Effect of Calotropis procera (Aiton) Dryand.based zinc oxide nanoparticles on the cotton pest Spodoptera litura Fab

Major loss in agricultural crops is caused by insect pests. In India, various synthetic insecticides are used against pests. These are much expensive and cause environmental hazards. The nanoparticles, as an alternative approach is gaining considerable interest in this field. In the present study, we explored the biological synthesis of zinc oxide nanoparticles using Giant milkweed, Calotropis procera (Aiton) Dryand. and its effects on the tobacco cutworm, Spodoptera litura. The reduction of zinc ions (Zn2+) to zinc nanoparticles (ZnO NPs) was prepared by mixing 50 g of C. procera leaves with 100 mL of single distilled water in a 250 mL glass beaker. To synthesize nanoparticles, 50 mL of C. procera leaf extract was taken using a stirrer-heater and 5 g of zinc oxide was added at 60ºC, boiled, then kept in a hot air oven at 70ºC for 24 h. Finally, the obtained light yellow coloured powder was carefully collected and characterized using X-ray diffraction (XRD) analysis. The results revealed that the biologically synthesized zinc oxide nanoparticles pesticide was highly effective against the pest. The weight of the pest decreased from low concentration to high concentration. It is concluded that the Calotropis Procera based zinc oxide nanoparticles could be used for the control of Spodoptera litura.

Validating lactate dehydrogenase (LDH) as a component of the PLASMIC predictive tool (PLASMIC-LDH)

Background@#The PLASMIC score is a convenient tool for predicting ADAMTS13 activity of ＜10%.Lactate dehydrogenase (LDH) is widely used as a marker of haemolysis in thrombotic thrombocytopenic purpura (TTP) monitoring, and could be used as a replacement marker for lysis. We aimed to validate the PLASMIC score in a multi-centre Asia Pacific region, and to explore whether LDH could be used as a replacement marker for lysis. @*Methods@#Records of patients with thrombotic microangiopathy (TMA) were reviewed. Patients’ ADAMTS13 activity levels were obtained, along with clinical/laboratory findings relevant to the PLASMIC score. Both PLASMIC scores and PLASMIC-LDH scores, in which LDH replaced traditional lysis markers, were calculated. We generated a receiver operator characteristics (ROC) curve and compared the area under the curve values (AUC) to determine the predictive ability of each score. @*Results@#46 patients fulfilled the inclusion criteria, of which 34 had ADAMTS13 activity levels of ＜10%. When the patients were divided into intermediate-to-high risk (scores 5‒7) and low risk (scores 0‒4), the PLASMIC score showed a sensitivity of 97.1% and specificity of 58.3%, with a positive predictive value (PPV) of 86.8% and negative predictive value (NPV) of 87.5%. The PLASMIC-LDH score had a sensitivity of 97.1% and specificity of 33.3%, with a PPV of 80.5% and NPV of 80.0%. @*Conclusion@#Our study validated the utility of the PLASMIC score, and demonstrated PLASMIC-LDH as a reasonable alternative in the absence of traditional lysis markers, to help identify high-risk patients for treatment via plasma exchange.

Haemophilia care and outcome in a major haemophilia treatment centre in Malaysia

@#Introduction/Objective: The management of potential treatment-related complications and bleeding events in haemophilia is challenging in developing countries. Providing optimal care among these patients improve their quality of life (QOL) and life expectancy. This study explores the demographic characteristics and treatment outcome in a major haemophilia treatment centre in Malaysia. Materials and Methods: A total of 260 patients were recruited in this retrospective cross-sectional analysis. Clinical data, including treatment regimens and outcome, were collected and analysed. Results: A total of 211 patients were diagnosed with haemophilia A (HA) (severe disease, 72.5%) and 49 patients had haemophilia B (HB) (severe disease, 65.3%). The median age was 31 (IQR;2-84) years. Majority of the patients had at least one episode of musculoskeletal bleeding since diagnosis. The mean annual bleeding event (ABE) was 4.91 (SD±6.07) in 2018. Target joints were identified in 80.4% of the patients. Chronic arthropathy and synovitis collectively accounted for more than half of the musculoskeletal complications. 30.1% of the patients had contracted hepatitis C with less than half received treatment. Thirty-one patients (16.8%) with severe haemophilia developed inhibitor and 12 patients successfully underwent immune tolerance induction. More than three-quarters of the severe haemophilia patients were treated with factor concentrate prophylaxis. The mean prophylaxis dose for HA and HB were 41.3 (SD±19.1) and 48.6 (SD±21.5) IU/kg/week, respectively. In patients with severe disease, prophylaxis significantly reduced the ABE (5.45,9.03;p=0.005). Conclusion: The importance of utilising a low to moderate dose regimen as prophylaxis in haemophilic patients is highlighted in our study. Future studies should include QOL assessment will further improve the management in haemophilia.

