High prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies among unvaccinated children of Chandigarh, Northwest India, in a household-based paediatric serosurvey post-second wave of pandemic (June to July 2021)

OBJECTIVE

Current national severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination policy covers children aged >12 years. Unvaccinated, uninfected children remain susceptible to SARS-CoV-2 and play a role in community transmission, as paediatric infection is mostly mild or asymptomatic. To estimate the proportion of susceptible children in a community for public health measures, there is a need to assess the extent of natural infection.

STUDY DESIGN

We performed a cross-sectional household serosurvey of SARS-CoV-2 antibodies in unvaccinated children aged between 6 and 18 years after the second COVID-19 wave.

METHODS

Anti-SARS-CoV-2 immunoglobin G (IgG) testing in serum was done using chemiluminescence immunoassay. We used a logistic regression model to investigate predicted factors of seropositivity.

RESULTS

We observed a high prevalence (weighted average: 68.3%) of anti-SARS-CoV-2 IgG in 2700 enrolled children. Logistic regression for predictors of IgG seropositivity showed lower odds in households with completely vaccinated adults (adjusted odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.26-0.71, P = 0.0011) compared with households with unvaccinated adults. Other factors for low seropositivity included frontline workers as family members (adjusted OR: 0.69, 95% CI: 0.52-0.91, P = 0.0091) and non-crowded households (adjusted OR: 0.74, 95% CI: 0.61-0.89, P = 0.0019).

CONCLUSION

A high SARS-CoV-2 IgG prevalence in unvaccinated children was indicative of previous exposure to potentially infected contacts. This implies in-person academic activities for children can be continued during future community transmission. Comparatively lower seropositivity in children of completely vaccinated households or frontline workers suggests decreased transmission due to vaccination-induced immunity of family members. Vaccination will still be required in these children to maintain protective IgG levels, particularly in low seroprevalence groups.

Analyzing the Impact of Image Denoising and Segmentation on Melanoma Classification Using Convolutional Neural Networks

Early skin cancer detection and its treatment are crucial for reducing death rates worldwide. Deep learning techniques have been used successfully to develop an automatic lesion detection system. This study explores the impact of pre-processing steps such as data augmentation, contrast enhancement, and segmentation on improving the convolutional neural network (CNN) performance for lesion classification. The classification network was designed from scratch by uniquely organizing its layers and using a different number of kernels, depth of the network, size, and hyperparameters. In addition, the network's performance was improved by pre-processing and segmentation steps. The proposed network was compared with the current state-of-the-art to demonstrate its best performance on the benchmark HAM10000 lesion dataset. The experimental study revealed that the classification network using denoised+segmented data achieved an accuracy (ACC), precision (PRE), recall (REC), specificity (SPE), and F-score of 93.40%, 93.45%, 94.51%, 92.08%, and 93.98%, respectively. To conclude, classification performance can be improved by incorporating pre-processing and segmentation steps.

Perceived stigma among diabetic patients and their caregivers: a review

AIMS

Considerable number of studies in the existing literature indicate the existence of stigma related to many diseases, disabilities, and disorders, but less attention has been given to diabetes-related stigma. This narrative review of literature aims to explore the existence of stigma surrounding type 1 diabetes mellitus (T1DM).

METHODS

Literature were searched using search engines, Google Scholar, PubMed, and Scopus electronic databases published from year 2000 to 2020. Both qualitative and quantitative studies focusing on the stigma associated with T1DM were included. A total of 21 articles met the inclusion criteria. Thematic analysis of collected research material was done.

RESULTS

Results provided substantial evidence that stigma associated with T1DM was experienced by T1DM patients and their caregivers at some point in their lives and it had affected their lives in different domains such as difficulty finding a spouse, discrimination at employment opportunities, educational institutions, management of disease, being misjudged as a druggie, poor quality of life of the patient and caregiver, depressive symptoms among parents of patients, constant worrying of their child's disease management, and so on.

CONCLUSION

Stigma related to T1DM is experienced by individuals suffering from it, and it is widespread. It not only affects the sufferers but their loved ones also. To reduce and cope-up with stigma, there is a need to increase public education and awareness at a mass level. Further research and awareness will serve to build our understanding of the experience of diabetes-related stigma.

Effect of Twin Block Therapy Versus Fixed Functional Appliances on Pharyngeal Airway Space in Skeletal Class II Patients: A Prospective Cephalometric Study

BACKGROUND

Class II malocclusion is one of the most common malocclusion with varied prevalence. Functional therapy with appliances like Twin Block or Fixed functional appliances forms the mainstay of treatment in growing Class II patients. These patients might demonstrate narrow airway due to the retrognathic position of the mandible. This study investigated the effects of twin block and fixed functional appliance therapy (Forsus™ FRD) on the pharyngeal airway space in skeletal Class II patients.

METHODS

Forty patients with Class II malocclusion were selected and divided into two equal groups of 20 patients each for both Twin block and Forsus group. Lateral cephalograms were obtained before and after the functional appliance therapy. Evaluation was done for changes in hyoid bone position, pharyngeal airway dimensions and tongue position.

