Perceptions of nurses on inter-shift handover: A descriptive study in Hospital Kuala Lumpur, Malaysia.

INTRODUCTION: The quality of information and efficiency in the practice and care environments are important aspects of nursing care. The use of a reliable and valid scale can monitor the quality of handover and provide information for continuous improvement of practice. This study aims to describe the perception of nurses, on the domains of quality of information, efficiency, interaction and support and patient involvement. METHOD: A cross-sectional descriptive study was conducted among 450 nurses from 37 wards in Hospital Kuala Lumpur. Nurses on shift duty were recruited by convenience sampling from the Medical, Surgery, Obstetrics & Gynaecology, Orthopaedic and Paediatric wards. Using a validated questionnaire (Handover Evaluation Scale), nurses self-rated their perceptions using a 7-point scale and provided open-ended responses to the strengths and challenges that they faced. Descriptive and inferential analyses were done while open-ended questions were summarised based on key themes. RESULTS: A total of 414 nurses completed the survey (92.0% response rate). Nurses had an overall mean (SD) perception score of 5.01 (SD 0.56). They perceived good interaction and support during handover and on the quality of information that they received, with mean scores of 5.54 (SD 0.79) and 5.19 (SD 0.69), respectively. There was an association between the departments where the nurses worked and their overall perceptions on nursing handover (p<0.001). Interruptions being the most common theme emerged from the open-ended section. CONCLUSION: Despite having substantial interaction and support amongst nurses, opportunities for improvements were noted. Improvements in the quality of handover information and reducing interruptions should be the main emphases as these were perceived to be essential in the current handover practices by nurses.

Feline Calicivirus Infection Disrupts Assembly of Cytoplasmic Stress Granules and Induces G3BP1 Cleavage.

UNLABELLED: In response to stress such as virus infection, cells can stall translation by storing mRNAs away in cellular compartments called stress granules (SGs). This defense mechanism favors cell survival by limiting the use of energy and nutrients until the stress is resolved. In some cases it may also block viral propagation as viruses are dependent on the host cell resources to produce viral proteins. Human norovirus is a member of the Caliciviridae family responsible for gastroenteritis outbreaks worldwide. Previous studies on caliciviruses have identified mechanisms by which they can usurp the host translational machinery, using the viral protein genome-linked VPg, or regulate host protein synthesis through the mitogen-activated protein kinase (MAPK) pathway. Here, we examined the effect of feline calicivirus (FCV) infection on SG accumulation. We show that FCV infection impairs the assembly of SGs despite an increased phosphorylation of eukaryotic initiation factor eIF2α, a hallmark of stress pathway activation. Furthermore, SGs did not accumulate in FCV-infected cells that were stressed with arsenite or hydrogen peroxide. FCV infection resulted in the cleavage of the SG-nucleating protein Ras-GTPase activating SH3 domain-binding protein (G3BP1), which is mediated by the viral 3C-like proteinase NS6(Pro) Using mutational analysis, we identified the FCV-induced cleavage site within G3BP1, which differs from the poliovirus 3C proteinase cleavage site previously identified. Finally, we showed that NS6(Pro)-mediated G3BP1 cleavage impairs SG assembly. In contrast, murine norovirus (MNV) infection did not impact arsenite-induced SG assembly or G3BP1 integrity, suggesting that related caliciviruses have distinct effects on the stress response pathway. IMPORTANCE: Human noroviruses are a major cause of viral gastroenteritis, and it is important to understand how they interact with the infected host cell. Feline calicivirus (FCV) and murine norovirus (MNV) are used as models to understand norovirus biology. Recent studies have suggested that the assembly of stress granules is central in orchestrating stress and antiviral responses to restrict viral replication. Overall, our study provides the first insight on how caliciviruses impair stress granule assembly by targeting the nucleating factor G3BP1 via the viral proteinase NS6(Pro) This work provides new insights into host-pathogen interactions that regulate stress pathways during FCV infection.

Non-Hodgkin's lymphoma by immunohistochemistry.

