Minimal agreement between basophil activation test and immunoassay in diagnosis of penicillin allergy

INTRODUCTION

Basophil activation test (BAT) and immunoassays are the most widely used in vitro tests to diagnose IgE-mediated allergic reactions to penicillin. However, studies to determine if one test is interdependent from another are limited.

OBJECTIVE

The present study aimed to measure the agreement between BAT and immunoassay in diagnosis of penicillin allergy.

METHOD

BAT was performed using penicillin G (Pen G), penicillin V (Pen V), penicilloyl-polylysine (PPL), minor determinant mix (MDM), amoxicillin (Amx) and ampicillin (Amp) in 25 patients. Immunoassay of total IgE (tIgE) and specific IgE (sIgE) antibodies to Pen G, Pen V, Amx and Amp were quantified. Skin prick test (SPT) using PPL-MDM, Amx, Amp and Clavulanic acid were also performed.

RESULTS

Minimal agreement was observed between BAT and immunoassay (k=0.25). Of two BAT-positive patients, one patient is positive to Amx (59.27%, SI=59) and Amp (82.32%, SI=82) but sIgE-negative to all drug tested. This patient is also SPT-positive to both drugs. Another patient is BAT-positive to Pen G (10.18%, SI=40), Pen V (25.07%, SI=100) and Amp (19.52%, SI=79). In sIgE immunoassay, four patients were sIgE-positive to at least one of the drugs tested. The sIgE level of three patients was between low and moderate and they were BAT-negative. One BAT-positive patient had a high level of sIgE antibodies (3.50-17.5kU/L) along with relatively high specific to total IgE ratio ≥0.002 (0.004-0.007).

CONCLUSIONS

The agreement between BAT and immunoassay is minimal. Performing both tests provides little increase in the sensitivity of allergy diagnosis work-up for immediate reactions to penicillin.

The antioxidant properties and α-amylase inhibition activities of polyphyto mixture with honey formulations

Ficus carica, Orthosiphon stamineus, Ficus deltoidea and Trigona honey are known for their high antioxidant amount. In this research, these plants and honey were used to study their interactions in terms of the antioxidant properties and the inhibition of α-amylase enzyme. These plants samples were chosen as they are usually used in traditional medicine to treat diabetes. Therefore, the objectives of this study are to measure the antioxidant activity as well as the α-amylase enzyme inhibition properties of the polyphyto formulations and Trigona honey. Simplex Centroid Mixture Design (SCMD) was used to design the formulations. In this experiment, the highest (p<0.05) antioxidant content for 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay was a formulation of 100% Trigona honey (90.09%). Meanwhile, a mixture of 50% F. carica – 50% O. stamineus and 50% O. stamineus – 50% Trigona honey yield the highest (p<0.05) total phenolic content (TPC) value (133.77 and 133.17 μg/mL, respectively), which indicated a synergistic interaction effect. However, for the measurement of ferric reduction antioxidant potential (FRAP), the formulation of 100% O. stamineus and 100% F. deltoidea exhibits the highest (p<0.05) value (148.95 and 148.78 μg/mL, respectively). In terms of enzyme inhibition, F. deltoidea showed the highest inhibition activity for α-amylase (8.826%). In conclusion, different percentages of F. carica, O. stamineus, F. deltoidea and Trigona honey have different interaction effects on the antioxidant activity and α-amylase inhibition depending on the amount of each factor.

The interaction effect and optimal formulation of selected polyherbal extracts towards antioxidant activity

