The effect of hypoxic ischemic encephalopathy towards multi-organ complications and its early outcome at a Malaysian district hospital.

INTRODUCTION: Hypoxic ischemic encephalopathy (HIE) is a clinically defined syndrome of disturbed neurologic function in the newborn with evidence of perinatal asphyxia. Stages of HIE are categorised into mild, moderate or severe based on the Sarnat classification. Neurological dysfunction constitutes a part of the wide spectrum of hypoxic ischemic insult as affected infants can have co-existing multi-organ dysfunction which further contributes to morbidities and mortality. This study aims to determine the relationship between the severity of HIE with multi-organ complications and early clinical outcomes. MATERIALS AND METHODS: All neonates who were admitted to the NICU at Hospital Sultan Abdul Halim between January 2018 to December 2022, who fulfilled the inclusion criteria were included. Demographic data, clinical course and investigation results were retrospectively obtained from the medical records. RESULTS: From a total of 90 infants (n = 90) who fulfilled our inclusion criteria, 31 (34%) were mild, 31 (34%) were moderate and 28 (31%) were severe HIE. The mean maternal age was 27 years. Common antenatal issues include diabetes mellitus (37.8%) and anaemia (22.2%). The Apgar scores at 1 and 5 minutes, initial resuscitation requiring intubation, chest compression and adrenaline were associated with higher severity of HIE (p < 0.05). Coagulation dysfunction was the most common complication (79.7%), followed by respiratory dysfunction (33.3%), cardiac dysfunction (28.9%), renal dysfunction (16.1%), haematological dysfunction (15.6%) and hepatic dysfunction (12%). Respiratory and haematological dysfunctions were significantly associated with higher mortality (p < 0.05). There was a significant longer hospital stay (p = 0.023), longer duration of ventilation (p < 0.001) and increase in frequency of seizures (p < 0.001) when comparing moderate and severe HIE patients to mild HIE patients. With increasing severity of HIE, there was also statistically significant higher mortality (p < 0.001). CONCLUSIONS: There is a significant relationship between multiorgan dysfunction, the severity of HIE and mortality. Early anticipation of multi-organ injury is crucial for optimal early management which would reduce the mortality and improve the neurological outcome of the patients.

The associations between whole grain, sugar and nutrients intakes in schoolchildren: a cross-sectional study.

BACKGROUND: Whole grains have gained extensive attention for their contribution to optimal diet quality in the child population. However, little is known about the association between whole grain and sugar intakes. This study aimed to determine whole grain intake and its associations with sugar and other nutrients intakes in schoolchildren. METHODS: A total of 415 healthy Malaysian schoolchildren aged 9-12 years were recruited in this cross-sectional study, through cluster random sampling. Nutrient and sugar intakes were assessed using 3-day 24-hour diet recalls. Whole grain intake was assessed using a validated whole grain food frequency questionnaire. RESULTS: In these 415 children (9.4-12.7 years), a total of 24 of them have been excluded due to over- and under-reported their dietary intake. Ultimate sample size was 391 children. Overall, consumption of whole grain, fiber, calcium and B vitamins were lower than the recommended intake. However, children consumed protein sufficiently. Whole grain intake was a significant predictor of calorie (ß = 0.1011; p < 0.001), carbohydrate (ß = 0.060; p = 0.002), fat (ß = 0.107; p = 0.044), riboflavin (ß = 3.537; p = 0.008) and sugar (ß = 0.138; p = 0.007) intakes, after controlling for sex, age and ethnicity. CONCLUSION: The findings provide insight to parents, educators and healthcare professionals in encouraging children to choose whole grain food that is low in sugar and fat. The outcome will also encourage food manufacturing companies to produce healthier whole grain products.

A combination of organic and inorganic cations in the synthesis of transition metal nitrates: preparation and characterization of canted rectangular Ising antiferromagnet (PyH)CsCo2(NO3)6.