RESULTS

The variables of the study showed better hyoid position in both the groups. In Twin Block group, an increase in hy-apw2 and hy-PoFH suggested anterior positioning of hyoid and a decrease in H-MP and hy-ML indicated superior positioning. In Forsus group an increase in H-H', hy-FH, hy-ML, hy-NL, hy-NSL and hy-OL suggested inferior positioning of hyoid, while an increase in hy-apw2, hy-CVT, hy-PoFH, hy-RL and hy'-tgo indicated anterior positioning of hyoid bone after functional therapy.

CONCLUSION

Both the twin block and Forsus™ FRD improved the position of the hyoid bone after the functional appliance therapy however the changes were not statistically significant. Twin block and Forsus™ had similar effect on the hyoid bone position, pharyngeal dimensions and the tongue position.

Lesion Border Detection of Skin Cancer Images Using Deep Fully Convolutional Neural Network with Customized Weights

Deep learning techniques have been widely employed in semantic segmentation problems, especially in medical image analysis, for understanding image patterns. Skin cancer is a life-threatening problem, whereas timely detection can prevent and reduce the mortality rate. The aim is to segment the lesion area from the skin cancer image to help experts in the process of deeply understanding tissues and cancer cells' formation. Thus, we proposed an improved fully convolutional neural network (FCNN) architecture for lesion segmentation in dermoscopic skin cancer images. The FCNN network consists of multiple feature extraction layers forming a deep framework to obtain a larger vision for generating pixel labels. The novelty of the network lies in the way layers are stacked and the generation of customized weights in each convolutional layer to produce a full resolution feature map. The proposed model was compared with the top four winners of the International Skin Imaging Collaboration (ISIC) challenge using evaluation metrics such as accuracy, Jaccard index, and dice co-efficient. It outperformed the given state-of-the-art methods with higher values of the accuracy and Jaccard index.

Drug Information Association (DIA) 2021 Global Annual Meeting (June 26-July 1, 2021 - Virtual Meeting)

At the 57th Global Annual Meeting of the Drug Information Association (DIA), attendees met virtually for the second time to support the theme of 'Collaboration without Boundaries.' Sessions included presenters and speakers from regulatory agencies, patient advocacy and academia, with patients at the forefront of discussions. This report covers a number of presentations and panel discussions from the 4-day meeting that primarily focused on the COVID-19 global pandemic.

Phenotypic presentation of PCOS with respect to BMI in a north Indian population

Abstract

PCOS is one of the emerging health issues of women in their reproductive age with a range of associated signs and symptoms. In the present study, 250 PCOS subjects age ranged from 18 to 45 years and residing in the Chandigarh Capital Region (CCR) were selected from the OPD, PGIMER, Chandigarh, (North India). In the present study H+O phenotypic group (NIH criteria) was the most commonly occurring with the prevalence of 50.4% followed by complete PCO or classic PCOS phenotype (P+H+O) with 39.2% prevalence. The ovula-tory PCOS (P+H) and non-hyperandrogenic PCOS (P+O) demonstrated little prevalence of 6% and 4.4% respectively. Maximum overweight/obese PCOS women were recorded in the (H+O) phenotypic group (27.2%) followed by classic PCOS phenotype (20.4%), (P+H) phe-notype (4%) and lowest prevalence in P+O phenotype (1.2%), thereby indicating that hyperandrogenism and oligo-anovulation was common symptoms among overweight/obese PCOS women.

Biodegradation of endocrine disrupting chemicals benzyl butyl phthalate and dimethyl phthalate by Bacillus marisflavi RR014

AIM

The objectives of the present study were to explore the benzyl butyl phthalate (BBP) and dimethyl phthalate (DMP) degradation potential of Bacillus marisflavi RR014 isolated from the tap water of public toilet and also to optimize the phthalates degradation process using response surface methodology.

METHODS AND RESULTS

The minimal salt medium was used for the biodegradation analysis of phthalates. The quantification of phthalates and their intermediate metabolites identification were done by using UHPLC and LC-MS/MS respectively. The results revealed that B. marisflavi RR014 is capable of degrading both the phthalates under varying pH, temperature and salinity conditions. The formation of phthalic acid from the breakdown of BBP and DMP (500 mg l^-1 ) in the medium was observed after 24 h. After 72 h, 61% of BBP and 98·9% of DMP in the medium was degraded as monitored by UHPLC. The identification of intermediate metabolites by LC-MS/MS revealed that hydrolysis of BBP and DMP produces phthalic acid.

CONCLUSIONS

The degradation rate of both the phthalates was increased as the parameters increased up to an optimum level. The three environmental factors (pH, temperature and salt concentration) strongly affect the rate of degradation of both the phthalates. The maximum degradation rate for both the phthalates was achieved at pH 7, temperature 35°C and salt concentration of 1% as observed from the central composite experimental design.

SIGNIFICANCE AND IMPACT OF THE STUDY

It is the first report on the phthalates biodegradation potential of B. marisflavi RR014 isolated from the tap water of public toilet. The bacterium is capable of degrading BBP and DMP under varying pH, temperature and salinity, therefore, ideal to treat the phthalate contaminated environments.

