Since the outbreak of the novel influenza H1N1 in April 2009 in Mexico, more then half a million cases have been recorded with more then 6000 deaths. In contrast to seasonal flu, this virus appears to have a predilection for the young, obese and pregnant. It’s most important and almost fatal complication is Acute Respiratory Distress Syndrome (ARDS). Intensive care units (ICU) around the world have scrambled to upgrade various treatment modalities including high frequency oscillation ventilation, inotropes, antivirals and antibiotics in an effort to reduce the mortality arising out of this complication. More importantly, this complication appears reversible if adequate and early therapy is instituted. In particular, rescue therapies that allow the lung to rest appear to have brought success in some clinical settings. This article describes the experiences of seven centers that have used various modalities as rescue therapy in patients having Acute Respiratory Distress Syndrome (ARDS). The experiences in 13 patients at the University of Michigan, 58 in Mexico, 168 in Canada, 180 patients at Leicester UK, 194 in Australia and New Zealand and case reports from Hong Kong and Singapore are described.

Objective: To investigate the antioxidant, antibacterial, and chemical ingredients of Ardisia elliptica (A. elliptica) methanolic extracts. Methods: The plant was extracted using methanol. Antibacterial and antioxidant activ-ities were evaluated. Results: The results showed that both fruit and leaf extract of A. elliptica have significant antibacterial activities against Gram-positive and Gram-negative bacteria. Fruit extracts showed higher content of phenolic (71 ± 0.03 GAE/mg extract dry weight), in com-parison to the leaf extracts (37 ± 0.05 GAE/mg extract dry weight). Flavonoid content, and Fe2+chelating activity of fruit extracts were higher than leaf extract. The percentage radical inhibition of fruit extract is found to be higher (70%) than that of leaf extract (60%). LCMS results indicated that the major compounds in the fruit extract were Gingerol, Aspidin, Kampherol, and Stercuresin, while the leaf extract contained Gingerol, Aspidin, Triangularin, and Salicyl acyl glucuronide. Furthermore, the results of GCMS indicated that fruit extract contained these major compounds:Vitamin E Tocopherol, 5-hepylresornicol, 2-Nonylmalonic acid, 5-pentadecylresornicol, and Stigmasta-7-22-dien-3-ol. However, leaf extract of A. elliptica contained these major compounds: Alpha Amyrenol, 4,4, 6, 6a, 6b, 8, 8a, 9,10, 11,12,12a, 14, 14a, 14b octadehydro-2H-picen-3-one, and Lonasterol, 4-t-Butyl-2-[4-nitrophenyl] phenol. Conclusions: The results provide evidence that fruit and leaf of A. elliptica extracts might indeed be used as a potential source of effective natural antimicrobial and anti-oxidant agents in pharmaceutical and food industries.

We evaluated the activity of methanolic extracts of Melaleuca cajuputi flowers against the filarial worm Brugia pahangi and its bacterial endosymbiont Wolbachia. Anti-Wolbachia activity was measured in worms and in Aedes albopictus Aa23 cells by PCR, electron microscopy, and other biological assays. In particular, microfilarial release, worm motility, and viability were determined. M. cajuputi flower extracts were found to significantly reduce Wolbachia endosymbionts in Aa23 cells, Wolbachia surface protein, and microfilarial release, as well as the viability and motility of adult worms. Anti-Wolbachia activity was further confirmed by observation of degraded and phagocytized Wolbachia in worms treated with the flower extracts. The data provided in vitro and in vivo evidence that M. cajuputi flower extracts inhibit Wolbachia, an activity that may be exploited as an alternative strategy to treat human lymphatic filariasis.
Adult ; Aedes ; Biological Assay ; Brugia pahangi ; Elephantiasis, Filarial ; Flowers* ; Humans ; In Vitro Techniques ; Melaleuca* ; Methanol* ; Microscopy, Electron ; Polymerase Chain Reaction ; Wolbachia

INTRODUCTIONVentilator-associated pneumonia (VAP) is a common risk among critically ill ventilated patients. This study aimed to investigate the effects of nurse-led education on: (a) knowledge of and compliance with ventilator care bundle (VCB) practices among intensive care unit (ICU) nurses; and (b) reduction in the rates of VAP post intervention.

