A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country.

BACKGROUND: The commonest indication for hospitalization in COVID-19 patients is hypoxemia or severe respiratory symptoms. However, COVID-19 disease may result in extrapulmonary complications including kidney-related pathology. The reported incidence of renal involvement related to COVID infection varies based on geographical location. OBJECTIVE: This study aimed to assess the incidence rate of AKI in hospitalized COVID-19 patients and identify risk factors and prognostic predictors. METHOD: In this retrospective study, we recruited hospitalized COVID-19 patients from January 2021 until June 2021 at the University Malaya Medical Center. The inclusion criteria were hospitalized for ≥ 48 h with confirmed COVID-19 infection and at least 18 years old. Patient demographic and clinical data were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines. RESULTS: One thousand five hundred twenty-nine COVID patients fulfilled the inclusion criteria with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36-66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n = 85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n = 323). The percentage of COVID patients in different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. Fifteen hospitalized patients (0.98%) required renal replacement therapy. 58.8% (n = 190) of AKI group had complete recovery of kidney function. Demographic factors included age (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.012), CKD (p < 0.001), and vaccination status (p = 0.042) were associated with an increased risk of developing AKI. We found that the AKI cohort had statistically significant lower platelet counts and higher ferritin levels than the non-AKI cohort. AKI is a risk predictor of prolonged hospitalization (p < 0.001) and higher mortality rates (P < 0.001). CONCLUSION: AKI is a common clinical complication among hospitalized COVID-19 patients. The etiology of AKI is multifactorial and may have an adverse impact on patient morbidity and mortality.

Annotated computed tomography coronary angiogram images and associated data of normal and diseased arteries.

Computed Tomography Coronary Angiography (CTCA) is a non-invasive method to evaluate coronary artery anatomy and disease. CTCA is ideal for geometry reconstruction to create virtual models of coronary arteries. To our knowledge there is no public dataset that includes centrelines and segmentation of the full coronary tree. We provide anonymized CTCA images, voxel-wise annotations and associated data in the form of centrelines, calcification scores and meshes of the coronary lumen in 20 normal and 20 diseased cases. Images were obtained along with patient information with informed, written consent as part of the Coronary Atlas. Cases were classified as normal (zero calcium score with no signs of stenosis) or diseased (confirmed coronary artery disease). Manual voxel-wise segmentations by three experts were combined using majority voting to generate the final annotations. Provided data can be used for a variety of research purposes, such as 3D printing patient-specific models, development and validation of segmentation algorithms, education and training of medical personnel and in-silico analyses such as testing of medical devices.

1.3 µm dissipative soliton resonance generation in Bismuth doped fiber laser.

In this work, a Figure-9 (F9) bismuth-doped fiber laser (BiDFL) operating in the dissipative soliton resonance (DSR) regime is presented. The 1338 nm laser used a BiDF as the active gain medium, while a nonlinear amplifying loop mirror (NALM) in an F9 configuration was employed to obtain high energy mode-locked pulses. The wave breaking-free rectangular pulse widened significantly in the time domain with the increase of the pump power while maintaining an almost constant peak power of 0.6 W. At the maximum pump power, the mode-locked laser delivered a rectangular-shaped pulse with a duration of 48 ns, repetition rate of 362 kHz and a radio-frequency signal-to-noise ratio of more than 60 dB. The maximum output power was recorded at around 11 mW with a corresponding pulse energy of 30 nJ. This is, to the best of the author's knowledge, the highest mode-locked pulse energy obtained at 1.3 µm as well as the demonstration of an NALM BiDFL in a F9 configuration.

Disseminated Melioidosis with Spinal Intraosseous Abscess.

Melioidosis is endemic in the State of Sabah, Malaysia. We report a case of a 34-year-old man with one-week history of fever and cough, three days history of diarrhoea and vomiting, which was associated with a loss of appetite and loss of weight for one-month. Clinically, he had hepatosplenomegaly and crepitation over his right lower zone of lung. Chest radiograph showed right lower lobe consolidation. Ultrasound abdomen showed liver and splenic abscesses. Ultrasound guided drainage of splenic abscess yielded Burkholderia pseudomallei. Magnetic resonance imaging (MRI) lumbosacral confirmed right sacral intraosseous abscess after he developed back pain a week later. He received 6 weeks of intravenous antibiotics and oral co-trimoxazole, followed by 6 months oral co-trimoxazole and had full recovery.

