Antiplatelet Therapy and Kidney Function in Non-Dialysis Chronic Kidney Disease: A Two-Centre Observational Study in Nigeria

Antiplatelet therapy used in preventing cardiovascular events in chronic kidney disease may be associated with higher risks of bleeding, low efficacy from fewer occlusive atherosclerotic disease), attenuation of the inflammatory process, and changes in the haemogram. We prospectively determined the kidney function, the haemogram, and the lipid profile of participants with and without antiplatelet therapy. The population with a mean age of 69.21 ± 11.73 years, had more women (65.88%), p=0.001. Participants' age was positively correlated with the CKD stage, p<0.001. Bleeding was more common with clopidogrel than aspirin and, less common with advancing CKD. Cardiovascular events were more common in CKD stage 5. The men had higher eGFR but lower platelet count and platelet neutrophil ratio (PNR) than the women, p=0.004, p<0.001, and p<0.001 respectively. The eGFR, bicarbonate, and HDL cholesterol were higher with versus without antiplatelets, p=0.04, p<0.001, and p=0.001 respectively. The platelet count and PNR were higher with antiplatelet therapy and with higher CKD stage, p<0.001 and p<0.001 and, p<0.001 and p<0.001 respectively. Higher platelet count (OR-0.410, 95% CI-0.02-1.04), lower uric acid levels (OR-0.550, 95% CI-0.271-0.948), higher HDL-C (OR-0.486, 95% CI-0.093-1.013), lower LDL-C (OR-0.572, 95% CI-0.082-1.002) and lower triglycerides (OR-1.274, 95% CI-0.755-1.493) were independently associated with antiplatelet therapy. The benefits of antiplatelet therapy in CKD are anchored on its anti-inflammatory, lipid-lowering, and kidney function-improving effects, these synergistically lead to lower cardiovascular events. The increased risk and consequences of bleeding, and reductions in leucocytes and erythrocytes population should be borne in mind to prevent heightening morbidity and mortality rates.

Fasting glucose: a cardiometabolic indicator for subclinical atherosclerosis on excess weight adolescents

Abstract Objective: To build a model based on cardiometabolic indicators that allow the identification of overweight adolescents at higher risk of subclinical atherosclerotic disease (SAD). Methods: Cross-sectional study involving 161 adolescents with a body mass index ≥ + 1 z-Score, aged 10 to 19 years. Carotid intima-media complex thickness (IMT) was evaluated using ultrasound to assess subclinical atherosclerotic disease. Cardiometabolic indicators evaluated included nutritional status, central adiposity, blood pressure, lipidic profile, glycemic profile, as well as age and sex. Data was presented using measures of central tendency and dispersion, as well as absolute and relative frequency. The relationship between IMT measurement (outcome variable) and other variables (independent variables) was assessed using Pearson or Spearman correlation, followed by multiple regression modeling with Gamma distribution to analyze predictors of IMT. Statistical analysis was performed using SPSS and R software, considering a significance level of 5 %. Results: It was observed that 23.7 % had Carotid thickening, and the prevalence of abnormal fasting glucose was the lowest. Age and fasting glucose were identified as predictors of IMT increase, with IMT decreasing with age by approximately 1 % per year and increasing with glucose by around 0.24 % per mg/dL. Conclusion: The adolescent at higher risk is younger with higher fasting glycemia levels.

Consumption and factors associating the provision of fruits and vegetables to children in Bayelsa state of Nigeria