Past study showed that lemongrass (Cymbopogon citratus), curry leaves (Murrya koenigii), turmeric (Curcuma longa) and ginger (Zingiber officinale) contain phytochemicals associated with antioxidant properties. However, all the herbs are tested individually and rarely mix together. This study was conducted to examine the antioxidant properties and interaction effect when combined. The plants studied were decocted with distilled water. Eighteen formulations of aqueous extracts were established using simplex lattice mixture design that was generated by Design Expert software. The antioxidant properties were analyzed by 2-diphenyl-2-picryl hydrazyl radical scavenging (DPPH), ferric reducing antioxidant power (FRAP), total phenolic content (TPC) and total flavonoid content (TFC) assays. The result showed that the mixture of lemongrass and curry leaves extracts gave the highest reading in DPPH assay (91.14%), FRAP assay (215.66 mM) and TFC (22.62 µg Rutin/mL). In the DPPH assay, the ratio of one to one (1:1) mixture of lemongrass with other plants extracts showed antagonistic interaction. There were five (5) formulations that showed synergistic interaction in all assays. However, there were two (2) formulations that showed antagonistic interactions on both DPPH and FRAP assays. No additive effect was observed in all formulations. The suggested optimum formulation contains 53.7% lemongrass, 43.4% curry leaves, 2.9% ginger and 0.0% turmeric. Most of the mixtures presented synergistic interactions. This indicated the potential of plant extract mixtures to be developed into nutraceutical products in the future by conducting in-vivo study.

Influence of parameters and radical scavengers on the visible-light-induced degradation of ciprofloxacin in ZnO/SnS2 nanocomposite suspension: Identification of transformation products

Removal of ciprofloxacin (CIP) pollutant from wastewater using conventional process is particularly challenging due to poor removal efficiency. In this work, CIP was photocatalytically degraded using a porous ZnO/SnS₂ photocatalyst prepared via microwaves. The influence of process parameters (e.g., pH, catalyst mass and initial CIP concentration) and radical scavengers on visible-light induced degradation of CIP on the catalyst was investigated. From the study, it was found that visible-light induced degradation of CIP on ZnO/SnS₂ is a surface-mediated process and the reaction kinetics followed the Langmuir-Hinshelwood first-order kinetics. It was found that the optimum condition for CIP degradation was at pH of 6.1 and catalyst dosage of 500 mg L^-1. Higher catalyst dosage however led to a decline in reaction rate due to light scattering effect and reduction in light penetration.

Safe practice guidance: a review for otorhinolaryngologists during COVID-19 pandemic and after reopen process

COVID-19’s rapid sweep across the world has caused an extraordinary disruption to the otorhinolaryngology (ORL) profession and its subspecialties including the rhinology section. The present pandemic forced our specialty practitioners to make quick clinical and practice management decisions. Staff safety must receive the highest prioritization along with strategies to provide the highest quality care. The purpose of the present manuscript is to provide a narrative review of the current knowledge and committee practices regarding ORL (including rhinology) professionals' safe practice during COVID-19 pandemic and after reopen process. The present review findings will allow the clinical practitioners to understand the factors involved in reducing the risk of transmission of COVID-19 in the ORL and rhinology settings, personal protective equipment (PPE) for different ORL and rhinology practices and criteria of practice in outpatient clinic (OPC), emergency operations and ORL surgeries. The emerging evidence based on COVID-19 is rapidly changing. Further updates may be needed to this review as new details or evidence emerge. ORL including rhinology doctors should consider the specific conditions of each individual place of work and comply with all applicable legislations.

Toxicity assessment of reduced graphene oxide and titanium dioxide nanomaterials on gram-positive and gram-negative bacteria under normal laboratory lighting condition

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Bacterial growth curve deviates from its normal pattern after the exposure to nanoparticles.

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Cell wall structure of Gram-positive and Gram-negative bacteria played the major factor contribute to its toxicity effect towards nanoparticles exposure.

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Smaller particle had greater impact on the bacterial growth.

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E. coli and B. subtilis cells suffered from morphological changes upon nanoparticles exposure.

Toxicity effect of reduced graphene oxide (rGO) and titanium dioxide (TiO₂) nanomaterials (NMs) on Gram-positive (Bacillus subtilis) and Gram-negative (Escherichia coli) bacteria was assessed. For both strains, study demonstrated that the toxicity was time and concentration dependent which led to reduction in growth rate and cell death. Upon NMs exposure, an instantaneous cell death in E. coli culture was observed. This is in contrast with B. subtilis, in which the culture growth remained in the log phase; however their growth rate constant, μg was reduced by ∼70%. The discrepancy between E. coli and B. subtilis was due to strain-specific response upon contact with NMs. TEM, SEM and EDX analysis revealed direct physical surface-surface interaction, as evidence from the adherence of NMs on the cell surface.