Antimicrobial Management of Complicated Skin and Soft Tissue Infections in an Era of Emerging Multi-Drug Resistance: Perspectives from 5 Gulf Countries

The number of complicated skin and soft tissue infections (cSSTIs) in the Arabian Gulf region has risen in recent years, particularly those caused by multi-drug resistant (MDR) pathogens. The high prevalence of diabetes, obesity, and associated cardio-metabolic comorbidities in the region renders medical and surgical management of cSSTI patients with MDR infections challenging. An experienced panel of international and regional cSSTI experts (consensus group on cSSTIs) was convened to discuss clinical considerations for MDR infections from societal, antimicrobial stewardship, and cost perspectives, to develop best practice recommendations. This article discusses antibiotic therapies suitable for treating MDR cSSTIs in patients from the Gulf region and recommends that these should be tailored according to the local bacterial ecology by country and region. The article highlights the need for a comprehensive patient treatment pathway and defined roles of each of the multidisciplinary teams involved with managing patients with MDR cSSTIs. Aligned and inclusive definitions of cSSTIs for clinical and research purposes, thorough and updated epidemiological data on cSSTIs and methicillin-resistant Staphylococcus aureus in the region, clearcut indications of novel agents and comprehensive assessment of comparative data should be factored into decision-making are necessary.

Blood management strategies in congenital Glanzmann thrombasthenia at a hematology referral center

Background@#Glanzmann thrombasthenia is associated with abnormalities in the glycoprotein IIb/IIIa receptor. This study, conducted at Ampang Hospital, Malaysia, aimed to assess outcomes of blood management strategies for Glanzmann thrombasthenia. @*Methods@#Ten patients with Glanzmann thrombasthenia aged 9 years (2009‒2018) were examined.Data on clinical characteristics, transfusion practices, and patient blood management were obtained from medical records. Patient blood management methods included parenteral iron, erythropoietin, hormonal pills, intrauterine progesterone contraceptive devices, tranexamic acid, and recombinant factor VIIa. Primary outcomes were hemoglobin levels and the proportion of patients who received blood transfusion. Secondary outcomes were morbidity and mortality. @*Results@#The median age at diagnosis was 8.2 years (range, 1‒15 yr). The female-to-male ratio was 9:1. Eight patients had type 2 disease (5‒20% of normal GPIIb/IIIa), and two patients had type 1 disease (normal GPIIb/IIIa ＜5%). All patients had iron deficiency. All female patients presented with significant menorrhagia. Other bleeding symptoms included epistaxis, spontaneous skin bruising, hemoptysis, gingival bleeding, knee hemarthrosis, and pelvic hematoma. No patient experienced life-threatening bleeding. Our patients had a mean hemoglobin level of 5.6 g/dL at diagnosis. All patients were optimized using non-transfusion methods as described above. Our patient had a current mean hemoglobin level of 11 g/dL. Approximately 70% (7/10) of patients did not experience receiving blood transfusions in the last 5 years. No patient experienced non-transfusion-related morbidities such as sepsis, thromboembolism, or cardiorespiratory events. @*Conclusion@#High cost, transfusion-related adverse events, and immunomodulation could be effectively prevented by avoiding unnecessary blood transfusions.