Anti-atherogenic properties of Kgengwe (Citrullus lanatus) seed powder in low-density lipoprotein receptor knockout mice are mediated through beneficial alterations in inflammatory pathways

Kgengwe fruits are commonly consumed in sub-Saharan countries. Recent reports indicated low coronary artery disease rates in those regions. To investigate anti-atherogenic properties and potential mechanisms of action of Kgengwe seed powder (KSP), male low-density lipoprotein receptor knockout (LDL-r-KO) mice were fed with an atherogenic diet supplemented with (treated, n = 10) or without (controls, n = 10) 10% (w/w) KSP for 20 weeks. Proximate analysis revealed that KSP contained 38% fibre and 15% lipids. KSP supplementation was not associated with significant changes in body weight gain rate, food intake, and plasma lipid levels. However, the average atherosclerotic lesion size in the aortic roots in the KSP-treated group was 58% smaller than that in the control group (0.26 vs 0.11 mm2, p < 0.05). This strong anti-atherogenic effect was associated with significant increases in the average plasma levels of certain cytokines such as IL-10 (6 vs 13 pg/mL, p < 0.05), GM-CSF (0.1 vs 0.2 pg/mL, p < 0.05), and EPO (7 vs 16 pg/mL, p < 0.05) along with reductions in the average levels of plasma MCP-1 (19 vs 14 pg/mL, p < 0.05) and MIP-2 (28 vs 13 pg/mL, p < 0.05). Except for relatively high levels of saturated fatty acids, KSP possesses balanced nutrient compositions with strong anti-atherogenic properties, which may be mediated through alterations in inflammatory pathways. Additional studies warrant confirmation and mechanism(s) of action of such effects. Novelty: Kgengwe seeds prevent atherogenesis in LDL-r-KO mice. Kgengwe seeds increase circulating levels of IL-10 and EPO. No reduction in plasma total cholesterol levels.

Identification and characterization of a halocin-producing haloarchaeon isolated from Pachpadra salt lake

Haloarchaea are known to produce antimicrobial proteins, halocins which are generally stable at extreme conditions suggesting their potential biotechnological applications. Here, we report a halocin-producing haloarchaeon isolated from salt lake and identified as Haloferax larsenii HA4 using partial 16S rDNA sequence and biochemical properties. Whole-cell methanolysate showed ether-linked lipids, which is a characteristic feature of haloarchaea. Strain HA4 was able to grow at pH 6·0-10·0 and 15-30% NaCl. The growth response was normal but antimicrobial activity was detected only during the log-phase. Crude halocin HA4 was active in the pH range of pH 2·0-10·0 with stability up to 100°C. Cell-free supernatant (CFS) was also stable in different organic solvents and detergents tested. However, halocin activity was reduced after treatment with proteinase K suggesting the proteinaceous nature of the active compound. Concentrated CFS showed the presence of several proteins from 6·5-66 kDa but bioassay suggested ~14 kDa protein as halocin. Crude halocin preparation showed cytocidal activity against indicator strain, H. larsenii HA10 and inhibited the growth of other related strains such as H. larsenii HA3, HA8, HA9 and HA10.

Nanotechnology and its challenges in the food sector: a review

Antibacterial activity of nanoparticles has received significant attention worldwide because of their great physical and chemical stability, excellent magnetic properties, and large lattice constant values. These properties are predominate in the food science for enhancing the overall quality, shelf life, taste, flavor, process-ability, etc., of the food. Nanoparticles exhibit attractive antibacterial activity due to their increased specific surface area leading to enhanced surface reactivity. When nanoparticles are suspended in the biological culture, they encounter various biological interfaces, resulting from the presence of cellular moieties like DNA, proteins, lipids, polysaccharides, etc., which helps antibacterial properties in many ways. This paper reviews different methods used for the synthesis of nanoparticles but is specially focusing on the green synthesis methods owing to its non-toxic nature towards the environment. This review highlights their antibacterial application mainly in the food sector in the form of food-nanosensors, food-packaging, and food-additives. The possible mechanism of nanoparticles for their antibacterial behavior underlying the interaction of nano-particles with bacteria, (i) excessive ROS generation including hydrogen peroxide (H₂O₂), OH^- (hydroxyl radicals), and O^- ₂ ² (peroxide); and (ii) precipitation of nano-particles on the bacterial exterior; which, disrupts the cellular activities, resulting in membranes disturbance. All these phenomena results in the inhibition of bacterial growth. Along with this, their current application and future perspectives in the food sector are also discussed. Nanoparticles help in destroying not only pathogens but also deadly fungi and viruses. Most importantly it is required to focus more on the crop processing and its containment to stop the post-harvesting loss. So, nanoparticles can act as a smart weapon towards the sustainable move.

Effectiveness of Interventional Strategies in Modulating Knowledge and Attitude of Health Care Professionals for Promoting Organ Donation: A Study in Tertiary Care Public Hospital of North India

Objective:

To evaluate the impact of interventional “educational module” on knowledge and attitude regarding organ donation amongst resident doctors and nurses in the Institute of National Importance.

Study Design:

Interventional and prospective.

Methods:

We devised an interactive educational module covering various aspects of organ donation through a series of audiovisual lectures and information booklets. Resident doctors and nurses posted in those areas of the 1948-bedded Postgraduate Institute of Medical Education and Research (PGIMER), where head injury patients were treated and were subject to intervention using this module. The pre and postinterventional scores of their knowledge and attitude regarding organ donation were compared to find out impact of the intervention.

