Transcriptomic response of an Antarctic yeast Rhodotorula sp. USM-PSY62 to temperature changes

Aims@#Rhodotorula sp. (USM-PSY62) is a psychrophilic yeast isolated from Antarctic sea ice that grows optimally at 15°C. The inevitable global warming poses many challenges to the microbial community in Antarctica. Therefore, this studywas conceptualized to observe how USM-PSY62 adapted to fluctuations in temperature.@*Methodology and results @#Rhodotorula sp. (USM-PSY62) was grown in YPD broth until the mid-log phase. Then, the culture was transferred to four different temperatures, specifically at 0 °C, 5 °C, 15 °C and 21 °C for 24 h. Then, the RNA was extracted, sequenced and analysed. During cold adaptation, an elevated transcription of the CorA magnesium transporter gene in USM-PSY62 indicated a higher requirement for magnesium ions to gain additional enzyme cofactors or maintain cytoplasmic fluidity. The HepA homologue coding for DNA/RNA helicase was also over-expressed with log fold change 2.89 in cold conditions possibly to reorganize secondary structures of DNA and RNA. An up-regulation of the catalase gene was also observed, reflecting an increment in the concentration of reactive oxygen species and fluctuations in the associated antioxidant system. The YOP1 gene, which encodes a membrane protein associated with protein transport and membrane traffic, was the most down-regulated, with log2 fold change values of -6.93 lower under cold shock conditions. The genes responsible for the structural maintenance of chromosome (SMC) have a -8.80 in expression log2 fold change, indicating the gene was down-regulated when the temperature was shifted to 0 °C. Upon cold shock, the gene for heat shock factor protein 1 (HSF1) was also down-regulated with a log2 fold change value of - 5.86. Hsf1 is a transcriptional regulator which regulates the heat shock responses.@*Conclusion, significance and impact of study: @#In conclusion, the transcriptomic responses demonstrated by Rhodotorula sp. USM-PSY62 characterized critical physiological and biochemical compensatory mechanisms especially cellular processes and signalling, information storage and processing, and metabolism to survive at low and high temperatures. This study provides valuable data for industry, especially in the usage of molecular chaperones.

Unveiling the multifaceted microbial strategies: Insights into ecological adaptations and interactions

@#Microorganisms, such as spanning bacteria, archaea and fungi, were ubiquitous and played pivotal roles in shaping ecosystems. This review offered a comprehensive investigation into the multifaceted strategies employed by microorganisms to thrive and adapt within complex ecological niches. Key themes explored in this review encompassed microbial defence mechanisms, biofilm formation, quorum sensing and altruistic behaviours. Microbial defence mechanisms were scrutinized, with a focus on bacteriocin production. Despite the costs associated with production, bacteriocins served as potent weapons that selectively targeted closely related strains, reducing competition and conferring indirect benefits to the producer's genetic kin. Biofilm formation, a critical facet of microbial survival, was discussed in detail. These structured microbial communities encased in self-secreted extracellular matrices provided structural support and protection, demonstrating their significance in diverse ecological contexts. The review further delved into the evolutionary implications of quorum sensing and altruism within microbial communities. Quorum sensing, a mechanism that allowed population density-dependent communication and cooperation, was revealed as essential for microbial survival. In conclusion, this review enhanced our understanding of the intricate strategies microorganisms employed for survival, adaptation and competition in intricate ecosystems. By shedding light on these mechanisms, it advanced our comprehension of microbial community dynamics and their indispensable roles in diverse environments.

Transposable elements: Uniqueness and applications

@#The study of transposable genetic elements, a cornerstone of molecular genetics, offers profound insights into the dynamic nature of genetic material. This exploration encompasses various types found in bacteria, including insertion sequences, composite and non-composite transposons. These elements are instrumental in shaping bacterial genomes by facilitating the movement of genetic information, driving evolution and contributing to genetic diversity. Understanding the mechanisms of transposition is essential for unravelling the intricate processes governing genetic rearrangements. Replicative and conservative transposition mechanisms, exemplified by the Tn3 family and phage Mu, illustrate the remarkable adaptability of these systems in reshaping genomes. However, it is the transposon Tn5 that steals the spotlight as a versatile molecular genetics tool. Tn5's transposition mechanism, characterized by precise control over gene expression, translational regulation, protein localization and the induction of conditional mutations, empowers researchers to dissect gene regulation intricacies with unprecedented accuracy. Transposable genetic elements, epitomized by Tn5, are indispensable instruments in molecular genetics. They allow researchers to navigate the intricate landscape of genetics, exploring gene regulation, protein function, and genetic diversity with unparalleled precision. These elements continue to be at the forefront of molecular genetics research, driving innovations that deepen our understanding of the fundamental mechanisms governing life's genetic code.