Background: The provision of adequate nutrition is of the utmost importance for the promotion of optimal growth and development in the early stages of human life as well as the stimulation of immune system function to combat infections. Therefore, this study aimed to assess the level of consumption and the factors affecting the provision of fruits and vegetables to children in Bayelsa state of Nigeria. Methods: This was a population-based survey conducted among 360 parents/caregivers of children aged 5 years and below randomly selected from Bayelsa state, Nigeria. The data for this study was collected with in-person interviews utilizing a standardized questionnaire. The results were presented in frequency and percentage. The level of significance was determined using a confidence interval of 95% and p<0.05. Results: Most of the respondents 355 (98.6%) were female with the age range 25-44 making 86.65% of the total population. Findings show that 40.8% of respondents gave their children fruits and vegetables only once a week while 3.6% gave their children fruits and vegetables 4 times and above a week. The majority of respondents 240 (66.7%) indicated that the high cost of fruits and vegetables was the main factor that affected consumption of fruits and vegetables. Conclusions: The findings demonstrated a low consumption level of fruits and vegetables among the children in Bayelsa state. Therefore, health professionals should be obliged to educate parents and caregivers of children on adequate provision of fruits and vegetables for their children.

Factors associated with cystic fibrosis mortality before the age of 30: retrospective analysis of a cohort in southern Brazil

The aim of this study was to retrospectively evaluate the factors associated with mortality before the age of 30 in adults with cystic fibrosis (CF) followed up at a referral center in southern Brazil. This study included individuals over 18 years of age. Clinical data related to childhood and the period of transition to an adult healthcare of individuals with CF were recorded, as well as spirometric and mortality data of individuals between 18 and 30 years of age. A total of 48 patients were included in this study, of which 28 (58.3%) were male. Comparing groups, we observed a higher prevalence of homozygosis for the F508del mutation (P=0.028), massive hemoptysis before the age of 18 (P=0.027), and lower values of pulmonary function, forced expiratory volume in the first second (FEV1) (%) (P=0.002), forced vital capacity (FVC) (%) (P=0.01), and FEV1/FVC (%) (P=0.001) in the group that died before age 30. F508del homozygosis, episodes of massive hemoptysis in childhood, and lower FEV1 values at age 18 were related to mortality before age 30 in a cohort of individuals with CF in southern Brazil.

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer / 예방의학회지

Objectives@#This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients. @*Methods@#This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking. @*Results@#The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT. @*Conclusions@#FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.

Whole genome sequencing of Streptococcus suis revealed potential drug resistance and zoonotic transmission in companion cat

@#Streptococcus suis is a bacterium of clinical importance in diverse animal hosts including companion animals and humans. Companion animals are closely associated in the living environment of humans and are potential reservoirs for zoonotic pathogens. Given the zoonotic potential of S. suis, it is crucial to determine whether this bacterium is present among the companion animal population. This study aimed to detect Streptococcus suis in companion animals namely cats and dogs of the central west coast of Peninsular Malaysia and further characterize the positive isolates via molecular and genomic approach. The detection of S. suis was done via bacterial isolation and polymerase chain reaction assay of gdh and recN gene from oral swabs. Characterization was done by multiplex PCR serotyping, as well as muti-locus sequence typing, AMR gene prediction, MGE identification and phylogenomic analysis on whole genome sequence acquired from Illumina and Oxford Nanopore sequencing. Among the 115 samples, PCR assay detected 2/59 of the cats were positive for S. suis serotype 8 while all screened dog samples were negative. This study further described the first complete whole genome of S. suis strain SS/UPM/MY/F001 isolated from the oral cavity of a companion cat. Genomic analysis revealed a novel strain of S. suis having a unique MLST profile and antimicrobial resistance genes of mefA, msrD, patA, patB and vanY. Mobile genetic elements were described, and pathogenic determinants matched to human and swine strains were identified. Phylogenetic tree analysis on the core genome alignment revealed strain SS/UPM/MY/F001 was distinct from other S. suis strains. This study provided insight into the detection and genomic features of the S. suis isolate of a companion cat and highlighted its potential for antimicrobial resistance and pathogenicity.