Mechanically exfoliated In2Se3 as a saturable absorber for mode-locking a thulium-doped fluoride fiber laser operating in S-band.

The rise of 2D materials since the discovery of graphene has been exponential. Their mechanical, electrical and optical properties are exceptional, similar to their 3D counterparts. In this paper, an α-In2Se3 crystal is mechanically exfoliated and transferred directly onto a fiber ferrule to serve as a saturable absorber (SA). A thulium-doped fluoride fiber is used as a gain medium to generate mode-locked pulses together with the In2Se3-based SA. The SA has a modulation depth of 14.6% and a saturation intensity of 0.4 kW/cm2. The passively generated mode-locked pulses have a repetition rate of 6.93 MHz and a pulse width of 5.79 ps. The mode-locked pulses also have a signal-to-noise ratio of 65.4 dB and a time-bandwidth product of 0.36. The pulse energy and peak power are 0.179 nJ and 27.2 W, respectively.

Necrotising pneumonia: A pneumonia that may need surgical intervention.

Pneumonia is primarily a disease that is usually managed medically with antibiotics. However, in rare cases it may progress to necrotising pneumonia, which is an uncommon but severe complication of bacterial pneumonia. This case illustrates a typical case of necrotising pneumonia complicated with parenchymal and pleural complication such as empyema, pneumothorax with possible bronchopleural fistula. Early consultation with thoracic surgeon can be life-saving.

Oscillatory behavior of vortex-lattice melting transition line in mesoscopic Bi_{2}Sr_{2}CaCu_{2}O_{8+y} superconductors.

The vortex-lattice melting transition of a limited number of vortices confined in mesoscopic square superconductors was studied by c-axis resistance measurements using stacks of intrinsic Josephson junctions in Bi_{2}Sr_{2}CaCu_{2}O_{8+y}. In contrast to the melting transition in bulk crystals, we have first found a clear oscillatory behavior in the field dependence of the melting temperature in small samples of 5-10 µm square. The periods of the oscillations roughly obey the regularity of the matching conditions of square vortex lattices surrounded by a square boundary and the melting temperatures are enhanced around the vortex number of i^{2} (where i is an integer). The results suggest that a confinement effect by the square boundary stabilizes square lattice structures which are realized around i^{2} vortex number even in competition with the favorable Abrikosov triangular lattice in the bulk.

Low muscle mass and sarcopenia: common and predictive of osteopenia in inflammatory bowel disease.

BACKGROUND: Body composition is poorly studied in inflammatory bowel disease (IBD). Sarcopenia describes a loss of muscle mass and strength. AIM: To assess the prevalence of low lean mass (LM), sarcopenia and associated morbidity in an adult IBD cohort. METHODS: Cross-sectional data were gathered on pre-menopausal 18- to 50-year-old patients with IBD. Whole-body dual-energy X-ray absorptiometry, anthropometric assessment and grip strength were performed. Low LM was defined as ≥1 s.d. below the population mean for appendicular skeletal muscle index [ASMI (kg)/height (m)²], and sarcopenia as both ASMI and grip strength ≥1 s.d. below population mean. Multivariate regression analyses were performed. RESULTS: Of 137 participants (median age 31 years, BMI 24.8 kg/m(2) ), 56% were male and 69% had Crohn's disease (CD). Low LM and sarcopenia were observed in 21% and 12% of patients, respectively, and osteopenia/osteoporosis in 38% of patients (mean lumbar spine t-score -0.3 ± s.d. 1.1). Grip strength predicted low LM and sarcopenia better than did body mass index (BMI) (OR 4.8 vs. OR 0.7 for low-LM, P < 0.05 both). Normal BMI was falsely reassuring in 72% and 76% of patients with low ASMI and sarcopenia, respectively. Low LM and sarcopenia (OR = 3.6, P = 0.03; OR = 6.3, P = 0.02; respectively), but not BMI nor fat mass, predicted osteopenia/osteoporosis. CONCLUSIONS: Low lean mass and sarcopenia are common in patients with IBD, and important to recognise as they predict osteopenia/osteoporosis. Grip strength testing should be incorporated into routine clinical practice to detect low lean mass deficits, which may go unrecognised using BMI alone.