Pyridinium cesium cobalt nitrate, (PyH)CsCo2(NO3)6, obtained from a nitric acid solution crystallizes in the orthorhombic space group Pnma with unit cell parameters a = 8.6905(14) Å, b = 11.9599(18) Å, c = 18.386(3) Å, V = 1911.0(5) Å3, and Z = 4. It consists of [Co(NO3)3]- layers, in which each Co2+ ion is connected with four monodentate bridging NO3-groups and one bidentate terminal NO3-group, forming a corrugated rectangular net. Magnetization and specific heat measurements show that (PyH)CsCo2(NO3)6 undergoes a long-range canted antiferromagnetic ordering in two steps at TC1 = 5.0 K and TC2 = 2.6 K. The temperature dependence of the magnetic susceptibility and the field dependence of the magnetization measured for (PyH)CsCo2(NO3)6 show that it is an Ising antiferromagnet. In support of these observations, our DFT + U + SOC calculations show that the Co2+ ions of (PyH)CsCo2(NO3)6 have an easy-axis magnetic anisotropy with preferred spin orientation along the b-axis. To a first approximation, the spin lattice of (PyH)CsCo2(NO3)6 is a weakly alternating Ising antiferromagnetic chain (J1/J2 ∼ 0.85), and these chains interact weakly (J3/J2 ∼ 0.07) to form a rectangular Ising antiferromagnetic lattice. In agreement with the prediction for a rectangular Ising antiferromagnet by Onsager, (PyH)CsCo2(NO3)6 undergoes a long-range antiferromagnetic ordering.

Dental Medicine and Engineering Unite to Transform Oral Health Innovations.

This perspective article urges the academic community to adopt a coordinated approach uniting dental medicine and engineering to support research, training, and entrepreneurship to address the unmet needs and spur oral health care innovations. We describe a new interschool institute that brings together dentists, scientists and engineers, resources, and a training program dedicated for affordable oral health care innovations, which may serve as a template for dental medicine-engineering integration.

A cascade of magnetic phase transitions and a 1/3-magnetization plateau in selenite-selenate Co3(SeO3)(SeO4)(OH)2 with kagomé-like Co2+ ion layer arrangements: the importance of identifying a correct spin lattice.

We prepared a new compound, Co3(SeO3)(SeO4)(OH)2, having layers in a kagomé-like arrangement of Co2+ (spin S = 3/2) ions. This phase crystallizes in the orthorhombic space group Pnma (62) with unit cell parameters a = 11.225(9) Å, b = 6.466(7) Å and c = 11.530(20) Å. Its layers, parallel to the ab-plane, are made up of Co1O5 square pyramids and Co2O6 and Co3O6 octahedra. As the temperature is lowered, Co3(SeO3)(SeO4)(OH)2 undergoes three successive magnetic transitions at 27.5, 19.4 and 8.1 K, and the magnetization of Co3(SeO3)(SeO4)(OH)2 measured at 2.4 K exhibits a 1/3-magnetization plateau between 7.8 and 19.9 T. The H-T magnetic phase diagram constructed for Co3(SeO3)(SeO4)(OH)2 from ac and dc magnetic susceptibility, specific heat and magnetization measurements contains three magnetic phases I, II and III. Phase I is antiferromagnetic, while phases II and III are ferrimagnetic and responsible for the 1/3-magnetization plateau. To interpret these complex magnetic properties, we identified the correct spin lattice for Co3(SeO3)(SeO4)(OH)2 by evaluating its intralayer and interlayer spin exchanges based on spin-polarized DFT+U calculations.

HOCl Rapidly Kills Corona, Flu, and Herpes to Prevent Aerosol Spread.

