Emergency Laparotomy in a COVID-19 patient with acute abdomen.

We describe here the first laparotomy involving a COVID-19 patient in Malaysia. A 60-year-old man screened positive for SARS-CoV-2 in March 2020 and developed acute abdomen in the ward in Hospital Sultanah Bahiyah, Kedah. He underwent laparotomy and cholecystectomy for gangrenous cholecystitis. All personnel adhered to infectious control precautions, donning full personal protective equipment (PPE) throughout the surgery. Post-operatively, due to raised septic parameters, he was carefully diagnosed with and treated empirically for superimposed bacterial sepsis instead of cytokine release syndrome, with confirmed blood culture of Klebsiella pneumoniae. Patient was discharged well later. None of the staff involved in his care developed COVID-19 infection.

Novel mutations in DNAJB6 cause LGMD1D and distal myopathy in French families.

BACKGROUND AND PURPOSE: The aim was to determine the genetic background of unknown muscular dystrophy in five French families. METHODS: Twelve patients with limb girdle muscular dystrophy or distal myopathy were clinically evaluated. Gene mutations were identified using targeted exon sequencing and mutated DNAJB6 was tested in vitro. RESULTS: Five patients presented with distal lower limb weakness whilst others had proximal presentation with a variable rate of progression starting at the mean age of 38.5 years. Two novel mutations (c.284A>T, p.Asn95Ile, two families; and c.293_295delATG, p.Asp98del, one family) as well as the previously reported c.279C>G (p.Phe93Leu, two families) mutation in DNAJB6 were identified. All showed a reduced capacity to prevent protein aggregation. CONCLUSIONS: The mutational and phenotypical spectrum of DNAJB6-caused muscle disease is larger than previously reported, including also dysphagia. The originally reported c.279C>G (p.Phe93Leu) mutation is now identified in four different populations and appears to be a mutational hotspot. Our report confirms that some DNAJB6 mutations cause distal-onset myopathy and hence DNAJB6 defects should be considered broadly in dominant muscular dystrophy families.

The Development of a Culturally Adapted Pilot Intervention for African American Family Members of Homicide Victims: A Preliminary Report.

African Americans are disproportionately impacted by homicide in the United States. Individuals who have lost a relative to homicide often experience symptoms of complicated grief. The objective of this study was to explore the impact of a culturally tailored psychoeducational pilot intervention whose development was informed by a conceptual model of coping for African American survivors of homicide victims and was designed to (a) educate participants about the manifestation of complicated grief and symptoms and (b) help participants develop ways to cope with their grief. Pre- and post-test results indicate preliminary support for this encouraging intervention in achieving its intended outcomes to help participants identify complicated grief symptoms, supports, and services to help them manage their grief. Implications for posthomicide research and practice are discussed.

Association study reveals novel risk loci for sporadic inclusion body myositis.

BACKGROUND AND PURPOSE: The aim was to identify potential genetic risk factors associated with sporadic inclusion body myositis (sIBM). METHODS: An association based case-control approach was utilized on whole exome sequencing data of 30 Finnish sIBM patients and a control cohort (n = 193). A separate Italian cohort of sIBM patients (n = 12) was used for evaluation of the results. RESULTS: Seven single nucleotide polymorphisms were identified in five genes that have a considerably higher observed frequency in Finnish sIBM patients compared to the control population, and the previous association of the genetic human leukocyte antigen region was confirmed. CONCLUSIONS: All seven identified variants could individually or in combination increase the susceptibility for sIBM.

Interfacial interaction study of EDTA with the defect structure of Fe3-δ O4 passive film in an aggressive alkaline medium based on the lattice theory of point defects.

Despite extensive research on the matter of corrosion inhibition efficiency, the interactions between the defect structure of the passive layer and the inhibitor molecules still remain poorly understood. In this study, the corrosion inhibition mechanism of ethylenediamine-tetraacetic acid as a carboxylate-based organic inhibitor on steel specimens in simulated concrete pore solution was studied. The point defect model was used to describe the response of the passive oxide film on the steel surface to the perturbation caused by the addition of the carboxylate compound. The electrochemical behavior of the steel specimens was evaluated through open circuit potential, electrochemical impedance spectroscopy and potentiodynamic analysis. The reduction in efficiency outside the optimal concentrations was discussed from an electrochemical point of view. We suggest that the performance of the inhibitor is highly dependent on the positively charged entities on the passive layer including anion vacancies and interstitial cations. To further investigate the physicochemical behavior of the organic molecules, density functional theory and adsorption isotherms were applied. The topography and morphology of the surface were analyzed through scanning electron microscopy. To confirm the inhibitive effect of EDTA, the elements and chemical bonds present on the surface were characterized via X-ray photoelectron spectroscopy. The surface analysis confirmed that the addition of EDTA formed a network of chemical bonds, which significantly hindered the corrosion phenomenon.

