An eight-year analysis of robotic surgery in morbidly obese women with endometrial cancer in a tertiary center in Singapore.

Introduction: Surgical management of endometrial cancer is a total hysterectomy, bilateral salphingo-oophorectomy and pelvic lymph node dissection (THBSO-PLND), which is a challenging surgery in the morbidly obese. Data on morbidly obese women undergoing robotic surgery is limited in Asia. We share our experience in Singapore and aim to demonstrate that robotic surgery is safe and effective in morbidly obese women with endometrial cancer. Materials and Methods: We performed a retrospective analysis of patients with BMI > 40 kg/m2, who underwent robotic surgery from January 2016 to September 2023 at the Singapore General Hospital. We recruited a total of 33 patients who underwent robotic surgery for endometrial malignancy and analysed surgical outcomes, operative complications, and survival rates. Results: The average age of patients was 53 years and mean BMI 45.7. The average operative time was 232 min and average blood loss 184 ml. 3 patients had THBSO while 27 underwent THBSO-PLND. None required conversion to laparotomy. 4 patients required a mini-laparotomy for the retrieval of bulky uterus. 12 required adhesiolysis. 6 patients had additional omentectomy done. The average inpatient stay was 4.8 days. The 1-year mortality rate is 0. However, 1 patient passed away 13 months after surgery due to complications from bowel obstruction and another passed away 39 months later due to disease recurrence. 1 patient readmitted on POD6 due to post-op ileus and another for port-site hematoma. Both were managed conservatively. Conclusion: Robotic surgery is a safe and effective alternative surgical tool for women who are morbidly obese with endometrial cancer.

Lung function parameters in overweight patients with COPD in relation to body mass index and waist circumference and impact on quality of life.

OBJECTIVE: We investigated the correlation of lung function parameters with increased body mass index (BMI) and waist circumference (WC) and determined the impact on health-related quality of life (HRQoL). METHODS: We conducted a cross-sectional analytical study at a teaching hospital among 173 individuals. We assessed anthropometric measurements, dynamic lung function, clinical history, and HRQoL using the Airway Questionnaire. Correlations of dynamic lung function parameters with BMI and WC were analyzed. RESULTS: In total, 51% were men (mean patient age 47.8 ± 10.5 years, median 48 years). The average BMI was 30.3 ± 8 kg/m2. Among 173 participants, 49% were smokers, with 16 ± 9 pack-years smoked; 80% of participants had chronic obstructive pulmonary disease (COPD). We observed compromised mid-expiratory flow (MEF), especially in young and overweight smokers. A moderately strong positive relationship was observed between WC and HRQoL scores, indicating a decline in HRQoL with increased WC. CONCLUSION: In our study, HRQoL declined with increasing WC. We found a decrease in MEF among young and overweight smokers who were otherwise healthy and whose other lung function parameters were normal; this finding can be regarded as a pre-COPD marker. These individuals should be reassessed for the development of COPD. Further prospective studies are needed to verify our findings.

Enhancing Oral Health via the Sense of Coherence Approach Among Adult Patients at University Dental Hospital.

Purpose: The purpose of the study was to assess the sense of coherence and its relationship with oral health and other study variables among adult patients at university dental hospital. Patients and Methods: This cross-sectional study included adult patients visiting the Dental Hospital of the College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam. Sense of coherence was determined by Antonovsky's Sense of Coherence scale (SOC-13), which consists of 13 items on a 7-point Likert. DMFT index, plaque index, gingival index, and simplified oral hygiene index were used to evaluate the oral health of study participants. Bivariate and multivariable analyses were performed, and 0.05 level of significance was used in the study. Results: The study included the data of 558 participants with a mean age of 32.19±10.11 years. The mean score of SOC was 52.77±13.11, which was significantly higher in high-income participants (P <0.001), participants without a medical condition (P=0.021), non-smokers (P <0.001), and those who visited the dentist in less than one year (P=0.028). Bivariate analysis showed statistically significant negative correlations between SOC and DMFT index (P=0.002), SOC and plaque index (P <0.001), SOC and gingival index (P=0.002), and SOC and simplified oral hygiene index (P=0.001). Multivariable analysis also showed that SOC was significantly correlated with DMFT index (P=0.001), plaque index (P <0.001), gingival index (P <0.001), and oral hygiene index (P=0.004) after controlling for age, gender, education, and monthly income. Conclusion: This study found that high-income and healthy participants, non-smokers, and those who visited the dental office during the last one year demonstrated significantly higher SOC. In addition, there was a statistically significant correlation between SOC and oral health. These study findings highlight the importance of raising awareness about SOC to improve oral health outcomes in adult patients.

