A Case Series of Kodamaea Ohmeri Infection: The Hidden Threat Unleashed

Intro: Kodamaea ohmeri, previously known as Pichia ohmeri, is an ascomycetous yeast that has emerged as an important cause of fungemia in immunocompromised patients. During the anamorphic stage this organism is also known as Candida guillermondii var. membranaefaciens. Method(s): We report five cases of Kodamaea ohmeri encountered from multicenter in Malaysia. Antifungal agent of choice will be discussed based on literature review. Finding(s): The cases were: (1) a contaminated peritoneal fluid in an adult patient on peritoneal dialysis;(2) a 60-year-old man with infected diabetic foot isolated K. ohmeri from a bone sample. Both cases discharged well without active antifungal fungal therapy. We observed fatality cases involving (3) an old man with underlying gastric adenocarcinoma who complicated with catheter- related bloodstream infection caused by K. ohmeri;(4) a patient with ventilator- associated pneumonia and septicaemic shock secondary to perforated terminal ileum;(5) and a severely ill COVID-19 stage 5b patient who passed away due to systemic fungaemia caused by K. ohmeri. Discussion(s): All three fatal cases received either amphotericin B or caspofungin as active antifungal agent. Literature evidence has shown that 40% of patient met demise despite on active antifungal agent, suggesting that currently no definitive antifungal agent proven to be a superior treatment option for K. ohmeri infection. Removal of indwelling medical device combined with antifungal therapy has favorable clinical outcome. Conclusion(s): Therefore, K. ohmeri infection in severely ill patients should be considered as a critical condition. Potential of alternative antifungal combinations need to be explored for an effective treatment option.Copyright © 2023

Detection of Leptospira DNA among Post-Mortem Specimens during Covid-19 Pandemic

Intro: Leptospirosis is an emerging zoonosis with a global health concern. In Malaysia, leptospirosis incidence remains significant, since its first gazettement as a compulsorily notifiable disease in 2010. However, the prevalence of this disease among local forensic cases is unknown. Therefore, the present study aimed to determine the frequency of human leptospirosis among post-mortem specimens. Method(s): Archived forensic specimens referred to the Institute for Medical Research (IMR), Malaysia between January 2020 and December 2021 were retrieved. DNA from the specimens were extracted using an automated MagNA Pure 96 instrument and subjected to in-house qPCR targeting LipL32 gene and 16S rRNA gene of the pathogenic group of Leptospira spp. Amplification of RNaseP gene was included as internal amplification control (IAC). Finding(s): A total of 408 forensic specimens from 365 patients were received during the study period. Majority of the specimens were blood (n = 195, 47.8%), followed by tissue (n = 136, 33.3%) and liver (n = 59, 14.5%). Of the tested specimens, 2.2% (n = 9) were positive for leptospiral DNA. These positive specimens belonged to 9 different patients, of which the vast majority were male (n = 8, 88.9%), with an average age of 37.5 years. Conclusion(s): Albeit low detection of leptospiral DNA among forensic specimens in Malaysia, this study highlighted that majority of the positive patients were males of productive age.Copyright © 2023

Production of Sars-Cov-2 Membrane Protein as Better Target Protein for Diagnostic Application