The COVID-19 pandemic has escalated the risk of SARS-CoV-2 transmission in the dental practice, especially as droplet-aerosol particles are generated by high-speed instruments. This has heightened awareness of other orally transmitted viruses, including influenza and herpes simplex virus 1 (HSV1), which are capable of threatening life and impairing health. While current disinfection procedures commonly use surface wipe-downs to reduce viral transmission, they are not fully effective. Consequently, this provides the opportunity for a spectrum of emitted viruses to reside airborne for hours and upon surfaces for days. The objective of this study was to develop an experimental platform to identify a safe and effective virucide with the ability to rapidly destroy oral viruses transported within droplets and aerosols. Our test method employed mixing viruses and virucides in a fine-mist bottle atomizer to mimic the generation of oral droplet-aerosols. The results revealed that human betacoronavirus OC43 (related to SARS-CoV-2), human influenza virus (H1N1), and HSV1 from atomizer-produced droplet-aerosols were each fully destroyed by only 100 ppm of hypochlorous acid (HOCl) within 30 s, which was the shortest time point of exposure to the virucide. Importantly, 100 ppm HOCl introduced into the oral cavity is known to be safe for humans. In conclusion, this frontline approach establishes the potential of using 100 ppm HOCl in waterlines to continuously irrigate the oral cavity during dental procedures to expeditiously destroy harmful viruses transmitted within aerosols and droplets to protect practitioners, staff, and other patients.

Predicting short-term suicidal thoughts in adolescents using machine learning: developing decision tools to identify daily level risk after hospitalization.

BACKGROUND: Mobile technology offers unique opportunities for monitoring short-term suicide risk in daily life. In this study of suicidal adolescent inpatients, theoretically informed risk factors were assessed daily following discharge to predict near-term suicidal ideation and inform decision algorithms for identifying elevations in daily level risk, with implications for real-time suicide-focused interventions. METHODS: Adolescents (N = 78; 67.9% female) completed brief surveys texted daily for 4 weeks after discharge (n = 1621 observations). Using multi-level classification and regression trees (CARTSs) with repeated 5-fold cross-validation, we tested (a) a simple prediction model incorporating previous-day scores for each of 10 risk factors, and (b) a more complex model incorporating, for each of these factors, a time-varying person-specific mean over prior days together with deviation from that mean. Models also incorporated missingness and contextual (study week, day of the week) indicators. The outcome was the presence/absence of next-day suicidal ideation. RESULTS: The best-performing model (cross-validated AUC = 0.86) was a complex model that included ideation duration, hopelessness, burdensomeness, and self-efficacy to refrain from suicidal action. An equivalent model that excluded ideation duration had acceptable overall performance (cross-validated AUC = 0.78). Models incorporating only previous-day scores, with and without ideation duration (cross-validated AUC of 0.82 and 0.75, respectively), showed relatively weaker performance. CONCLUSIONS: Results suggest that specific combinations of dynamic risk factors assessed in adolescents' daily life have promising utility in predicting next-day suicidal thoughts. Findings represent an important step in the development of decision tools identifying short-term risk as well as guiding timely interventions sensitive to proximal elevations in suicide risk in daily life.

Observation of a 1/3 magnetization plateau in Pb2Cu10O4(SeO3)4Cl7 arising from (Cu2+)7 clusters of corner-sharing (Cu2+)4 tetrahedra.

A mixed-valence compound Pb2Cu10O4(SeO3)4Cl7 has a complex structure consisting of one nonmagnetic Cu+ (S = 0) ion and four nonequivalent magnetic Cu2+ (S = 1/2) ions. It exhibits antiferromagnetic ordering at TN = 10.2 K. At a temperature below TN, a sequence of spin-flop transition at Bspin-flop = 1.3 T and 1/3 plateau formation at Bspin-flip = 4.4 K is observed in the magnetization curve M(B). The 1/3 magnetization plateau persists at least up to 53.5 T. The spin exchanges of Pb2Cu10O4(SeO3)4Cl7 evaluated by performing energy-mapping analysis based on DFT+U calculations show that the magnetic properties of Pb2Cu10O4(SeO3)4Cl7 are described by the (Cu2+)7 cluster of corner-sharing (Cu2+)4 tetrahedra, and that each (Cu2+)7 cluster has a S = 3/2 spin arrangement in the ground state. The 1/3 magnetization plateau observed for Pb2Cu10O4(SeO3)4Cl7 is explained by the field-induced flip of every second (Cu2+)7 cluster within a unit cell.

