or physical activities with hope. The data are useful in providing information towards developing treatment and rehabilitation programs for drug addicts. In general, the data showed the importance of incorporating self-control in rehabilitation modules to increase hope among drug addicts in their effort to combat drug addiction. The data can be used by researchers and practitioners to further understand the role of positive psychology variables in developing and advancing current empirical understanding and knowledge about drug addiction.

An Augmented Multiple Imputation Particle Filter for River State Estimation With Missing Observation.

In this article, a new form of data assimilation (DA) method namely multiple imputation particle filter with smooth variable structure filter (MIPF-SVSF) is proposed for river state estimation. This method is introduced to perform estimation during missing observation by presenting new sets of data. The contribution of this work is to overcome the missing observation, and at the same time improve the estimation performance. The convergence analysis of the MIPF-SVF is discussed and shows that the method depends on the number of particles and imputations. However, the number of particles and imputations is influenced by the error difference in the likelihood function. By bounding the error, the ability of the method can be improved and the number of particles and computational time are reduced. The comparison between the proposed method with EKF during complete data and multiple imputation particle filter shows the effectiveness of the MIPF-SVSF. The percentage improvement of the proposed method compared to MIPF in terms of root mean square error is between 12 and 13.5%, standard deviation is between 14 and 15%, mean absolute error is between 2 and 7%, and the computational error is reduced between 73 and 90% of the length of time required to perform the estimation process.

The reliability of a rapid molecular detection method in determining the prevalence of rifampicin-resistant Mycobacterium tuberculosis in an urban district health facility in Malaysia.

INTRODUCTION: Rifampicin is a key first-line antimycobacterial agent employed for the treatment of pulmonary tuberculosis (PTB). This study sought to obtain prevalence data on rifampicin-resistant Mycobacterium tuberculosis among smear-positive PTB patients in the Klang District of Malaysia. MATERIALS AND METHODS: A total of 103 patients from the Chest Clinic of Hospital Tengku Ampuan Rahimah with sputum smears positive for acid-fast bacilli were included in this cross-sectional study. All sputa were tested using Xpert MTB/RIF to confirm the presence of M. tuberculosis complex and detect rifampicin resistance. Sputa were also sent to a respiratory medicine institute for mycobacterial culture. Positive cultures were then submitted to a reference laboratory, where isolates identified as M. tuberculosis complex underwent drug susceptibility testing (DST). RESULTS: A total of 58 (56.3%) patients were newly diagnosed and 45 (43.7%) patients were previously treated. Xpert MTB/RIF was able to detect rifampicin resistance with a sensitivity and specificity of 87.5% and 98.9%, respectively. Assuming that a single resistant result from Xpert MTB/RIF or any DST method was sufficient to denote resistance, a total of 8/103 patients had rifampicinresistant M. tuberculosis. All eight patients were previously treated for PTB (p<0.05). The overall prevalence of rifampicin resistance among smear-positive PTB patients was 7.8%, although it was 17.8% among the previously treated ones. CONCLUSION: The local prevalence of rifampicin-resistant M. tuberculosis was particularly high among previously treated patients. Xpert MTB/RIF can be employed in urban district health facilities not only to diagnose PTB in smear-positive patients, but also to detect rifampicin resistance with good sensitivity and specificity.

Serum and milk concentrations of oxidant and anti-oxidant markers in dairy cows affected with bloody milk.

This study was conducted to determine the serum and milk levels of thiobarbturic acid-reac- tive substances (TBARS), nitric oxide (NO), superoxide dismutase (SOD), glutathione peroxi- dase (GSH-Px), vitamin E and selenium, IL-4 and IL-6 in lactating dairy cows affected with bloody milk using commercially available ELISA kits. Milk and whole blood samples were collected from 60 cows affected with bloody milk and 20 apparently healthy cows for control. In the serum, levels of GSH-Px and SOD were significantly (p˂0.05) higher in healthy cows compared to cows affected with bloody milk while the levels of TBARS and NO were significantly (p˂0.05) higher in affected cows. In the milk, levels of SOD, TBARS and NO were significantly (p˂0.05) higher in affected cows. In the serum, levels of vitamin E were significantly (p˂0.05) lower in affected cows compared to healthy cows, while no significant changes were observed in the levels of this vitamin in the milk between healthy and affected cows. In the serum, levels of selenium were significantly (p˂0.05) lower in affected cows while in milk, selenium levels were significantly (p˂0.05) higher in affected cows compared to healthy ones. Levels of IL-4 were significantly (p˂0.05) lower in the serum and milk of affected cows compared to healthy cows while levels of IL-6 were significantly (p˂0.05) higher in both serum and milk of affected cows. Results of this study suggest a possible role of oxidative stress in the pathogenesis of bloody milk in dairy cows.

Is Procalcitonin more superior to hs-CRP in the diagnosis of infection in diabetic foot ulcer?

INTRODUCTION: Procalcitonin (PCT) has recently emerged as a marker for diagnosing infection. This study aimed to compare the performance of PCT and other infection markers in diagnosing infected diabetic foot ulcer (IDFU). MATERIALS AND METHODS: A total of 128 diabetic patients with foot ulcers were recruited and divided into two groups, consisting of 73 patients in the IDFU group and 55 in the non-infected diabetic foot ulcer (NIDFU). The severity of infection in IDFU patients was graded based on the Infectious Disease Society of America-International Working Group on the Diabetic Foot classification. Blood samples from all the patients were collected for measurement of PCT, high sensitivity C-reactive protein (hs-CRP) and white cell count (WBC). The area under the receiver operating curves (AUC) were then constructed and analysed. RESULTS: PCT, hs-CRP and WBC levels were significantly higher in the IDFU group compared to NIDFU with hs-CRP demonstrated the highest AUC (0.91; p <0.001) followed by PCT (0.814; p < 0.001) and lastly WBC (0.775; p < 0.001). The best cut off value, sensitivity and specificity for the presence of infection in diabetic foot, were 3.47 mg/dL, 80% and 89% for hs-CRP, 0.11 ng/ml, 70% and 87% for PCT and 11.8x109/L, 60% and 90% for WBC. All the infection markers showed significant positive correlations with infection severity of DFU. CONCLUSION: This study showed that hs-CRP is a more sensitive marker for diagnosing IDFU. Although PCT is useful in differentiating IDFU from NIDFU, the use of PCT is not necessary as it adds little value to the current practice.