Prognostic Role of Lymphovascular Invasion in Patients with Early Breast Cancer.

In this study, our aim was to evaluate the role of lymphovascular invasion (LVI) in the prognosis of patients with early stage breast cancer. The medical records of more than 7000 patients who suffered from invasive breast cancer and had undergone surgical treatment since December 1994 till December 2019, retrospectively. Patient's history, physical examination and the clinicopathological features, histopathology characteristics, immunohistochemical findings, adjuvant systemic therapy, recurrence rate, metastasis-free survival (MFS), disease-free survival (DFS), and overall survival (OS) were reviewed. A total of 5425 eligible patients were categorized into two groups based on the presence of LVI; 3031 (55.9%) patients had no LVI (group 1) and LVI was present in 2394 (44.1%) patients (group 2), then divided into LN-positive and -negative groups. Presence of LVI was significantly associated with patient age ≤ 40 years (p = 0.048), high histological grade (grades II and III, p < 0.001), tumor size between 2-5 cm and > 5 cm (p < 0.001), number of involved LN ≥ 4 (p < 0.001), and negative ER (p = 0.042) tumors. Five-year OS, MFS, and DFS were 93%, 88.9%, and 76.1% and 85.2%, 84.7%, and 73.6 in groups 1 and 2, respectively (P < 0.001). On multivariate analysis, LVI was an independent prognostic factor for DFS in all patients. Furthermore, histological grade II, histological grade III, and a higher number of involved LNs (≥ 4) were independent predictors in all patients. Thus, the presence of LVI can be considered as an independent prognostic factor for patients with operable breast cancer, irrespective of the LN status.

Thyroid autoantibodies and associated complications during pregnancy.

This study was undertaken to determine the presence of thyroid autoantibodies and associated pregnancy complications from 49 pregnant women with thyroid disease. There were 31 (63%) women with Graves' disease (GD) and 18 (37%) with primary hypothyroidism (PHT). A total of 26 (53.1%) women, 19 (61%) with GD and seven (39%) with PHT, had positive antibodies. Six had thyroid peroxidase antibodies (TPO), one with thyroglobulin antibody (TG) and eight had TSH receptor antibodies (TR). Two had a mixture of antibodies involving TG/TPO (one GD vs one PHT), four with TG/TPO/TR (all had GD) and five with TPO/TR (four with GD vs one with PHT). There were associations in women with positive thyroid antibodies and pre-eclampsia (15.4%), abruptio placenta (4%), caesarean deliveries (31%), postpartum thyroiditis (19.2%) and abnormal neonatal thyroid function (15.4%). Women with positive thyroid antibodies in pregnancy need close care during and after pregnancy, as they can develop complications affecting both mother and fetus.

Dosimetry of Critical Organs in Maxillofacial Imaging with Cone-beam Computed Tomography.

BACKGROUND: While the benefits of cone-beam computed tomography (CBCT) are well known in maxillofacial imaging, the use of this modality is not risk-free. OBJECTIVE: The aim of this study was to evaluate the exposure doses received by patients during maxillofacial imaging with CBCT. METHODS: Entrance surface dose (ESD) was measured by using thermoluminescent dosimeters (TLDs) attached to the eyes lids, parotid glands and thyroid of 64 patients in two imaging centers (A and B). Phantom dosimetry was performed by a cylindrical poly-methyl methacrylate (PMMA) head-size phantom and an ionization chamber for different exposure parameters. NewTom VGi and Planmeca Promax 3D CBCT scanners were used at centers A and B, respectively. RESULTS: The mean ESD of the eyes, parotid glands and thyroid were 2.57, 2.33 and 0.28 mGy in center A, 0.35, 2.11 and 0.37 mGy in center B, respectively. ESD of the eyes revealed a significant difference in two centers; in center B, it was 86.4% lower than center A. In the phantom dosimetry, the measured doses of NewTom VGi were 2.63 and 2.08 mGy, respectively by changing field of view (FOV) size from 8×8 cm2 (height × diameter) to 6×6 cm2. For Planmeca Promax 3D, it ranged from 0.98 to 3.24 mGy depending on exposure parameters. CONCLUSION: There is a wide range of radiation doses dependent on the units, patients and selected scan parameters. Inappropriate selection of exposure settings, especially FOV size, can seriously increase patient dose.