Microrobotics for Precision Biofilm Diagnostics and Treatment.

Advances in small-scale robotics and nanotechnology are providing previously unimagined opportunities for new diagnostic and therapeutic approaches with high precision, control, and efficiency. We designed microrobots for tetherless biofilm treatment and retrieval using iron oxide nanoparticles (NPs) with dual catalytic-magnetic functionality as building blocks. We show 2 distinct microrobotic platforms. The first system is formed from NPs that assemble into aggregated microswarms under magnetic fields that can be controlled to disrupt and retrieve biofilm samples for microbial analysis. The second platform is composed of 3-dimensional (3D) micromolded opacifier-infused soft helicoids with embedded catalytic-magnetic NPs that can be visualized via existing radiographic imaging techniques and controlled magnetically inside the root canal, uninterrupted by the soft and hard tissues surrounding the teeth in an ex vivo model. These microrobots placed inside the root canal can remove biofilms and be efficiently guided with microscale precision. The proof-of-concept paradigm described here can be adapted to target difficult-to-reach anatomical spaces in other natural and implanted surfaces in an automated and tether-free manner.

Biomaterial and Biofilm Interactions with the Pulp-Dentin Complex-on-a-Chip.

Calcium silicate cements (CSCs) are the choice materials for vital pulp therapy because of their bioactive properties, promotion of pulp repair, and dentin bridge formation. Despite the significant progress made in understanding CSCs' mechanisms of action, the key events that characterize the early interplay between CSC-dentin-pulp are still poorly understood. To address this gap, a microfluidic device, the "tooth-on-a-chip," which was developed to emulate the biomaterial-dentin-pulp interface, was used to test 1) the effect of CSCs (ProRoot, Biodentine, and TheraCal) on the viability and proliferation of human dental pulp stem cells, 2) variations of pH, and 3) release within the pulp chamber of transforming growth factor-ß (TGFß) as a surrogate of the bioactive dentin matrix molecules. ProRoot significantly increased the extraction of TGFß (P < 0.05) within 24 to 72 h and, along with Biodentine, induced higher cell proliferation (P > 0.05), while TheraCal decreased cell viability and provoked atypical changes in cell morphology. No correlation between TGFß levels and pH was observed. Further, we established a biofilm of Streptococcus mutans on-chip to model the biomaterial-biofilm-dentin interface and conducted a live and dead assay to test the antimicrobial capability of ProRoot in real time. In conclusion, the device allows for direct characterization of the interaction of bioactive dental materials with the dentin-pulp complex on a model of restored tooth while enabling assessment of antibiofilm properties at the interface in real time that was previously unattainable.

Intervening in Symbiotic Cross-Kingdom Biofilm Interactions: a Binding Mechanism-Based Nonmicrobicidal Approach.