Intro: The COVID-19 pandemic is caused by the SARS-CoV-2 virus, an enveloped RNA of the coronavirus family. The advancement in molecular technology and biochemistry has accelerated the development of diagnostic reagents and assays. Much attention has been focused on the S protein, but the high mutation rate in this region could lead to false negative results. Thus, a better target protein for diagnostic application is needed for accurate detection. Method(s): Nucleotide sequences encoded for membrane (M) glycoprotein gene region of SARS-CoV-2 from Malaysian isolates were extracted from GISAID, aligned, and selected accordingly. The DNA plasmid was commercially synthesized with codon optimization for Escherichia coli (E. coli), and the presence of the M gene was confirmed by PCR. The plasmid was then transformed into E. coli. Later, the expression of M glycoprotein was induced, separated on an SDS-PAGE gel, and transferred onto a nitrocellulose membrane, followed by immunostaining. Finding(s): The analysis of the M glycoprotein against the Omicron strains demonstrated that the amino acid is conserved (99.5%). The M glycoprotein was successfully expressed and detected with antibodies from SARS-CoV-2 infected patients at ~26 kDa. The protein is currently upscale for the generation of monoclonal Ab (Mab). Discussion(s): The M protein of SARS-CoV-2 is more conserved among the virus and also has been reported to confer antigenic properties. Selection of M protein perhaps a better option compared to current detection assays that use spike (S) protein, which could lead to false negative results, as this gene region particularly the ribosome-binding domain (RBD) rapidly undergoes mutations. The utilization of M protein potentially improves negative predictive value (NPV) of the diagnostic test. Conclusion(s): Further development of diagnostic reagents is needed to improve the assay's specificity. The newly developed M protein and the MAb can be used to generate a more accurate viral detection assay.Copyright © 2023

Use of awake prone positioning in acute COVID-19

Introduction: Awake prone positioning (APP) may reduce ventilation-perfusion mismatch in the context of acute respiratory distress syndrome. The Intensive Care Society recommends its use in COVID-19 to improve oxygenation and reduce risk of progression to invasive mechanical ventilation. This audit project measured the use of APP on an Acute Respiratory Care Unit (ARCU). Method(s): Observations and patient outcomes were recorded for non-intubated patients where a clinical decision had been made to prone. The activPALTM accelerometer was used as an objective measure of APP (prone or lateral-lie positioning). Analysis was performed using STATA v16. Result(s): Between September 2020 and February 2021, 19 individuals with a median age of 68 years were included. 74% were male. In the first 48 hours, 747 person-hours of data were recorded, with 358 person-hours spent in APP. Eight individuals spent at least 50% of their first 48 hours in APP. Lateral lie was better tolerated than full prone positioning, with a median (interquartile range, IQR) of 11.6 (8.0, 20.2) hours spent in lateral lie and median (IQR) of 1.6 (0.5, 8.3) hours spent fully proned in the first 48 hours. Median (interquartile range, IQR) improvement from baseline in respiratory rate/oxygenation (ROX) index at 48 hours was +1.65 (0.90, 1.89). Median (IQR) ROX index at 12 hours for individuals not in APP was 4.80 (3.04, 8.51) and 10.41 (9.09, 11.42) for individuals who were fully proned. Nine individuals were admitted to intensive care, 13 survived to discharge. Conclusion(s): Accelerometry is an objective method to measure time spent in APP and showed that lateral lie was preferred to full prone position in this cohort. Trends suggest possible improvement in ROX, although numbers were small.

Assistive Video Filters for People with Parkinson's Disease to Remove Tremors and Adjust Voice

COVID ushered in the widespread use of videocon-ferencing and it's here to stay. In virtual communication, we can alter everything from our appearance, voice and backgrounds. Most of these changes are fun gimmicks, but what if we could leverage these filtering technologies to a life-changing assistive technology? We propose the idea of developing assistive video filters for people with Parkinson's disease (PwP) that will remove involuntary tremors and smooth the stuttering in their voice. We surveyed 177 PwP and 107 people from the general public, and we personally interviewed 52 PwP as well as 3 health care professionals. We find overwhelming statistical evidence that these filters would fulfill a demonstrated communication need for PwP and that the general public also approves of a video filter that could assist with communication for PwP. To test the feasibility of our concept, we developed a filter prototype to remove physical tremors and tested it on two PwP. Although this paper focuses on PwP as a use case, we hope this work encourages others to ethically develop filtering technologies to help individuals with other movement disorders, eye-contact impairment and stuttering in computer-mediated conversations.