METHODSA quasi-experimental design with pretest-posttest evaluation and observation was used to investigate nurses' knowledge of and compliance with VCB practices, and the incidence of VAP. The study was conducted among 71 nurses, and the intervention involved structured education on VAP and its prevention using VCB in an ICU setting. Data were analysed using descriptive and inferential statistics.

RESULTSNurse-led education significantly increased nurses' knowledge of (t[70] = -36.19; p < 0.001) and compliance with (t[65] = -21.41; p < 0.001) VCB practices. The incidence of VAP, which was 39 per 1,000 ventilator days during the two-month period before intervention, dropped to 15 per 1,000 ventilator days during the two-month period following intervention.

CONCLUSIONOur findings show that nurse-led education on VAP and VCB significantly increased knowledge of and compliance with VCB practices among ICU nurses, and was associated with a reduction in the incidence of VAP among intubated and mechanically ventilated ICU patients. Inclusion of recent knowledge and evidence-based VCB guidelines for VAP prevention when educating anaesthetists, nurses, physiotherapists and other healthcare providers in the critical care setting is recommended.

Adult ; Clinical Competence ; Critical Care ; methods ; standards ; Critical Illness ; Education, Nursing ; Education, Nursing, Continuing ; methods ; Female ; Humans ; Intensive Care Units ; standards ; statistics & numerical data ; Male ; Nursing ; standards ; Pneumonia, Ventilator-Associated ; prevention & control ; Respiration, Artificial ; standards ; Ventilators, Mechanical ; standards ; Young Adult

Around June 2020, many institutions restarted full operating schedules to clear the backlog of postponed surgeries because of the first wave in the COVID-19 pandemic. In an online survey distributed among anaesthestists in Asian countries at that time, most of them described their safety concerns and recommendations related to the supply of personal protective equipment and its usage. The second concern was related to pre-operative screening for all elective surgical cases and its related issues. The new norm in practice was found to be non-standardized and involved untested devices or workflow that have since been phased out with growing evidence. Subsequent months after reinstating full elective surgeries tested the ability of many hospitals in handling the workload of non-COVID surgical cases together with rising COVID-19 positive cases in the second and third waves when stay-at-home orders eased.

Objective: To determine the prevalence of the filarial parasites,. ie.,. Brugia malayi, Brugia, Brugia pahangi(B. pahangi), Dirofilaria immitisand. Dirofilaria repens (D. repens) in domestic and stray cats. Methods: A total of 170 blood sample were collected from domestic and stray cats and examined for filarial worm parasites in two localities, Pulau Carey and Bukit Gasing, Selangor State, Malaysia. Results: The overall prevalence of infection was 23.5% (40/170; 95% CI = 17.4-30.6). Of this, 35% (14/40; 95% CI = 22.1-50.5) and 50% (20/40; 95% CI = 35.2-64.8) were positive for single B. pahangi nd D. repens, respectively. The remaining of 15% (6/40; 95% CI = 7.1-29.1) were positive for mixed B. pahangi and D. repens. In addition, 75% of the infected cats were domestic, and 25% were strays. No Brugia malayi and Dirofilaria immitis was detected. Eighty-four cats were captured at Pulau Carey, of which 35.7% (30/84) were infected. Among the cats determined to be infected, 93% (28/30; 95% CI = 78.7-98.2) were domestic, and only 6.7% (2/30; 95% CI = 19.0-21.3) were strays. Conversely, the number of infected cats was three times lower in Bukit Gasing than in Pulau Carey, and most of the cats were stray. Conclusions: B. pahangi and D. repens could be the major parasites underlying filariasis in the study area. Adequate prophylactic plans should be administrated in the cat population in study area.

Objective To investigate the antioxidant, antibacterial, and chemical ingredients of Ardisia elliptica (A. elliptica) methanolic extracts. Methods The plant was extracted using methanol. Antibacterial and antioxidant activities were evaluated. Results The results showed that both fruit and leaf extract of A. elliptica have significant antibacterial activities against Gram-positive and Gram-negative bacteria. Fruit extracts showed higher content of phenolic (71 ± 0.03 GAE/mg extract dry weight), in comparison to the leaf extracts (37 ± 0.05 GAE/mg extract dry weight). Flavonoid content, and Fe