Results:

A total of 242 nurses and 87 resident doctors participated in this research. Higher knowledge score was observed preintervention amongst doctors as compared to nurses. Significant improvement was seen in total knowledge scores of both groups postintervention. Doctors had better scores for the “concept of organ donation,” while nurses were more familiar with “procedures and protocols.” Both had low knowledge about “clinical criteria for brain death” and “legal issues” preintervention which improved significantly postintervention. The positive impact of intervention was also observed on attitude in both categories. A significant impact of intervention was observed on overall propensity of doctors and nurses to promote organ donation, for pledging their own organs and for counseling of the patient/attendants on this cause.

Conclusion:

Scientifically designed educational modules have a promising role in improving awareness and attitude of health care professionals regarding organ donation and their propensity to be prospective donors, effective counselors, and advocates of organ donation.

Interpregnancy interval and risk of perinatal death: a systematic review and meta-analysis

BACKGROUND

Interpregnancy interval (IPI) <6 months is a potentially modifiable risk factor for adverse perinatal health outcomes.

OBJECTIVE

This systematic review evaluated the international literature on the risk of perinatal death associated with IPI.

SEARCH STRATEGY

Two independent reviewers screened titles and abstracts identified in MEDLINE, EMBASE and Scopus from inception to 4 April 2019 (Prospero Registration #CRD42018092792).

SELECTION CRITERIA

Studies were included if they provided a description of IPI measurement and perinatal death, including stillbirth and neonatal death.

DATA COLLECTION AND ANALYSIS

A narrative review was performed for all included studies. Random effects meta-analysis was used to compare unadjusted odds of perinatal death associated with IPI <6 months and IPI ≥6 months. Analyses were performed by outcome of the preceding pregnancy and study location.

MAIN RESULTS

Of the 624 unique articles identified, 26 met the inclusion criteria. The pooled unadjusted odds ratio of perinatal death for IPI <6 months was 1.34 (95% CI 1.17-1.53) following a previous live birth, 0.85 (95% CI 0.73-0.99) following a previous miscarriage and 1.07 (95% CI 0.84-1.36) following a previous stillbirth compared with IPI ≥6 months. However, few high-income country studies reported an association after adjustment. Fewer studies evaluated the impact of long IPI on perinatal death and what evidence was available showed mixed results.

CONCLUSIONS

Results suggest a possible association between short IPI and risk of perinatal death following a live birth, particularly in low- to middle-income countries.

TWEETABLE ABSTRACT

Short IPI <6 months after a live birth was associated with greater risk of perinatal death than IPI ≥6 months.

Consumers� Attitudes Toward Functional Foods: A�Review

The market for functional foods, fortified with added nutrients such as minerals, vitamins, micronutrients, antioxidants and fibers, is on the rise. In this review, we discuss the concept and nature of functional foods, the constituents or ingredients that are commonly used to fortify these foods, and the purpose of fortification. Finally, the review surveys consumers� attitudes toward functional foods and their importance to help their development and marketing.

Was Hawan Designed to Fight Anxiety-Scientific Evidences?

Anxiety is a psychiatric disorder with unknown neurobiology; however, neurotransmitters like gamma-amino butyric acid, norepinephrine and serotonin (5-HT) play crucial roles in mediating anxiety. Present drug modules pose dependence risk to the patient; hence, there is a great need to develop complementary therapies to fight this disorder. Aromatherapy has also been employed in ancient times for a number of mental disorders. Mahamrituanjay Mantra, Om triambkum yajamahe, sughandhim puushtivardhanam, urvarukmev vandhanaat, mrityu mokshay mamritaat!!!!, the part of veda enlightens that aroma gives rise to good health (sughandhim puushtivardhanam). Hawan is a religious practice recommended for mental peace. Hawan is a process in which special herbs are offered in the fire of medicinal woods ignited in a specially designed fire pit. Analysis of literature demonstrates that the components of Hawan are having a number of volatile oils that are specifically useful for prevention and treatment of anxiety through some mechanism of action. Due to high temperature of fire, the vapors of these oils from herbs enter into the central nervous system through nasal route. As per modern science and ancient texts on medicine, nasal drug delivery systems are the best for the diseases related to brain and head. The routine of performing Hawan might keep the threshold value of the therapeutic components in the body and help in preventing anxiety. In the present manuscript, authors highlight and integrate the modern and ancient concepts for treatment and prevention of anxiety through scientific evidences.

An endophytic Penicillium oxalicum isolated from Citrus limon possesses antioxidant and genoprotective potential

AIMS

This study aimed at isolating endophytic fungi from Citrus limon (L.) possessing antioxidative and genoprotective potential.

