Assessing the efficacy of tocotrienol-rich fraction vitamin E in obese children with non-alcoholic fatty liver disease: a single-blind, randomized clinical trial.

BACKGROUND: Childhood obesity is a growing concern, and non-alcoholic fatty liver disease (NAFLD) is a significant consequence. Currently, there are no approved drugs to treat NAFLD in children. However, a recent study explored the potential of vitamin E enriched with tocotrienol (TRF) as a powerful antioxidant for NAFLD. The aims of the present study were to investigate the effectiveness and safety of TRF in managing children with obesity and NAFLD. METHODS: A total of 29 patients aged 10 to 18 received a daily oral dose of 50 mg TRF for six months (January 2020 to February 2022), and all had fatty liver disease were detected by ultrasonography and abnormally high alanine transaminase levels (at least two-fold higher than the upper limits for their respective genders). Various parameters, including biochemical markers, FibroScan, LiverFASt, DNA damage, and cytokine expression, were monitored. RESULTS: APO-A1 and AST levels decreased significantly from 1.39 ± 0.3 to 1.22 ± 0.2 g/L (P = 0.002) and from 30 ± 12 to 22 ± 10 g/L (P = 0.038), respectively, in the TRF group post-intervention. Hepatic steatosis was significantly reduced in the placebo group from 309.38 ± 53.60 db/m to 277.62 ± 39.55 db/m (p = 0.048), but not in the TRF group. Comet assay analysis showed a significant reduction in the DNA damage parameters in the TRF group in the post-intervention period compared to the baseline, with tail length decreasing from 28.34 ± 10.9 to 21.69 ± 9.84; (p = 0.049) and with tail DNA (%) decreasing from 54.13 ± 22.1to 46.23 ± 17.9; (p = 0.043). Pro-inflammatory cytokine expression levels were significantly lower in the TRF group compared to baseline levels for IL-6 (2.10 6.3 to 0.7 1.0 pg/mL; p = 0.047 pg/mL) and TNF-1 (1.73 5.5 pg/mL to 0.7 0.5 pg/mL; p = 0.045). CONCLUSION: The study provides evidence that TRF supplementation may offer a risk-free treatment option for children with obesity and NAFLD. The antioxidant and anti-inflammatory properties of TRF offer a promising adjuvant therapy for NAFLD treatment. In combination with lifestyle modifications such as exercise and calorie restriction, TRF could play an essential role in the prevention of NAFLD in the future. However, further studies are needed to explore the long-term effects of TRF supplementation on NAFLD in children. TRIAL REGISTRATION: The study has been registered with the International Clinical Trial Registry under reference number (NCT05905185) retrospective registration on (15/06/2023).

Beyond Bronchopulmonary Dysplasia: A Comprehensive Review of Chronic Lung Diseases in Neonates.

In neonates, pulmonary diseases such as bronchopulmonary dysplasia and other chronic lung diseases (CLDs) pose significant challenges due to their complexity and high degree of morbidity and mortality. This review discusses the etiology, pathophysiology, clinical presentation, and diagnostic criteria for these conditions, as well as current management strategies. The review also highlights recent advancements in understanding the pathophysiology of these diseases and evolving strategies for their management, including gene therapy and stem cell treatments. We emphasize how supportive care is useful in managing these diseases and underscore the importance of a multidisciplinary approach. Notably, we discuss the emerging role of personalized medicine, enabled by advances in genomics and precision therapeutics, in tailoring therapy according to an individual's genetic, biochemical, and lifestyle factors. We conclude with a discussion on future directions in research and treatment, emphasizing the importance of furthering our understanding of these conditions, improving diagnostic criteria, and exploring targeted treatment modalities. The review underscores the need for multicentric and longitudinal studies to improve preventative strategies and better understand long-term outcomes. Ultimately, a comprehensive, innovative, and patient-centered approach can enhance the quality of care and outcomes for neonates with CLDs.

Innovative approaches for augmenting dielectric properties in cross-linked polyethylene (XLPE): A review.