A Review on Finite Element Modelling and Simulation for Upper Limb of Human Bone and Implant

@#Medical implants are normally used in clinical practice to treat most orthopaedics situations involving bone fractures, deformities, dislocation, and lengthening. It should be noted that specific measures regarding biomechanical and biomaterial characteristics are required for a successful post-surgery procedure. Biomechanical evaluations on the medical implants could be performed by utilising computer and engineering technology. One of them is in silico studies using finite element method that could be simulated in high-performance computer. However, various assumptions are required in computer simulation, such as the constraints on data input and computer resources. This review paper discusses current approaches of constructing a finite element model of human bone with specific material properties for upper limb such as the shoulder joint, humerus, elbow joint, radius and wrist joint. Previous related literatures were reviewed from selected keywords and search engines. To narrow the literature search in this study, inclusion and exclusion criteria of the literature searching were applied. We looked at the current level of knowledge in this field and offered recommendations for future study. In conclusion, studies from previous literature have demonstrated several ways for developing mathematical models and simulating medical implants.

Anti-Obesity Effect of Methanolic Extracts of Local Punica granatum in High-Fat Diet-Induced Obese Rats

@#Introduction: Obesity has been linked to coronary artery disease, type II diabetes, metabolic syndrome, stroke, and cancer. Pomegranate (Punica granatum; PG) has been used extensively in folk medicine for several therapeutic purposes. The goal of this study is to investigate the anti-obesity effect of PG peel and pulp methanolic extracts in highfat diet (HFD)-induced Sprague-Dawley rats. Methods: The animals were separated into 7 groups namely Normal control group (normal diet); HFD-induced only as negative control group, and positive control group (HFD-induced + orlistat); treatment group included HFD-induced + peel 125 mg/kg, HFD-induced +peel 250 mg/kg, HFD-induced + pulp 125 mg/kg and HFD-induced + pulp 250 mg/kg. Results: It was observed that methanolic extract of peel and pulp PG 250 mg/kg showed low increment of body weight with a reduction in weight of liver, visceral fat, and subcutaneous fat. Compared to the negative control group, total cholesterol, triglyceride, and low-density lipoprotein levels were shown to be lowered for PG peel and pulp groups also showed higher values in high-density lipoprotein. Conclusion: PG reduced obesity-related markers in blood, liver, and adipose tissue and inhibited obesity caused by a high-fat diet probably because of its antioxidant properties.

COVID-19 vaccine-induced immune thrombotic thrombocytopenia: a review

Rare but serious thrombotic incidents in relation to thrombocytopenia, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), have been observed since the vaccine rollout, particularly among replication-defective adenoviral vector-based severe acute respiratory syndrome coronavirus 2 vaccine recipients. Herein, we comprehensively reviewed and summarized reported studies of VITT following the coronavirus disease 2019 (COVID-19) vaccination to determine its prevalence, clinical characteristics, as well as its management. A literature search up to October 1, 2021 using PubMed and SCOPUS identified a combined total of 720 articles. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, after screening the titles and abstracts based on the eligibility criteria, the remaining 47 full-text articles were assessed for eligibility and 29 studies were included. Findings revealed that VITT cases are strongly related to viral vector-based vaccines, which are the AstraZeneca COVID-19 vaccine (95%) and the Janssen COVID-19 vaccine (4%), with much rarer reports involving messenger RNA-based vaccines such as the Moderna COVID-19 vaccine (0.2%) and the Pfizer COVID-19 vaccine (0.2%). The most severe manifestation of VITT is cerebral venous sinus thrombosis with 317 cases (70.4%) and the earliest primary symptom in the majority of cases is headache. Intravenous immunoglobulin and non-heparin anticoagulant are the main therapeutic options for managing immune responses and thrombosis, respectively. As there is emerging knowledge on and refinement of the published guidelines regarding VITT, this review may assist the medical communities in early VITT recognition, understanding the clinical presentations, diagnostic criteria as well as its management, offering a window of opportunity to VITT patients. Further larger sample size trials could further elucidate the link and safety profile.