METHODS AND RESULTS

Endophytic fungi were screened for antioxidant activity using 2,2-diphenyl,1-picryl hydrazyl radical scavenging assay and maximum activity (79·70%) was exhibited by culture MP1 identified to be Penicillium oxalicum on the basis of morphological and molecular characteristics. The ethyl acetate extract of MP1 was subjected to silica column chromatography followed by LH 20 column chromatography for purification of active metabolites. The partially purified active fraction of P. oxalicum MP1 possessed good antioxidant activity as detected using various assays. It also exhibited a strong DNA damage protection potential on pUC19 plasmid DNA treated with Fenton reagent. On exposure to active fraction of MP1 significant reduction (P < 0·05) in nuclear deformities (like nuclear buds, micronuclei, nuclear ridges and binucleated cells) was observed in human lymphocytes pretreated with a toxic concentration of H₂ O₂ . In vivo genoprotectivity studies were conducted in fresh water fish Channa punctatus pretreated with a damaging compound 4-nonyl phenol. The active fraction of P. oxalicum MP1 caused a reduction of 94·7 and 66·60% in micronuclei and aberrant cell formation, respectively. A significant reduction (P < 0·05) in tail length and tail DNA parameters was also observed in comet assay.

CONCLUSION

The endophytic P. oxalicum isolated in this study has the potential to produce metabolites possessing antioxidant and genoprotective activities.

SIGNIFICANCE AND IMPACT OF THE STUDY

The isolated culture can be exploited in the field of therapeutics by virtue of its in vitro and in vivo genoprotective potential.

P263 Characterisation of patients with acute myocardial infarction complicated by left ventricular thrombus

Funding Acknowledgements

None

Background/Introduction

Left ventricular (LV) thrombus is a widely recognized complication of acute myocardial infarction (AMI).  Limited data are available from South East Asian patients with this post-infarction complication nor on whether patients with non-ST segment elevation myocardial infarction (NSTEMI) or STEMI with associated LV thrombosis exhibit differing clinical characteristics and/or outcomes. Left Ventricular Ejection Fraction (LVEF) ≤ 40% is a recognized predictor of LV thrombus formation, but there is limited data on LV thrombus patients with EF &gt; 40% or in NSTEMI patients.

Purpose

This study aims to investigate and compare the clinical characteristics, treatment and outcomes of post-AMI patients with LV thrombus formation, with a particular emphasis on those with EF ≤ 40% and in NSTEMI patients. 

Methods

Among 5829 consecutive echocardiogram results containing the keyword "thrombus" from August 2006 to September 2017, we identified 289 post-AMI patients with acute LV thrombus formation. Demographics, treatment and outcome measures were analysed.

Results

Cardiovascular risk factors such as dyslipidaemia (54.0%) and hypertension (50.5%) were commonly present in post-AMI patients with LV thrombus. Mean LVEF was 33.0 ± 10.4%. The majority (68.0%) of patients received triple therapy and 59.5% achieved thrombus resolution. NSTEMI patients had greater number of co-morbidities including heart failure (p &lt; 0.01), documented history of  ischaemic heart disease preceding the AMI leading to thrombus formation (p &lt; 0.01) and lower LVEF (28.3 ± 9.3% vs. 34.8 ± 10.3% , p &lt; 0.01) compared with STEMI cases. On multivariate analysis, having a lower EF was a significant independent predictor of stroke (HR 0.96, 95% CI 0.93-1.00, p = 0.03) and all-cause mortality (HR 0.95, 95% CI 0.92-0.99, p &lt; 0.01). The categories of STEMI and NSTEMI did not predict thrombus resolution, stroke events or all-cause mortality after adjustment.

Conclusion(s)

  Post-AMI LV thrombus patients with NSTEMI and STEMI differed in terms of their co-morbidities in their demographics and co-morbidities but it was a lower EF that was associated with an increased risk of stroke and all-cause mortality. Further studies on this topic are required.

MSTO1 mutations cause mtDNA depletion, manifesting as muscular dystrophy with cerebellar involvement

MSTO1 encodes a cytosolic mitochondrial fusion protein, misato homolog 1 or MSTO1. While the full genotype–phenotype spectrum remains to be explored, pathogenic variants in MSTO1 have recently been reported in a small number of patients presenting with a phenotype of cerebellar ataxia, congenital muscle involvement with histologic findings ranging from myopathic to dystrophic and pigmentary retinopathy. The proposed underlying pathogenic mechanism of MSTO1-related disease is suggestive of impaired mitochondrial fusion secondary to a loss of function of MSTO1. Disorders of mitochondrial fusion and fission have been shown to also lead to mitochondrial DNA (mtDNA) depletion, linking them to the mtDNA depletion syndromes, a clinically and genetically diverse class of mitochondrial diseases characterized by a reduction of cellular mtDNA content. However, the consequences of pathogenic variants in MSTO1 on mtDNA maintenance remain poorly understood. We present extensive phenotypic and genetic data from 12 independent families, including 15 new patients harbouring a broad array of bi-allelic MSTO1 pathogenic variants, and we provide functional characterization from seven MSTO1-related disease patient fibroblasts. Bi-allelic loss-of-function variants in MSTO1 manifest clinically with a remarkably consistent phenotype of childhood-onset muscular dystrophy, corticospinal tract dysfunction and early-onset non-progressive cerebellar atrophy. MSTO1 protein was not detectable in the cultured fibroblasts of all seven patients evaluated, suggesting that pathogenic variants result in a loss of protein expression and/or affect protein stability. Consistent with impaired mitochondrial fusion, mitochondrial networks in fibroblasts were found to be fragmented. Furthermore, all fibroblasts were found to have depletion of mtDNA ranging from 30 to 70% along with alterations to mtDNA nucleoids. Our data corroborate the role of MSTO1 as a mitochondrial fusion protein and highlight a previously unrecognized link to mtDNA regulation. As impaired mitochondrial fusion is a recognized cause of mtDNA depletion syndromes, this novel link to mtDNA depletion in patient fibroblasts suggests that MSTO1-deficiency should also be considered a mtDNA depletion syndrome. Thus, we provide mechanistic insight into the disease pathogenesis associated with MSTO1 mutations and further define the clinical spectrum and the natural history of MSTO1-related disease.