Solvent used in extraction process of agarwood: a systematic review

The method of extraction of Agarwood is usually dependent on the purpose of the extract. This systematic review aims to look at the number of studies that use different types of solvents in the process of extraction. There are 3 types of solvents commonly used in the extraction of agarwood essential oils namely methanol, ethanol and water. Each solvent produces different extracts in terms of quantity and quality of the final product. However, there is controversy over the use of solvents as it may cause a cytotoxic effect on the user. Another common type of solvent is water. Although water is a cheap solvent and relatively safe, aqueous extracts have more impurities that make isolating the desired compound difficult. After the extraction process, the crude extract was fractionated into the desired compounds and this technique is widely applied, especially in the whole process of extraction of the agarwood. In conclusion, extraction solvents have certain advantages and disadvantages, and this is one of the reasons why this extraction method depends on the purpose of using the final product such as agarwood essential oil.

Goals, beliefs, knowledge, and barriers for diabetes self-care in a multi-ethnic population in Malaysia: A qualitative study

INTRODUCTION

Ethnic differences may influence diabetes selfcare practices and glycaemic control among people with type 2 diabetes mellitus. This qualitative study explored goals, beliefs about treatment effectiveness, knowledge, and barriers to and facilitators for diabetes self-care among the three main ethnic groups in Malaysia.

METHODS

Patient focus group discussions were conducted in three different ethnic groups: Malays, Chinese, and Indians. Participants were recruited from the primary-care clinic of a university medical centre located in an urban area. Focus group discussions were audio-recorded, transcribed, and analysed using a thematic approach.

RESULTS

A total of 31 patients participated in the study: Malays (n=12), Indians (n=10), and Chinese (n=9). There were three sessions for each ethnic group. Reported goals primarily related to quality of life and glycaemic control. Participants expressed the belief that the combination of diet, exercise, and medications is effective for controlling diabetes. Groups described their obtaining information external to a healthcare system and reported a need for more specific, practical counselling from health professionals on diet, exercise, and medications. Barriers to and facilitators for diabetes self-care practices were categorised into three major themes: having discipline, social habits, and "other" themes.

CONCLUSION

Emerging themes were similar across the ethnic groups and included quality-of-life goals, confidence in combination treatment, common use of complementary and alternative medicine, need for further counselling, and the challenge regarding self-discipline.

Genetic Modifiers of Fetal Haemoglobin (HbF) and Phenotypic Severity in β-Thalassemia Patients

BACKGROUND

The phenotypic severity of β-thalassemia is highly modulated by three genetic modifiers: β-globin (HBB) mutations, co-inheritance of α-thalassemia and polymorphisms in the genes associated with fetal haemoglobin (HbF) production. This study was aimed to evaluate the effect of HbF related polymorphisms mainly in the HBB cluster, BCL11A (B-cell CLL/lymphoma 11A) and HBS1L-MYB (HBS1-like translational GTPase-MYB protooncogene, transcription factor) with regards to clinical severity.

METHODS

A total of 149 patients were included in the study. HBA and HBB mutations were characterised using multiplex PCR, Sanger sequencing and multiplex ligationdependent probe amplification. In addition, 35 HbF polymorphisms were genotyped using mass spectrometry and PCR-restriction fragment length polymorphism (PCRRFLP). The genotype-phenotype association was analysed using SPSS version 22.

RESULTS

Twenty-one HBB mutations were identified in the study population. Patients with HBB mutations had heterogeneous phenotypic severity due to the presence of other secondary modifiers. Co-inheritance of α-thalassemia (n = 12) alleviated disease severity of β-thalassemia. In addition, three polymorphisms (HBS1LMYB, rs4895441 [P = 0.008, odds ratio (OR) = 0.38 (0.18, 0.78)], rs9376092 [P = 0.030, OR = 0.36 (0.14, 0.90)]; and olfactory receptor [OR51B2] rs6578605 [P = 0.018, OR = 0.52 (0.31, 0.89)]) were associated with phenotypic severity. Secondary analysis of the association between single-nucleotide polymorphisms with HbF levels revealed three nominally significant SNPs: rs6934903, rs9376095 and rs9494149 in HBS1L-MYB.