Nanostructure characterisation of flow-formed Cr-Mo-V steel using transmission Kikuchi diffraction technique.

Nowadays flow-forming has become a desired near net shape manufacturing method as it provides excellent mechanical properties with improved surface finish and significant manufacturing cost reduction. However, the material is subjected to excessive plastic deformation during flow-forming process, generating a very fine and complex microstructure. In addition, the intense dislocation density and residual stress that is generated in the component during processing makes the microstructure characterisation using conventional micro-analytical tools challenging. Thus, the microstructure/property relationship study in such a material is rather difficult. In the present study a flow-formed Cr-Mo-V steel nanostructure and crystallographic texture were characterised by means of Transmission Kikuchi Diffraction (TKD). Here, TKD is shown to be a powerful technique in revealing very fine martensite laths within an austenite matrix. Moreover, fine precipitates in the order of 20-70 nm on the martensite lath boundaries were clearly imaged and characterised. This greatly assisted in understanding the preferable site formation of the carbides in such a complex microstructure. The results showed that the actual TKD spatial resolution was in the range of 5-10 nm using 25 kV for flow-formed Cr-Mo-V steel.

ß-Catenin and NF-κB co-activation triggered by TLR3 stimulation facilitates stem cell-like phenotypes in breast cancer.

Cancer stem cells (CSCs) are responsible for tumor initiation and progression. Toll-like receptors (TLRs) are highly expressed in cancer cells and associated with poor prognosis. However, a linkage between CSCs and TLRs is unclear, and potential intervention strategies to prevent TLR stimulation-induced CSC formation and underlying mechanisms are lacking. Here, we demonstrate that stimulation of toll-like receptor 3 (TLR3) promotes breast cancer cells toward a CSC phenotype in vitro and in vivo. Importantly, conventional NF-κB signaling pathway is not exclusively responsible for TLR3 activation-enriched CSCs. Intriguingly, simultaneous activation of both ß-catenin and NF-κB signaling pathways, but neither alone, is required for the enhanced CSC phenotypes. We have further identified a small molecule cardamonin that can concurrently inhibit ß-catenin and NF-κB signals. Cardamonin is capable of effectively abolishing TLR3 activation-enhanced CSC phenotypes in vitro and successfully controlling TLR3 stimulation-induced tumor growth in human breast cancer xenografts. These findings may provide a foundation for developing new strategies to prevent the induction of CSCs during cancer therapies.

Lower urinary tract dysfunction in children after intravesical ureteric reimplantation surgery under one year of age.

OBJECTIVE: To report the results of a study conducted on voiding function in children who have undergone intravesical trans-trigonal Cohen ureteric reimplantation surgery before the age of one year. SUBJECTS: Twenty-eight children (18 males, 10 females) had surgery at a mean age of 4.9 months (range 8-352 days). METHODS: Bladder function was assessed at a mean age of 7.3 years using questionnaires, the dysfunctional voiding scoring system, PinQ quality of life tool, uroflowmetry and post-void residuals. RESULTS: Of the total children, 72% had normal lower urinary tract (LUT) function. Eight children (28%) had evidence of LUT dysfunction, two had urge incontinence, two had giggle incontinence, two had voiding postponement, one had dysfunctional elimination syndrome and one had evidence of dysfunctional voiding. Five of the eight children were managed with continence physiotherapy (urotherapy) and one required ongoing anticholinergic therapy. CONCLUSION: When compared to the published rates of LUT dysfunction in the general paediatric community, no evidence was found to suggest an increased incidence of bladder dysfunction in children undergoing intravesical Cohen ureteric reimplantation surgery under one year of age.

Visfatin and its genetic variants are associated with obesity-related morbidities and cardiometabolic risk in severely obese children.