Adjunctive left atrial posterior wall isolation for atrial fibrillation: An updated systematic review and meta-analysis.

OBJECTIVE: Posterior left atrial wall isolation (PWI) plus traditional pulmonary vein isolation (PVI) has been proposed as a promising intervention to decrease atrial fibrillation (AF) recurrence. We aim to investigate the efficacy and safety of adding PWI to the traditional PVI in patients with AF. METHODS: A systematic review and meta-analysis was conducted using synthesizing randomized controlled trials (RCTs) retrieved by systematically searching PubMed, Web of Science, SCOPUS, EMBASE, and Cochrane through June 14, 2023. We used Stata version 17 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI) (PROSPERO ID: CRD42023446227). RESULTS: We included 11 RCTs with a total number of 1534 patients. Combined ablation with PWI + PVI was not associated with any significant difference over PVI only regarding the recurrence of clinical AF (RR: 0.86 with 95% CI [0.70-1.06]), all atrial arrhythmia (RR: 0.93 with 95% CI [0.82-1.07]), nonatrial fibrillation arrhythmia (RR: 1.22 with 95% CI [0.97-1.53]), early AF (RR: 0.89 with 95% CI [0.62-1.27]), and antiarrhythmic drugs at discharge (RR: 0.83 with 95% CI [0.67-1.04]). However, it was associated with increased total ablation duration (minutes) (MD: 12.58 with 95% CI [6.80-18.37]) and total procedure duration (minutes) (MD: 16.77 with 95% CI [9.63-23.91]), without any significant difference regarding adverse events (RR: 1.05 with 95% CI [0.63-1.74]). CONCLUSION: While the pooled data from PWI + PVI using point-by-point radiofrequency did not suggest a benefit in the recurrence of various atrial arrhythmias compared to PVI alone, PWI+PVI using direct posterior wall ablation, especially with cryoballoon, demonstrated a significant reduction in recurrence of AF/atrial arrhythmias. Also, PWI + PVI significantly increased the ablation and total procedure durations.

Evaluation of in vitro osteoblast and osteoclast differentiation from stem cell: a systematic review of morphological assays and staining techniques.

Background: Understanding human stem cell differentiation into osteoblasts and osteoclasts is crucial for bone regeneration and disease modeling. Numerous morphological techniques have been employed to assess this differentiation, but a comprehensive review of their application and effectiveness is lacking. Methods: Guided by the PRISMA framework, we conducted a rigorous search through the PubMed, Web of Science and Scopus databases, analyzing 254 articles. Each article was scrutinized against pre-defined inclusion criteria, yielding a refined selection of 14 studies worthy of in-depth analysis. Results: The trends in using morphological approaches were identified for analyzing osteoblast and osteoclast differentiation. The three most used techniques for osteoblasts were Alizarin Red S (mineralization; six articles), von Kossa (mineralization; three articles) and alkaline phosphatase (ALP; two articles) followed by one article on Giemsa staining (cell morphology) and finally immunochemistry (three articles involved Vinculin, F-actin and Col1 biomarkers). For osteoclasts, tartrate-resistant acid phosphatase (TRAP staining) has the highest number of articles (six articles), followed by two articles on DAPI staining (cell morphology), and immunochemistry (two articles with VNR, Cathepsin K and TROP2. The study involved four stem cell types: peripheral blood monocyte, mesenchymal, dental pulp, and periodontal ligament. Conclusion: This review offers a valuable resource for researchers, with Alizarin Red S and TRAP staining being the most utilized morphological procedures for osteoblasts and osteoclasts, respectively. This understanding provides a foundation for future research in this rapidly changing field.