Non Hodgkin's lymphomas (NHL) constitute a heterogeneous group of neoplasm of the lymphoid system. There are many histological subtype of NHL based on WHO classification of hematopoietic and lymphoid neoplasm. This cross-sectional study was carried out in the department of Pathology, Dhaka Medical College, Dhaka from January 2009 to December 2010 to observe the different subtypes of NHL using immunohistochemistry (IHC) with CD3. A total of 50 microscopically diagnosed case of NHL irrespective of age and sex were included in the study. The diagnostic morphologic criteria of each lymphoma subcategory were compiled and diagnosis was made. Mean age of the study subjects were 42.0±19.7 years with range 3-75 years and male female ratio was 1.8:1. Nodal NHL was 66% and extranodal cases were 34%. Maximum number of histolgic subtypes belonged to diffuse large B-cell lymphoma (DLBCL) and male was predominant in all histological subtypes, except peripheral T-cell lymphoma (PTCL). DLBCL was predominant in all B-cell NHL whereas PTCL was predominant in all T-cell NHL. The most childhood patients belonged to lymphoblastic lymphoma. Regarding cell lineage B-cell NHL was more common than T-cell NHL (88% vs. 12%), but high grade pattern was more predominant in T-cell type (83.3% vs. 65.9%). Among 50 study subjects histological (H & E) diagnosis reveals 46 cases as B-cell NHL and 4 as T-cell NHL but IHC confirms 6 cases as T-cell NHL.

Histological scoring and associated risk factors of non-alcoholic fatty liver disease.

Non alcoholic steatohepatitis is a hepatic disorder with histological features of alcohol induced liver disease that occurs in individual who do not consume significant alcohol. Liver biopsy is an important part of the evaluation in term of both grade & stage. A cross sectional study was carried out in the department of Pathology, Dhaka Medical College, Dhaka & department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2007 to June 2009. Total 55 adult subjects of both sex were included on the basis of predefined inclusion & exclusion criteria in this study to evaluate the histological pattern of non alcoholic fatty liver disease (NAFLD) and its correlation with risk factors. Liver biopsy was done and H & E and Masson's Trichrome stain slides were examined to evaluate the grade and stage of NAFLD. Scoring and semiquantitative assessment of steatosis and NAFLD severity was done according to Kleiner scale known as NAFLD activity score (NAS). The results of Pearson correlation showed only BMI and triglyceride level significantly correlated with NAS score. The results of Spearman's rank correlation showed that BMI, central obesity, triglyceridaemia and age significantly correlated with staging of fibrosis. The results of multiple regression analysis showed that variation of NAS depend on BMI and triglyceride level. The study also revealed that risk factors contributed about 29% risk for the occurrence of non alcoholic steatohepatitis.

Impact of long-term forest enrichment planting on the biological status of soil in a deforested dipterocarp forest in Perak, Malaysia.

Deforestation leads to the deterioration of soil fertility which occurs rapidly under tropical climates. Forest rehabilitation is one of the approaches to restore soil fertility and increase the productivity of degraded areas. The objective of this study was to evaluate and compare soil biological properties under enrichment planting and secondary forests at Tapah Hill Forest Reserve, Perak after 42 years of planting. Both areas were excessively logged in the 1950s and left idle without any appropriate forest management until 1968 when rehabilitation program was initiated. Six subplots (20 m × 20 m) were established within each enrichment planting (F1) and secondary forest (F2) plots, after which soil was sampled at depths of 0-15 cm (topsoil) and 15-30 cm (subsoil). Results showed that total mean microbial enzymatic activity, as well as biomass C and N content, was significantly higher in F1 compared to F2. The results, despite sample variability, suggest that the rehabilitation program improves the soil biological activities where high rate of soil organic matter, organic C, N, suitable soil acidity range, and abundance of forest litter is believed to be the predisposing factor promoting higher population of microbial in F1 as compared to F2. In conclusion total microbial enzymatic activity, biomass C and biomass N evaluation were higher in enrichment planting plot compared to secondary forest. After 42 years of planting, rehabilitation or enrichment planting helps to restore the productivity of planted forest in terms of biological parameters.

