This finite element analysis is aimed at comparing relative stiffness of three different posterior instrumentation constructs: the Hospital Universiti Kebangsaan Malaysia Spinal Instrumentation System (HUKM-SIS), the Cotrell-Dubousset Instrumentation (CDI) and Harrington Instrumentation System (HIS), used in the treatment of adolescent idiopathic scoliosis (AIS). The constructs were tested under various loads using MSC Patran 2001 r2a. Under increasing flexion loads, there was a linearly corresponding increase in deflection magnitudes for all constructs on the load-deflection curve. The CDI was the stiffest construct under axial, forward flexion and extension loads, followed by the HUKM-SIS and HIS. Under lateral bending loads, the HUKM-SIS construct was the stiffest followed by CDI and HIS. The HUKM-SIS construct was stiffer than HIS under torsional loads. We conclude that multiple pedicle screws increase the stiffness of posterior instrumentation constructs under all loads and inter-segmental spinous processes wiring increase the stiffness against lateral bending.
instrumentation ; PDGFB Gene ; System ; Spinal ; Scoliosis, unspecified

Introduction: In this study, we sought to determine whether laboratory and physiological parameters can be useful in predicting mortality in patients with sepsis-induced hypotension and septic shock. Methodology: This prospective cohort study was carried out in the emergency department at an academic medical center. A total of 51 patients met enrollment criteria during the study period and 41 of them were included in the study. Inclusion criteria were patients 18 years old or older, diagnosed to have either sepsis-induced hypotension or septic shock and investigated sepsis marker (blood lactate and leukocytes) measured. Other physiological variables were also measured in this study. The main outcome measure was 30-day mortality. Kaplan-Meier, Log-rank and Cox's methods were used for statistical analysis using SPSS version 12.0.1. Results: 61% were diagnosed to have sepsis-induced hypotension and 39% were diagnosed with septic shock. Twenty two (54%) deaths occurred within the 30 day follow up. The overall mean blood lactate level and leukocyte counts were 3.52 mmol/L (SD=2.29) and 11.37 x 109 (SD=6.38) respectively. A Cox Proportional Hazard Analysis revealed an increase in blood lactate levels in the ED was associated with an increased risk of death (B=0.35, HR=1.45, 95% CI 1.22,1.73, p<0.001). However no significant correlation between the physiological parameters and the 30-day mortality. Patients with septic shock state prior to initial presentation has a lower 30 day survival compared to any other septic conditions. Conclusion: Our results support blood lactate level as a promising risk stratification tool when compared with leukocytes counts and other physiological parameters. The multivariate analysis showed that for every increment of lactate value of 1 mmol/L, the hazards of dying are expected to increase by 1.5 times (p<0.001).

An understanding of common pathogens and their antibiotic sensitivity patterns is critical for proper management of sepsis in Emergency Department (ED). The goal of the study was to identify common organisms isolated from blood cultures of patients attended to ED and their antimicrobial susceptibility. Beginning from 2002, all cases of positive blood culture collected by the ED, Hospital Universiti Sains Malaysia (HUSM) were recorded and analysed. Over the period of eight years, we documented 995 cases of positive blood cultures. Of these samples, 549 (55.2%) were Gram-negative bacteria; 419 (42.1%) were Gram-positive bacteria; 10 (1.0%) were anaerobic organisms; 10 (1.0%) were fungus; and 7 (0.7%) cases were mixed organisms. Gram-negative bacteria were observed to develop more resistance to antimicrobial agents, especially those commonly used in an outpatient setting with less than 80% sensitivity to ampicillin, cotrimoxazole and ciprofloxacin. By contrast, there has been no marked change in the sensitivity trends of Gram-positive bacteria over the same period. In conclusion, ED physicians are more equipped to initiate empirical antimicrobial therapy especially when dealing with possibility of Gram-negative sepsis.

Coccidiosis is a major recurring problem in the poultry industry and is caused by infection of one or more of the seven Eimeria species known to infect chickens, with Eimeria tenella among the best studied and economically important. Studies on the genetic diversity of E. tenella strains is essential for the development of universally acceptable diagnostic markers and vaccines against the disease. Eimeria tenella internal transcribed spacer-1 (ITS-1) and apical membrane antigen-1 (AMA-1) sequences from different parts of the world are available in the public domain and therefore provide suitable comparative markers for genetic diversity study. In this study, the ITS-1 and AMA-1 sequence diversity of two local E. tenella strains, namely EtNSN6 and EtSGR6 were characterized. Both ITS-1 and AMA-1 sequences for EtNSN6 and EtSGR6 were retrieved by mapping to their respective genome sequences generated using next generation sequencing. Multiple sequence alignment of the ITS-1 and AMA-1 sequences with selected homologous sequences revealed the presence of a total of five and 13 single nucleotide polymorphisms (SNPs) respectively. All SNPs appeared to occur at random and did not show any unique pattern based on geographical regions while no insertions and deletions (indels) was found to occur in the aligned sequences. However, unique bases that defined certain strains were detected. Phylogenetics analyses performed with Maximum Parsimony (MP) and Maximum Likelihood (ML) methods revealed similar topology for the internal groups with all the E. tenella ITS-1 and AMA-1 sequences grouped in the same clade supported by high bootstrap confidence. This confirmed that both EtNSN6 and EtSGR6 samples are E. tenella strains. Sequence comparison and phylogenetics analyses further suggest the possibility of low genetic diversity among E. tenella strains.

Coronavirus Disease 2019 (COVID-19) has been spreading like a wildfire everywhere in the globe. It has been challenging the global health care system ever since the end of 2019, with its virulence and pathogenicity. Recent studies have shown the association between ABO blood group, Rhesus blood type and susceptibility to COVID-19 infection. Various studies and few meta-analyses have been done and some might be inconsistent; therefore, this meta-analysis was done to assess the relationship between different ABO and Rhesus blood types on the susceptibility to COVID-19 infections. This meta-analysis assessed the odds ratio of COVID-19 infection of different ABO and Rhesus blood types. Subgroup analyses according to (1) age and gender matched; (2) different blood group antigens; (3) Rhesus positive and negative of each blood group were carried out. Publication bias and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) were also done to assess the risk of bias in these publications. It was found that blood group A showed significant difference in odds ratio of COVID-19 infection (OR, 1.16; 95% CI, 1.08-1.24). Blood group AB showed significant difference in odds ratio when studies with lower QUADAS-2 score were removed. This means that populations with blood group A and AB are more likely to be infected with COVID-19. As there is a higher tendency that blood group A and AB to be infected with COVID19, precautious care should be taken by these populations.