Assessing the determinants of crash propensity using structural equation modeling: Role of distractions caused by fellow drivers.

INTRODUCTION: Aggressive behavior of drivers is a source of crashes and high injury severity. Aggressive drivers are part of the driving environment, however, excessive aggressive driving by fellow drivers may take the attention of the recipient drivers away from the road resulting in distracted driving. Such external distractions caused by the aggressive and discourteous behavior of other road users have received limited attention. These distractions caused by fellow drivers (DFDs) may agitate recipient drivers and ultimately increase crash propensity. Aggressive driving behaviors are quite common in South Asia and, thus, it is necessary to determine their contribution to distractions and crash propensity. METHOD: Our study aimed to evaluate the effects of DFDs using primary data collected through a survey conducted in Lahore, Pakistan. A total of 801 complete responses were obtained. Various hypotheses were defined to explore the associations between the latent factors such as DFDs, anxiety/stress (AS), anxiety-based performance deficits (APD), hostile behavior (HB), acceptability of vehicle-related distractions (AVRD), and crash propensity (CP). Structural Equation Modeling (SEM) was employed as a multivariate statistical technique to test these hypotheses. RESULTS: The results supported the hypothesis that DFDs lead to AS among recipient drivers. DFDs and AS were further found to have positive associations with APDs. Whereas, there was a significant negative association between DFD, AS, and AVRD. As hypothesized, DFD and AS had positive associations with CP, indicating that distractions caused by aggressive behaviors leads to stress and consequently enhances crash propensity. PRACTICAL APPLICATIONS: The results of this study provide a statistically sound foundation for further exploration of the distractions caused by the aggressive behaviors of fellow drivers. Further, the results of this study can be utilized by the relevant authorities to alter aggressive driving behaviors and reduce DFDs.

Bibliometric Mapping of Psychological Flexibility Research: Trends and Future Directions.

In this article, we offer an exhaustive analysis of academic work on psychological flexibility using bibliometric techniques. We identify emerging trends in a dataset of 3535 scholarly articles from the Web of Science database. We highlight key publications, map out the field's intellectual framework, and anticipate future research avenues through co-citation and co-word analytics. The co-citation assessment revealed five distinct clusters, while the co-word analysis showed three. Although research regarding psychological flexibility has gained recent popularity, there remains a need for more scholarly initiatives to achieve a nuanced understanding of this subject.

Mapping the evolution of neurofeedback research: a bibliometric analysis of trends and future directions.

Introduction: This study conducts a bibliometric analysis on neurofeedback research to assess its current state and potential future developments. Methods: It examined 3,626 journal articles from the Web of Science (WoS) using co-citation and co-word methods. Results: The co-citation analysis identified three major clusters: "Real-Time fMRI Neurofeedback and Self-Regulation of Brain Activity," "EEG Neurofeedback and Cognitive Performance Enhancement," and "Treatment of ADHD Using Neurofeedback." The co-word analysis highlighted four key clusters: "Neurofeedback in Mental Health Research," "Brain-Computer Interfaces for Stroke Rehabilitation," "Neurofeedback for ADHD in Youth," and "Neural Mechanisms of Emotion and Self-Regulation with Advanced Neuroimaging. Discussion: This in-depth bibliometric study significantly enhances our understanding of the dynamic field of neurofeedback, indicating its potential in treating ADHD and improving performance. It offers non-invasive, ethical alternatives to conventional psychopharmacology and aligns with the trend toward personalized medicine, suggesting specialized solutions for mental health and rehabilitation as a growing focus in medical practice.

Are we eating plastic? Science mapping of microplastic pollution in the aquatic food chain.