Smart Diabetic Screening and Managing Software, A Novel Decision Support System.

BACKGROUND: Diabetes is a serious chronic disease, and its increasing prevalence is a global concern. If diabetes mellitus is left untreated, poor control of blood glucose may cause long-term complications. A big challenge encountered by clinicians is the clinical management of diabetes. Many IT-based interventions such ad CDSS have been made to improve the adherence to the standard care for chronic diseases. OBJECTIVE: The aim of this study is to establish a decision support system of diabetes management based on diabetes care guidelines in order to reduce medical errors and increase adherence to guidelines. MATERIALS AND METHODS: To start the process, at first the existing guidelines in the field of diabetes mellitus such as ADA 2017 and AACE guideline 2017 were reviewed, and accordingly, flowcharts and algorithms for screening and managing of diabetes were designed. Then, it was passed on to the information technology team to design software. RESULTS: The most significant outcome of this research was to establish a smart diabetic screening and managing software, which is an important stride to promote patients' health status, control diabetes and save patients' information as an important and reliable source. CONCLUSION: Health care technologies have the potential to improve the quality of diabetes care through IT-based intervention, such as clinical decision support systems. In a chronic disease like diabetes, the critical component is the disease management. The advantages of this web-based system are on-time registration, reports of diabetic prevalence, uncontrolled diabetes, diabetic complications and reducing the rate of mismanagement of diabetes, so that it helps the physicians in order to manage the patients in a better way.

Removal of copper from water using limestone filtration technique. Determination of mechanism of removal.

This paper discusses heavy metal removal from wastewater by batch study and filtration technique through low-cost coarse media. Batch study has indicated that more than 90% copper (Cu) with concentration up to 50 mg/l could be removed from the solution with limestone quantity above 20 ml (equivalent to 56 g), which indicates the importance of limestone media in the removal process. This indicates that the removal of Cu is influenced by the media and not solely by the pH. Batch experiments using limestone and activated carbon indicate that both limestone and activated carbon had similar metal-removal efficiency (about 95%). Results of the laboratory-scale filtration technique using limestone particles indicated that above 90% removal of Cu was achieved at retention time of 2.31 h, surface-loading rate of 4.07 m3/m2 per day and Cu loading of 0.02 kg/m3 per day. Analyses of the limestone media after filtration indicated that adsorption and absorption processes were among the mechanisms involved in the removal processes. This study indicated that limestone can be used as an alternative to replace activated carbon.

Neonatal melioidosis.

We report a neonate with melioidosis. The presentation, progress and treatment are described, followed by a discussion on melioidosis.

Epidemiology of Haemophilus influenzae invasive disease in hospitalised Kelantanese children, 1985-1994.

AIM: Data is lacking with regard to the epidemiology of invasive haemophilus influenzae (HI) disease in Malaysia. This study was carried out to document the epidemiology of invasive HI disease in hospitalised Kelantanese children. METHODS: We conducted a retrospective study of 65 children who had invasive HI disease from June 1985 to December 1994. Data regarding age, sex, duration of illness, weight, diagnosis, complications, duration of hospitalisation, outcome, full blood count and sensitivity pattern of HI to various antibiotics were reviewed. RESULTS: The age distribution varied from one day to 72 months with a mean of 13 months. Peak incidence occurred in the 7-12 months age group. Majority (89.1%) was below two years of age. The relative frequencies of the 75 clinical entities documented were as follows: meningitis 64%, pneumonia 29.3%, septicaemia 5.4%, and abscess 1.3%. In addition, 13.5% of cases had meningitis associated with pneumonia. Serotype b accounted for all strains in cases where serotyping was done. Anaemia (Hb < 10 g%) was seen in 71.4% of cases. Long term complications were noted in 41.5% of cases of meningitis. Case fatality rate was 12.3%. The percentage of HI strains sensitive to penicillin, ampicillin, chloramphenicol and co-trimoxazole were 83.7%, 87.7%, 98.2% and 89.7%, respectively. CONCLUSION: The data suggest that invasive HI disease causes considerable morbidity and mortality in Kelantanese children.

