Background: Acute kidney injury (AKI) following cardiac surgery is well established but the reported incidence is variable due to varying definitions and criteria. Furthermore there is a paucity of such data from Southeast Asia. Objectives: To determine the incidence of AKI, the associated risk factors, and its impact on early mortality and intensive care unit/hospital stay. Method: This is a single centre retrospective observational study to evaluate outcomes on 1260 consecutive patients from a multi-ethnic Southeast Asian population who underwent a primary isolated coronary artery bypass graft (CABG) operation. Data was collected from the hospital’s electronic database and analysed using basic descriptive statistics and logistic regression. Results: Overall incidence was 36.2% including 5.5% of patients who required renal replacement therapy (RRT). Multivariate analysis identified age, insulin-dependent diabetes mellitus (IDDM), baseline serum creatinine level (SCr), recent myocardial infarction (MI), cardiopulmonary bypass (CPB) time and intra-aortic balloon pump (IABP) use as independent risk factors for AKI. For patients who required RRT, the SCr and IDDM remained independent predictors. Early 30-day mortality (11.5% vs 0.9%) was significantly higher in patients who developed AKI following CABG. Similarly, AKI was associated with a slight but statistically significant increase in intensive care unit (ICU) and hospital stay. Conclusion: Better prognostication and preventative strategies are required to better risk stratify patients undergoing CABG and optimise utilisation of limited healthcare resources.
Acute Kidney Injury

SUMMARY Introduction: Urinary tract infection (UTI) is a common bacterial infection affecting children and therefore, prompt recognition and accurate antimicrobial management are vital to prevent kidney damage. This study aims to determine the bacterial pathogens and their patterns of antimicrobial resistance in children presenting with UTI. Methods: A retrospective study of 721 cases, involving children between the ages of 1-day old to 13 years old with culture-proven UTI in Selayang Hospital, Malaysia between January 2007 and December 2011. The bacterial pathogens and antibiotic resistance patterns in the total population, prophylaxis and no prophylaxis groups were studied. Results: The 3 most common organisms isolated in the total population were E.Coli (41.6%), Klebsiella spp. (21.2%) and Enterococcus spp. (11.0%). With regards to the antibiotic resistance, E.Coli resistance rates to ampicillin, cefuroxime and gentamicin were 67.7%, 15.3% and 7.3% respectively. Ampicillin-resistance was also highest in Klebsiella spp. (84.3%), Enterococcus spp. (15.5%) and Proteus spp. (55.5%). Conclusion: E.coli remains to be the leading bacterial pathogen causing UTI in children, with ampicillin-resistance occurring in more than half of these cases. Therefore, accurate choice of antibiotics is important to ensure optimal outcome. In our study, cefuroxime and gentamicin have lower antibiotic resistance rates and can be used in the treatment of UTI in children.
Urinary Tract Infections

Objective: To identify and determine the composition of antioxidant compounds, and to evaluate the antioxidant abilities of Gac fruit parts (peel, pulp, seed and aril) grown in Malaysia. Methods: LC-MS/MS was used for identification of antioxidant compounds and UV-Vis for estimation of the contents of phenolics, flavonoids, and carotenoids. Lycopene and β-carotene were quantified using high-performance liquid chromatography. DPPH (2, 2-diphenyl-1-picrylhydrazyl) and ferric reducing antioxidant power assays were employed to evaluate antioxidant capacities. Results: Phytochemicals were found amongst all the fruit parts. Notably, significant amounts of carotenoids [(107.4 ± 4.5), (85.7 ± 4.4), (110.6 ± 2.1) mg/100 g dry weight (DW)], and relatively high levels of both phenolics [(27.3 ± 1.7), (28.9 ± 2.4), (30.8 ± 2.7) mg/100 g DW] and flavonoids [(38.1 ± 2.2), (8.8 ± 1.3), (24.5 ± 3.3) mg/100 g DW] were found in the fruit's peel, pulp and aril, respectively. Seed part also showed a relatively high level of flavonoids [(18.1 ± 2.3) mg/100 g DW]. Lycopene and β-carotene were found to be significantly high (P < 0.05) in aril [(579.3 ± 22.7) and (621.0 ± 35.0) μg/g DW], followed by peel [(51.0 ± 7.5) and (210.0 ± 12.5) μg/g DW] and pulp [(37.6 ± 10.9) and (205.6 ± 22.1) μg/g DW)]. Antioxidant assays revealed that aril possessed the highest scavenging activity (IC