Pregnancy outcome among gestational diabetes mellitus patients in a tertiary care centre

Background: Gestational diabetes mellitus poses numerous health problems for both mother and the fetus. Even though there are improved outcomes, complications of gestational diabetes still persists. Objectives of this study was to find out the maternal and perinatal outcomes in gestational diabetes mellitus.Methods: This study was done among pregnant women attending antenatal outpatient department at Sree Mookambika Institute of Medical Sciences, Kulasekharam. oral glucose tolerance test was done at between 24 to 28 weeks and the values more than their cutoff was labelled as gestational diabetes and their outcome was measured as complications during antenatal period, mode of delivery and perinatal outcome in view of neonatal intensive care unit admissions due to hyperbilirubinemia and respiratory distress syndrome.Results: Out of 500 antenatal mothers 65 were found to have gestational diabetes which is approximately 13%. Obstetric outcomes were 10% of them developed pregnancy induced hypertension, 12% of them ended in preterm labour and polyhydramnios in 2%. Delivery by caesarean section and vaginal route is almost similar. Maximum number of neonatal intensive care admissions are due to hyperbilirubinemia followed by respiratory distress.Conclusions: Screening for gestational diabetes and adequate glycemic control is necessary in preventing short term and long-term complications.

Comparison of clinical outcomes of sitagliptin+metformin combination and glimepiride in the management of uncomplicated type 2 diabetics

Background: To evaluate the comparison of clinical outcomes of sitagliptin +metformin and glimepiride in uncomplicated Type-2 diabetics.Methods: This one year (July 2016 to August 2017) prospective, open label, observational clinical cohort study was carried out on type-2 diabetics. In this study 299 Type-2 diabetics patients were enrolled and were randomly allocated to two groups viz Group A and Group B. Group A received sitaglitin+metformin (50+500) mg/day and Group B received glimepiride 1mg/day respectively. The follow up started after 10 days of stabilization of the patient and data recorded on 10th day was considered Zero month data and follow up continued up to Six month in each group. Comparison of FPG, PPG and HbA1c was evaluated between zero and six months within group and at six month between groups. Adverse events were recorded and summarized by treatment group.Results: At the end of six months follow up the patients of Group A who received sitaglitin+metformin (50+500) mg/day had greater reduction in FPG, PPG and HbA1c (all P<0.001) was recorded when compared between zero and six month within group. A significant reduction in FPG, PPG and HbA1c (all P<0.01) also recorded in Group B who received glimepiride 1mg/day when compared between zero and six months within group. A statically significant difference (all P<0.05) was recorded at six months between group. The adverse events like hypoglycemic episodes, gastrointestinal adverse events etc were greater in Group B than Group A. Changes in weight also noted in both Groups. Weight loss in Group A and weight gain in Group B was recorded.Conclusions: The present study suggests that a significant difference may be existing in the clinical outcome interm of glycemia control and adverse events between sitagliptin+metformin combination and glimepiride in type-2 diabetic patients.

Reference interval establishment of full blood count extended research parameters in the multi-ethnic population of Malaysia

@#Haematological cellular structures may be elucidated using automated full blood count (FBC) analysers such as Unicel DxH 800 via cell population data (CPD) analysis. The CPD values are generated by calculating volume, conductivity, and five types of scatter angles of individual cells which would form clusters or populations. This study considered 126 CPD parameter values of 1077 healthy Malaysian adults to develop reference intervals for each CPD parameter. The utility of the CPD reference interval established may range from understanding the normal haematological cellular structures to analysis of distinct cellular features related to the development of haematological disorders and malignancies.

The protective effect of L. siceraria against depression using behavioural despair animal models

Background: In recent years, the search for novel pharmacotherapy from medicinal plants for psychiatric illness was significantly progressed. The present study was performed to evaluate the antidepressant activity of ethanolic extract of Lagenaria siceraria in animal models.Methods: The antidepressant activity of ethanolic extract of the fruit of L. siceraria in rats was assessed using forced swim test and tail suspension test. Imipramine at 15 mg/kg was used as standard antidepressant drug.Results: The ethanolic extract of L. siceraria fruit (EELS) was significantly and dose-dependently reduced the duration of immobility after repeated treatment for 7 days in Forced swim test and Tail suspension Test. But combination of L. siceraria (200mg/kg) with Imipramine gave a highly significant result (p<0.001) in reduction of immobility duration and the effect of high dose (400mg/kg) with imipramine (15mg/kg) did not decrease the duration of immobility period in both animal models at end of the study. In this work the dose of 400mg/kg afforded more protection than the imipramine.Conclusions: The results obtained from this study was indicate that the antidepressant activity of L. siseraria.