CONCLUSION

This study revealed 3 types of HbF polymorphisms that play an important role in ameliorating disease severity of β-thalassemia patients which may be useful as a predictive marker in clinical management.

Association of coronary artery calcium score with calcification and degree of stenosis: An autopsy study

INTRODUCTION

Coronary artery disease (CAD) is a known cause of major cardiovascular events and calcium score (CS) has been developed as a marker of coronary atherosclerosis. Yet, the relationship between post mortem computed tomography (PMCT) CS with histologically observed calcification and the severity of coronary artery stenosis has not been widely explored and is still unclear. This study aims to determine the association between coronary artery PMCT CS with histologically observed calcification and degree of stenosis of coronary arteries in post-mortem cases.

MATERIALS & METHODS

This was a cross-sectional study involving 101 subjects recruited from the National Institute of Forensic Medicine (IPFN) Hospital Kuala Lumpur (HKL) over a period of 15 months, from December 2012 until April 2014. PMCT CS of the coronary arteries was calculated using Agatston-Janowitz score. Histological presence of calcification was observed and the degree of stenosis was calculated using an image analysis technique.

RESULTS

PMCT CS increased with increasing severity of stenosis (p<0.001). PMCT CS showed a positive correlation with the presence of calcification (r=-0.82, p<0.001).

CONCLUSION

Calcium score is strongly associated with coronary artery calcification and the degree of luminal stenosis in post mortem subjects. Thus, PMCT may be useful as a non-invasive tool in diagnosing CAD in the event that an autopsy is not possible.

Stature estimation in the South-East Asian population: A systematic review

INTRODUCTION

Stature estimation is population dependent, and population-specific regression equations should be generated for accurate anthropological assessments. Nevertheless, stature estimation data was inaccessible and limited in some of the South-East Asian countries. The systematic review was conducted to analyse the regression equations of stature estimations developed in South-East Asian region.

MATERIALS AND METHODS

A systematic literature search was performed through SCOPUS database and Google Scholar from January till March 2018. All published articles which developed stature estimation from different types of bone, methods and type of statures (i.e. living stature, forensic stature and cadaveric stature) were included in this study. Risks of biases were also assessed. Population studies with no regression equations were excluded from the study.

RESULTS

Seven studies that met the inclusion criteria were identified. In the South-East Asia region, regression equations for stature estimation were developed in Thailand and Malaysia. In these studies, bone measurements were done either by radiography, direct bone measurement, or palpation on body surface for anatomical bony prominence. All of these studies used various parts of bones for stature estimation.

CONCLUSION

The most widely used regression equations for stature estimation in South-East Asian population were from the Thailand population. Further research is recommended to develop regression equations for other South-East Asian countries.

A web-based educational intervention module to improve knowledge and attitudes towards thalassaemia prevention in Malaysian young adults

BACKGROUND

Thalassaemia is a public health burden in Malaysia and its prevention faces many challenges. In this study, we aimed to assess the effectiveness of a web-based educational module in improving knowledge and attitudes about thalassaemia prevention amongst Malaysian young adults.

METHODS

We designed an interactive web-based educational module in the Malay language wherein videos were combined with text and pictorial visual cues. Malaysians aged 18-40 years old who underwent the module had their knowledge and attitudes assessed at baseline, post-intervention and at 6-month follow-up using a selfadministered validated questionnaire.