Patterns of cardiovascular risk and disease in HIV-positive adults on anti-retroviral therapy in Mozambique.

INTRODUCTION: With improved access to anti-retroviral therapy (ART) the focus of HIV treatment is changing to reducing chronic co-morbidities and their effects, but guidelines for HIV care in many African countries do not include screening for cardiac disease. Our study aimed to determine the pattern of cardiac abnormalities in HIV-positive patients on ART. METHODS: We implemented a prospective, observational study for 24 months on a random sample of adult patients seen at a dedicated HIV clinic in Mozambique. Demographic, clinical and full cardiovascular evaluations were performed on all participants. RESULTS: We enrolled 264 HIVvpositive patients (mean age 39.3 years; 186 female, 70.5%). The mean time on ART was 46 (SD 36) months and most had low viral load (174, 65%). Obesity (45, 17%), overweight (65, 24.6%), hypertension (54, 20.5%) and severe anaemia (21, 8.3%) were frequent. Diabetes was present in four patients (1.5%). The most important conditions in 252 patients submitted to echocardiography (88, 34.9% had cardiac abnormalities) were: severe rheumatic heart valve disease (six), severe dilated cardiomyopathy (five), aortic degenerative disease and congenital heart disease (in three patients each). At 24-month follow up, six of the 252 patients had died; of the 196 reviewed on echocardiography 29 had progressed and two had improved ventricular systolic function. CONCLUSION: This young cohort of HIV-positive patients on ART showed lower occurrence of tuberculous pericarditis and dilated cardiomyopathy but high cardiovascular risk, as assessed by the presence of obesity, hypertension and anaemia. Cardiac abnormalities needing multidisciplinary care were also found. There is a need for tailored cardiovascular risk stratification and screening for cardiovascular disease in HIV-positive patients on ART in Africa.

Characteristics of Pelargonium radula as a mercury bioindicator for safety assessment of drinking water.

Identification of Pelargonium radula as bioindicator for mercury (Hg) detection confers a new hope for monitoring the safety of drinking water consumption. Hg, like other non-essential metals, inflicts the deterioration of biological functions in human and other creatures. In the present study, effects of Hg on the physiology and biochemical content of P. radula were undertaken to understand the occurrence of the morphological changes observed. Young leaves of P. radula were treated with different concentrations of Hg-containing solution (0.5, 1.0 and 2.0 ppb) along with controls for 4 h, prior to further analysis. Elevated Hg concentration in treatment solution significantly prompted an increased accumulation of Hg in the leaf tissues. Meanwhile, total protein, chlorophyll and low molecular mass thiol contents (cysteine, glutathione and oxidized glutathione) decreased as Hg accumulation increased. However, phytochelatin 2 productions were induced in the treated leaves, in comparison to the control. Based on these findings, it is postulated that as low as 0.5 ppb of Hg interferes with the metabolic processes of plant cells, which was reflected from the morphological changes exhibited on P. radula leaves-the colour of the Hg-treated leaves changed from green to yellowish-brown, became chlorosis and wilted. Changes in the tested characteristics of plant are closely related to the Hg-induced morphological changes on P. radula leaves, a potential bioindicator for detecting Hg in drinking water.

Molecular Detection of Coxiella burnetii from Farm Animals and Ticks in Malaysia.

Coxiella burnetii, the causative agent of Q fever, is an intracellular bacterium of medical and veterinary importance. The reservoirs of C. burnetii are extensive which include mammals and arthropods, particularly ticks. As the organism is difficult to culture, this study was aimed to detect C. burnetii DNA in animal (mainly blood and vaginal samples of cattle, goats and sheep) and tick samples obtained from farm animals, wild rodents and vegetation. Two polymerase chain reaction (PCR) assays targeting IS1111 transposon-like gene (TransPCR) and com1 gene (OMP-PCR) were used for C. burnetii detection. Sequence determination of the amplified fragments and a real-time PCR assay were used to confirm PCR findings. C. burnetii DNA was detected from 9.1% of cattle blood and 4.2% vaginal samples, respectively. A small percentage (5.8%) of ticks (including Amblyomma, Dermacentor, Rhipicephalus and Haemaphysalis spp.) haboring C. burnetii were identified in this study. This study provides molecular evidence on the presence of C. burnetii in cattle and ticks. The possible zoonotic transmission of C. burnetii is yet to be investigated.