Determination of Serum Thyroglobulin Concentration in Simple Diffuse Goiter Patients with Known Iodine Status

Background: Thyroglobulin (TG) seems to be a valuable indicator of thyroid function and iodine nutrition status. Aim of the study: The aim of the study was to observe the relationship between serum thyroglobulin and urinary iodine (UI) in simple diffuse goiter patients.Methods:This cross-sectional observational study was conducted at the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study duration was 2 years, starting from May 2014 to March 2016. Total 87 patients with simple diffuse goiter attending the OPD Department of Endocrinology of BSMMU had been recruited as study population. A purposive sampling technique was followed for sample selection.Results:Serum thyroglobulin (ng/mL, mean盨D and median) was lowest in the age group 12-16 years (6.0�5, 5.16 ng/mL) followed by age>31 years (8.8�1, 6.16 ng/mL), whereas other age groups showed level around 13.0 and 10.0 ng/mL (p= 0.520). Mean (盨D) Urinary Iodine was not statistically different among age groups (347.4� 226.5 vs. 337.08�8.9 vs. 300.5� 95.37 vs. 337.7� 225.42 vs. 278.3� 105.7, 礸/L; F 0.451, p=0.771) while median values were 325.26 vs. 355.68 vs. 325.80 vs. 338.86 and 300.90 礸/L respectively. Neither thyroglobulin (5.76�72 vs. 11.60� 13.50; 3.47 vs. 8.9 ng/mL, m盨D and median; p=0.294) nor Urinary Iodine (373.5� 44.5 vs. 317.2� 180.32; 378.1 vs. 308.9 礸/L, m盨D and median; p=0.450) were statistically different between the gender groups. Similarly, thyroglobulin and Urinary Iodine were also statistically similar for grade-1 and grade-2 goiter (thyroglobulin: 6.79�33 vs. 11.67�.69 and 6.74 vs. 8.02 ng/mL, m盨D and median, p=0.319; Urinary Iodine: 361.33� 51.60 vs. 317.09� 182.44, 362.69 vs. 305.35 礸/L, m盨D and median, p=0.498).Conclusion:Thyroglobulin seems to have an inverse association in iodine deficiency state and positive association in over sufficient state with UI. There was no statistically significant difference of TG concentration between males and females nor between Grade-1 and Grade-2 goiter.

Effect of Auditory Stimulation by Upbeat Music on Radial Pulse

@#Introduction: Music of varying tempo or beats have physiological as well as adverse effects on the body. This study throws light on the influence of upbeat music on properties of radial pulse, in healthy young adults. Methods: One hundred and seventy-five students between the age of nineteen and twenty-four years were included in this study. The experiment was conducted in a room, devoid of any external disturbances. Subjects were made to listen the chosen upbeat music for 4 minutes using a headphone. The radial pulse was measured before and immediately after the experiment. Data analysis was done by using SPSS software version 16.0.Results: In this study we observed that normal mean pulse rate was 76 per minute in males and 72 per minute in female young adults. Following the auditory stimulation with upbeat music, rise in pulse rate was observed in more than 70% of subjects. Whilst, 24% showed a decrease pulse rate and 5% showed no change in pulse rate. Increased pulse rate was associated with decrease in amplitude of pulse wave but no change in rhythm and character of the pulse when compared to resting state. Conclusion: This study indicates that the music can increase the pulse rate in the majority of the subjects but also decreases the pulse rate in few individuals. This study provides the preliminary evidence to promote the music therapy in many preventive programs for patients with depression, patients with depressed cardiac functioning and useful in improving daily performances.