Resistance of bmr energy sorghum hybrids to sugarcane borer and fall armyworm / Resistência de híbridos de sorgo energia bmr à broca-da-cana-de-açúcar e lagarta-do-cartucho

Abstract The lower lignin content in plants species with energy potential results in easier cellulose breakdown, making glucose available for ethanol generation. However, higher lignin levels can increase resistance to insect attack. The objective of this work was to evaluate the susceptibility of a bmr-6 biomass sorghum (a mutant genotype with a lower concentration of lignin) to important pests of energy sorghum, Diatraea saccharalis and Spodoptera frugiperda. Experiments were performed in the laboratory and greenhouse to evaluate the development of these pests on the biomass sorghum bmr hybrids BR007, BR008, and TX635 and their respective conventional near-isogenic genotypes (without the bmr gene). The lignin content was higher in non-bmr hybrids, but the evaluated insect variables varied between treatments, not being consistent in just one hybrid or because it is bmr or not. The lowest survival of S. frugiperda was observed in the BR008 hybrid, both bmr and non-bmr. The S. frugiperda injury scores on plants in the greenhouse were high (>7) in all treatments. For D. saccharalis, there was no difference in larval survival in the laboratory, but in the greenhouse, the BR007 hybrid, both bmr and non-bmr, provided greater survival. Due the need to diversify the energy matrix and the fact that greater susceptibility of the bmr hybrids to either pests was not found in this study, these results hold promise for cultivation of these biomass sorghum hybrids for the production of biofuels.

Resumo O menor teor de lignina em espécies de plantas com potencial energético resulta na maior facilidade de quebra da celulose, disponibilizando glicose para geração de etanol. Porém, maiores teores de lignina representa um fator de resistência ao ataque de insetos. O objetivo deste trabalho foi avaliar como importantes pragas do sorgo energia, Diatraea saccharalis e Spodoptera frugiperda, se comportam quanto à alimentação e desempenho em sorgo bmr-6, um genótipo mutante com menor concentração de lignina. Foram realizados experimentos em laboratório e casa de vegetação, avaliando o desenvolvimento destas pragas nos híbridos de sorgo biomassa bmr 007, 008, TX635 e seus respectivos genótipos isogênicos convencionais (sem o gene bmr). O teor de lignina foi maior nos híbridos não bmr, mas nos parâmetros avaliados nos insetos, houve variação entre os tratamentos, não sendo consistente em apenas um híbrido e nem por ser ou não bmr. A menor sobrevivência de S. frugiperda foi verificada no híbrido BR008 tanto bmr quanto não bmr. As notas de injúria por S. frugiperda no sorgo em casa de vegetação foram altas (>7) em todos os tratamentos. Para D. saccharalis, não houve diferença significativa para a sobrevivência larval em laboratório, mas em casa de vegetação o híbrido BR007 tanto bmr quanto não bmr proporcionaram maior sobrevivência. Diante da necessidade de diversificar a matriz energética e o fato de que não foi comprovada neste estudo maior suscetibilidade dos híbridos bmr a ambas as pragas, estes resultados são promissores para o cultivo desses híbridos de sorgo biomassa para produção de biocombustíveis.

Resistance of bmr energy sorghum hybrids to sugarcane borer and fall armyworm

Abstract The lower lignin content in plants species with energy potential results in easier cellulose breakdown, making glucose available for ethanol generation. However, higher lignin levels can increase resistance to insect attack. The objective of this work was to evaluate the susceptibility of a bmr-6 biomass sorghum (a mutant genotype with a lower concentration of lignin) to important pests of energy sorghum, Diatraea saccharalis and Spodoptera frugiperda. Experiments were performed in the laboratory and greenhouse to evaluate the development of these pests on the biomass sorghum bmr hybrids BR007, BR008, and TX635 and their respective conventional near-isogenic genotypes (without the bmr gene). The lignin content was higher in non-bmr hybrids, but the evaluated insect variables varied between treatments, not being consistent in just one hybrid or because it is bmr or not. The lowest survival of S. frugiperda was observed in the BR008 hybrid, both bmr and non-bmr. The S. frugiperda injury scores on plants in the greenhouse were high (>7) in all treatments. For D. saccharalis, there was no difference in larval survival in the laboratory, but in the greenhouse, the BR007 hybrid, both bmr and non-bmr, provided greater survival. Due the need to diversify the energy matrix and the fact that greater susceptibility of the bmr hybrids to either pests was not found in this study, these results hold promise for cultivation of these biomass sorghum hybrids for the production of biofuels.