Bevacizumab in clinical practice.

The development of targeted therapies and especially angiogenesis inhibitor drugs is undoubtedly a major advancement in the treatment of cancer in the 21st century. Bevacizumab is a recombinant humanized monoclonal antibody directed against vascular endothelial growth factor that was approved for the treatment of multiple solid tumors, we have reviewed the side effects cited in clinical trials of bevacizumab and the guidelines for their management and we can conclude that bevacizumab, is generally well tolerated but is associated with increase in some adverse side effects for which monitoring is required particularly vascular and renal side effects including hypertension, proteinuria, thromboembolic events and hemorrhage. The better understanding of bevacizumab toxicity profile and the guidelines for their optimal management as well as the education of patients may allow prolonged therapy and thus improved clinical outcomes.

Combined conventional mechanical and ultrasonic debridement for aortic valvular stenosis.

Ultrasound decalcification of aortic valve stenosis was performed in 31 patients. There were 16 men and 15 women with a mean age of 71.03 +/- 9.6 years (range, 51 to 89 years). Each had severe calcific aortic stenosis with an aortic valve gradient greater than 40 mm Hg, aortic valve area (AVA) less than 0.6 cm2, and no serious insufficiency. Feasibility of aortic valve debridement was determined under direct vision. Intraoperative epicardial or transesophageal color Doppler two-dimensional echocardiography was used before and after the aortic valve debridement to evaluate aortic cusp motion and aortic regurgitation. Direct transseptal aortic valve gradient was measured on all patients before and after aortic valve debridement, and the AVA was determined. Aortic valve debridement was performed as the primary procedure in 17 cases and combined with other cardiac procedures in 14 patients. Preoperative aortic valve gradient was reduced from 72.5 +/- 22.5 mm Hg (range, 40 to 130 mm Hg) to 15.5 +/- 11.9 mm Hg (range, 2 to 50 mm Hg), and the average AVA of 0.41 +/- 0.10 cm2 (range, 0.22 to 0.63 cm2) was increased to 1.55 +/- 0.58 cm2 (range, 0.65 to 3.50 cm2) after ultrasound decalcification. There were two early deaths in octogenerian, high-risk patients, and two late deaths (6.45% early and 6.45% late mortality), none of them related to AVD. Postoperative follow-up included clinical evaluation and color Doppler echocardiography every 6 months. The aortic valve gradient was measured using a continuous-wave Doppler probe, and the AVA was calculated by the simplified continuity equation: AVA = aAOA x vLVOT/vAV.(ABSTRACT TRUNCATED AT 250 WORDS)

Intake from an energy-dense porridge liquefied by amylase of germinated wheat: a controlled trial in severely malnourished children during convalescence from diarrhoea.

OBJECTIVE: To evaluate the role of an energy-dense diet liquefied with amylase-rich flour from germinated wheat (ARF) in increasing the energy intake in severely malnourished infants and young children and its acceptability to mothers. DESIGN: A randomized controlled clinical trial with two sets of controls. SETTING: Nutrition rehabilitation unit of a large diarrhoea treatment centre where mothers stay with their very severely malnourished children. SUBJECTS: 78 severely malnourished children aged 5-18 months just recovered from diarrhoea. INTERVENTION: Children were randomly assigned to receive either an energy-dense porridge made liquid by adding ARF (test diet) or an unaltered thick porridge of similar energy density (control 1 diet), or the porridge made liquid with addition of water to have the same viscosity as the test diet but of lower energy (control 2 diet), in four major meals a day for 5 days and intake was measured; breast-milk was measured by test weighing. Children also received an additional three milk-cereal meals a day. RESULTS: The mean energy intake (95% CI, P value for difference between test and control) was 385 (339-431), 289 (251-327, P < 0.005), and 255 (222-289, P < 0.001) kJ/kg.d respectively. Feeding test diet was not associated with significant adverse effects e.g. on diarrhoea, vomiting, breast-milk intake, and was well accepted by mothers. CONCLUSION: The results suggest that use of an energy-dense ARF-treated liquefied porridge increases calorie intake by very severely malnourished children during convalescence from diarrhoea, and that it does not produce any adverse effect.