A Case Report: Vitreous Haemorrhage – A Rare Presentation Of Retinoblastoma

@#Retinoblastoma very rarely presents as vitreous haemorrhage. We are presenting a case of atypical presentation of retinoblastoma in a 3-year-old girl. She initially came with right eye vitreous haemorrhage of unknown cause. B-mode ultrasound showed dense vitreous opacity without evidence of mass. Initial MRI Brain/Orbit was inconclusive. Diagnostic vitrectomy was performed and noted thickened abnormal retina which was suspicious for retinoblastoma. The parents refused for enucleation for diagnostic histopathological examination and opted for conservative management. Repeated MRI Brain/Orbit done six months later showed disease progression through optic nerve involvement and suggestive of retinoblastoma. The parents were re-counselled for enucleation however refused and defaulted. 2 months later, the child was brought back with proptosed and disorganized eye. This time, they agreed for intervention. The patient underwent three cycles of chemoreduction therapy before enucleation. After enucleation, she received six cycles of adjuvant chemotherapy. She was well with no disease recurrence at two-year post treatment.

Performance of a selected Trichoderma strain as plant pathogen inhibitor and biofertilizer

Aims@#The application of beneficial microbes is a suitable alternative to synthetic pesticides and fertilizers for agriculture. This study was aimed to evaluate the potential of a selected Trichoderma strain as a biocontrol agent against Rhizoctonia sp. and as a biofertilizer to improve paddy growth.@*Methodology and results@#Four Bipolaris strains were identified via DNA barcoding as the cause of brown spot disease, whereas two Rhizoctonia strains were similarly identified as the cause of sheath blight disease in Brunei Darussalam. Eight Trichoderma strains were initially screened using confrontation assay and were found to substantially inhibit the growth of Rhizoctonia sp. Hybrid rice named BDR5 was treated with Trichoderma sp. UBDFM01 and/or Rhizoctonia sp. It was found that the selected strain showed the potential as a biofertilizer by significantly increasing the vigour index I, chlorophyll a, chlorophyll b, total chlorophyll and dry shoot weight of the rice plants. The pathogen negatively affected the plants by significantly reducing the vigour index II, chlorophyll a, chlorophyll a/b ratio, total chlorophyll, and total weight of grains. Trichoderma strain showed the potential as a biocontrol agent by significantly diminishing the negative effects of the pathogen on the chlorophyll a, chlorophyll a/b ratio and total chlorophyll.@*Conclusion, significance and impact of study@#This study highlights the potential of Trichoderma sp. UBDFM01 as a biocontrol agent against Rhizoctonia sp. and also as a biofertilizer for rice plants. In addition, this study is the first to provide DNA-based evidence of Bipolaris sp. and Rhizoctonia sp. as the fungi that caused rice diseases in Brunei Darussalam.

Emericella nidulans (4DP5), Cladosporium herbarum (7DF12) and Bacillus subtilis improve the nutritional value of palm kernel cake (PKC) through solid-state fermentation (SSF)

Aims@#Palm kernel cake (PKC) is a high-protein, high-energy food that is widely utilized in the animal feed business. However, the high fibre and limited amino acid content of untreated PKC were the main issues for it to be used as animal feed, particularly in non-ruminants. To improve the quality of PKC, this study combined the use of solid-state fermentation (SSF) and consortia of fungi and bacteria to treat the PKC.@*Methodology and results@#Two fungi, Emericella nidulans (4DP5) and Cladosporium herbarum (7DF12) and three strains of bacteria, Bacillus subtilis, which were active mannanase producers, were used in different combinations to reduce the hemicellulose content and improve the crude protein content of PKC in a lab-scale solid-state fermentation. PKC inoculated separately with five types of mixed culture treatments were allowed to ferment. The fermentation conditions were 20% inoculum (w/v), 85-92% humidity, pH 7.0 and PKC particle size 0.8 mm. PKC treatments with two fungi, E. nidulans (4DP5) and C. herbarum (7DF12), as well as a fungus-bacterium combination, E. nidulans (4DP5) and B. subtilis, outperformed the other three treatments. The crude protein levels were increased by 3.34% and 1.86%, respectively, due to these treatments. Furthermore, the level of aflatoxins produced increased marginally but remained within the permissible limits.@*Conclusion, significance and impact of study@#The treated PKC has more sugar and crude protein and less than 20 parts per billion (ppb) of aflatoxin, making it appropriate for animal consumption. The SSF technique of combining fungi and Bacilli enhanced the nutritional and market value of PKC substantially, which can be upscaled.