RESULTS

Sixty-five participants: 47 Malays (72.3%), 15 Chinese (23.1%), three Indians (4.6%) underwent the module. Questionnaires were completed at baseline (n=65), postintervention (n=65) and at 6-month follow-up (n=60). Out of a total knowledge score of 21, significant changes were recorded across three time-points- median scores were 12 at pre-intervention, 19 at post-intervention and 16 at 6-month follow-up (p<0.001). Post-hoc testing comparing preintervention and 6-month follow-up scores showed significant retention of knowledge (p<0.001). Compared to baseline, attitudes at 6-month follow-up showed an increased acceptance for "marriage avoidance between carriers" (pre-intervention 20%, 6-month follow-up 48.3%, p<0.001) and "prenatal diagnosis" (pre-intervention 73.8%, 6-month follow-up 86.2%, p=0.008). Acceptance for selective termination however, remained low without significant change (pre-intervention 6.2%, 6-month follow-up 16.7%, p=0.109).

CONCLUSION

A web-based educational module appears effective in improving knowledge and attitudes towards thalassaemia prevention and its incorporation in thalassaemia prevention programs is potentially useful in Malaysia and countries with a high internet penetration rate.

Enzymatic hydrolysis drastically reduces fibre content of palm-kernel expeller, but without enhancing performance in broiler chickens

The effectiveness of enzymatic hydrolysis of palm-kernel expeller (PKE) is dependent on various factors that influence the stability and functionality of the enzymes. In the present study, parameters influencing the enzymatic treatment of PKE were optimised employing response surface methodology. In addition, the effectiveness of enzymatic hydrolysed PKE in increasing inclusion rates in broiler diets was evaluated. Results showed that temperature, enzyme concentration and duration of hydrolysis had significant (P &lt; 0.01) effects on the enzymatic hydrolysis of PKE. Using the crude enzyme produced by Aspergillus terreus K1 isolated in our laboratory, maximum reduction of crude fibre (40%) was achieved by fermenting the PKE at 60% initial moisture with 9.0 U/g PKE mannanase at 51°C for 18 h, with the production of 9.9% (w/w) of monosaccharides and oligosaccharides. Results of the growth-performance study indicated that inclusion rate of PKE with or without enzyme treatment in broiler diet is 5% for starter period and 20% for the finisher diet, without any detrimental effect on animal performance. Although the inclusion rate of enzyme-treated PKE can be increased to 30% without affecting average daily gain, feed conversion ratio of the birds will be compromised.

Adjuvant endocrine therapy side-effects among postmenopausal breast cancer patients in Malaysia

OBJECTIVE

This study was conducted to determine the prevalence and severity of menopausal symptoms and their associated risk factors among postmenopausal breast cancer patients receiving adjuvant endocrine therapy.

METHODS

Postmenopausal breast cancer patients on endocrine therapy were recruited at three hospitals in Malaysia. Presence and severity of menopausal symptoms were determined using the Menopause Rating Scale. Sociodemographic and clinical data were collected from medical records.

RESULTS

A total of 192 patients participated in this study. Commonly reported symptoms were musculoskeletal pain (59.9%), physical and mental exhaustion (59.4%), and hot flushes (41.1%). Multivariate analyses indicated that increasing number of years after menopause until the start of endocrine therapy was significantly associated with less likelihood of reporting menopausal symptoms and musculoskeletal pain. Patients with primary or secondary education levels reported significantly less menopausal urogenital symptoms compared to patients with a tertiary education level. Patients using aromatase inhibitors were twice as likely to experience musculoskeletal pain compared to patients using tamoxifen (odds ratio, 2.18; 95% confidence interval, 1.06-4.50; p < 0.05).

CONCLUSION

Menopausal symptoms and musculoskeletal pain are common problems encountered by postmenopausal breast cancer patients receiving adjuvant endocrine therapy and should be closely monitored for successful treatment.

Profiling of rumen fermentation, microbial population and digestibility in goats fed with dietary oils containing different fatty acids

BACKGROUND

The effects of the dietary oils with differing fatty acid profiles on rumen fermentation, microbial population, and digestibility in goats were investigated. In Experiment I, rumen microbial population and fermentation profiles were evaluated on 16 fistulated male goats that were randomly assigned to four treatment groups: i) control (CNT), ii) olive oil (OL), iii) palm olein oil (PO), and iv) sunflower oil (SF). In Experiment II, another group of 16 male goats was randomly assigned to the same dietary treatments for digestibility determination.