Persistent diarrhoea: factors affecting absorption and clinical prognosis during management with a rice-based diet.

Twenty-six persistent diarrhoea patients aged 4 to 18 months were treated with a diet prepared with rice powder, soya oil, glucose, egg white and water. Absorption of macronutrients was estimated in a 72 h balance study and clinical response was examined during one week of dietary treatment. Nutrient absorption was compared with that of 25 healthy age-matched controls treated with the same diet. Twenty-one patients (81%) recovered from diarrhoea within seven days. Absorption of nutrients was significantly reduced among the persistent diarrhoea patients. More malnourished patients had a significantly reduced absorption of nutrients except carbohydrate and an increased severity and longer duration of diarrhoea. Total gut transit time had significant association with nutrient absorption in the persistent diarrhoea patients. The period of recovery negatively correlated with coefficient of absorption and positively with initial stool weight. Failure to recover was associated with severity of diarrhoea and systemic infection. The study indicates that nutrient absorption is significantly reduced in patients with persistent diarrhoea and nutritional status, and that initial purging rate and intestinal hurry are significantly related to the prognosis and nutrient absorption.

Cause-specific child mortality in a mountainous community in Pakistan by verbal autopsy.

In Pakistan's rural areas population-based cause of death data from systematic verbal autopsies are rare. Using verbal autopsy algorithms with multiple coding and decision rules, we assigned causes of death among 79% of children under age five years dying between July, 1988 and December, 1991 in Oshikhandass, a remote mountainous community in Pakistan's Northern Areas. Main causes of death were pneumonia (44%), diarrhoea (35%), and neonatal sepsis (6%). Combined (main plus associated) analysis revealed 48% died with diarrhoea, 46% with malnutrition, 44% with pneumonia, 15% with neonatal sepsis, and 15% with low birth weight. Median age of death with pneumonia was 2 months, with diarrhoea 8 months. Half died by month 4. The inquiry was well received by villagers. Population-based verbal autopsy surveillance is a cost-effective strategy to guide health managers. Plans are underway to institute it for the surrounding population of 400,000. Creative ways to access, treat and reduce risk among young infants are needed.

Efficacy and safety of bevacizumab in the treatment of human epidermal growth factor receptor type 2 negative metastatic breast cancer: About a large series in moroccan population.

Context: Randomized studies have shown different magnitude of bevacizumab (BV) benefit in the treatment of advanced breast cancer. Aims: The aim of the study is to evaluate the efficacy and safety of BV for the treatment of human epidermal growth factor receptor type 2 (HER2) negative metastatic disease. Settings and Design: A large observational institutional study in Moroccan population. Materials and Methods: From January 2009 to December 2011, 42 patients with HER2 negative metastatic breast cancer were analyzed. Results: The median age was 51 years. Approximately two-third of patients analyzed were treated at the first line with BV in association with (paclitaxel, docetaxel or capecitabine) in (40.7%; 40.7% and 18.5%) and the other third at second-line therapy with a combination of the same drugs in (46.6%, 26.6% and 266% respectively); the median number of cycles was 15. In terms of the clinical benefit rate there was a trend in favor of the combination with taxanes and among responders, median duration of objective response was longer with paclitaxel. In addition, analyses of progression-free survival (PFS) across subgroups in both first and second line therapy showed consistent improvements in PFS with the combination of BV and paclitaxel the difference was statistically significant. Concerning safety, the BV was generally well-tolerated. Conclusions: BV in HER2 negative metastatic diseases potentially improved objective response rate and PFS especially in combination with Paclitaxel, which confirm and expand on the results from published literature, with tolerable toxicity.