Fruit and vegetable intake among overweight and obese school children: A cluster randomised control trial

@#Introduction: Adequate daily intake of fruits and vegetables is crucial for the prevention of chronic diseases. This study aimed to determine the effects of My Body is Fit and Fabulous at School (MyBFF@school) with nutrition education intervention (NEI) on the stages of change for fruit and vegetable intake among overweight and obese secondary school children based on the trans-theoretical model (TTM). Methods: This was a cluster randomised controlled trial involving 15 out of 415 eligible government secondary schools in central Peninsular Malaysia, which were randomly assigned into intervention (six schools; 579 school children) and control (nine schools; 462 school children). The intervention group was given NEI for 24 weeks, while the control group followed the existing school programme by the Ministry of Education. Results: There was no significant difference between the intervention and control groups for the stages of change, with majority at the maintenance stage after six months (intervention: 34.9%; control: 39.0%). The within group analysis showed a significant reduction after six months for those at the action stage (action and maintenance stage) from 68.0% to 60.4% in the intervention group and from 71.4% to 65.6% in the control group. However, there was a significant increase among those with adequate fruit and vegetable intake in the intervention group and no significant increase in the control group. Conclusion: MyBFF@school with NEI based on TTM provided acceptable changes in fruit and vegetable intake among overweight and obese secondary school children.

Bacterial diversity on wild shrimp post larvae in a mangrove biodiversity hotspot

Aims@#This study aims to assess the impact of anthropogenic activities on shrimp microbiome in a biodiverse mangrove forest ecosystem, along the Merbok River, Kedah, Malaysia.@*Methodology and results@#To assess the impacts, a microbiome study of wild post larvae shrimps along the river was conducted as a health indicator of the shrimp hosts which in turn would reflect the river conditions. A 16S rRNA gene amplicon sequencing of the wild post larvae shrimp microbiomes sampled across areas of varying human activities was conducted. Samples were obtained from four sites ranging from upstream river habitat to downstream brackish water towards the marine coast. Individuals detected from the sequence were then counted and their relative abundance of bacterial diversity were compared. All abundances are up to 100% and the diversity indices were calculated using proportions of each species. The Operational Taxonomy Unit (OTUs) were obtained by using USEARCH and UPARSE software. Twenty-eight bacterium phyla were detected, dominated by phyla Proteobacteria, Actinobacteria, Firmicutes and Bacteroidetes at each site. Eighteen families were dominant at each site with Streptomycetaceae being the major abundant. At the genus level, the most abundant genera were Streptomyces sp., Mesorhizobium sp., Rhizobium sp., Bacillus sp. and Pseudomonas sp.@*Conclusion, significance and impact of study@#In general, the diversity of opportunistic and coliform bacteria was low. Thus, despite being exposed to various levels of human activities, the Merbok River and its mangrove surroundings still serve as a good spawning and nursery sites of shrimps and presumably other inhabitants.

Effects of nutrient additives and incubation period on sporulation and viability of the entomopathogenic fungus, Metarhizium anisopliae (Hypocreales: Clavicipitaceae)

Aims@#Metarhizium anisopliae is an entomopathogenic fungus (EPF) that exists naturally in the environment and potentially be used as a biological control agent against many insect pests. This study aims to evaluate the effect of nutrient additives on the yield and viability of M. anisopliae spore and to determine the optimum incubation period for maximum spore production.@*Methodology and results@# In this study, M. anisopliae was cultivated by solid-state fermentation using rice as a growth medium. Three different nutrient additives were examined which aimed to maximize the production of M. anisopliae spores. Among the three nutrient additives evaluated, yeast (1.84 ± 0.04 g) supported better growth and spore production than molasses (0.58 ± 0.04 g) and palm oil (0.47 ± 0.09 g). The incubation period between 2-6 weeks produced higher spore yield (0.97 ± 0.02 g spores) at week 4 with a better spore viability (86.30 ± 0.45%) at week 2. @*Conclusion, significance and impact of study@#Hence, it is suggested that the optimum incubation period is between 2 and 6 weeks after inoculation, and M. anisopliae could be mass produced in large quantities on rice substrate with the addition of yeast as the nutrient additives.