Throughout the history of power systems, power cables have been used to securely and efficiently distribute electrical energy to the destined locations. Cross-linked polyethylene (XLPE), a commonly used insulator in high-voltage cables, have several desirable properties, such as low dielectric loss, high dielectric constant, high thermal conductivity, enhanced thermal stability, and superior resistance against electrical stress. However, further improvements of XLPE's performance are needed. The incorporation of large specific surface area nanoparticles, such as boron nitride nanosheets and graphene oxide, exhibited a great potential in enhancing XLPE's properties. These nanoparticles create numerous trapping sites, even at small loading levels, due to their large interfacial regions. In addition, voltage stabilisers with polar groups can scavenge high-energy electrons generated by local electric fields, thereby inhibiting the electrical tree growth. Another important aspect of enhancing XLPE's dielectric performance is the inclusion of antioxidants with phenolic groups. These antioxidants react with peroxyl radicals, mitigating their harmful effects. This review summarises the effects of nanoparticles, voltage stabilisers, antioxidants, and polymer amalgamation on dielectric performance of XLPE as an insulation material. The major challenges in dielectric insulation such as breakdown voltage strength, electrical tree growth, structural defect, space charge accumulation, and thermal aging are addressed.

Parotid Enlargement as a Rare First Site of Manifestation in Extramedullary Acute Lymphoblastic Leukemia: A Case Report.

Parotid neoplasm in children is very rare, and most of these tumors are benign. Parotid enlargement in children is usually caused by infection or inflammation. We report a case of a 12-year-old boy who presented with the initial manifestation of bilateral parotid enlargement. He complained of two weeks of parotid swelling, during which the tumor gradually increased in size as he battled a monthlong on-and-off fever. An intravenous antibiotic was administered, as the first diagnosis was infection. Imaging studies of the swelling displayed features of infection, which was not resolved by the antibiotic. Fine-needle aspiration cytology was initially planned to establish a diagnosis. However, due to other findings in the clinical examination, such as bilateral scrotal swelling with abnormal blood work, the child was referred to other specialists for further assessment. Eventually, he was diagnosed with B-cell acute lymphoblastic leukemia by a hematology team.

Outcome and Prognostic Factors of Hemophagocytic Lymphohistiocytosis in Children: Experience From a Low- and Middle-Income Country.

Objective Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition especially in low- and middle-income countries (LMICs). This study was done to evaluate the outcome and prognostic factors of HLH in patients presenting to our center. Methods The study was carried out at the Paediatric Oncology Department of Combined Military Hospital (CMH) in Rawalpindi, Pakistan. All cases of HLH, from one month to 15 years of age enrolled between January 1, 2013 to June 30, 2023, were included. IBM SPSS Statistics for Windows, version 25.0 (released 2017, IBM Corp., Armonk, NY) was used for statistical analysis, and t-test and chi-square tests were used for comparison between continuous and categorical variables. Frequencies and percentages were calculated for categorical variables. Results Out of 115 patients, seven (6%) abandoned the treatment. The data of 108 cases, including 58 males (53.7%), were analyzed. The mean age at diagnosis was 31.5 ± 39.03 months. The mean time to reach a pediatric oncologist was 30.20 ± 22.15 days. Fever and pallor were common symptoms occurring in 107 (99.1%) and 98 (90.7%) cases, respectively. Jaundice was present in 44 (40.7%), visceromegaly in 64 (59.3%), and bruising/bleeding in 16 cases (14.8%). Twenty-six (24.1%) patients underwent hematopoietic stem cell transplant (HSCT), out of which 17 (65.4%) children were cured. Overall survival at two years, five years, and 10 years was 38%, 37%, and 36.1%, respectively. Disease-free survival at two years, five years, and 10 years was 33.3%, 32.4%, and 31.5%, respectively. Conclusion HLH leads to high mortality due to delayed or misdiagnosis in LMICs. Early diagnosis and early referral to a pediatric oncologist is the detrimental factor in survival for HLH. HSCT is the treatment of choice for primary, refractory, or relapse cases.