Resumo O menor teor de lignina em espécies de plantas com potencial energético resulta na maior facilidade de quebra da celulose, disponibilizando glicose para geração de etanol. Porém, maiores teores de lignina representa um fator de resistência ao ataque de insetos. O objetivo deste trabalho foi avaliar como importantes pragas do sorgo energia, Diatraea saccharalis e Spodoptera frugiperda, se comportam quanto à alimentação e desempenho em sorgo bmr-6, um genótipo mutante com menor concentração de lignina. Foram realizados experimentos em laboratório e casa de vegetação, avaliando o desenvolvimento destas pragas nos híbridos de sorgo biomassa bmr 007, 008, TX635 e seus respectivos genótipos isogênicos convencionais (sem o gene bmr). O teor de lignina foi maior nos híbridos não bmr, mas nos parâmetros avaliados nos insetos, houve variação entre os tratamentos, não sendo consistente em apenas um híbrido e nem por ser ou não bmr. A menor sobrevivência de S. frugiperda foi verificada no híbrido BR008 tanto bmr quanto não bmr. As notas de injúria por S. frugiperda no sorgo em casa de vegetação foram altas (>7) em todos os tratamentos. Para D. saccharalis, não houve diferença significativa para a sobrevivência larval em laboratório, mas em casa de vegetação o híbrido BR007 tanto bmr quanto não bmr proporcionaram maior sobrevivência. Diante da necessidade de diversificar a matriz energética e o fato de que não foi comprovada neste estudo maior suscetibilidade dos híbridos bmr a ambas as pragas, estes resultados são promissores para o cultivo desses híbridos de sorgo biomassa para produção de biocombustíveis.

Occurrence of genital ulcer due to herpes simplex virus type-1 (HSV-1) in attendees of a regional centre for sexually transmitted infections, central India: how disturbing is it?

Background: Genital herpes is caused predominantly by Herpes simplex virus type 2 (HSV-2) and less commonly by HSV-1. Genital HSV-1 infection results from oral sex, with fewer recurrences, mild symptoms, less asymptomatic shedding and poor genital transmission. The present study was undertaken to identify frequency of occurrence of HSV-1 and HSV-2 in genital herpes by microscopy, serology and Real Time Polymerase Chain Reaction (RT-PCR). Methods: Genital ulcer swabs and serum were collected at regional STI centre, Govt Medical College and Hospital, Nagpur. A total of 53 patients of Genital Ulcer Disease from December 2020 -22 were examined for etiology by microscopy, serum IgM and IgG against HSV-1 and 2 by ELISA and HSV-1 and 2 DNA by RT- PCR. Results: Out of 53 genital swabs processed, 6 (11.3%) and 28 (52.8%) samples were positive for HSV-1 and 2 DNA respectively. Of the 6 HSV-1 DNA positive samples, seropositivity for HSV-1 IgM was in 2 (33.3%) samples and for HSV-1 IgG in 4 (66.7%) samples. Of the 28 HSV-2 DNA samples, HSV-2 IgM was positive in 4 (14.3%) samples and HSV-2 IgG was positive in 7 (25%) samples, multi nucleated giant cells were seen in 2 (7.14%) samples. The remaining 15 (53.6%) HSV-2 DNA positive samples were seronegative. Conclusions: HSV-1 was detected in 6 (11.3%) samples. Though these genital ulcers may be mild, it is important to counsel the patients for abstinence or safe sex practices to prevent their partners from acquiring painful non-genital ulcers due to HSV-1.

Rabies and its prevention: are our medical students well informed?