Characterization of Diabetic Nephropathy and Its Correlates in a Selected Outdoor-Based Diabetic Clinic in Rangpur, Bangladesh

Introduction@#Diabetes mellitus (DM) is a global public health problem. DM is associated with the rising burden of diabetic complications. Diabetic nephropathy (DN) is one of the life-threatening and irreversible microvascular complications of DM.@*Methods@#A cross-sectional study was conducted from November 2017 to April 2018. This study aimed to characterize the proportion of DN among people living with diabetes (n=290, where 40 T1DM, 200 T2DM as cases group and 50 nondiabetic as a control group) and the factors associated with it. The sample was selected using convenience sampling. Data were collected using structured questionnaire and analyzed by SPSS-22. Stages of DN were classified according ‘Revised Classification of DN’ given by the ‘Joint Committee on Diabetic Nephropathy’, Japan, 2014.@*Results@#The proportion of pre-nephropathy (PN), incipient nephropathy (IN) and overt nephropathy (ON) was 10%, 82.5% and 7.5% respectively in T1DM. Similarly, in T2DM the proportion of PN, IN, ON and chronic kidney failure (CKF) was 5.5% 81%, 10%, and 3.5% respectively. Irrespective of diabetic group, according to multivariate analysis, older age (adjusted OR =1.05, CI: 1.01-1.08; adjusted OR: 2.33, CI: 2.01-2.99), and female sex (adjusted OR = 0.39, CI: 0.19-0.77) were independently associated with DN adjusting BMI, SBP, DBP and FBS level.@*Conclusions@#This study showed the proportion of DN was high among diabetic and mostly in type 2 diabetics with severe stage. Older age, and female sex were independently associated with DN.

Discovering the thermophiles microbial diversity of Malaysian hot spring in Ulu Slim, Perak

@#Aims: Hot springs are major sources of useful thermophilic microbes. Our study therefore aimed at documenting and analysing the microbial communities at Ulu Slim hot spring in Perak, Malaysia, for bacteria with beneficial enzymes for industrial applications. Methodology and results: The study sampled water and sediment materials from the Ulu Slim hot spring at two sublocations of different temperatures, 45 °C and 72 °C. The samples were then extracted for genomic DNA, followed by paired-end metagenome sequencing using prokaryotic-conserved, locus specific primers for 16S rRNA V3 and V4 domains, and Illumina MiSeq (2  300) sequencing platform. Raw data were optimized using Trimmomatic and FLASH, followed by operational taxonomy units (OUT) determination and clustering. 16S rRNA gene sequences were then analysed against Silva (SSU123) 16S rRNA gene databases for phylum and genus classifications. Data analysis showed relevant alignment of present bacteria phyla against data from a previous study on Ulu Slim hot springhead, though the different sample temperatures significantly affected phylum and genus composition. Our study also confirmed the presence of a site-specific genus, Fervidobacteria, which are anaerobic bacteria with a unique ability in degrading keratin. Conclusion, significance and impact of study: The study further completes and complement the findings on microbial communities at the Ulu Slim hot spring. The findings help to reveal the associations between microbes and environmental factors at thermophilic locations, as well as potential thermostable enzymes like lipase and amylase that can be isolated from thermophilic sample as they are indispensable for industry.