Evaluation of genotoxic and cytotoxic effects of ethyl acetate extract of Aspergillus flavus on Spodoptera litura

AIM

Recent concerns about the possible adverse effects of agricultural chemicals on health and environment have generated a considerable interest in biological alternatives. This study aimed to test the insecticidal potential of fungus Aspergillus flavus and revealed its genotoxic and cytotoxic effects using Spodoptera litura (Fabricius) as a model.

METHODS AND RESULTS

The fungus was isolated from the surface of the dead insect and investigated for its insecticidal potential against S. litura by bioassay studies. Significant increase in mortality, prolonged development period and reduced adult emergence in S. litura were observed in larva fed on diet supplemented with fungal extract. In addition, fungus was also found to cause oxidative stress, DNA damage and cell death. Significantly higher percentages of necrotic cells and DNA damage were observed in larvae treated with fungal extract. Furthermore, DNA repair studies predicted the longevity of toxic effects induced by fungus. Phytochemical and ultra-high performance liquid chromatography studies revealed the presence of phenolic compounds in the extract and liquid chromatography-mass spectrometry indicated it to be a non-aflatoxin strain of A. flavus. Fungal extract was less toxic to mammalian cell lines as compared to cytotoxic drug doxorubicin (DOX) in the MTT assay.

CONCLUSION

The study highlights the insecticidal potential of A. flavus by revealing its genotoxicity and cytotoxicity causing potential. This is the first report showing the genotoxic and cytotoxic effects of the fungus A. flavus on S. litura.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study provides a useful insight to explore microbial agents as biopesticides in order to reduce various environmental as well as human health problems due to synthetic pesticides.

Patient-Reported Outcome Measures Among Breast Cancer Survivors in Malaysia: A Comparative Study With Patients From High-Income Countries

Background: Patient-reported outcome measures (PROMs) are essential for identifying how patients perceive the outcomes of their cancer treatment, and is the ultimate success of cancer care. Although a growing number of studies have focused on PROMs in high income countries (HICs), outcomes relevant to patients in developing countries are less understood. Furthermore, the lack of standardization in PROMs makes it difficult to interpret these data for research or quality monitoring. Aim: In this study, we compared the results of PROM measures between patients in Malaysia, a middle income country, and those in HICs, using standard PROMs questionnaires. We also explored the differences in perceived importance of patient reported outcomes within the multiracial Malaysian cohort. Methods: Breast cancer patients (n=1063) were recruited in hospitals serving suburban areas of Malaysia. Of these, 969 patients were eligible for analysis. The surveys were conducted through face-to-face interviews (68%) or were self-administered (30%). An outcome was considered important if it was scored between 7-9 on a 9-point Likert scale. We compared PROMs scores between Malaysian patients and data previously collected from patients in HICs using logistic regression models, adjusting for demographic and clinical characteristics. A two-step cluster analysis was conducted to explore differences in the perceived importance of PROMs between clusters of Malaysian patients. Results: Compared with 1777 patients from HICs, Malaysian patients were less likely to rate overall and recurrence free survival, as well as emotional, cognitive, social and sexual functioning as very important outcomes. Interestingly, more Malaysian women reported that pain (50% vs. 39%), breast symptoms (51% vs. 35%), and major complications (60% vs. 44%) were very important outcomes ( P < 0.001). Compared with young, married Malaysian women, the cluster of older married women (mean age of 57 vs. 52), who were less likely to have received breast reconstructive surgery (8.6% vs. 16.8%), was more likely to rate sexual functioning (32.8% vs. 25.0%, P = 0.036), body image (63.9% vs. 42.4%, P < 0.001), and satisfaction with the breast (50.7% vs. 37.0%, P = 0.011) as very important outcomes. Conclusion: The differences in breast cancer patient needs between and within populations should be considered carefully to better clinician-patient relationship, patient care and satisfaction and assess the outcomes of our cancer care. Future research is needed to find suitable targeted interventions to identify and address the diverse needs of breast cancer patients in low and middle income countries.