Evaluation of energy potential of MSW in the Tamale metropolis, Ghana: An assessment of solid waste characteristics and energy content.

In the present investigation, a thorough examination of waste composition was undertaken in the Tamale Metropolis, Ghana. The methodology employed was carefully designed, incorporating both commercial and residential sectors as well as various socioeconomic classes. Source-based sampling of waste materials covered a range of locations, including households, markets, hotels, and restaurants, while socioeconomic-based categorization followed the zoning of the metropolis. Waste audit sampling involved collecting a total of 90 batches of solid waste over the three-month period from August to October 2023. The primary objectives were to physically characterize the waste and evaluate its chemical properties through proximate and ultimate analysis of waste fractions, aiming to determine the waste-to-energy potential and compatibility with waste-to-energy technologies. The study revealed that the Tamale Metropolis generates 176.1 tons/day of Municipal Solid Waste (MSW) at a rate of 0.47 kg/capita/day.Organic matter constituted the majority (44.9%), followed by inert, miscellaneous, and plastic waste at 20% each. The remaining 14.3% comprised paper, metal, glass, leather, and textile components. Notably, the hospitality sector exhibited the highest organic matter content at 62.3%, contrasting with average households and markets at 44.9% and 13.1%, respectively. Moisture content ranged from 5.4% to 12.6%, volatile solids from 21.8% to 77.2%, and gross calorific values from 7.9 MJ/kg to 28.9 MJ/kg. Household waste demonstrated the highest energy content at 6693.8 kcal/kg, followed by hotels/restaurants (2003.94 kcal/kg) and markets (1883.62 kcal/kg). This study's findings offer valuable insights that can inform the development of effective policies by regulatory bodies such as the Public Utility Regulatory Commission (PURC) and the Ghana Ministry of Energy, as well as city authorities like the Tamale Metropolitan Assembly and the Environmental Protection Agency. These insights can be used to address waste and energy challenges in the metropolis.Implications: The findings reveal critical insights with substantial implications for stakeholders and regulatory bodies. It emphasizes the waste-to-energy potential of various waste fractions, highlighting the need for sustainable municipal waste management strategies. Particularly, the high organic content in the hospitality sector presents significant energy recovery opportunities. For bodies like the Public Utility Regulatory Commission and the Ghana Ministry of Energy, this data is crucial for developing policies that support waste-to-energy technologies. Additionally, the Tamale Metropolitan Assembly and the Environmental Protection Agency can use these insights to improve local waste management practices, customizing interventions to address specific sectoral waste composition. The study also underlines the importance of ongoing monitoring to ensure the effectiveness of these strategies over time.

The AutoSpawner system - Automated ex situ spawning and fertilisation of corals for reef restoration.

The restoration of reefs damaged by global and local pressures remains constrained by the scale of intervention currently feasible. Traditional methods for ex situ sexual propagation of corals produce limited materials, typically of limited genetic diversity and only sufficient for small field trials. The development and validation of new technologies to upscale and automate coral propagation is required to achieve logistically and financially feasible reef restoration at ecologically relevant scales. To address the need for upscaled production of genetically diverse material for use in reef restoration we designed an automated system (the AutoSpawner) for harvesting, fertilising and washing gametes from tropical broadcast-spawning corals. The system includes a novel high density dynamic fertilisation process, which enables the production of large numbers of fertilised coral eggs (>7 million per night for highly fecund species) without any downstream negative effects on larval quality. The functionality of the system and the quality of the produced larvae was assessed using multiple species from two coral families (Acroporidae and Merulinidae) across a range of spawning and gamete characteristics. We present the schematics and protocols required for automated sexual propagation of high-quality coral larvae using this novel system; and demonstrate that the time demands, and labour costs, associated with traditional manual-based sexual propagation of corals can be reduced by up to 113-fold using the AutoSpawner.

Evaluation of in vitro osteoblast and osteoclast differentiation from stem cell: a systematic review of morphological assays and staining techniques.