A peculiar case of Morel-Lavelle lesion of upper limb

@#594Med J Malaysia Vol 75 No 5 September 2020SUMMARYMorel-Lavallee lesions (MLL) are post-traumatic, closedinternal degloving injuries that can result in severecomplications if not diagnosed early. It is conventionallyseen in cases of the high energy injuries of the pelvis andlower limb. The accumulation of extravasated blood,secondary to fracture and soft tissue damage may causeinternal degloving injury, skin necrosis, soft tissue damageand acute osteomyelitis. We report here the clinical andradiological features in a 32-year-old male referred from theemergency department of a tertiary hospital who hadsustained high energy motor vehicle accident. Onexamination, there was a fluctuant, mobile, non-tendersubcutaneous mass over the distal arm with suspicion ofinternal degloving injury. Plain radiographs showed nofractures. Ultrasound showed a fluid collection with thepresence of septations and echogenic debris within thecollection. Extravasation was noted between subcutaneoustissue layer and fascia at the posterolateral aspect of thearm. Wound debridement under general anaesthesia wascarried out. Intraoperative findings reported a significantamount of thick serous fluid with necrotic debris. Unhealthyskin and fat layers were debrided. Underlying muscles werefound to be healthy. The results of the intraoperative fluidculture and sensitivity showed no growth. Negative pressurevacuum dressing was carried out. After five cycles ofvacuum dressing, the wound showed signs of healing withan improved range of motion of the elbow. Orthopaedicsurgeons need to be vigilant of the possibility of MLL in theupper limb as a differential diagnosis in the management ofhigh energy trauma.

A Meta-Analysis on the Performance of Cystatin C- versus Creatinine-based eGFR Equations in Predicting Vancomycin Clearance

Background@#The objective of this study was to compare the performance of cystatin C- and creatinine-based estimated glomerular filtration rate (eGFR) equations in predicting the clearance of vancomycin. @*Methods@#MEDLINE and Embase databases were searched from inception up to September 2019 to identify all studies that compared the predictive performance of cystatin C- and/or creatinine-based eGFR in predicting the clearance of vancomycin. The prediction errors (PEs) (the value of eGFR equations minus vancomycin clearance) were quantified for each equation and were pooled using a random-effects model. The root mean squared errors were also quantified to provide a metric for imprecision. @*Results@#This meta-analysis included evaluations of seven different cystatin C- and creatinine-based eGFR equations in total from 26 studies and 1,234 patients. The mean PE (MPE) for cystatin C-based eGFR was 4.378 mL min −1 (95% confidence interval [CI], −29.425, 38.181), while the creatinine-based eGFR provided an MPE of 27.617 mL min −1 (95% CI, 8.675, 46.560) in predicting clearance of vancomycin. This indicates the presence of unbiased results in vancomycin clearance prediction by the cystatin C-based eGFR equations.Meanwhile, creatinine-based eGFR equations demonstrated a statistically significant positive bias in vancomycin clearance prediction. @*Conclusion@#Cystatin C-based eGFR equations are better than creatinine-based eGFR equations in predicting the clearance of vancomycin. This suggests that utilising cystatin C-based eGFR equations could result in better accuracy and precision to predict vancomycin pharmacokinetic parameters.

Colonization of Acinetobacter baumannii, Streptococcus agalactiae (GBS) and Candida albicans in preterm premature rupture of membrane (PPROM) compared to normal labor at term

Aims@#Preterm premature rupture of membrane (PPROM) is usually associated with maternal vaginal colonization of Group B Streptococci (GBS). However, there are reports on isolation of Acinetobacter baumannii in PPROM cases. In order to ascertain A. baumannii’s role in PPROM, we determine the colonization of A. baumannii and other common vaginal tract flora, i.e. GBS and Candida albicans, in women with PPROM, and compared them to those with normal labor at term (NLT). The transmissibility of the organisms to their babies was also investigated. @*Methodology and results@#A total of 218 high vaginal swabs from 108 and 100 women with PPROM and NLT respectively were collected. The transmission of these organisms to their 215 babies was determined by swabbing the ears and axillae. These were cultured for isolation of A. baumannii, GBS and C. albicans. Results showed that mothers with PPROM were predominantly colonized with GBS (32.4%), followed by C. albicans (19.4%) and A. baumannii (7.4%), compared to 10.9%, 17.3% and 7.2% respectively, in women with NLT. Between 34 to 50% of the babies of mothers with PPROM acquired the organisms, with GBS being the most significantly (p=0.000) transferred compared to other organisms. Co-existence of A. baumannii with either GBS or C. albicans, or both, did not enhance the occurrence of PPROM. @*Conclusion, significance and impact of study@#Colonization of A. baumannii in vaginal tract of pregnant women does not increase the possibility of PPROM, as compared to GBS.