Clinical characteristics and outcomes of thrombotic microangiopathy in Malaysia

BACKGROUND: Thrombotic microangiopathy (TMA) with non-deficient ADAMTS-13 (a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13) outcome is unknown hence the survival analysis correlating with ADAMTS-13 activity is conducted in Malaysia. METHODS: This was a retrospective epidemiological study involving all cases of TMA from 2012–2016. RESULTS: We evaluated 243 patients with a median age of 34.2 years; 57.6% were female. Majority of the patients were Malay (62.5%), followed by Chinese (23.5%) and Indian (8.6%). The proportion of patients with thrombotic thrombocytopenic purpura (TTP) was 20.9%, 72.2% of which were acquired while 27.8% were congenital. Patients with ADAMTS-13 activity ≥5% had a four-fold higher odds of mortality compared to those with ADAMTS-13 activity <5% (odds ratio: 4.133, P=0.0425). The mortality rate was 22.6% (N=55). Most cases had secondary etiologies (42.5%), followed by acquired TTP (16.6%), atypical hemolytic uremic syndrome (HUS) or HUS (12.8%) and congenital TTP (6.4%). Patients with secondary TMA had inferior overall survival (P=0.0387). The secondary causes comprised systemic lupus erythematosus (30%), infection (29%), pregnancy (10%), transplant (8%), malignancy (6%), and drugs (3%). Transplant-associated TMA had the worst OS (P=0.0016) among the secondary causes. Plasma exchange, methylprednisolone and intravenous immunoglobulin were recorded as first-line treatments in 162 patients, while rituximab, bortezomib, vincristine, azathioprine, cyclophosphamide, cyclosporine, and tacrolimus were described in 78 patients as second-line treatment. CONCLUSION: This study showed that TMA without ADAMTS-13 deficiency yielded inferior outcomes compared to TMA with severeADAMTS-13 deficiency, although this difference was not statistically significant.

Adult cases of H1N1 influenza dmitted from 2015 to 2016

Background: The clinical characteristics, risk factors and outcomes of H1N1 influenza cases in Bahrain have not been reported

Objective: To evaluate personal and clinical characteristics, risk factors, and outcomes in adults with confirmed H1N1 infection

Setting: Salmaniya medical complex, Bahrain

Design: A retrospective observational study

Method: All H1N1-confirmed-patients admitted between 1 September 2015 and 31 March 2016 were reviewed. Personal and clinical characteristics, risk factors, and outcomes were documented. The analyses were performed using STATA software, version 12 and P-value of <.05 was considered significant

Result: Twenty-six confirmed H1N1 cases were admitted and reviewed. Eight [30.7%] were admitted to the intensive care unit and 5 [19.2%] died. None of the patients received flu vaccine.The age range was 24 to 83 years.The presence of comorbid conditions and smoking were common among the study population; however, it was not statistically significant. A significant association was discovered between mortality and the need for vasopressors [all patients requiring vasopressors died compared to only one among other patients, P-value<.005]

Conclusion: In our study of the flu season of 2015-2016, 5 patients died. We recommend vaccination, especially for high risk groups. The study is limited by the small study-population size and one missing file

Antibiotics point prevalence

Background: Antibiotics have changed the practice of medicine. The widespread use of antibiotics has led to the emergence of drug resistance. The Global Point Prevalence Survey of Antimicrobial Consumption and Resistance [Global-PPS] is a motivated project to develop the point-prevalence surveys [PPS] carried out by the European Surveillance of Antimicrobial Consumption [ESAC]

Objective: To monitor the prescription of antibiotics, improve the quality of antibiotics prescription and determine the variations in drug prescription. Design: A Prospective Study. Setting: Salmaniya Medical Complex, Bahrain

Method: The Laboratory of Medical Microbiology [UA, Belgium] designed the Global-PPS WebPPS program, a web-based application for data-entry and reporting. Online registration of participating hospitals on the WebPPS program was performed by the locally designated personnel. All wards in the hospital were included in the data collection. Three hundred seventy two patients were included in the study. Data collected from 1 February 2015 to 30 April 2015 were documented

Result: Three hundred seventy-two patients were included in the study. Three hundred and seven [82.5%] patients were adults, 45 [12.1%] were children and 20 [5.4%] were neonates. Two hundred sixty-three [70.7%] were on antibiotics. All the children, 45 [12.1%] were on antibiotics. beta-lactams other than penicillin was prescribed in 158 [42.5%] patients followed by penicillin in 57 [15.3%] patients. The most common indication for antibiotics use was pneumonia, 43 [11.5%] patients and lower urinary tract infections, 31 [8.3%] patients