Background: Understanding human stem cell differentiation into osteoblasts and osteoclasts is crucial for bone regeneration and disease modeling. Numerous morphological techniques have been employed to assess this differentiation, but a comprehensive review of their application and effectiveness is lacking. Methods: Guided by the PRISMA framework, we conducted a rigorous search through the PubMed, Web of Science and Scopus databases, analyzing 254 articles. Each article was scrutinized against pre-defined inclusion criteria, yielding a refined selection of 14 studies worthy of in-depth analysis. Results: The trends in using morphological approaches were identified for analyzing osteoblast and osteoclast differentiation. The three most used techniques for osteoblasts were Alizarin Red S (mineralization; six articles), von Kossa (mineralization; three articles) and alkaline phosphatase (ALP; two articles) followed by one article on Giemsa staining (cell morphology) and finally immunochemistry (three articles involved Vinculin, F-actin and Col1 biomarkers). For osteoclasts, tartrate-resistant acid phosphatase (TRAP staining) has the highest number of articles (six articles), followed by two articles on DAPI staining (cell morphology), and immunochemistry (two articles with VNR, Cathepsin K and TROP2. The study involved four stem cell types: peripheral blood monocyte, mesenchymal, dental pulp, and periodontal ligament. Conclusion: This review offers a valuable resource for researchers, with Alizarin Red S and TRAP staining being the most utilized morphological procedures for osteoblasts and osteoclasts, respectively. This understanding provides a foundation for future research in this rapidly changing field.

Nutritional and toxicological assessment of Piliostigma thonnigii leaves and Tubaani food samples: a preliminary investigation.

Tubaani is a local delicacy prepared with Piliostigma thonningii leaves. The leaves may contain trace/heavy metals and important phytonutrients that could impact consumers' health. Concerns over the nutritional and toxicological implications of Piliostigma thonningii leaves are critical. Tubaani food and Piliostigma thonningii leaf samples were investigated using Neutron Activation Analysis (NAA) and Spectrophotometry technique. The health risk of Tubaani was also assessed by calculating the target hazard quotient (THQ) and hazard index (HI) of potentially toxic elements. Fifteen trace elements were detected at non-toxicological concentrations in the samples analyzed. No significant difference (p > 0.05) was observed between the samples' mean concentrations. The phenolic content in leaf extracts was higher as compared to the flavonoids. However, the flavonoids in the leaves had an effect on the food samples, unlike the phenols. The THQ and HI of the elements were below 1.0. There is no reason to be concerned about the current dietary intake of the potentially toxic elements in the routine consumption of Tubaani as portrayed in data obtained in this investigation by NAA, THQ, and HI.

Transgenic tobacco plants overexpressing a wheat salt stress root protein (TaSSRP) exhibit enhanced tolerance to heat stress.

BACKGROUND: Heat stress is a detrimental abiotic stress that limits the development of many plant species and is linked to a variety of cellular and physiological problems. Heat stress affects membrane fluidity, which leads to negative effects on cell permeability and ion transport. Research reveals that heat stress causes severe damage to cells and leads to rapid accumulation of reactive oxygen species (ROS), which could cause programmed cell death. METHODS AND RESULTS: This current study aimed to validate the role of Triticum aestivum Salt Stress Root Protein (TaSSRP) in plants' tolerance to heat stress by modulating its expression in tobacco plants. The Relative Water Content (RWC), total chlorophyll content, and Membrane Stability Index (MSI) of the seven distinct transgenic lines (T0 - 2, T0 - 3, T0 - 6, T0 - 8, T0 - 9, T0 - 11, and T0 - 13), increased in response to heat stress. Despite the fact that the same tendency was detected in wild-type (WT) plants, changes in physio-biochemical parameters were greater in transgenic lines than in WT plants. The expression analysis revealed that the transgene TaSSRP expressed from 1.00 to 1.809 folds in different lines in the transgenic tobacco plants. The gene TaSSRP offered resistance to heat stress in Nicotiana tabacum, according to the results of the study. CONCLUSION: These findings could help to improve our knowledge and understanding of the mechanism underlying thermotolerance in wheat, and the novel identified gene TaSSRP could be used in generating wheat varieties with enhanced tolerance to heat stress.