Background: Rabies is a vaccine-preventable, viral disease. However, once clinical symptoms appear, rabies is 100% fatal. Significantly, India accounts for 36% of the world’s rabies deaths. Recently, in Kerala, a surge in dog bite cases and a consequent rise in the incidence of rabies deaths has been noted, which is a serious public health medical concern. The present study was done to assess the level of knowledge of rabies and its prevention among medical students of Government T D Medical College, Alappuzha to identify lacunae in knowledge if any and to provide sessions on rabies prevention and control. Methods: A cross-sectional study was conducted among the medical students of Government T. D. Medical College, Alappuzha in 2022. Convenient sampling was done, and data was collected using a pre-tested questionnaire which was analysed using SPSS software. Results: Out of the 261 students who took part in the study, 88.13% of the study participants were observed to have medium to sufficient level of knowledge regarding rabies and its prevention, while 11.87% had low level of knowledge. In general, the level of knowledge was noted to be roughly proportional to the year of study of MBBS. Conclusions: The level of knowledge of the participants with regards to the schedule of vaccination and knowledge of symptoms of rabies, was observed to be less than what would be desirable. Structured training and education of medical students can rectify this lacuna, and thereby bring about significant reduction in fatality rates.

Incidence and profile of psoriasis in the dermatology-venereology department Bali Mandara General Hospital, Denpasar during 2020-2022

Background: Psoriasis is a chronic inflammatory disease mediated by the immune system that mainly involves skin inflammation, epidermal hyperplasia, enriched risk of destructive arthritis, and cardiovascular morbidity. Accurate epidemiology of psoriasis is limited, just very few studies on the incidence of psoriasis. This study aims to determine the incidence and profile of psoriasis patients at the dermatology and venereology polyclinic, Bali Mandara General Hospital Denpasar Bali, 2020 to 2022. Methods: This research is a descriptive cross-sectional retrospective study at the dermatology-venereology polyclinic of Bali Mandara General Hospital Denpasar from May to June 2023 and uses secondary data from the patient register book and medical records with total sampling. Samples were all new cases that met the inclusion and exclusion criteria would be sampled. Data were analyzed with statistical package for the social sciences (SPSS) 28 for Windows, categorized by numbers and percentages, providing cross-tabulations for age and sex variables. Results: Psoriasis was grouped into five types. Psoriasis vulgaris is the most common type with total of 71 (85.5%) patients, guttate psoriasis 6 (7.2%), sebopsoriasis 5 (6.0%) patients, pustular psoriasis 1 (1.2%) patients, and psoriasis erythroderma 0 (0%) patients. Conclusions: Psoriasis vulgaris is the most common type of psoriasis. It occurs more frequently in the age, 20-30 to 50-60 years. According to studies, the incidence of psoriasis by sex between males and females is equally the same. We present data categorized by numbers and percentages, providing cross-tabulations for age and sex variables.

A cross sectional study on depression among paramedical students in MES Institute of Paramedical Sciences

Background: Depression is characterized by persistent sadness and a lack of interest or pleasure in previously rewarding or enjoyable activities. It is very important to identify the factors predisposing to depression among paramedical students. The main objective of this study was to assess the prevalence of depression and the factors associated with depression among the paramedical students. Methods: A cross-sectional study was done among all the 208 paramedical students studying in MES using a predesigned questionnaire along with Beck’s depression inventory tool to identify depression. Chi-square test and multivariate regression analysis were used to find the association between variables. Results: The prevalence of depression was found to be 24.5%. 11.54 % of the total study participants have borderline depression, while 10.58%, 1.92% and 0.48 % had moderate, severe and extreme form of depression respectively. Chi square test showed type of family, course of study, smoking habits, traumatic events in the past, bad interpersonal relationship, concern regarding the future were found to be statistically associated with depression. In multivariate analysis, bad interpersonal relationship between friends and family members (OR= 3.13), worrying about the future (OR=6.03) and those who never sought any form of help for mental stress (OR=1.5) were the risk factors identified. Conclusions: Course selection, type of family they came from, any traumatic events in the past, lack of interpersonal relationship between friends, worrying about the job opportunities after completing the course, not seeking help for mental stress were the factors contributing towards depression.