Early childhood caries is a severe oral disease that results in aggressive tooth decay. Particularly, a synergistic association between a fungus, Candida albicans, and a cariogenic bacterium, Streptococcus mutans, promotes the development of hard-to-remove and highly acidic biofilms, exacerbating the virulent damage. These interactions are largely mediated via glucosyltransferases (GtfB) binding to mannans on the cell wall of C. albicans Here, we present an enzymatic approach to target GtfB-mannan interactions in this cross-kingdom consortium using mannan-degrading exo- and endo-enzymes. These exo- and endo-enzymes are highly effective in reducing biofilm biomass without killing microorganisms, as well as alleviating the production of an acidic pH environment conducive to tooth decay. To corroborate these results, we present biophysical evidence using single-molecule atomic force microscopy, biofilm shearing, and enamel surface topography analyses. Data show a drastic decrease in binding forces of GtfB to C. albicans (∼15-fold reduction) following enzyme treatment. Furthermore, enzymatic activity disrupted biofilm mechanical stability and significantly reduced human tooth enamel demineralization without cytotoxic effects on gingival keratinocytes. Our results represent significant progress toward a novel nonbiocidal therapeutic intervention against pathogenic bacterial-fungal biofilms by targeting the interkingdom receptor-ligand binding interactions.IMPORTANCE Biofilm formation is a key virulence factor responsible for various infectious diseases. Particularly, interactions between a fungus, Candida albicans, and a bacterium, Streptococcus mutans, have been known to play important roles in the pathogenesis of dental caries. Although some antimicrobials have been applied to treat fungal-involved biofilm-associated diseases, these often lack targeting polymicrobial interactions. Furthermore, these may not be appropriate for preventive measures because these antimicrobials may disrupt ecological microbiota and/or induce the prevalence of drug resistance over time. By specifically targeting the interaction mechanism whereby mannoproteins on the C. albicans surface mediate the cross-kingdom interaction, we demonstrated that mannoprotein-degrading enzymes can effectively disrupt biofilm interactions without microbiocidal effects or causing cytotoxicity to human cells. This suggests a potential application as a targeted approach for intervening a pathogenic cross-kingdom biofilm associated with a costly and unresolved oral disease.

Metabolomics Insights in Early Childhood Caries.

Dental caries is characterized by a dysbiotic shift at the biofilm-tooth surface interface, yet comprehensive biochemical characterizations of the biofilm are scant. We used metabolomics to identify biochemical features of the supragingival biofilm associated with early childhood caries (ECC) prevalence and severity. The study's analytical sample comprised 289 children ages 3 to 5 (51% with ECC) who attended public preschools in North Carolina and were enrolled in a community-based cross-sectional study of early childhood oral health. Clinical examinations were conducted by calibrated examiners in community locations using International Caries Detection and Classification System (ICDAS) criteria. Supragingival plaque collected from the facial/buccal surfaces of all primary teeth in the upper-left quadrant was analyzed using ultra-performance liquid chromatography-tandem mass spectrometry. Associations between individual metabolites and 18 clinical traits (based on different ECC definitions and sets of tooth surfaces) were quantified using Brownian distance correlations (dCor) and linear regression modeling of log2-transformed values, applying a false discovery rate multiple testing correction. A tree-based pipeline optimization tool (TPOT)-machine learning process was used to identify the best-fitting ECC classification metabolite model. There were 503 named metabolites identified, including microbial, host, and exogenous biochemicals. Most significant ECC-metabolite associations were positive (i.e., upregulations/enrichments). The localized ECC case definition (ICDAS ≥1 caries experience within the surfaces from which plaque was collected) had the strongest correlation with the metabolome (dCor P = 8 × 10-3). Sixteen metabolites were significantly associated with ECC after multiple testing correction, including fucose (P = 3.0 × 10-6) and N-acetylneuraminate (p = 6.8 × 10-6) with higher ECC prevalence, as well as catechin (P = 4.7 × 10-6) and epicatechin (P = 2.9 × 10-6) with lower. Catechin, epicatechin, imidazole propionate, fucose, 9,10-DiHOME, and N-acetylneuraminate were among the top 15 metabolites in terms of ECC classification importance in the automated TPOT model. These supragingival biofilm metabolite findings provide novel insights in ECC biology and can serve as the basis for the development of measures of disease activity or risk assessment.

Cross-Kingdom Cell-to-Cell Interactions in Cariogenic Biofilm Initiation.