A Case on Papillary Thyroid Carcinoma With Intraluminal Tracheal Extension: A Malaysian Experience and Literature Review.

Papillary thyroid carcinoma (PTC) is a common malignancy originating from the thyroid gland. In rare cases, it can invade the trachea, resulting in airway obstruction. Subsequent surgical planning may be complicated as the technique selected depends on a case-by-case basis. Here, we report a case of PTC with tracheal involvement and a literature review on the latest surgical options. A 56-year-old gentleman presented with an anterior neck swelling of 3 x 3 cm for 3 months. Flexible endoscopy showed irregular mass in the subglottic region. Subsequent aspiration for cytology confirmed a diagnosis of PTC. Neck contrast enhanced computed tomography showed an ill-defined lesion in the right thyroid (3.1 x 3.8 x 2.9 cm) with a subtle irregularity of the adjacent tracheal wall suggestive of infiltration. The findings indicated a clinical staging of cT4aN0M0 (Stage III) with Shin's staging of Stage IV. The patient underwent a total thyroidectomy and a single-stage partial cricoid-tracheal resection with anastomosis. There were no immediate post-operative complications reported. Unfortunately, the patient suffered from pulmonary embolism, which eventually resulted in his demise. A subsequent histopathology report confirmed the diagnosis of PTC. Surgical planning for such cases may be complicated. The risk of recurrent laryngeal nerve injury is increased as the site of resection is close to the nerve. Multiple intraoperative nerve monitoring systems may be required. Meticulous planning of intraoperative airway management is needed as a large intraluminal tumor may interfere with intubation. Generally, extensive tracheal invasion would require radical surgical approaches such as circumferential resection and total laryngectomy. Less extensive cases can be treated with shave excision or window resection. PTC with tracheal invasion is an uncommon condition, and surgical excision is indicated for cases with high Shin's staging.

Andrographolide targets EGFR to impede epithelial-mesenchymal transition in human breast cancer cells.

Despite the primary surgical treatment for breast cancer patients, malignant invasiveness and metastasis remain threatening factors for women with breast cancer. As chemotherapy yields unsatisfactory results, it prompted us to search for effective natural agents with few side-effects. Although andrographolide (ADGL), a natural diterpenoid lactone isolated from Andrographis paniculata, presents anticancer effects, the molecular mechanism remains unknown. Initially, on comparing the expression of proteins related to epithelial-mesenchymal transition (EMT) between nonmetastatic cancer MCF7 cells and highly metastatic cancer MDA-MB-231 cells, we found that MDA-MB-231 cells exhibit higher protein levels of N-cadherin and vimentin and lower protein levels of E-cadherin when compared to MCF7 cells. Moreover, MDA-MB-231 cells also exhibited higher EGFR expression and activity, higher STAT1 activity and abundant HDAC4 expression. To elucidate whether these proteins are closely associated with EMT, EGFR, STAT1 or HDAC4, the proteins were silenced in MDA-MB-231 breast cancer cells by their specific siRNAs. We found that silencing these proteins reduced EMT, indicating an important role of EGFR, STAT1 and HDAC4 in EMT progression. When we treated MDA-MB-231 cells with ADGL as a potential therapeutic drug, we found that ADGL treatment inhibited cell migration and invasion. Furthermore, it also recovered E-cadherin expression and decreased N-cadherin and vimentin protein levels. ADGL treatment reduced EGFR expression at a lower concentration (1 µg/mL); however, STAT1 activity and HDAC4 expression was reduced by a higher concentration (5 µg/mL) of ADGL. Moreover, we observed that the combined treatment with ADGL and siRNAs against these proteins highly sensitized the MDA-MB-231 cells to apoptosis compared to that with ADGL and control siRNA. Collectively, our results suggest that ADGL targets EGFR, thereby inhibiting EMT in human breast cancer cells.

