Aims: Waste electric and electronic equipment (WEEE) are among the fastest growing waste products worldwide and solutions to their remediation are urgently needed. Bioremediation is a green approach that is helpful to minimize environmental pollution associated with Electronic waste (E-waste). The present study aimed at exploring the potential of endophytic fungi from Nepenthes ampullaria for bioremediation purposes of the plastic component in E-waste, polyurethane (PUR) polymers. Methodology and results: Endophytic fungal isolates were assessed for their ability to degrade PUR as well as their ability to utilise PUR as sole carbon source. Nine (9) out of 150 isolates demonstrated the ability to efficiently degrade polyurethane in solid medium and the top three (3) isolates were able to grow on PUR as the only carbon source. These three isolates were identified using ITS1 and ITS4 and found to be closely related to the genus Pestalotiopsis. The top two of the three isolates were then assessed for their esterase enzyme activity as well as changes in their proteome when grown with and without PUR. The highest enzymatic activity was found to be 1850.4 U/mL when tested using pnitrophenol acetate as the substrate. Analyses of the 2-dimensional electrophoresis profile revealed changes in the abundance of proteins when treated with polyurethane. Conclusion, significance and impact of study: This study is to our knowledge the first on endophytes isolated from N. ampullaria that can degrade PUR, and also their proteomes. Results obtained from this study can in the future help to reduce polyurethane wastes. Besides degrading PUR polymer, endophytic fungi produce potential valuable proteins that may find broad applications in bioremediation applications.

COVID-19 ; Humans ; Intensive Care Units ; Nutrition Therapy ; Nutritional Support ; Pandemics/prevention & control*

Aims: Palm oil mill effluent (POME) is a major agricultural waste product of Malaysia. The aim of this study was to identify endophytic fungi capable of producing biofuel feedstock utilizing POME. Methodology and results: Endophytes were isolated from the Nipah palm tree, Nypa fruticans, and exposed to different POME concentrations (25%, 50% and 75%), with and without the addition of nutrients. The utilization of glucose was measured using the Dinitrosalicylic Acid assay whereas the lipid content in the fungal cells was extracted using the Bligh and Dyer method with slight modifications. Three endophytic fungi that displayed the highest growth on POME were identified using ITS 1 and 4 primers and found to be related to Pestalotiopsis sp., Lasiodiplodia theobromae and Rhizoctonia bataticola. Nutrient addition caused an average increase of 8 times in biomass, indicating nitrogen requirement for cell proliferation. The highest POME concentration (75%) resulted in lower biomass yield. Furthermore, all fungal samples in high POME concentration and nutrient conditions showed a decrease in lipids accumulated per milligram of biomass whereby lipid synthesis was enhanced under nitrogen limitation (25% without nutrients). Conclusion, significance and impact of study: In conclusion, all fungal samples can be classified as oleaginous microorganisms with Pestalotipsis sp. being the most efficient (up to 70% of its biomass). This is to our knowledge the first study that shows the potential use of Pestalotiopsis sp., L. theobromae and R. bataticola for the utilisation of POME as biofuel feedstock and could in the future potentially provide an alternative approach to the treatment of POME with value-added effect.

INTRODUCTION: Telestroke allows for remote determination of suitability for treatment with thrombolysis in patients with acute ischaemic stroke. However, this approach is time-dependent and most centres have yet to achieve the recommended treatment times. We describe a quality improvement initiative aimed at improving the telestroke workflow and treatment times at our centre. METHODS: A multidisciplinary workgroup comprising clinicians, stroke case managers and radiology staff was formed to oversee the initiative. A phase-by-phase review of the existing workflow was done to identify the reasons for delay. Phase-specific measures were then introduced to address these delays, and a data-monitoring system was established to track the impact of these measures. The initiatives were implemented through four Plan-Do-Study-Act cycles. The door-to-needle (DTN) times for thrombolysis and clinical outcomes before and after the interventions were compared. RESULTS: A total of 104 patients were evaluated. The median DTN time improved from 96 minutes to 78 minutes post implementation of initiatives (p = 0.003). Fewer patients had symptomatic intracranial haemorrhages (8.5% vs. 24.2%; p = 0.03), and more patients had improvements in their National Institutes of Health Stroke Scale score (47.9% vs. 25.0%; p = 0.031) after the initiatives were introduced. CONCLUSION The quality improvement initiative resulted in a reduction in median DTN time. Our approach allowed for a systematic method to resolve delays within the telestroke workflow. This initiative is part of an ongoing effort aimed at providing thrombolysis safely to eligible patients in the shortest possible time.
Adult ; Aged ; Aged, 80 and over ; Emergency Service, Hospital ; organization & administration ; Female ; Humans ; Interprofessional Relations ; Intracranial Hemorrhages ; prevention & control ; Male ; Middle Aged ; Quality Improvement ; Severity of Illness Index ; Singapore ; Stroke ; therapy ; Telemedicine ; methods ; organization & administration ; standards ; Thrombolytic Therapy ; methods ; Time ; Tissue Plasminogen Activator ; therapeutic use ; Treatment Outcome