Effectiveness of Breast Care Nurse Led Video Orientation Programme on Information and Navigation for Newly Diagnosed Breast Cancer Patients at University Malaya Medical Center, Malaysia

Background: Advancement in medical treatment with wider treatment options have made breast cancer (BC) care more complex. Short consultation time with physicians, treatment complexities, patients' fears and poor coping skills at the time of diagnosis may affect patient´s decision that cause treatment delays and nonadherence. Main reasons for advance BC presentation in Malaysia are delay in taking treatment decision and poor breast health literacy on disease and treatment outcomes may contribute to nonadherence to treatments. To address this knowledge gap, a breast care nurse (BCN) led orientation video for new patients to navigate them through complex multimodal treatment processes. This audio-visual educational tool address multimodal treatments and its side effects and in addition navigating admission, discharge and follow-up, advice on diet and exercise to maintain a healthy life style during survivorship period was developed in layperson language in Malay, Mandarin and English. Aim: To assess the effectiveness of BCN led video orientation on the improvement of patient knowledge and satisfaction. Methods: A pilot study was carried out in 50 patients to assess the effectiveness of the video, and found that patients needed a face to face interaction to watch the video. Hence, a BCN led orientation was developed to use the video. A self-administered pre- and postsurvey on 246 newly diagnosed breast cancer patients in University Malaya Medical Center (UMMC) was performed to evaluate expectations, satisfactions and knowledge (a Likert scale response using items 4 number scale was used, 0 means “no knowledge” and 4 means “a great degree of knowledge”). The scoring was done before and after the video orientation was done. A Wilcoxon matched-paired signed-rank test was perform to analyze the changes in the scoring. Results: Among 247 patients, who received the BCN led video orientation program, 79.3% (n= 197) found that the video met or exceeded their expectations. 23.9% (n=59) and 56.3% (139) consecutively found the video very effective and effective in broadening their perspective on BC treatments. And 171 (69.2%) of them overall rated the video highly met their expectations. There were significant improvement in knowledge for treatment options for BC, mean scores (M=0.93 versus M=2.97) before and after watching the video ( P < 0.001). Similar findings were found in different types of operation for BC; procedure for admission in UMMC, information on chemotherapy; radiotherapy; hormone therapy and alternative medicine for BC. It also showed improved knowledge scores for healthy diet; physical activity after treatments and care of the arm after operation ( P < 0.001). Conclusion: Video-based information on treatments and navigating care through a BCN led service had effectively improved patients' knowledge and satisfaction. This approach can be used to educate cancer patients in a middle resource setting.

Exploration of insecticidal potential of an alpha glucosidase enzyme inhibitor from an endophytic Exophiala spinifera

AIM

The present study aimed to isolate and screen endophytes from Trachyspermum ammi with the ability to inhibit alpha glucosidase enzyme and evaluate their insecticidal potential.

METHODS AND RESULTS

Endophytic fungi isolated from T. ammi were screened for alpha glucosidase inhibitory activity. Maximum inhibition (96%) was observed in an isolate AZ-9, identified to be Exophiala spinifera on morphological and molecular basis. Production of fungal metabolites was carried out in malt extract broth followed by extraction with ethyl acetate. Brown coloured gummy residue obtained after evaporation of ethyl acetate was partially soluble in water yielding white precipitates. The precipitate exhibiting α-glucosidase inhibitory activity was purified by repeated washing and centrifugation. The insecticidal activity of inhibitor was evaluated on Spodoptera litura (Fab.) by feeding this pest on diet amended with inhibitor. It resulted in significant larval mortality as well as deformities in emerging adults. A reduction in vivo digestive enzyme activity was also observed. Nutritional analysis revealed the toxic effect of AZ-9 inhibitor on various food utilization parameters of S. litura. A significant reduction was recorded in relative growth and consumption rate of S. litura.

CONCLUSIONS

This is the first report on production of an alpha glucosidase inhibitor from E. spinifera with insecticidal activity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study highlights the importance of endophytes in providing protection against insect pests to the host. It also suggests the insecticidal potential of alpha glucosidase inhibitor from E. spinifera against polyphagous pest S. litura.

The effect of temperate or tropical pasture grazing state and grain-based concentrate allocation on dairy cattle production and behavior