Assessment of the impacts of artificial intelligence (AI) on intercultural communication among postgraduate students in a multicultural university environment.

Artificial intelligence (AI) broadly influences different aspects of human life, especially human communication. One of the main concerns of the broad use of AI in daily interactions among different people could be whether it helps them interact easily or complicates their interactions. To answer the mentioned question, this study assessed the impacts of AI on intercultural communication among postgraduate students in a multicultural university environment. A newly developed survey instrument was used to conduct this study. The participants of this study were 115 postgraduate students from nine different countries. The descriptive statistics, reliability analysis, and Bivariate correlation tests of the 29th version of IBM-SPSS software were used to analyze the quantitative data, and inductive coding and conceptual content analysis were used to code and analyze the qualitative data. Based on descriptive results, the vast majority (93%) of the participants already used and experienced AI in their daily lives, and the majority of them believed that AI and AI technologies connect different cultures, reduce language and cultural barriers, and help people of different cultures to interact and be connected. Based on the results from the correlation test, there were strong positive correlations between AI attitudes and AI benefits, and also between AI regulation and AI benefits.

Evaluation of Serum Interleukin-33 Level in Iraqi Patients with and without Periodontal Disease.

Objective: Periodontitis is a multifactorial inflammatory illness characterized by periodic tissue support deterioration. Interleukin-33 has recently been discovered as a new pro-inflammatory cytokine implicated in the pathogenesis of periodontitis. The objective of this case control study is to compare IL-33 levels among periodontitis patients and healthy volunteers using serum samples and investigate the potential association with clinical periodontal parameters. Materials and Methods: A total of 100 subjects (50 patients with periodontal disease and 50 healthy individuals) were included in this case control study. Clinical plaque index (PLI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment loss (CAL) were assessed. Serum was extracted from the venous blood that was collected. Serum IL-33 values were measured using an enzyme-linked immunosorbent assay (ELISA). Results: Serum levels of interleukin-33 showed considerably elevated level in the patient's group than in the healthy control group (P<0.01). There was a strong correlation between the blood levels of IL-33 and PLI, GI, and BOP (P≤ 0.05). While PPD and CAL demonstrated a non-significant relationship (P˃0.05). Conclusion:  The results of this study suggested that IL-33 may be used as a potential indicator of the inflammation associated with periodontitis and might have a role in the development of the disease. Further studies with large sample sizes are needed to improve knowledge about the role of IL-33 in periodontal health and disease. Clinical Significance: Owing to the noticeable role that IL-33 plays in the pathogenicity of periodontitis as a local waring clue for the periodontal tissue breakdown, tissue-specific therapeutic strategies may improve.

Virtual Group Cognitive Stimulation Therapy for Dementia: Mixed-Methods Feasibility Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Cognitive stimulation therapy (CST) is an evidence-based group intervention for people with dementia, with benefits for cognition and quality of life when delivered face-to-face. Many people are unable to attend face-to-face groups for reasons including health and transport issues. This study aimed to assess the feasibility and acceptability of online or "virtual" CST (vCST). RESEARCH DESIGN AND METHODS: Single-blind, randomized controlled feasibility design with qualitative interviews. Forty-six people with mild-to-moderate dementia were randomly allocated to attend either 14 sessions of twice-weekly vCST (n = 24) or treatment as usual (TAU, defined as usual care; n = 22) over 7 weeks. Cognition, quality of life, and depression were assessed pre- and posttreatment. Qualitative interviews (n = 16) with participants and carers were analyzed using thematic analysis. RESULTS: High levels of attendance, adherence, fidelity to the manual, and completion of outcomes were recorded. Recruitment appeared feasible although randomization may not have been acceptable to some. There were no statistical differences noted between vCST and TAU in any of the outcomes evaluated, although both quantitative and qualitative data indicated acceptability, with qualitative reports of improved outcomes including cognition. DISCUSSION AND IMPLICATIONS: vCST appeared feasible to deliver but did not result in any changes in outcomes, as expected from an underpowered feasibility trial. CST is the main psychosocial intervention delivered for dementia in UK memory services and globally, with many services moving towards virtual CST delivery. Therefore, a fully powered RCT of the effectiveness of vCST is feasible and justified.