This study evaluates the knowledge structure of microplastic pollution and its effects on the aquatic food chain. The presence of microplastics has seriously harmed the ecosystem. Through bibliometric analysis, 216 journal publications were retrieved from the Web of Science (WoS) from 2008 to 2023 (April), with no restriction in the time frame. Applying bibliographic coupling and co-word analysis, the emerging, current, and future themes of microplastic pollution are presented. Three research streams are derived from bibliographic coupling, centralized on the source of microplastic pollution and its impact. At the same time, research streams from co-word analysis are associated with overcoming the issue of microplastics in the ecosystem. This study's implications suggest three main principles to mitigate microplastic issues: (1) educating the public on the impact of microplastic pollution, (2) implementing holistic regulations and policies, and (3) developing treatment strategies through conventional, innovative, and hybrid approaches. Microplastic pollution is a global concern, requiring a holistic and comprehensive approach to overcome it. This review is the first to present a scientific mapping of the microplastics literature, which is a fundamental basis for future research on microplastic pollution and its impact on the ecosystem. Integr Environ Assess Manag 2024;00:1-12. © 2024 SETAC.

Triggering Chinese lecturers' intrinsic work motivation by value-based leadership and growth mindset: Generation difference by using multigroup analysis.

This cross-sectional study investigated the effects of value-based leadership and growth mindset on the intrinsic work motivation of Chinese lecturers. In addition, this study used age as a categorical moderator to investigate generational differences between the effects of Millennials and their predecessors. A sample of 518 lecturers from various Chinese universities was used to collect data, and SEM-PLS was used to analyse the data. The results showed that value-based leadership and growth mindset had a significant positive impact on both younger and older lecturers' intrinsic work motivation, with the effect of value-based leadership on younger lecturers' intrinsic motivation being significantly stronger than on older lecturers' intrinsic motivation, whereas the effect of growth mindset on intrinsic work motivation did not differ significantly between the younger and older groups. This study contributes to the existing research literature by contrasting the value-based leadership and growth mindset in relation to lecturers' intrinsic work motivation across younger and older groups in Chinese higher education settings, where greater heterogeneity between age groups was identified. The findings also provided university administrators with recommendations for boosting the intrinsic work motivation of lecturers, influencing future education policy.

Research landscape of energy transition and green finance: A bibliometric analysis.

This study utilizes bibliometric analysis to examine historical and present research patterns in the area of energy transition and green finance and to forecast potential future domains. Using the bibliometric method, 328 scholarly articles from the Web of Science database were evaluated. This paper identifies influential publications, maps the research landscape, and forecasts emerging tendencies through co-citation and co-word analyses. Co-citation analysis found three main clusters, while co-word analysis revealed four main clusters. Despite the growing significance of research on energy transition and green finance research, further in-depth investigation is necessary to offer a thorough depiction of the research domain. This research represents a pioneering endeavour in the utilization of bibliometric analysis to investigate the interrelationship between two items. It offers valuable insights into the rapidly expanding field of energy transition and green finance, effectively highlighting its contours and indicating potential future developments.

Identification and mechanism determination of the efflux pump subunit amrB gene mutations linked to gentamicin susceptibility in clinical Burkholderia pseudomallei from Malaysian Borneo.

The bacterium Burkholderia pseudomallei is typically resistant to gentamicin but rare susceptible strains have been isolated in certain regions, such as Thailand and Sarawak, Malaysia. Recently, several amino acid substitutions have been reported in the amrB gene (a subunit of the amrAB-oprA efflux pump gene) that confer gentamicin susceptibility. However, information regarding the mechanism of the substitutions conferring the susceptibility is lacking. To understand the mechanism of amino acid substitution that confers susceptibility, this study identifies the corresponding mutations in clinical gentamicin-susceptible B. pseudomallei isolates from the Malaysian Borneo (n = 46; Sarawak: 5; Sabah: 41). Three phenotypically confirmed gentamicin-susceptible (GENs) strains from Sarawak, Malaysia, were screened for mutations in the amrB gene using gene sequences of gentamicin-resistant (GENr) strains (QEH 56, QEH 57, QEH20, and QEH26) and publicly available sequences (AF072887.1 and BX571965.1) as the comparator. The effect of missense mutations on the stability of the AmrB protein was determined by calculating the average energy change value (ΔΔG). Mutagenesis analysis identified a polymorphism-associated mutation, g.1056 T > G, a possible susceptible-associated in-frame deletion, Delta V412, and a previously confirmed susceptible-associated amino acid substitution, T368R, in each of the three GENs isolates. The contribution of Delta V412 needs further confirmation by experimental mutagenesis analysis. The mechanism by which T368R confers susceptibility, as elucidated by in silico mutagenesis analysis using AmrB-modeled protein structures, is proposed to be due to the location of T368R in a highly conserved region, rather than destabilization of the AmrB protein structure.