INTRODUCTION: Spontaneous bacterial peritonitis (SBP) is the commonest complication of liver cirrhosis. Timely and appropriate treatment of SBP is crucial, particularly with the rising worldwide prevalence of multidrug-resistant organisms (MDROs). We aimed to investigate the clinical outcomes of SBP in Singapore. METHODS: All cirrhotic patients with SBP diagnosed between January 2014 and December 2017 were included. Nosocomial SBP (N-SBP) was defined as SBP diagnosed more than 48 hours after hospitalisation. Clinical outcomes were analysed as categorical outcomes using univariate and multivariate analysis. RESULTS: There were 33 patients with 39 episodes of SBP. Their mean age was 64.5 years and 69.7% were male. The commonest aetiology of cirrhosis was hepatitis B (27.3%). The Median Model for End-stage Liver Disease (MELD) score was 17; 33.3% had acute-on-chronic liver failure and 60.6% had septic shock at presentation. N-SBP occurred in 25.6% of SBP cases. N-SBP was more commonly associated with MDROs, previous antibiotic use in the past three months (p = 0.014) and longer length of stay (p = 0.011). The 30-day and 90-day mortality among SBP patients was 30.8% and 51.3%, respectively. MELD score > 20 was a predictor for 30-day mortality. N-SBP and MELD score > 20 were predictors for 90-day mortality. CONCLUSION N-SBP was significantly associated with recent antibiotic use, longer hospitalisation, more resistant organisms and poorer survival among patients with SBP. N-SBP and MELD score predict higher mortality in SBP. Judicious use of antibiotics may reduce N-SBP and improve survival among cirrhotic patients.

INTRODUCTION: H. pylori eradication reduces the risk of gastric malignancies and peptic ulcer disease. First-line therapies include 14-day PAC (proton pump inhibitor [PPI], amoxicillin, clarithromycin) and PBMT (PPI, bismuth, metronidazole, tetracycline). Second-line therapies include 14-day PBMT and PAL (PPI, amoxicillin, levofloxacin). This clinical audit examined current treatment outcomes in Singapore. METHODS: Clinical data of H. pylori-positive patientswho underwent empirical first- and second-line eradication therapies from 1 January 2017 to 31 December 2018 were reviewed. Treatment success was determined by ¹³C urea breath test performed at least 4 weeks after treatment and 2 weeks off PPI. RESULTS: A total of 963 patients (862 PAC, 36 PMC [PPI, metronidazole, clarithromycin], 18 PBMT, 13 PBAC [PAC with bismuth], 34 others) and 98 patients (62 PMBT, 15 PAL, 21 others) received first-and second-line therapies respectively. A 14-day treatment duration was appropriately prescribed for first- and second-line therapies in 65.2% and 82.7% of patients, respectively. First-line treatment success rates were noted for PAC (seven-day: 76.9%, ten-day: 88.3%, 14-day: 92.0%), PMC (seven-day: 0, ten-day: 75.0%, 14-day: 69.8%), PBMT (ten-day: 100%, 14-day: 87.5%) and PBAC (14-day: 100%). 14-day treatment was superior to seven-day treatment (90.8% vs. 71.4%; P = 0.028). PAC was superior to PMC (P < 0.001) but similar to PBMT (P = 0.518) and PBAC (P = 0.288) in 14-day therapies. 14-day second-line PAL and PBMT had similar efficacy (90.9% vs. 82.4%; P = 0.674). CONCLUSION First-line empirical treatment using PAC, PBMT and PBAC for 14 days had similar efficacy. Success rates for second-line PBMT and PAL were similar.
Humans ; Helicobacter pylori ; Clarithromycin/therapeutic use* ; Helicobacter Infections/drug therapy* ; Metronidazole/therapeutic use* ; Bismuth/therapeutic use* ; Singapore ; Drug Therapy, Combination ; Amoxicillin/therapeutic use* ; Proton Pump Inhibitors/therapeutic use* ; Anti-Bacterial Agents/therapeutic use* ; Treatment Outcome ; Clinical Audit