Prognostic Significance of ALT/AST in diabetic patients having Myocarditis secondary to COVID Pneumonia

Aim: To compare the predictive accuracy of raised ALT/AST ratio in diabetic patients for survival and myocarditis due to COVID- 19 pneumonia. Study design: It was a cross-sectional study, conducted at Department of Medicine, Services Hospital, Lahore for about 6 months (March 2020 to September 2020) Methods: A cross-sectional study was conducted for six months at Services Hospital in Lahore (March 2020 to September 2020). A total of 350 patients' ALT and AST levels will be tested in blood. Patients' survival rates will be tracked. Patients with myocarditis and ALT/AST ratios below 0.90 had a dismal prognosis. Results: The average female age was 47.87.15.82. There were 142 men (40%) and 208 women (59.4%). There were 131 light (36.4%), 77 moderate (22%), 83 severe (23.7%), and 59 serious cases (16.9%). Mean ALT/AST was 0.89 0.33. 58 patients (16.6%) had myocarditis, and 66 (18.9%) died in the hospital. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the ALT/AST ratio for predicting diabetic patient survival were 56.1%, 39.1%, 17.6%, 79.3%, and 42.3%. The ALT/AST ratio's sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 78%, 42.9%, 20%, 91.3%, and 48.3% for predicting the survival of diabetic patients with COVID-19 pneumonia-related myocarditis. Conclusion: This study found that ALT/AST ratio is not a strong predictor of mortality in diabetic patients with COVID-19-related myocarditis.

A stochastic computing procedure to solve the dynamics of prevention in HIV system

The motive of this work is to find the numerical simulations of a dynamical HIV model along with the effects of prevention, i.e., HIPV nonlinear mathematical system. An advance computational framework using the procedures of Meyer neural networks (MNNs) together with the compotnecies of local/global search approaches is presented to solve the HIPV nonlinear mathematical system. The global and local operators will be used as genetic algorithm (GA) and interor-point algorithm (IPA), i.e., GAIPA. The dynamicis of HIPV mathematical system is classified into four categories, ‘T-cells attentiveness’, ‘Infected from disease, ‘Prevention actions’ and ‘Virus free particles. An error function is constructed using the differential system and its boundary conditions. The optimization of this function is presented through the hybridization computing paradigms of MWNNs-GAIPA. The correctness of the designed MWNNs-GAIPA is obtained by using the comparion of the obtained and reference solutions. The performance of this scheme is also acheived through the overlapping of the results with the accuracy of order 5 t 7 in the plots of absolute error. The reliability of the proposed MWNNs-GAIPA solver is observed by providing the statistical analysis by using different operators.

Clinical and biochemical indicators of disease severity and neurological findings in COVID-19: A study of King Edward Medical University (KEMU), Pakistan

This study investigated the significance of difference between presence and absence of different neurological findings in COVID-19, in relation with the biochemistry. Various significant correlations in connection with the disease severity and clinical factors were also identified. 351 COVID-19 patients were included. Different laboratory/ clinical findings were investigated. Correlations Kendall's tau and Pearson Chi-Square were applied to find the correlations between severity and clinical findings. The Mann-Whitney Test was applied for a comparison between two types of neurological groups for each biochemistry parameter. Headache was reported in 28% and dizziness in 13% patients. The impaired smell and impaired taste were reported in 28.5% and 36.2% patients, respectively. The muscle pain was present in 39% patients. 80% patients had low lymphocytes & 70% had high neutrophils. 54.5% were found with high ALP. LDH was elevated in 73%. Severity was found significantly correlated with decreased oxygen saturation, age and raised levels of urea, creatinine and LDH. The groups (with/without CNS involvement) were statistically different in ALP, groups (with/without PNS involvement) in WBC, lymphocytes, neutrophils, ALP, urea, creatinine, CK, CKMB and LDH and groups (with/without MSK involvement) in WBC. Oxygen saturation, age, urea, creatinine and LDH are significant indicators of disease severity in COVID-19. The altered levels of different biochemistry can impact the neurological states of COVID-19 patients.