Barriers and facilitators to seeking care for persons with acute brain infections: a cross sectional study

Background: Acute brain infections including encephalitis are less common but serious conditions characterized by the inflammation of the brain requiring immediate accurate diagnosis and management. For many infections appropriate therapies exist, but the outcome is often less desirable because of failure to receive appropriate treatment on time due to multiple factors. The aim of the study was to understand the barriers and facilitators towards receiving care for persons with acute brain infections in a low resource setting. Methods: The study design was cross sectional exploratory study. Consecutive patients presenting to neurology department of a tertiary referral care center for Neuropsychiatry in South India from July 2020 to September 2020 with the diagnosis of acute brain infections were assessed using the modified Kuppuswamy scale, Glasgow coma scale, the pathway scale: encounter form, patient centered health services in India and client socio-demographic and service receipt inventory. Results: A total of 110 participants, both male and female, were recruited for the study. The average age was 39.64�.5 years, with more female (65.45%) representation. 29% of individuals reported continued use of traditional practices while seeking care for the brain infections. Costs associated with care increased with the increase in duration of infection. There are major barriers and facilitators which either prohibit or facilitate care for persons with acute brain infections. Conclusions: Acute brain infections continuing to be a public health challenge in developing country context, and the recognition that the delay in treatment causes significant disability, it becomes imperative to focus on the social, cultural, economic, environmental factors to understand the barriers and facilitators to health seeking among this population.

Study of histopathological pattern of endometrium in abnormal uterine bleeding in a tertiary care center

Background: It is estimated that 9-30% of women of reproductive age suffer from abnormal uterine bleeding. As most cases are associated with anovulatory menstrual cycles, adolescent and perimenopausal women are particularly vulnerable to this particular condition. The aim of this study was to evaluate the histopathological pattern of endometrial biopsy from patients presenting with abnormal uterine bleeding. Methods: The retrospective study was conducted in the Department of Pathology in tertiary care centre from 1st January 2021 to 31 December 2022. All the patients presenting with abnormal uterine bleeding and who underwent endometrial biopsy were included in this study. Distribution of various histopathological patterns was observed in the different age groups. Results: A total of 260 cases were included in the study. The commonest pattern in these patients was proliferative endometrium (31 %) and products of conception (31%), hyperplasia without atypia (13.7%). Other patterns identified were secretory endometrium, chronic endometritis, endometrial polyp, complete mole, partial mole, and Ca endometrium. Conclusions: As observed from the study, there is an age specific association of endometrial bleeding, with highest incidence in 21-30 years of age group. Hence, dilatation and curettage are helpful for diagnosis, to assess therapeutic response and to know the pathological incidence of organic lesions in cases of abnormal uterine bleeding.

ABO blood group and rhesus factor association with inpatient COVID-19 mortality and severity: a two-year retrospective review

Background@#Early reports have indicated a relationship between ABO and rhesus blood group types and infection with SARS-CoV-2. We aim to examine blood group type associations with COVID-19 mortality and disease severity. @*Methods@#This is a retrospective chart review of patients ages 18 years or older admitted to the hospital with COVID-19 between January 2020 and December 2021. The primary outcome was COVID-19 mortality with respect to ABO blood group type. The secondary outcomes were 1. Severity of COVID-19 with respect to ABO blood group type, and 2. Rhesus factor association with COVID-19 mortality and disease severity. Disease severity was defined by degree of supplemental oxygen requirements (ambient air, low-flow, high-flow, non-invasive mechanical ventilation, and invasive mechanical ventilation). @*Results@#The blood type was collected on 596 patients with more than half (54%, N=322) being O+. The ABO blood type alone was not statistically associated with mortality (P=0.405), while the RH blood type was statistically associated with mortality (P＜0.001). There was statistically significant association between combined ABO and RH blood type and mortality (P=0.014). Out of the mortality group, the O+ group had the highest mortality (52.3%), followed by A+ (22.8%). The combined ABO and RH blood type was statistically significantly associated with degree of supplemental oxygen requirements (P =0.005).The Kaplan-Meier curve demonstrated that Rh- patients had increased mortality. @*Conclusion@#ABO blood type is not associated with COVID-19 severity and mortality. Rhesus factor status is associated with COVID-19 severity and mortality. Rhesus negative patients were associated with increased mortality risk.