Candida albicans is known to form polymicrobial biofilms with various Streptococcus spp., including mitis and mutans group streptococci. Streptococcus gordonii (mitis group) has been shown to bind avidly to C. albicans hyphae via direct cell-to-cell interaction, while the cariogenic pathogen Streptococcus mutans (mutans group) interacts with the fungal cells via extracellular glucans. However, the biophysical properties of these cross-kingdom interactions at the single-cell level during the early stage of biofilm formation remain understudied. Here, we examined the binding forces between S. mutans (or S. gordonii) and C. albicans in the presence and absence of in situ glucans on the fungal surface using single-cell atomic force microscopy and their influence on biofilm initiation and subsequent development under cariogenic conditions. The data show that S. gordonii binding force to the C. albicans surface is significantly higher than that ofS. mutans to the fungal surface (~2-fold). However, S. mutans binding forces are dramatically enhanced when the C. albicans cell surface is locally coated with extracellular glucans (~6-fold vs. uncoated C. albicans), which vastly exceeds the forces between S. gordonii andC. albicans. The enhanced binding affinity of S. mutans to glucan-coated C. albicans resulted in a larger structure during early biofilm initiation compared to S. gordonii-C. albicans biofilms. Ultimately, this resulted in S. mutans dominance composition in the 3-species biofilm model under cariogenic conditions. This study provides a novel biophysical aspect of Candida-streptococcal interaction whereby extracellular glucans may selectively favor S. mutans binding interactions with C. albicans during cariogenic biofilm development.

Spontaneous coronary artery dissection: clinical implications and diagnostic challenges. Overlooked and underappreciated in Asia?

Over the last decade, spontaneous coronary artery dissection (SCAD) has garnered much attention as a significant cause of acute coronary syndrome (ACS) and sudden cardiac death in women without classic cardiovascular risk factors. SCAD has been mostly studied in the West, with little recognition in Asia leading to under-diagnosis and under-representation. In this review, we highlight two distinct cases occurring at our center in Singapore, affecting two Singaporean women of Malay and Chinese descent. These 2 cases highlight that pregnancy-associated SCAD is neither the most common nor only manifestation of SCAD. Through review of the literature, we emphasize the heterogeneity in case presentation paying particular attention to SCAD and its association with connective tissue disorders such as fibromuscular dysplasia. SCAD remains a diagnostic challenge for many cardiologists, here we shed light and dispel myths surrounding coronary angiography and review the use of intracoronary imaging. The successful treatment of this unique group of patients requires a high index of suspicion, and management within a multidisciplinary team. The development of a recovery program with access to support groups, allied health, and cardiac rehabilitation is paramount in improving outcomes for these patients in the long term. Further research and studies in our Asian population will help to enhance our understanding of this disease and develop practices to best manage our patients.

Reasons why patients with tuberculosis in South Korea stop anti-TB treatment: a cross-sectional study.

BACKGROUND: As there had been no reduction in the TB burden in South Korea since 2000, a public-private mix (PPM) strategy was launched in 2011. The purpose of this study was to investigate the reasons for lost to follow-up (LTFU) among TB patients and their clinical characteristics.METHOD: A multicentre, cross-sectional study based on in-depth interviews with patients and their families by TB specialist nurses was conducted. Patients who were reported with a final outcome of LTFU in 2015-2017 at all PPM hospitals across the country were enrolled. Enrolled patients were classified into six subgroups by age and three major reasons for LTFU (adverse effects, refusal of treatment, marginalisation) and their clinical features were compared.RESULTS: Among 780 patients, those who were lost to follow-up due to adverse effects accounted for the largest proportion (n = 387). LTFU in those aged <65 years who refused treatment (n = 189) and those aged <65 years who were marginalised (n = 108) were related to having smear-positive TB and a previous history of unfavourable outcomes.CONCLUSION: To reduce LTFU in South Korea, comprehensive strategies, including management of adverse effects, systematic counselling and education, should be implemented.

Biofilm Matrixome: Extracellular Components in Structured Microbial Communities.