Conclusion: The point prevalence study has shown an overuse of antimicrobials with an increasing use of drugs, particularly among pediatrics. Therefore, antibiotic supervising initiatives to limit the overuse is needed

Antibiotic appropriateness for urinary tract infection in the emergency room

Background: Urinary Tract Infections [UTI] are a common cause of emergency room [ER] visits and antibiotic misuse

Objective: To evaluate the characteristics of UTI attending ER and to assess antibiotic prescription and inappropriate treatment implications

Design: A Prospective Study

Setting: Salmaniya Medical Complex, Bahrain

Method: Patients aged more than 14 years who presented to the ER with UTI from 1 July 2014 to 31 July 2014 were reviewed. Data was obtained from patients' emergency records and classified according to the type of UTI as complicated, uncomplicated or UTI in pregnancy. Antibiotic treatment was considered appropriate if it followed the Local or International Guidelines

Result: A total of 239 patients were included in the study; 83 [34.7%] were males, 75 [31.4%] were pregnant females and 81 [33.9%] were non-pregnant females, the mean age was 37.56 years. One hundred forty-five [60.7%] patients had complicated UTI. The most prescribed antibiotics were cefuroxime and ciprofloxacin. Seventy-two [30.1%] of inappropriate antibiotics prescription were mostly due to improper duration. Inappropriate antibiotic treatment was significantly more common among males, 43 [17.9%] P-value <0.001; complicated UTI were 63 [26.4%], P-value <0.001. One hundred thirty-three [55.6%] prescriptions were written by emergency doctors, P- value <0.001. There was no significance among the different age groups

Conclusion: High rate of inappropriate antibiotics use in UTI patients mostly in complicated UTI and in patients treated by emergency doctors physicians

The modern implementation of patient blood management (PBM) in Malaysia: the use of intravenous iron in severe anaemia with iron deficiency – A Case Report

Anaemia is a common condition in Malaysia, and is mostly due to iron deficiency. In many cases, allogeneic blood transfusion (ABT) is administered unnecessarily to treat anaemia. Patient blood management (PBM) is a concept whereby a patient becomes his or her “own blood bank”, instead of receiving ABT. The concept encompasses three pillars namely optimising erythropoiesis, minimising blood loss and harnessing human physiological reserve. We present a safe and fruitful outcome of managing severe anaemia without utilising any ABT, made possible with the PBM approach including administration of intravenous iron.

Gene expression in obstetric antiphospholipid syndrome: a systematic review

Background: Antiphospholipid syndrome (APS) is a multisystem disease that may present as venous or arterial thrombosis and/or pregnancy complications with the presence of antiphospholipid antibodies. Until today, heterogeneity of pathogenic mechanism fits well with various clinical manifestations. Moreover, previous studies have indicated that genes are differentially expressed between normal and in the disease state. Hence, this study systematically searched the literature on human gene expression that was differentially expressed in Obstetric APS. Methodology: Electronic search was performed until 31st March 2015 through PubMed and Embase databases; where the following Medical Subject Heading (MeSH) terms were used and they had been specified as the primary focus of the articles; gene, antiphospholipid, obstetric, and pregnancy in the title or abstract. From 502 studies retrieved from the search, only original publications that had performed gene expression analyses of human placental tissue that reported on differentially expressed gene in pregnancies with Obstetric APS were included. Two reviewers independently scrutinized the titles and the abstracts before examining the eligibility of studies that met the inclusion criteria. For each study; diagnostic criteria for APS, method for analysis, and the gene signature were extracted independently by two reviewers. The genes listed were further analysed with the DAVID and the KEGG pathways. Results: Three eligible gene expression studies involving obstetric APS, comprising the datasets on gene expression, were identified. All three studies showed a reduction in transcript expression on PRL, STAT5, TF, DAF, ABCA1, and HBEGF in Obstetric APS. The high enrichment score for functionality in DAVID had been positive regulation of cell proliferation. Meanwhile, pertaining to the KEGG pathway, two pathways were associated with some of the listed genes, which were ErBb signalling pathway and JAK-STAT signalling pathway. Conclusion: Ultimately, studies on a genetic level have the potential to provide new insights into the regulation and to widen the basis for identification of changes in the mechanism of Obstetric APS.