Unveiling the sweetness: evaluating yield and quality attributes of early generation sweet corn (Zea mays subsp. sachharata) inbred lines through morphological, biochemical and marker-based approaches.

BACKGROUND: Sweet corn is gaining tremendous demand worldwide due to urbanization and changing consumer preferences. However, genetic improvement in this crop is being limited by narrow genetic base and other undesirable agronomic traits that hinder the development of superior cultivars. The main requirement in this direction is the development of potentially promising parental lines. One of the most important strategies in this direction is to develop such lines from hybrid-oriented source germplasm which may provide diverse base material with desirable biochemical and agro-morphological attributes. METHODS AND RESULTS: The study was undertaken to carry out morphological and biochemical evaluation of 80 early generation inbred lines (S2) of sweet corn that were developed from a cross between two single cross sweet corn hybrids (Mithas and Sugar-75). Moreover, validation of favourable recessive alleles for sugar content was carried out using SSR markers. The 80 sweet corn inbreds evaluated for phenotypic characterization showed wide range of variability with respect to different traits studied. The highest content of total carotenoids was found in the inbred S27 (34 µg g-1) followed by the inbred S65 (31.1 µg g-1). The highest content for total sugars was found in S60 (8.54%) followed by S14 (8.34%). Molecular characterization of 80 inbred lines led to the identification of seven inbreds viz., S21, S28, S47, S48, S49, S53, and S54, carrying the alleles specific to the sugary gene (su1) with respect to the markers umc2061 and bnlg1937. Comparing the results of scatter plot for biochemical and morphological traits, it was revealed that inbreds S9, S23, S27 and S36 contain high levels of total sugars and total carotenoids along with moderate values for amylose and yield attributing traits. CONCLUSION: The inbred lines identified with desirable biochemical and agro-morphological attributes in the study could be utilized as source of favourable alleles in sweet corn breeding programmes after further validation for disease resistance and other agronomic traits. Consequently, the study will not only enhance the genetic base of sweet corn germplasm but also has the potential to develop high-yielding hybrids with improved quality. The inbreds possessing su1 gene on the basis of umc2061 and bnlg1937 markers were also found to possess high sugar content. This indicates the potential of these lines as desirable candidates for breeding programs aimed at improving sweet corn yield and quality. These findings also demonstrate the effectiveness of the molecular markers in facilitating marker-assisted selection for important traits in sweet corn breeding.

The evolution of smart hotels: A bibliometric review of the past, present and future trends.

This study provides a bibliometric analysis of smart hotel research, drawing from 613 publications in the Web of Science (WoS) database to examine scholarly trends and developments in this dynamic field. Smart hotels, characterized by integrating advanced technologies such as AI, IoT, cloud computing, and big data, aim to redefine customer experiences and operational efficiency. Utilizing co-citation and co-word analysis techniques, the research delves into the depth of literature from past to future trends. In co-citation analysis, clusters including "Sustainable Hotel and Green Hotel", "Theories Integration in Smart Hotel Research", and "Consumers' Decisions about Green Hotels" underscore the pivotal areas of past and current research. Co-word analysis further reveals emergent trend clusters: "The New Era of Sustainable Tourism", "Elevating Standards and Guest Loyalty", and "Hotels' New Sustainable Blueprint in Modern Travel". These clusters reflect the industry's evolving focus on sustainability and technology-enhanced guest experiences. Theoretically, this research bridges gaps in smart hotel literature, proposing new frameworks for understanding customer decisions amid technological advancements and environmental responsibilities. Practically, it offers valuable insights for hotel managers, guiding technology integration strategies for enhanced efficiency and customer loyalty while underscoring the critical role of green strategies and sustainability.