Biofilms consist of microbial communities embedded in a 3D extracellular matrix. The matrix is composed of a complex array of extracellular polymeric substances (EPS) that contribute to the unique attributes of biofilm lifestyle and virulence. This ensemble of chemically and functionally diverse biomolecules is termed the 'matrixome'. The composition and mechanisms of EPS matrix formation, and its role in biofilm biology, function, and microenvironment are being revealed. This perspective article highlights recent advances about the multifaceted role of the 'matrixome' in the development, physical-chemical properties, and virulence of biofilms. We emphasize that targeting biofilm-specific conditions such as the matrixome could lead to precise and effective antibiofilm approaches. We also discuss the limited knowledge in the context of polymicrobial biofilms, and the need for more in-depth analyses of the EPS matrix in mixed communities that are associated with many human infectious diseases.

Development, validity and reproducibility of a whole grain food frequency questionnaire in Malaysian children.

BACKGROUND: To date, there is no validated whole grain assessment tool for children in any Southeast Asian countries. Hence, there is a need for a valid tool to assess whole grain intake among Malaysian children. This study aimed to develop, validate and test the reproducibility of a food frequency questionnaire (FFQ) in estimating whole grain intake among Malaysian children. METHODS: A total of 392 children participated in the FFQ development and 112 children aged 9-12 years participated in the validation phase; with a subsample of 50 children participating in the reproducibility phase. Three-day diet record (3DR) as the reference method in validation phase. Spearman correlations, mean difference, Bland-Altman plot and cross-classification analyses were used to assess validity. The reproducibility was tested through a repeat administration of the FFQ, with 1 month time interval. Reproducibility analyses involved intra-class correlation coefficient (ICC), Cronbach's alpha and cross-classification analyses. RESULTS: The FFQ consisted of 156 whole grain food items from six food groups. Mean intake of whole grain in FFQ1 and 3DR were correlated well (r = 0.732), demonstrated good acceptance of the FFQ. Bland Altman plots showed relatively good agreement for both the dietary methods. Cross-classification of whole grain intake between the two methods showed that < 9.9% of children were grossly misclassified. Outcomes from ICC (0.989) and Cronbach's alpha (0.995) demonstrated excellent reliability. All the children were classified in the same or adjacent quartile of whole grain intake. CONCLUSIONS: Overall, the findings support the validity of the developed FFQ to appropriately estimate the whole grain intake in Malaysian children. This validated FFQ will be a valuable tool for future studies, to analyses the impact of whole grain consumption with disease relationship among Malaysian schoolchildren.

Whole-grain intake and its inverse relationships with fatty acids intake among multiethnic Malaysian schoolchildren.

INTRODUCTION: Little is known about the relationship of whole-grain intake with dietary fatty acids intake. The present study aimed to assess the whole-grain intake and its relationships with dietary fatty acids intake among multiethnic schoolchildren in Kuala Lumpur, Malaysia. METHODS: This cross-sectional study was conducted among 392 schoolchildren aged 9-11 years, cluster sampled from five randomly selected schools in Kuala Lumpur. Whole-grain and fatty acids intakes were assessed by 3-day, 24-h diet recalls. All whole-grain foods were considered irrespective of the amount of whole grain they contained. RESULTS: In total, 55.6% (n = 218) were whole-grain consumers. Mean (SD) daily intake of whole grain in the total sample was 5.13 (9.75) g day-1 . In the whole-grain consumer's only sample, mean (SD) intakes reached 9.23 (11.55) g day-1 . Significant inverse associations were found between whole-grain intake and saturated fatty acid (SAFA) intake (r = -0.357; P < 0.001), monosaturated fatty acid (MUFA) (r = -0.373; P < 0.001) and polyunsaturated fatty acid (PUFA) (r = -0.307; P < 0.001) intake. Furthermore, whole-grain intake was a significant predictor of SAFA (ß = -0.077; P = 0.004), MUFA (ß = -0.112; P = <0.001) and PUFA (ß = -0.202; P = <0.001) intakes, after controlling for sex, age and ethnicity. CONCLUSIONS: Whole-grain intake in Malaysia was well below recommendations. Schoolchildren who consumed higher whole grain tend to reduce fat intake; however, it would also reduce the SAFA, MUFA and PUFA intakes. Future collaboration may be conducted between industry, government and universities to promote unsaturated fatty acids-rich foods and whole-grain food, although not to promote processed whole-grain foods with a high sugar and salt content.