Epidemiological risk factors and phylogenetic affinities of Sarcocystis infecting village chickens and pigs in Peninsular Malaysia

@#The intake of food and water containing the Sarcocystis parasite has been linked to a number of outbreaks worldwide, including Malaysia. Nevertheless, the lack of surveys and epidemiological data on Sarcocystis infections in Malaysia makes it difficult to estimate its occurrence in humans and animals. A cross-sectional study was conducted to determine the prevalence of Sarcocystis and the risk factors associated with infection among village chickens and pigs reared under different farm managements in Peninsular Malaysia. Phylogenetic trees were constructed using partial fragments of the 18S rRNA gene and ITS1 sequences. In the present study, 680 sera samples were collected from village chickens (n=250) and commercial pigs (n=433) and anti-Sarcocystis antibodies were screened using the enzymelinked immunosorbent assays (ELISA) kit. At the animal level, the prevalence of Sarcocystis was 9.2% (95% CI: 5.92-13.48) and at the farm level, it was 64.0% (95% CI: 42.52-82.03) in village chickens. The animal-level seroprevalence of Sarcocystis for pigs was 3.7% (95% CI: 2.13-5.93) and 36.8% (95% CI: 16.29-61.64) at the farm-level. Polymerase Chain Reaction (PCR) was conducted on meat samples from various parts of village chickens (n=250) consisting of brain, heart, lung, and pectoralis muscle tissues, and pork (n=121) consisting of intercostal muscle, diaphragm, and tongue. Sarcocystis DNA was detected in 6.4% (95% CI: 4.60-11.60) of village chicken samples but zero in pork samples. A total of 11 unique Sarcocystis haplotypes were isolated from these tissue samples. Multivariable logistic regression analysis of the putative risk factors showed a statistically significant association between Sarcocystis infection in pigs and uncovered storage of feed. Although no zoonotic Sarcocystis was isolated in this study, we reported the first discovery of S. wenzeli in Malaysia.

First molecular detection of porcine circovirus type 4 (PCV4) in Malaysia

@#Porcine circovirus type 4 (PCV4) is the newest member in the porcine circovirus family, first reported in 2020. To date, the presence of PCV4 has only been reported in China, South Korea and most recently in Thailand. Detection of PCV4 have been reported in various production stages of pigs from piglets, finishers to sows; associated with a myriad of clinical manifestations including porcine dermatitis and nephropathy syndrome (PDNS), postweaning multisystemic wasting syndrome (PMWS), respiratory, enteric and neurological diseases. While successful virus isolation and culture has yet to be reported, pathogenicity of PCV4 has been demonstrated through infectious clone studies. The objective of this study is to investigate the presence of PCV4 in Malaysian porcine population to update the epidemiology of porcine circoviruses in Malaysia. A total of 49 samples from commercial intensive pig farms, abattoir and wild boar population were subjected to conventional polymerase chain reaction assay to detect PCV4 capsid (cap) genome. Resulting cap nucleotide sequences were analyzed for maximum likelihood phylogeny relationship. Results revealed that PCV4 is present in Peninsular Malaysia at a molecular prevalence of 4.08% (2 / 49 samples). Both PCV4 positive samples originated from clinically healthy finishers. Malaysian PCV4 strains were classified as genotype PCV4b, and were found to be phylogenetically distinct from the China, South Korea and Thailand strains. With this latest update of the novel PCV4 in Malaysia, it is clear that more attention needs to be given to the investigation of novel porcine circoviruses (PCV) and management of PCV diseases.

Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study

Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index.