Transforming higher education institutions through EDI leadership: A bibliometric exploration.

This comprehensive bibliometric study analyzes 1820 journal articles from the Web of Science database to explore Equity, Diversity, and Inclusion (EDI) leadership in higher education institutions (HEIs). Utilizing co-citation and co-word analysis, the study identifies distinct thematic clusters. The co-citation analysis reveals five key themes: Race, Diversity, and Inclusion (RDI), Diversity, Leadership, and Self-Efficacy (DLSE), Gender Dynamics and Leadership Challenges, Women's Representation in Academic Medicine Leadership, and Transformational Leadership in HEIs. Meanwhile, the co-word analysis highlights three critical areas: Transformative Collaborative Resilience in HEIs, Advancing Gender Equality in Academic Medicine and STEM, and Inclusive Educational Leadership in HEIs. These themes collectively provide a deep understanding of the EDI leadership field's intellectual structure, suggesting significant areas for future research and practical application. The study emphasizes the necessity for HEIs to engage comprehensively in EDI leadership research, shedding light on the importance of transformative collaborative resilience, gender equality in STEM, and inclusive leadership. This research offers valuable insights for developing effective EDI leadership policies and practices, highlighting the interconnectedness of these themes in fostering a more equitable, diverse, and inclusive environment in higher education and beyond.

Psychological capital research in HEIs: Bibliometric analysis of current and future trends.

This study presents a comprehensive bibliometric analysis of the literature on psychological capital (PsyCap) within higher education institutions (HEIs). Its main objective is to offer an encompassing perspective on this field's current state and potential developments. To achieve this, the study examines present research trends and predicts future directions using a bibliometric approach. A total of 412 journal articles were gathered from the Web of Science database. The analysis identifies influential publications, outlines the knowledge structure, and forecasts future trends through bibliographic coupling and co-word analyses. The bibliographic coupling revealed five distinct clusters, while the co-word analysis identified four clusters. Despite the growing significance of PsyCap research in HEIs, there remains a need for greater academic efforts to comprehend the research landscape fully. This paper provides valuable insights into the expanding area of PsyCap research within HEIs. In conclusion, the study sheds light on the extensive research conducted on PsyCap in the context of HEIs and offers insights into its potential for further growth.

Bioinformatics analysis of multi-epitope peptide vaccines against Hepatitis C virus: a molecular docking study.

BACKGROUND: Hepatitis C Virus (HCV) infection is one of the causal agents of liver disease burden. Six multiple antigenic peptides were synthesized including (P315, P412, and P517) plus (P1771, P2121, and P2941) to induce humoral and cellular responses, respectively against HCV infection. AIM: This paper aimed to employ computational tools to evaluate the efficacy of each peptide individually and to determine the most effective one for better vaccine development and/or immunotherapy. METHODS: VaxiJen web and AllerTOP servers were used for antigenicity and allergenicity prediction, respectively. The ToxinPred web server was used to investigate the peptide toxicity. Each peptide was docked with its corresponding receptors. RESULTS: No peptides were expected to be toxic. P315 and P2941 are predicted to have robust antigenic properties, lowest allergenicity, and minimal sOPEP energies. In turn, P315 (derived from gpE1) formed the highest hydrophobic bonds with the BCR and CD81 receptors that will elicit B cell function. P2941 (derived from NS5B) was shown to strongly bind to both CD4 and CD8 receptors that will elicit T cell function. CONCLUSION: P315 successfully bound to B cell (BCR and CD81) receptors. Also, P2941 is strongly bound to T cell (CD4 and CD8) receptors.

Missed opportunities to prevent hypertension at a tertiary care centre in Pakistan.