Spatial Design of Polymicrobial Oral Biofilm in Its Native Disease State.

Biofilms are structured microbial communities adhered to surfaces that cause many human infections. The study of oral biofilms has revealed complex composition, spatial organization, and phenotypic/genotypic diversity of the resident microbiota at the various sites in the mouth. Yet, knowledge about the spatial arrangement, positioning, and function of the polymicrobial community across the intact biofilm architecture remains sparse. Using multiple length scale imaging and computational analysis, we discovered unique spatial designs comprising mixed interbacterial species and interkingdom communities within intact biofilms formed on teeth of toddlers with caries. Intriguing structural patterns ranging from intermixed communities with extensive coaggregation (including bacterial-fungal clustering) to spatially segregated species forming a multilayered architecture were found. Among them, a distinctive 3-dimensional structure exhibited densely clustered cariogenic pathogens that were surrounded by outer layers of mixed bacterial communities in juxtaposition, forming a highly ordered spatial organization. These findings are particularly relevant as we approach the postmicrobiome era whereby studying the spatial structure of the pathogen and commensal microbiota may be important for understanding the microbiome function at the infection site to coordinate the disease process in situ.

GReat-Child Trial™ based on social cognitive theory improved knowledge, attitudes and practices toward whole grains among Malaysian overweight and obese children.

BACKGROUND: Studies have reported that improvement of dietary habits through increased whole grain foods consumption at an early age has the potential to lead to betterment in lifelong health and wellness. The GReat-Child Trial™ was a 12-week quasi-experimental study with 6 months follow-up investigating a multi-component whole grain intervention, which consisted of behavioral, personal and environmental factors based on Social Cognitive Theory (SCT). This study aimed to evaluate the feasibility and acceptability of the GReat-Child Trial™, as well as to determine the changes in knowledge, attitudes and practices (KAP) of whole grains consumption among overweight/obese children. METHODS: Two schools in Kuala Lumpur with similar socio-demographic characteristics were assigned as intervention (IG) and control (CG), respectively. Inclusion criteria were healthy Malaysian overweight/obese children aged 9 to 11 years who had no serious co-morbidity. Children who reported consuming whole grain foods in their 3-day diet-recall during recruitment were excluded. A total of 63 children (31 IG; 32 CG) completed the intervention. KAP questionnaire was self-administered at baseline [T0] and post intervention (at 3rd [T1] and 9th month [T2]). The baseline differences between the IG and CG across socio-demographics and scores of KAP toward whole grains were determined using chi-square and t-test, respectively. ANCOVA was performed to determine the effect of the GReat-Child Trial™ on KAP towards whole grains at post-intervention and follow-up. Baseline variables were considered as covariates. RESULTS: The IG attained significantly higher scores in knowledge (mean difference = 4.23; 95% CI: 3.82, 4.64; p < 0.001), attitudes (mean difference = 7.39; 95% CI: 6.36, 8.42; p < 0.001) and practice (mean difference = 6.13; 95% CI: 4.49, 7.77; p < 0.001) of whole grain consumption compared to the CG, after adjusting for confounders. The IG reported significantly higher scores in knowledge (mean difference = 6.84; 95% CI: 6.53, 7.15; p < 0.001), attitudes (mean difference = 9.16; 95% CI: 8.08, 10.24; p < 0.001) and practice (mean difference = 8.03; 95% CI: 5.34, 10.73; p < 0.001) towards whole grains at T2 compared to T0. CONCLUSIONS: These findings indicate that this intervention made a positive impact on improving children's KAP on whole grains. We anticipate the GReat-Child Trial™ to be a program that could be incorporated into school interventions to improve whole grain consumption among Malaysian children for obesity prevention.