Effects of an early rehabilitation program for adult cystic fibrosis patients during hospitalization: a randomized clinical trial

There is little information on pulmonary rehabilitation in patients with cystic fibrosis (CF) with pulmonary exacerbation. This study aimed to evaluate the effects of an early rehabilitation program on lung function, muscle strength, inflammatory markers, and quality of life in adults with CF hospitalized for pulmonary exacerbation. In this randomized controlled trial, 19 patients were included in the intervention group and 15 in the control group. The intervention group underwent an early rehabilitation program for 14 days after admission. All patients underwent spirometry, one-repetition maximum tests (1RM), and the 6-min walk test, and answered the Revised Cystic Fibrosis Questionnaire (CFQ-R) for quality of life and the International Physical Activity Questionnaire. Serum levels of interleukin and tumor necrosis factor alpha (TNF-α) were measured. In the intervention group, there were increases in 1RM biceps (P=0.009), triceps (P=0.005), shoulder abductors (P=0.002), shoulder flexors (P=0.004), hamstrings (P<0.001), and quadriceps values (P<0.001). In addition, there were improvements in CFQ-R-emotion (P=0.002), treatment burden (P=0.002), vitality (P=0.011), and physical scores (P=0.026), and a reduction in the Borg resting fatigue score (P=0.037). The interleukins levels did not change after the intervention. In adult CF patients with pulmonary exacerbation, early hospital rehabilitation had a significant impact on improving resting fatigue, muscle strength, and quality of life.

The Serra Spanish mackerel fishery (Scomberomorus brasiliensis – Teleostei) in Southern Brazil: the growing landings of a high trophic level resource / A pesca da cavala, Scomberomorus brasiliensis (Teleostei), no sul do Brasil: o aumento nos desembarques de um recurso de alto nível trófico

In fisheries, the phenomenon known as fishing down food webs is supposed to be a consequence of overfishing, which would be reflected in a reduction in the trophic level of landings. In such scenarios, the resilience of carnivorous, top predator species is particularly affected, making these resources the first to be depleted. The Serra Spanish mackerel, Scomberomorus brasiliensis, exemplifies a predator resource historically targeted by artisanal fisheries on the Brazilian coast. The present work analyzes landings in three periods within a 50-year timescale on the Parana coast, Southern Brazil, aiming to evaluate whether historical production has supposedly declined. Simultaneously, the diet was analyzed to confirm carnivorous habits and evaluate the trophic level in this region. Surprisingly, the results show that from the 1970's to 2019 Serra Spanish mackerel production grew relatively to other resources, as well as in individual values. The trophic level was calculated as 4.238, similar to other Scomberomorus species, consisting of a case where landings increase over time, despite the high trophic level and large body size of the resource. The results agree with a recent global assessment that has demystified a necessary correlation between high trophic level and overexploitation, but possible factors acting on the present findings are discussed.

Na pesca, o fenômeno fishing down food webs, ou 'pescando teias tróficas abaixo', expressa a redução do nível trófico na composição das capturas, e tem origem tradicionalmente atribuída à sobrepesca. Sob intenso extrativismo, a resiliência das espécies carnívoras, predadoras de topo, é particularmente afetada, sendo seus estoques os primeiros a entrarem em depleção. A cavala, ou serra, ou sororoca, Scomberomorus brasiliensis, é exemplo de recurso predador historicamente alvo da pesca artesanal, de pequena escala, na costa brasileira. O presente trabalho analisa os valores de desembarque do recurso em três períodos ao longo de 50 anos na costa paranaense, sul do Brasil, com objetivo de avaliar se sua produção tem efetivamente diminuído. Ainda, estuda-se a dieta da espécie na região, para confirmar seus hábitos carnívoros e avaliar o nível trófico na região. Os resultados mostram que, surpreendentemente, dos anos 1970 para 2019 a produção de S. brasiliensis tem aumentado em valores absolutos, bem como relativamente à de outros recursos, em que pese o nível trófico 4,238, similar a outras espécies do gênero. Constata-se que a pesca da cavala na região de estudo constitui um caso de aumento nos desembarques a despeito de elevado nível trófico e grande tamanho corpóreo. Os resultados concordam com recente levantamento em nível mundial, que nega existir correlação necessária entre sobrepesca e nível trófico alto, mas fatores que podem explicar os resultados do presente trabalho são discutidos.