Objective: To investigate the impact of the extracts of Gac fruit parts (peel, pulp, seed, and aril) on the cell viability and angiogenesis markers of human retinal pigment epithelial (ARPE-19) cells under high glucose conditions. Methods: The effect of the extracts of Gac fruit peel, pulp, seed and aril on the ARPE-19 cells was determined using MTT viability assay, Trypan blue dye and morphological changes were observed using light microscopy. Enzyme-linked immunosorbent-based assay was performed to evaluate the effect of Gac fruit parts on the reactive oxygen species (ROS), vascular endothelial growth factor (VEGF) and pigmented epithelium-derived factor (PEDF) secretions. Results: High glucose (HG) at 30 mmol/L increased ARPE-19 cell viability and ROS and VEGF secretions. While, the exposure of ARPE-19 cells in high glucose condition to Gac fruit extracts led to inhibition of cell viability, induced morphological changes, decreased ROS and VEGF secretions, and increased PEDF level. Gac pulp, seed, and aril at 1 000 μg/mL showed significant inhibition activities [(7.5 ± 5.1)%, (2.7 ± 0.5)%, (3.2 ± 1.1)%, respectively] against HG-induced ARPE-19 cell viability. The findings also demonstrated that Gac aril at 250 μg/mL significantly decreased ROS and VEGF levels [(40.6 ± 3.3) pg/mL, (107.4 ± 48.3) pg/mL, respectively] compared to ROS [(71.7 ± 2.9) pg/mL] and VEGF [(606.9 ± 81.1) pg/mL] in HG untreated cells. Moreover, 250 μg/mL of Gac peel dramatically increased PEDF level [(18.2 ± 0.3) ng/mL] compared to that in HG untreated cells [(0.48 ± 0.39) ng/mL]. Conclusions: This study indicates that the extracts of Gac peel, pulp, seed and aril reduced cell viability, minimized ROS generations and showed angiogenic activities. Therefore, our findings open new insights into the potentiality of Gac fruit against HG-related diabetic retinopathy disease.

Breast cancer is the most common cancer among the female population of Malaysia, with an average lifetime risk of 31.1%.1 Typical sites for metastasis of the breast carcinoma include the bones, liver, lungs, skin, and brain. In most cases, breast cancer is diagnosed first, but in 12- 31% of the cases like in this case, the metastasis appear first as the initial presentation. In this case, we reported a case of a healthy young woman who presented with orbital metastasis as the initial presentation of breast cancer.

The Corona pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) calls on the Saudi government to take action to control the infection. The government closed borders, prohibited travel, limited outdoor movements, and told primary and secondary care facilities to reduce all regular non-urgent health services. It is not known whether these measures have impacted the prevalence of parasitic intestinal infections. This study has therefore been carried out to investigate this issue. Dataset of 217 stool samples submitted to the King Faisal Medical Complex (KFMC) Microbiology Laboratory in Taif, Saudi Arabia for parasitological examination during the pandemic (January-June 2020) and 649 samples submitted during the corresponding months of the previous year (January-June 2019) were extracted and analyzed. Overall, 24.1% (209/866) of samples were parasitespositives; 26.6% (173/649) before and 16.5% (36/217) during the pandemic, with 79% reduction. There was a significant difference in gender-parasitism between the two periods where the majority of parasitism were for males (p<0.001). Infections were frequent in patients aged 5- 14 years both before (84/649; 12.9%) and during (12/217; 5.5%) the pandemic, with significant difference observed between the two cohorts (p<0.002). Moreover, the majority of infected patients were non-Saudi (67.9%; 142/209), with a significant difference in nationality reported, (p=0.024). Protozoa were identified in 21.8% (189) of all samples investigated, of which, Blastocystis hominis, Entamoeba coli, Giardia lamblia, Entamoeba histolytica/dispar and Cryptosporidium species were identified in 6.1% (53), 5.4% (47), 5.0% (44), 2.8% (25), and 2.3% (20), respectively. Helminths were diagnosed in 2.3% (20/866) of samples. Eggs of hookworm, Ascaris, Taenia spp, and Hymenolepis nana were detected in 0.9% (8), 0.5% (5), 0.3% (3) and 0.4% (4), respectively. In parallel with our research hypothesis, a substantial decrease in the burden of intestinal parasitic infections was recorded with the lock-down measures taken during the Corona pandemic.

We aimed to perform a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that examined the analgesic benefits of preemptive pregabalin among patients undergoing minimally invasive hysterectomy. Five major databases were systematically screened from inception until August 29, 2021 Relevant studies were evaluated for risk of bias. Endpoints were analyzed using the random-effects model and pooled as the mean difference or risk ratio with a 95% confidence interval. Four studies with seven treatment arms met the inclusion criteria. The total sample size was 304 patients: 193 and 111 patients were allocated to the pregabalin and placebo groups, respectively. Overall, the included studies revealed a low risk of bias. The summary results revealed that the mean postoperative pain scores at rest were significantly lower in the pregabalin group than in the control group at 0, 2, 4, 6, 12, and 24 hours. Moreover, the mean postoperative pain scores on movement/coughing were significantly lower in the pregabalin group than in the control group at 12 and 24 hours. The rate of patients who were opioid-free postoperatively was significantly higher in the pregabalin group than in the control group. There was no significant difference between the groups in terms of the mean postoperative time to first rescue analgesic and the rates of adverse events. Compared with placebo, preemptive pregabalin was largely safe, and was correlated with superior analgesic effects in terms of lower postoperative pain scores and higher opioid-sparing effects. Additional RCTs are needed to confirm these findings.

BACKGROUND: Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%–98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia. METHODS: In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1–5, whereas practice was assessed as a yes/no categorical variable. RESULTS: A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20–35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics – nurses group and EMT – nurses group. CONCLUSION This study demonstrates that there is a gap in EHCWs' KAP, particularly regarding when to provide OT to a patient. This gap can affect patients' safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.