Sbaja a novel foliar applied growth and yield enhancer in Malaysia / Sbaja, um novo potenciador de crescimento foliar aplicado e de rendimento na Malásia

Product efficacy testing during 2006 to 2010 with SBAJA (a novel scientifically formulated foliar-spray growth and yield enhancer) in the greenhouse and multi-location field trials registered measurable increase in chlorophyll contents, robust and healthier crop growth and increased yield and biomass production. In field trial, rice plants receiving normal NPK fertilizer at the rates of 100:50:30 served as control and spray treated with SBAJA at 40 and 60 days after sowing (DAS). All the experiments were laid out in Randomized Complete Block (RCB) Design and replicated five times. Tiller number and panicle characteristics; length, weight, number of grains, number of filled grains were significantly increased with 1:300 SBAJA treatment. In addition, 1000 grain weight and rice yield increased significantly with SBAJA treatments. Normal fertilizer applications in field trials augmented with SBAJA in 2008-2010 in the Selangor North West Project (SNWP), registered measurable increase in rice yields by 25-30% from 6.2 - 6.5 tons/ha to 7.8 - 8.9 tons/ha. It is concluded that foliar spraying with SBAJA at 40 and 60 days after sowing increased growth and yield of rice under green house and field conditions.

Os testes de eficácia do produto durante 2006 a 2010 com SBAJA (um novo spray foliar cientificamente formulado) em estufa e ensaios de campo em várias localizações registraram aumento mensurável nos teores de clorofila, crescimento robusto e mais saudável das culturas e aumento do rendimento e da produção de biomassa. No ensaio de campo, plantas de arroz recebendo adubo NPK normal nas doses de 100:50:30 serviram como controle e foram tratadas com SBAJA aos 40 e 60 dias após a semeadura (DAS). Todos os experimentos foram dispostos no formato Randomized Complete Block (RCB) e replicados cinco vezes. Número de perfilhos e características da panícula; comprimento, peso, número de grãos, número de grãos preenchidos foram significativamente aumentados com o tratamento com 1:300 SBAJA. Além disso, o peso de 1000 grãos e o rendimento de arroz aumentaram significativamente com os tratamentos da SBAJA. Aplicações normais de fertilizantes em testes de campo aumentados com a SBAJA em 2008-2010 no Projeto Selangor North West (SNWP), registraram aumento mensurável na produção de arroz de 25-30% de 6,2 a 6,5 toneladas/ha para 7,8 a 8,9 toneladas/ha. Conclui-se que a pulverização foliar com SBAJA aos 40 e 60 dias após a semeadura aumentou o crescimento e o rendimento do arroz em estufa e em campo.

Evaluation of the safety of domestic food preparation in Malaysia.

Food-handling practices were studied in 119 and 158 households, respectively, in an urban and a rural community in Peninsular Malaysia. Hazard analyses, including microbiological analysis of foods, were carried out in two households in each community and in a house that prepared food for distribution in the urban area. Kitchen hygiene was generally acceptable, although rated "poor" in some instances in the rural area. Food prepared for lunch was usually sufficient for dinner also, the leftover items being stored at ambient temperature until required. In the house that prepared food for distribution, breakfast was prepared during the evening, stored at ambient temperature overnight, and reheated before sale the next morning. There was a local preference for cooking food at temperatures close to boiling point; this reduced the numbers of vegetative cells but not those of spores. In some stored foods the populations of Staphylococcus aureus, Bacillus cereus and mesophilic aerobic bacteria increased, the last-mentioned reaching spoilage levels. Reheating reduced the populations of proliferating bacteria in most foods to acceptable levels but would not have destroyed heat-resistant enterotoxins. Because of their importance in combating acute bacterial foodborne disease, the control of the temperature and time factors during the cooking and storage of food should receive special attention in education on health and food safety.

Incorporation of sewage sludge in clay brick and its characterization.

This study reports the use of sewage sludge generated from sewage treatment plant (STP) as raw material in a clay brick-making process. The physico-chemical and mineralogical characterization of the sewage sludge and clay were carried out in order to identify the major technological constraints and to define the sludge pretreatment requirements if necessary. Moreover, the effects on processing conditions and/or on changes of typical final characteristics are also evaluated. Bricks were produced with sewage sludge additions ranging from 10 to 40% by dry weight. The texture and finishing of the surface of sludge-amended clay bricks were rather poor. As for the physical and chemical properties, bricks with a sludge content of up to 40 wt.% were capable of meeting the relevant technical standards. However, bricks with more than 30 wt.% sludge addition are not recommended for use since they are brittle and easily broken even when handled gently. A tendency for a general degradation of brick properties with sludge additions was observed due to its refractory nature. Therefore, sludge bricks of this nature are only suitable for use as common bricks, which are normally not exposed to view, because of poor surface finishing.