Background: Cardiovascular disease is the leading cause of mortality worldwide, affecting ~1.28 billion adults, and ~46% of these adults are not aware of their condition. One-third of patients do not receive appropriate care for their cardiovascular disease. Aim: To identify missed opportunities to prevent cardiovascular disease and its associated risk factors. Methods: This study was conducted among 359 adult patients aged 18-77 years leaving the outpatient department of Civil Hospital, Karachi, Pakistan, during June to September 2020. We recorded their sociodemographic information, perceived duration of clinical consultation, body weight and height, and blood pressure. We investigated if their physicians obtained sufficient medical history, performed medical examination, or counselled them on cardiovascular disease risk factors. Data were analysed using SPSS version 24.0. Results: Almost all the participants (98%) had at least 1 risk factor for hypertension. Only 35.9% of those in the highrisk group with ≥ 3 risk factors received counselling from a physician about their hypertension, leaving a 37.6% missed opportunity rate. Conclusion: The frequency of missed opportunities for the prevention of cardiovascular disease, and the risk factors for hypertension were high among the study population. This was partly due to excess workload of the attending physicians; the outpatient departments were used more for the treatment of general ailments than for specialist and referral care. It is recommended to establish primary care clinics within the tertiary settings where cardiovascular risk factors can be evaluated and patients referred for appropriate care.

Improving the clinical recognition, prognosis, and treatment of melioidosis through epidemiology and clinical findings: The Sabah perspective.

INTRODUCTION: Melioidosis is a deadly endemic disease in northern Australia and Southeast Asia, including Sabah, Malaysia, which is caused by the bacterium Burkholderia pseudomallei. It contributes to high fatality rates, mainly due to misdiagnosis leading to the wrong treatment being administered to the patients. Local epidemiology and data on clinical features could assist clinicians during diagnosis and treatment. However, these details are still scarce, particularly in Sabah. METHODS: A retrospective study of 246 culture-confirmed melioidosis cases in Queen Elizabeth Hospital, Sabah, Malaysia was performed between 2016 and 2018. The epidemiological data and clinical and laboratory findings were extracted and analysed. RESULTS: The annual incidence of culture-confirmed melioidosis cases was estimated to be 4.97 per 100,000 people. The mean age of the patients was 50±15 years. Males and members of the Kadazan-Dusun ethnic group accounted for the majority of the melioidosis cases. The odds ratio analysis indicated that bacteraemic melioidosis in this region was significantly associated with fever (76%), and patients having at least one underlying illness (43%), including diabetes mellitus (32%). Sixty-eight patients (28%) succumbed to melioidosis. Contrary to what is known regarding factors that promote bacteraemic melioidosis, neither patients with fever nor patients with at least one comorbid disease, including diabetes mellitus, were significantly associated with death from melioidosis. There was no statistically significant difference between patients without comorbidities (24, 27%) and those with at least one comorbid disease (26, 25%), including diabetes mellitus (18, 23%). The odds ratios indicate that melioidosis mortality in this region is related to patients showing respiratory organ-associated symptoms (29%), bacteraemia (30%), and septic shock (47%). Burkholderia pseudomallei isolates in this study were highly susceptible to ceftazidime (100%), imipenem (100%), and trimethoprim-sulfamethoxazole (98%). CONCLUSIONS: Information obtained from this study can be used by clinicians to recognise individuals with the highest risk of acquiring melioidosis, estimate an accurate prognosis, and provide effective treatment for melioidosis patients to reduce death from melioidosis.

Role of sustainable development goals in advancing the circular economy: A state-of-the-art review on past, present and future directions.

The purpose of this study is to review the relationship between the highly anticipated concept of circular economy (CE) and sustainable development goals (SDGs). These two sustainability principles have transformed organizations and countries in their quest to achieve sustainable development. Despite their importance to the business and corporate realm, the discussion of these two concepts has been developed in silos, arbitrarily connected. Through a bibliometric approach, this study reviewed 226 journal publications and 16,008 cited references from the Web of Science (WoS) to understand the past, present and future trends of the two concepts and their impact on the sustainability development. The bibliometric approach of citation, co-citation and co-word analysis uncovers the relevant and significant themes and research streams. Theoretical and practical implications were discussed within the broader business and governance perspective to develop a substantial triple bottom line in creating a sustainable future for civil society.