Genetic relatedness, antibiogram and virulence factors of Staphylococcus aureus isolated from bovine mastitis and related human contacts.

The objectives of this study were to determine the genetic relatedness, antibiogram and virulence factors of Staphylococcus aureus (S. aureus) isolated from bovine mastitis, associated farm workers, dairy cow farm veterinarians (private veterinarians), veterinary students, and non-veterinary university students. A total of 84 S. aureus isolates (27 from mastitis, 11 from farm workers, 9 from private veterinarians, 22 from veterinary students, and 16 from non-veterinary university students) were used to determine antimicrobial sensitivity patterns using disk diffusion test, virulence factors using PCR technique and phylogenic analysis using pulsed field gel electrophoresis. All S. aureus isolates were resistant to 2 or more commonly used antibiotics. All isolates from mastitis, farm workers, and veterinary students carried the genes encoding coagulase and thermonuclease factors while isolates from non-veterinary university students carried the genes encoding coagulase, clumping, and thermonuclease factors. The mecA gene was detected in 22.2%, 81.8%, 100%, 95.5% and 100% of isolates from mastitis, farm workers, private veterinarians, veterinary students, and non-veterinary university students, respectively. In the phylogenic analysis, 10 (45.5%), 6 (66.7%) and 8 (72.7%) isolates from veterinary students, private veterinarians and farm workers, respectively were more than 80% similar to isolates from mastitis. Results of this study indicate that S. aureus isolates from mastitis milk and those from related dairy cow personnel and veterinarians share similar antimicrobial sensitivity patterns and virulence factors, therefore a common source of bacteria may exist. Furthermore, possible transmission of S. aureus between cows and cow-related personnel and vice versa could also exist.

Methanol outbreak: a Malaysian tertiary hospital experience.

INTRODUCTION: Methanol poisoning usually occurs in a cluster and initial diagnosis can be challenging. Mortality is high without immediate interventions. This paper describes a methanol poisoning outbreak and difficulties in managing a large number of patients with limited resources. METHODOLOGY: A retrospective analysis of a methanol poisoning outbreak in September 2018 was performed, describing patients who presented to a major tertiary referral centre. RESULT: A total of 31 patients were received over the period of 9 days. Thirty of them were males with a mean age of 32 years old. They were mostly foreigners. From the 31 patients, 19.3% were dead on arrival, 3.2% died in the emergency department and 38.7% survived and discharged. The overall mortality rate was 61.3%. Out of the 12 patients who survived, two patients had toxic optic neuropathy, and one patient had uveitis. The rest of the survivors did not have any long-term complications. Osmolar gap and lactate had strong correlations with patient's mortality. Serum pH, bicarbonate, lactate, potassium, anion gap, osmolar gap and measured serum osmolarity between the alive and dead patients were significant. Post-mortem findings of the brain were unremarkable. CONCLUSION: The mortality rate was higher, and the morbidity includes permanent visual impairment and severe neurological sequelae. Language barrier, severity of illness, late presentation, unavailability of intravenous ethanol and fomipezole and delayed dialysis may have been the contributing factors. Patient was managed based on clinical presentation. Laboratory parameters showed difference in median between group that survived and succumbed for pH, serum bicarbonate, lactate, potassium and osmolar and anion gap. Management of methanol toxicity outbreak in resource-limited area will benefit from a well-designed guideline that is adaptable to the locality.

Process for lanthanides-Y leaching from phosphogypsum fertilizers using weak acids.

Phosphogypsum (PG) precipitates as a by-product of the phosphoric acid industry when treating phosphate rocks with H2SO4. Lanthanides and trivalent yttrium content, Ln-Y, in the rock are mostly found in the PG. After a slight modification of the precipitated PG, some portion of the PG containing ˜2.0% P2O5 is used as a low-grade phosphogypsum fertilizer (PGF). In this work, studies on Ln-Y, leaching from PGF were carried out using different concentration of weak acids such as boric acid, malic acid and citric acid at different retention time (Rt). It was found that the leaching efficiency of the total Ln-Y by citric acid solution is more favorable than that using boric or malic acid solutions. In this concern, 1.0 mol/L citric acid solution leach about 40.9% of Ln-Y, when the acid volume (L) to solid mass of PGF (S) ratio equals 2.0, L/S = 2.0, after Rt of 15 min at temperature of 298.0 K. Therefore, leaching of total Ln-Y from PGF by citric acid was investigated in terms of the acid concentration, Rt, and L/S as well as temperature. It is found that one leaching cycle by 1.0 mol/L citric acid solution using L/S ratio of 5.0 and Rt 15.0 min at temperature of 358 K, produced 53.3% from the total Ln-Y present in the used PGF sample. From these result a flow sheet was developed based on three leaching cycles to give a maximum leaching efficiency of 83.4%. Analysis of different Ln-Y in the final product indicated that 1.0 mol/L citric acid solution has high leaching selectivity for Er (89.4%), Ce (88.2%) and La (81.8%) and lower leaching selectivity for Pr (71.9%) and Y(40.7%).