Grain-based concentrate (GBC) supplement is of high cost to dairy farmers as a feed source as opposed to grazed pasture. Milk production response to GBC is affected by the composition and nutritive value of the remainder of the diet, animal factors, and interactions between forage type and level of GBC. In grazing systems, dairy cattle encounter contrasting pasture states, primarily because the social structure of the herd affects the timing of when each animal accesses a paddock after milking as a result of a relatively consistent cow milking order. However, the effect of feed management, namely pasture state and GBC allocation, on dairy cattle production and behavior is unknown. We examined the effect of varying GBC allocation for dairy cattle grazing differing states of kikuyu grass (Pennisetum clandestinum, a tropical pasture species; experiment 1) and annual ryegrass (Lolium multiflorum L., a temperate pasture species; experiment 2) on dry matter intake, milk production and composition, and grazing behavior. For each experiment, 90 lactating dairy cattle were randomly allocated to 2 consistent (fresh-fresh and depleted-depleted) and 2 inconsistent (fresh-depleted and depleted-fresh pasture state treatments (defined as sequences of pasture state allocation for the morning and afternoon grazing events) and 3 GBC treatments [2.7, 5.4, and 8.1 kg of dry matter (DM)/cow per day], giving 12 treatment combinations for each experiment. The duration of each experiment was 14 d, with the first 7 d used as adaptation to treatment. In each experiment, 3 cattle were selected from each of the 12 pasture type × GBC treatment groups within the experimental herd to determine herbage intake and total DM digestibility using the n-alkanes method (n = 36). There was no interaction between kikuyu grass or ryegrass pasture state and GBC level for intake, digestibility, or milk yield or components. Dairy cattle offered fresh-fresh and depleted-fresh ryegrass produced 9% more milk yield, in line with greater pasture intakes, compared with fresh-depleted and depleted-depleted pasture states. Dairy cattle offered fresh-fresh kikuyu grass had 8% more milk yield and 14% more milk protein yield than other pastures states, but there was no effect of pasture state on milk composition. Milk yield increased with GBC level for both pasture species (∼0.7-0.8 kg of milk/kg of DM GBC) as GBC level increased from 2.5 to 5.4 kg of DM/cow per day. There was a poor response (0.3 kg of milk/kg of DM GBC), and no response, when GBC levels increased from 5.4 to 8.1 kg of DM/cow per day for kikuyu grass and ryegrass, respectively, in line with pasture DMD. Time spent grazing, lying, and ruminating were not associated with kikuyu grass pasture state, GBC, or their interaction. Despite this, there was a linear increase in grazing time in the afternoon coinciding with a linear decrease in lying and rumination time for both kikuyu grass and ryegrass pasture. Together these findings reveal the effect of pasture state and GBC allocation on dairy cattle production and behavior. Tailoring GBC allocation to the state of pasture accessed by cattle appears unwarranted, but there is an opportunity to alter the timing of pasture access to increase herd-level milk production efficiency.

Perspectives of oncology nurses and oncologists regarding barriers to working with patients from a minority background: Systemic issues and working with interpreters

This study aimed to ascertain the systemic barriers encountered by oncology health professionals (HPs) working with patients from ethnic minorities to guide the development of a communication skills training programme. Twelve medical and five radiation oncologists and 21 oncology nurses were invited to participate in this qualitative study. Participants were interviewed individually or in a focus group about their experiences working with people from minority backgrounds. All interviews were transcribed verbatim and analysed thematically. HPs encountered language and communication barriers in their interactions with patients and their families, which were perceived to impact negatively on the quality and amount of information and support provided. There was a shortage of, and poor processes for engaging, interpreters and some HPs were concerned about the accuracy of interpretation. HPs expressed a need for training in cultural awareness and communication skills with a preference for face-to-face delivery. A lack of funding, a culture of "learning on the job", and time constraints were systemic barriers to training. Oncologists and oncology nurses encounter complex challenges in clinical interactions with minority patients and their families, including difficulties working with interpreters. Formal training programmes targeted to the development of culturally competent communication skills are required.

Contact sensitisation in adults: a 5-year retrospective review in hospital Kuala Lumpur

BACKGROUND

The pattern of contact sensitisation should be monitored in order to detect the changing trend of sensitising allergens. We aim to evaluate contact sensitisation in adults suspected to have allergic contact dermatitis.

METHODS

This is a five-year retrospective review on contact sensitisation in adults patch-tested with the European Standard and extended series between 2011 and 2015 in the Department of Dermatology, Hospital Kuala Lumpur.

RESULTS

There were 689 adults (M:F= 1:2.04; mean age 40.5 years) who were patch-tested. The majority (175, 25.4%) were white collar workers and 118 (17.1%) were healthcare workers. The provisional diagnoses of patients included contact dermatitis (80.8%); endogenous eczema (7.9%); hand eczema (3.2%); hand and foot eczema (3.5%); foot eczema (1.4%) and photodermatitis (1.2%). The allergens selected for testing were based on past and present history of exposure. Almost all (688, 99.8%) were patch-tested with the European standard allergens and 466 (67.6%) were tested with the extended series. About three quarter (528, 76.6%) developed at least one positive reaction. The top five most frequent reactions were to nickel sulphate (35.3%); potassium dichromate (16.5%); methylchloroisothiazolinone (12.9%), fragrance mix I (12.6%), and cobalt chloride (10.2%). The commonest sensitisations identified in the extended series were palladium chloride (23/105, 21.9%), stannous chloride (18/85, 21.2%), miconazole (7/44, 15.9%), gold(I)sodium thiosulfate (16/105, 15.2%) and thimerosal (29/202, 14.4%).

CONCLUSION

Contact sensitisation was detected in 76.6% of adults patch-tested. Nickel sulphate was found to be the most frequently sensitising allergen. The rising prevalence of methylchloroisothiazolinone/methylisothiazolinone sensitization poses significant concern.

Setting the right foundations: improving the approach used to teach concepts of hand hygiene to medical students

A pre- and postintervention study was conducted to evaluate the impact of a new hand hygiene (HH) teaching module on the knowledge and attitudes amongst medical students towards HH. The teaching module significantly improved knowledge about HH indications and duration (T1=7.9, T2=9.2, T3=9.1; P=0.001), the use of HH materials (T1=1.3, T2=3.8, T3=4.3; P=0.004), and the 'Five Moments for HH' (T1=3.1, T2=6.7, T3=5.9; P=0.012). It also improved the students' attitudes towards HH (T1=48.5, T2=56.2, T3=54.1; P=0.04). Additional studies are warranted to evaluate the impact of this intervention on actual HH compliance of medical students.