Evaluating the Effectiveness of Geriatric-Specific Cancer Rehabilitation Programs on Patient Health Outcomes.

OBJECTIVE: This study evaluated a specialized rehabilitation program's impact on senior cancer patients' quality of life. METHODS: one hundred and thirty patients aged ≥65 years with various cancer types undergoing/recovering from treatment were enrolled in oncology clinics in Al-Ahsa, Saudi Arabia. The intervention arm (n=65) participated in a tailored geriatric cancer rehabilitation program. The control group (n=65) received standard oncology care. The Functional Assessment of Cancer Therapy-General (FACT-G) tool assessed the quality of life across physical, social, emotional, and functional domains. T-tests and multivariate regression analyses compared outcomes. RESULT: Total FACT-G scores showed a significantly higher quality of life for the geriatric cancer rehabilitation group versus standard care. Rehabilitation patients also demonstrated meaningful improvements across physical, social, and functional subscales. Rehabilitation involvement was the most predictive factor for optimized outcomes. CONCLUSION: Specialized geriatric cancer rehabilitation meaningfully improved several quality of life domains in older patients over standard care. Despite persistent barriers, rehabilitation programming optimized older cancer patients' physical and psychosocial health. Oncology and geriatrics must collaborate to ensure evidence-based rehabilitation access meets older cohorts' unique needs.

Detection of Macrolide-Resistant Streptococcus pneumoniae Genes and Its Clinical Outcomes in a Tertiary Teaching Hospital in Malaysia.

Background: Streptococcus pneumoniae is one of the leading causes of mortality and morbidity worldwide. The dramatic increase in in-vitro resistance of antimicrobial agents, particularly beta-lactams and macrolides, makes pneumococcal infections difficult to treat. The aim of this study was to describe the drug resistance rate, assess the prevalence of macrolide-resistant genes and review the clinical complications of pneumococcal infections among patients presented to Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia. Methods: This is a descriptive cross-sectional study. All S. pneumoniae isolates collected from clinical specimens within a 1-year period were subjected to selected antimicrobial susceptibility testing using E-test strips. Polymerase chain reaction (PCR) analysis was conducted to detect macrolide-resistant determinants. The patient's clinical data were obtained from clinical notes. Results: A total of 113 patients with a positive growth of S. pneumoniae were included in the study. The most common predisposing factors among them were bronchopulmonary diseases (15.9%). The penicillin-resistant rate was 7.1%, with minimal inhibitory concentration (MIC) ranging between 0.012 µg/mL and >32 µg/mL, and the erythromycin-resistant rate was 26.5%, with a MIC range of 0.03 µg/mL-> 256 µg/mL. Most of the erythromycin-resistant isolates were found to have the mef(A) gene (50.4%) and the erm(B) gene (20%); 16.7% had a combination of genes mef(A) and erm(B), and 13.3% had none of the two genes. Community-acquired pneumonia is the predominant type of pneumococcal infection. There was no significant association between the presence of macrolide resistance determinants and mortality (P = 0.837) or complications (P > 0.999 for empyema and cardiac complication; P = 0.135 for subdural abscess). Conclusion: The majority of erythromycin-resistant isolates were found to have the mef(A) gene, followed by the erm(B) gene and a combination of genes mef(A) and erm(B).

Salivary levels of catalase, total antioxidant capacity and interleukin-1ß and oral health-related quality of life after matcha and green tea consumption for patients with gingivitis: A randomized clinical trial.