INTRODUCTIONParenteral nutrition (PN) is indicated for patients who are unable to progress to oral or enteral nutrition. There are no local studies done on estimating the cost of PN in acute settings. The aims of this study are to describe the demographics, costs of PN and manpower required; and to determine the avoidable PN costs for patients and hospital on short-term PN.

MATERIALS AND METHODSPatient data between October 2011 and December 2013 were reviewed. Data collected include demographics, length of stay (LOS), and the indication/duration of PN. PN administration cost was based on the cost of the PN bags, blood tests and miscellaneous items, adjusted to subsidy levels. Manpower costs were based on the average hourly rate.

RESULTSCosts for PN and manpower were approximately S$1.2 million for 2791 PN days. Thirty-six cases (18.8%) of 140 PN days were short-term and considered to be avoidable where patients progressed to oral/enteral diet within 5 days. These short-term cases totalled $59,154.42, where $42,183.15 was payable by the patients. The daily costs for PN is also significantly higher for patients on short-term PN (P <0.001).

CONCLUSIONIn our acute hospital, 90% of patients referred for PN were surgical patients. Majority of the cost comes from the direct daily cost of the bag and blood tests, while extensive manpower cost was borne by the hospital; 18.8% of our cohort had short-term avoidable PN. Daily PN may cost up to 60% more in patients receiving short-term PN. Clinicians should assess patient's suitability for oral/enteral feeding to limit the use of short-term PN.

Enteral Nutrition ; Health Care Costs ; Health Manpower ; economics ; Hematologic Tests ; economics ; Hospitals ; Humans ; Length of Stay ; economics ; Medical Overuse ; economics ; prevention & control ; Nutritional Support ; economics ; utilization ; Parenteral Nutrition ; economics ; utilization ; Singapore ; Time Factors

INTRODUCTIONThis retrospective study aims to assess the epidemiology of road traffic accident (RTA) fatalities in Singapore, other causes of death besides trauma in a RTA, and identify the groups at risk.

MATERIALS AND METHODSData of 1038 RTA fatalities were reported between 2000 and 2004. Analyses using the Fisher's exact test for discrete variables and multivariate Cox regression analysis were performed to identify groups at risk. The risk of fatality was measured using the prevalence rate ratio (PRR).

RESULTSThe median age of victims in the sample was 36 years (interquartile range 24 to 55). Eight hundred and thirty six cases (78%) were in the economically productive age range of 15 to 65 years. Over the 5-year period, there was a preponderance of males. Majority of fatalities involved multiple injuries. There were also 64 (6.2%) and 25 (2.4%) cases of RTA fatalities from infective and cardiovascular (CVS) causes, respectively. Multivariate analyses showed that those > or = 60 years were 4 (95% CI of PRR, 3.04 to 5.43) times as likely to be pedestrian fatalities. Conversely, the risk of fatalities involving pedestrians and cyclists was reduced for males (PRR = 0.58; 95% CI, 0.46 to 0.73). However, males were at increased risk of fatalities involving motorcyclists, scooter and pillion riders (PRR = 1.96; 95% CI, 1.43 to 2.70), whereas such risk was reduced for those aged 30 to 59 (PRR = 0.70; 95% CI, 0.58 to 0.85) or > or = 60 years (PRR = 0.30; 95% CI, 0.21 to 0.42), respectively.

CONCLUSIONAs such, it appears that the groups at-risk had varying demographic characteristics. Public education could be modified to target these different groups to reduce the number of fatalities.

Accidents, Traffic ; mortality ; Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Middle Aged ; Motorcycles ; Prevalence ; Risk Factors ; Sex Distribution ; Singapore ; epidemiology ; Walking ; Young Adult