RESULTS

Rumen ammonia concentration was higher in CNT group compared to treatment groups receiving dietary oils. The total VFA and acetate concentration were higher in SF and OL groups, which showed that they were significantly affected by the dietary treatments. There were no differences in total microbial population. However, fibre degrading bacteria populations were affected by the interaction between treatment and day of sampling. Significant differences were observed in apparent digestibility of crude protein and ether extract of treatment groups containing dietary oils compared to the control group.

CONCLUSIONS

This study demonstrated that supplementation of different dietary oils containing different fatty acid profiles improved rumen fermentation by reducing ammonia concentration and increasing total VFA concentration, altering fibre degrading bacteria population, and improving apparent digestibility of crude protein and ether extract.

Purple urine bag syndrome: A startling phenomenon of purple urine in a urine drainage bag. A primary care approach and literature review

Purple urine bag syndrome (PUBs) is a rare and startling phenomenon of purple discolouration in the urine or urinary catheter and bag. It is reported in chronically debilitated elderly patients, mostly in women on long-term urinary catheters. Its prevalence is strikingly more common in nursing home residents. Several factors contribute to the formation of indigo (blue) and indirubin (red) pigments from a breakdown of dietary tryptophan, which stains the urine purple. These factors include constipation, dysmotility of the bowel, bowel bacterial overgrowth, dehydration, and urinary tract infection. The presence of purple urine may cause undue alarm to both the patient and the doctor. Thus, we present this case report on an 86-year-old woman, a nursing home resident on a long-term urinary catheter, who presented to the primary care clinic. Her urine cleared after antibiotic therapy, replacement of her urinary catheter, and supportive management, which included hydration and nutrition. In addition to these measures, reducing the time between urinary catheter changes was recommended to prevent recurrence of this condition.

Novel Anodic Catalyst Support for Direct Methanol Fuel Cell: Characterizations and Single-Cell Performances

This study introduces a novel titanium dioxide carbon nanofiber (TiO2-CNF) support for anodic catalyst in direct methanol fuel cell. The catalytic synthesis process involves several methods, namely the sol-gel, electrospinning, and deposition methods. The synthesized electrocatalyst is compared with other three electrocatalysts with different types of support. All of these electrocatalysts differ based on a number of physical and electrochemical characteristics. Experimental results show that the TiO2-CNF support gave the highest current density at 345.64 mA mgcatalyst-1, which is equivalent to 5.54-fold that of carbon support while the power density is almost double that of the commercial electrocatalyst.

Autologous mononuclear cells from different sources are seen to improve wound healing in patients with haematological malignancies

INTRODUCTION

Immunosuppressive state due to haematological malignancies and chemotherapy may cause disruption to wound healing despite optimum conventional treatment and standard wound dressing. Non-healing wounds are predisposed to infection whereas chemotherapy dose reductions or interruptions are associated with poor survival.

BACKGROUND

Mononuclear cells contain progenitor cells including haematopoietic and mesenchymal stem cells, endothelial progenitor cells and fibroblasts which facilitate wound healing through cytokines, growth factor secretions, cell-cell interactions and provision of extracellular matrix scaffolding. Clinical applications of autologous mononuclear cells therapy in wound healing in non-malignant patients with critical limb ischaemia have been reported with remarkable outcome.

METHODS

We report three patients with haematological malignancies undergoing chemotherapy, who received autologous mononuclear cells implantation to treat non-healing wound after optimum conventional wound care. The sources of mononuclear cells (MNC) were from bone marrow (BM), peripheral blood (PB) and mobilised PB cells (mPB-MNC) using granulocyte colony stimulating factor (G-CSF). The cells were directly implanted into wound and below epidermis. Wound sizes and adverse effects from implantation were assessed at regular intervals.

RESULTS

All patients achieved wound healing within three months following autologous mononuclear cells implantation. No implantation adverse effects were observed.

CONCLUSIONS

Autologous mononuclear cells therapy is a feasible alternative to conventional wound care to promote complete healing in non-healing wounds compounded by morbid factors such as haematological malignancies, chemotherapy, diabetes mellitus (DM), infections and prolonged immobility.