BACKGROUND: Visfatin is an adipokine, associated with obesity and possibly glucose regulation. OBJECTIVE: The aim of this study was to examine the association of visfatin and its genetic variants with adiposity, cardiometabolic risk factors and obesity-related morbidities in obese children. METHODS: Anthropometric measurements, dual energy X-ray absorptiometry scan, fasting blood samples and oral glucose tolerance tests were performed for 243 obese children. We screened the visfatin gene of 24 obese subjects and then performed genotyping of identified genetic variants in other 219 obese children through direct DNA sequencing. RESULTS: Fasting serum visfatin correlated with measures of obesity and liver enzymes and was elevated in obese children with abnormal glucose tolerance and non-alcoholic fatty liver disease. The two upstream single nucleotide polymorphisms, -3187G>A (rs11977021) and -1537C>T (rs61330082), were at complete linkage disequilibrium. The AA genotype of -3187G>A was associated with higher serum visfatin (6.17 ± 0.76 ng mL(-1) vs. 3.92 ± 0.44 ng mL(-1)) and higher triglyceride (1.39 ± 0.08 mmol L(-1) vs. 1.19 ± 0.07 mmol L(-1)) as compared with the GG genotype. There was also a significant linear increase in serum visfatin across GG to GA to AA genotype of -3187G>A, indicating possible additive effect of A allele. The dominant GA + AA genotype model of +21426G>A (rs2302559) was associated with lower serum visfatin (3.83 ± 0.56 ng mL(-1) vs. 5.13 ± 0.34 ng mL(-1)) and lower plasma glucose (4.37 ± 0.08 mmol L(-1) vs. 4.77 ± 0.12 mmol L(-1)) as compared with the GG genotype. CONCLUSION: Visfatin and its genetic variants were associated with adiposity, obesity-related morbidities and adverse cardiometabolic parameters. This supported our hypothesis that visfatin plays a significant role in the development of obesity-related morbidities and cardiometabolic risk.

Aedes larval population dynamics and risk for dengue epidemics in Malaysia.

Early detection of a dengue outbreak is an important first step towards implementing effective dengue interventions resulting in reduced mortality and morbidity. A dengue mathematical model would be useful for the prediction of an outbreak and evaluation of control measures. However, such a model must be carefully parameterized and validated with epidemiological, ecological and entomological data. A field study was conducted to collect and analyse various parameters to model dengue transmission and outbreak. Dengue prone areas in Kuala Lumpur, Pahang, Kedah and Johor were chosen for this study. Ovitraps were placed outdoor and used to determine the effects of meteorological parameters on vector breeding. Vector population in each area was monitored weekly for 87 weeks. Weather stations, consisting of a temperature and relative humidity data logger and an automated rain gauge, were installed at key locations in each study site. Correlation and Autoregressive Distributed Lag (ADL) model were used to study the relationship among the variables. Previous week rainfall plays a significant role in increasing the mosquito population, followed by maximum humidity and temperature. The secondary data of rainfall, temperature and humidity provided by the meteorological department showed an insignificant relationship with the mosquito population compared to the primary data recorded by the researchers. A well fit model was obtained for each locality to be used as a predictive model to foretell possible outbreak.

Relationship between cervical spine injury and helmet use in motorcycle road crashes.

Motorcycle helmets have been proven to prevent head injury and reduce fatality in road crashes. However, certain studies indicate that the helmet increases the mass to the head, and thus the potential of neck injury due to the flexion/extension of the head-neck segment in a road crash may increase. This study was conducted to evaluate the effects of motorcycle helmets and the ways in which the accidents that occurred affected the incidence of cervical spine injury. Nevertheless, it is not intended to and does not discredit the fact that helmet use prevents many motorcyclists from sustaining serious and fatal head injuries. A total of 76 cases were collected and analyzed based on the data collected from real-world crashes. The Abbreviated Injury Scale (AIS) was used to assess the severity of injury, whereas the statistical Pearson χ(2) correlation method was used for analysis. The results showed that motorcycle helmets did not affect the severity of cervical spine injury. However, when the samples were further subcategorized into different crash modes, it was found that helmets affect the incidence of a severe cervical spine injury. In frontal collisions, the use of helmets significantly reduces the severity of cervical spine injury, whereas in rear-end, side impact, and skidded accidents, the use of helmets increases the probability of a severe cervical spine injury. However, in the latter crash modes, a motorcyclist without a helmet will have to trade-off with head injury. A logistic regression model has been developed with respective crash modes and the probabilities of risk in having severe cervical spine injury have been calculated. Future designs in motorcycle helmets should therefore consider the significance of nonfrontal accidents and the interaction of helmet with other parts of the body by possibly considering the weight of the helmet.