OBJECTIVES: To evaluate the changes in salivary levels of catalase (CAT), total antioxidant capacity (TAC) and IL-1ß (primary outcomes) as well as gingival health and oral health-related quality of life (OHRQOL) 1 month after the consumption of matcha and green tea in adult patients with gingivitis. METHODS: This study was a parallel randomized clinical trial. Forty gingivitis adult patients were randomly assigned to drink either matcha or green tea cup twice daily for a duration of 1 month. They were asked to keep their habitual oral hygiene measures. Plaque index (PI) and bleeding on probing (BOP) were recorded. In addition, saliva was collected at baseline and 1 month after tea consumption. Salivary levels of CAT, TAC and IL-1ß were determined by ELISA. Each participant was asked to fill OHIP-14 questionnaire before and after tea consumption. RESULTS: Following tea intake, 40.6% of the study sample had healthy gingiva. Both groups similarly showed reductions in PI (0.32 ± 0.11-0.22 ± 0.08) and BOP (0.24 ± 0.08-0.13 ± 0.07) scores after tea consumption. There was a significant difference between mean TAC before and after matcha tea consumption only. Non-significant reductions in salivary levels of CAT and IL-1ß were detected after tea consumption. OHRQOL of participants was improved after tea, both types, consumption. CONCLUSION: Despite study limitations, daily consumption of matcha and green tea might be beneficial as they potentially enhance OHRQOL of individuals with gingivitis and reduce the extent of gingivitis despite non-significant changes in salivary antioxidants and IL-1ß levels.

Successful Treatment of a Thyroid Abscess in a Pediatric Patient: A Case Report.

Thyroid abscess, or acute suppurative thyroiditis (AST), is an exceedingly rare condition, particularly in the pediatric population. It often results from congenital anomalies or is secondary to infections. Despite its rarity, prompt diagnosis and management are crucial to prevent serious complications. We report a case of a five-year-old girl with no significant medical history who presented with a two-week history of anterior neck swelling, odynophagia, fever, and leukocytosis. Notably, the patient did not exhibit symptoms of thyroid dysfunction. Initial treatment with antibiotics for a suspected bacterial infection at a private clinic did not lead to improvement. Ultrasound and computed tomography scans revealed a multiloculated abscess within the left thyroid lobe. The patient underwent successful incision and drainage, supported by antibiotic therapy, resulting in a full recovery without complications. Imaging studies played a critical role in diagnosing and guiding the management of this condition. Thyroid abscess, though rare, should be part of the differential diagnosis for pediatric patients presenting with acute neck swelling, fever, and pain. Early diagnosis and appropriate management, typically involving surgical drainage and antibiotics, are essential for a favorable outcome.

Long-term medical and quality of life outcomes among voluntary liver donors.

BACKGROUND: Long-term medical and quality of life (QOL) outcomes in voluntary liver donors remain under investigated. The objective of the current study was to report long-term medical outcomes and re-evaluate QOL in living liver donors. METHODS: This was a single-center retrospective cohort study of donors who underwent donor hepatectomy between 2012 and 2018. We investigated long-term outcomes in 7 domains. These include medical problems, surgical procedures, work-related issues, pregnancy outcomes, psychiatric interventions, willingness to donate again, and long-term mortality. QOL was evaluated using short-form 36. RESULTS: The median follow-up time was 61.4 months (53.3-83.7). Among 698 donors, 80 (11.5%) experienced medical problems, 4 (0.6%) had work-related issues, and 20 (2.9%) needed psychiatric assistance. Surgery was performed in 49 donors (7%), and females were more likely to have undergone incisional hernia repair (5.8% vs 1.9%, P = .006). There were 79 postdonation pregnancies including 41 normal vaginal deliveries (51.9%), 35 cesarean sections (44.3%), and 3 miscarriages (3.8%). Willingness to donate again was reported by 658 donors (94.3%). Donors whose recipients were alive were more likely to donate again (95.5% vs 90.5%, P = .01). There were 3 deaths (0.4%) in the long-term. The mean physical composite score at initial and follow-up evaluation was 86.7 ± 13.9 and 76.5 ± 20.9 (P = .001), and the mean mental composite score at initial and follow-up evaluation was 92.1 ± 13.5 and 80.7 ± 16 (P = .001). CONCLUSION: The overall long-term outlook in living liver donors is promising. QOL parameters might deteriorate over time and frequent re-evaluation might be considered.