Celiac disease, enteropathy-associated T-cell lymphoma, and primary sclerosing cholangitis in one patient: a very rare association and review of the literature.

Enteropathy-associated T-cell lymphoma (EATL) is a very rare peripheral T-cell lymphoma which is mostly associated with celiac disease. However, the association of primary sclerosing cholangitis and enteropathy-associated T-cell lymphoma is uncommon. Herein we report and discuss the first case of patient who presented simultaneously with these two rare diseases. It is a 54-year-old man who stopped gluten-free diet after 15 years history of celiac disease. The diagnosis was based on the histological examination of duodenal biopsy and the diagnosis of primary sclerosing cholangitis was made on liver biopsy, as well as the magnetic resonance cholangiogram. The treatment of EATL is mainly based on chemotherapy in addition to the optimal management of complications and adverse events that impact on the response to treatment and clinical outcomes, although the prognosis remains remarkably very poor.

Iranian patient's expectations about coronary angiography: A qualitative study.

BACKGROUND: Coronary angiography is recognized as the gold test for diagnosis of coronary artery diseases. Based on the literature review, little is known about patients' expectations about this procedure. Understanding the patient's expectations is an important way to achieve patient-centered care. The purpose of this study was to explore the expectations of Iranian patients undergoing coronary angiography. MATERIALS AND METHODS: This descriptive exploratory qualitative study was carried out between 2011 and 2012 in three hospitals in Shiraz, Iran, with a purposive sample of 15 patients (7 men and 8 women, about 28-70 years of age). Data were collected using semi-structured interviews to explore the patients' expectations. Interview data were analyzed using conventional qualitative content analysis approach. RESULTS: The interviews revealed that the participants had four main categories of expectations about coronary angiography. The patient's expectations were those from angiography, from the treatment team, and the need for preparation of angiography, education, and training. CONCLUSIONS: In general, the results of this study revealed a new insight into the expectations of patients undergoing coronary angiography. Patient education and preparation should include information addressing the expectations. Moreover, an appropriate care program based on the patients' expectations can promote the quality of care and satisfaction of patients.

Bilateral ewing sarcoma/primitive neuroectodermal tumor of the breast: a very rare entity and review of the literature.

Peripheral primitive neuroectodermal tumors (PNET) are rare malignant tumors, affecting mostly children and adolescents and have been described in breast in eight case reports only. In this paper, we present a case of bilateral mammary ES/PNET where distinction between primary and metastatic diseases was discussed through a literature review. The aim of this work is to demonstrate that although rare, the possibility of PNET should be kept in mind while evaluating a palpable breast abnormality in a young female.

Alanine- and glucose-based hypo-osmolar oral rehydration solution in infants with persistent diarrhoea: a controlled trial.

To evaluate the efficacy of a hypo-osmolar and a standard (World Health Organization) oral rehydration salt (ORS) solution in persistent diarrhoea, a randomized controlled clinical trial was conducted in 55 children. After a 1-day observation period the children were assigned to one of three solutions: standard ORS (WHO-ORS) (osmolality 311 mosmol/l), hypo-osmolar ORS containing L-alanine and glucose (osmolality 255 mosmol/l) and i.v. polyelectrolyte solutions (osmolality 293 mosmol/l) for ongoing replacement of stool loss for the next 4 days. Excellent acceptability of ORS (101-160 ml/kg body weight/day) by the children was observed. There were no significant differences in the total intake of solutions and food, and frequency of stools among the groups. Stool outputs were significantly less in infants receiving hypo-osmolar ORS than in those receiving WHO-ORS for 0-24 h (p = 0.04), 0-48 h (p = 0.01), 0-72 h (p = 0.04) and 0-96 h (p = 0.03). The results indicate a sufficient scope of ORS practice in persistent diarrhoea. Furthermore, we found that a hypo-osmolar ORS containing L-alanine and glucose is as efficacious as an iv solution and more effective than WHO-ORS for replacement of ongoing stool loss in persistent diarrhoea.