Utilisation of emergency medical service among Singapore patients presenting with ST-segment elevation myocardial infarction: prevalence and impact on ischaemic time.

BACKGROUND: Previous studies in Western countries found that the emergency medical service (EMS) was under-used in patients with myocardial infarction. AIM: We sought to determine the prevalence of immediate EMS utilisation among Singapore patients presenting with ST-segment elevation myocardial infarction (STEMI), and correlated the use of the EMS with the symptom-to-balloon and door-to-balloon times. METHODS: We studied 252 patients admitted with STEMI to our institution from August 2008 to September 2009. Information regarding demographic characteristics, whether EMS was used, reperfusion procedural details and mortality rates were collected prospectively. RESULTS: Among the recruited patients, 89 (35.3%) used the EMS (EMS group) and 163 (64.7%) did not use the EMS (non-EMS group). In the latter group, 98 (60.1%) arrived at our institution through their own transport, 56 (34.4%) first consulted general practitioners, and 9 (5.5%) initially consulted another hospital without acute medical services. Among the 245 (out of 252, 97.2%) patients who received percutaneous coronary intervention (PCI), the EMS group was more likely to undergo primary PCI (P= 0.003) while the non-EMS group was more likely to undergo non-urgent PCI (P= 0.002). In patients who underwent primary PCI, the EMS group had a shorter symptom-to-balloon time (average difference 81.6 min, P= 0.002). The door-to-balloon time was similar for both groups. CONCLUSION: Despite the availability of a centralised EMS, 64.7% of patients with STEMI did not contact EMS at presentation. These patients were less likely to receive primary PCI and had a significantly longer symptom-to-balloon time.

Aedes larval population dynamics and risk for dengue epidemics in Malaysia

Early detection of a dengue outbreak is an important first step towards implementing effective dengue interventions resulting in reduced mortality and morbidity. A dengue mathematical model would be useful for the prediction of an outbreak and evaluation of control measures. However, such a model must be carefully parameterized and validated with epidemiological, ecological and entomological data. A field study was conducted to collect and analyse various parameters to model dengue transmission and outbreak. Dengueprone areas in Kuala Lumpur, Pahang, Kedah and Johor were chosen for this study. Ovitraps were placed outdoor and used to determine the effects of meteorological parameters on vector breeding. Vector population in each area was monitored weekly for 87 weeks. Weather stations, consisting of a temperature and relative humidity data logger and an automated rain gauge, were installed at key locations in each study site. Correlation and Autoregressive Distributed Lag (ADL) model were used to study the relationship among the variables. Previous week rainfall plays a significant role in increasing the mosquito population, followed by maximum humidity and temperature. The secondary data of rainfall, temperature and humidity provided by the meteorological department showed an insignificant relationship with the mosquito population compared to the primary data recorded by the researchers. A well fit model was obtained for each locality to be used as a predictive model to foretell possible outbreak.

A review of elderly injuries seen in a Singapore emergency department.

INTRODUCTION: The elderly population in Singapore is steadily increasing, thus increasing the stress on healthcare provision and financing. Elderly injuries result in significant mortality and morbidity. This study aimed to identify the injury patterns, specific risk factors involved and needs of the elderly so that the current emergency model of care for the injured elderly can be improved and injury prevention strategies devised. METHODS: We conducted a retrospective study of all elderly aged 65 years and older seen for trauma in an emergency department over six months. Data captured in the real-time computer system was studied with regard to patient profile, mechanism of injury and patient disposition. RESULTS: 720 patients aged 65 years and older were seen for trauma in the first six months of 2005, accounting for 10.4 percent of the total attendance for that age group. Home injuries (67.9 percent) were the most common, followed by road-related injuries (21.2 percent). 85.3 percent of the injuries were due to falls. 49.9 percent of the patients were admitted to hospital. We also examined the underlying causes of the injuries and the common injuries sustained. CONCLUSION: Injuries in the elderly is a significant problem. Most of the injuries occur at home and falling is the commonest cause. Many of the injuries are potentially preventable. Several possible injury prevention strategies and improvements to the current emergency model of care of the injured elderly are discussed. The establishment of a national elderly injury surveillance database is advocated.