Indoor air quality is an essential aspect for occupational health including in a densely populated university. This study aimed to assess the indoor airborne microorganisms via biochemical and molecular approaches in five enclosed workplaces, and their resistance towards six commonly used antibiotics. Cfu/dm2/h for five enclosed workplaces was determined using settle plate technique with 1/1/1 scheme and Gram staining was performed for all pure strains isolated. Two strains with the highest count and with different morphologies were identified using biochemical test as well as 16S rRNA amplification and direct sequencing. Minimum inhibitory concentration for antibiotics was carried out for these two strains. In this study, 27 microbial strains with different morphologies were obtained from all workplaces and 2 strains with the highest count were strain J in café and strain M in library, which were identified as Bacillus cereus and Staphylococcus cohnii, respectively. Both of them were highly susceptible to ampicillin and tetracycline. With resistance up to 0.78 µg/mL; B. cereus was less sensitive to kanamycin and neomycin whereas S. cohnii was less sensitive to streptomycin. In conclusion, antibiotics resistant B. cereus and S. cohnii were two of the microorganisms showing the most abundance in the café and library of a Malaysian public university, respectively. This study may serve as the baseline for the prescriptions of antibiotics to airborne microbial related infections especially to the community in the university who seek for medical treatments; particularly for respiratory and digestive infections which often associated with indoor microenvironment.
antibiotic resistance ; Bacillus cereus ; indoor air quality ; minimum inhibitory concentration ; Staphylococcus cohnii

Aged ; Aortic Aneurysm ; diagnostic imaging ; etiology ; Aortic Valve Insufficiency ; diagnostic imaging ; Echocardiography ; Giant Cell Arteritis ; complications ; diagnostic imaging ; Humans ; Male

INTRODUCTIONThis was a single centre registry study on clinical efficacy and safety of drug-eluting stent (DES) in diabetic patients undergoing percutaneous coronary intervention (PCI) for complex coronary lesions.

MATERIALS AND METHODSA total of 288 diabetic patients who underwent elective PCI between September 2003 and June 2006 in our centre were enrolled and followed-up for 18 months. Among them, 79 (27.4%) patients received sirolimus-eluting stent (SES), 138 (47.9%) paclitaxel-eluting stent (PES) and 71 (24.7%) zotarolimus-eluting stent (ZES). The endpoints were major adverse cardiac events (MACE) and stent thrombosis rates.

RESULTSBaseline demographics were comparable among the 3 DES groups (median age was 60 years; 69% men). Complex lesions (defined as ACC/AHA type C stenosis) accounted for 55.6% of the total lesions: SES (50.6%), PES (65.2%) and ZES (43.7%), P = 0.005. At 18 months follow-up, the composite endpoint of MACE was found in 12.7% in SES group, 8.7% in the PES group, 12.7% in ZES group and (P = 0.55). Stent thrombosis (ST) occurred in 1 patient (1.3%) in the SES group, 2 patients (1.4%) in PES group and 1 patient (1.4%) in ZES group, respectively (P = 1.00).

CONCLUSIONThe use of DES for elective PCI in diabetic patients was associated with favourable intermediate-term clinical outcomes with no significant differences in efficacy among the 3 groups. Stent thrombosis had low event occurrence rate.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Restenosis ; prevention & control ; Coronary Stenosis ; complications ; surgery ; Diabetes Complications ; Drug-Eluting Stents ; Female ; Humans ; Immunosuppressive Agents ; administration & dosage ; Male ; Middle Aged ; Myocardial Infarction ; Paclitaxel ; administration & dosage ; Sirolimus ; administration & dosage ; analogs & derivatives ; Survival Analysis ; Treatment Outcome

INTRODUCTIONThe World Health Organization Quality of Life (WHOQOL-BREF) questionnaire is a 26-item questionnaire that evaluates 4 domains of quality of life (QoL), namely Physical, Psychological, Social Relationships and Environment. This study aimed to evaluate the validity and reliability of the WHOQOL-BREF among Singapore residents aged 21 and above.

MATERIALS AND METHODSWe recruited participants from the general population by using multistage cluster sampling and participants from 2 hospitals by using convenience sampling. Participants completed either English, Chinese or Malay versions of the WHOQOL-BREF and the EuroQoL 5 Dimension 5 Levels (EQ-5D-5L) questionnaires. Confirmatory factor analysis, known-group validity, internal consistency (Cronbach's alpha) and test-retest reliability using the intraclass correlation coefficient (ICC) were performed.

RESULTSData from 1316 participants were analysed (Chinese: 46.9%, Malay: 41.0% and Indian: 11.7%; 57.5% mean, mean standard deviation [SD, range] age: 51.9 [15.68, 24 to 90] years); 154 participants took part in the retest in various languages (English: 60, Chinese: 49 and Malay: 45). Tucker-Lewis Index (TLI) was 0.919, 0.913 and 0.909 for the English, Chinese and Malay versions, respectively. Cronbach's alpha exceeded 0.7 and ICC exceeded 0.4 for all domains in all language versions.

CONCLUSIONThe WHOQOL-BREF is valid and reliable for assessing QoL in Singapore. Model fit is reasonable with room for improvement.

INTRODUCTIONWe aim to examine the risk predictors of contrast-induced nephropathy (CIN) in patients with normal baseline serum creatinine (Cr). CIN is an important complication postpercutaneous coronary intervention (PCI). Previous studies examined CIN predictors in patients with chronic renal impairment. No large studies investigated patients with normal renal function which constitute the majority undergoing PCI. We aim to identify risk predictors in this cohort and examine the clinical outcomes.

MATERIALS AND METHODSA total of 3036 patients with normal baseline Cr (<1.5 mg/dL) who did not receive prophylaxis while undergoing PCI were enrolled. We examined the occurrence of CIN and the mortality outcome at 1 and 6 months.

RESULTSCIN occurred in 7.3% of patients. The median age was 59.5 years (range, 26 to 86), 78.7% men, 34.6% diabetics. Risk predictors for CIN include age [odds ratio (OR), 6.4; 95% CI, 1.01-13.3; P = 0.042], female gender (OR, 2.0; 95% CI, 1.5-2.7; P = 0.001), abnormal left ventricular ejection fraction (LVEF) <50%(OR,1.02; 95% CI, 1.01-1.04; P = 0.01), anaemia with haemoglobin <11 mg/dL (OR, 1.5; 95% CI, 1.01-2.4; P = 0.044) and systolic hypotension with blood pressure <100 mmHg (OR, 1.5; 95% CI, 1.01-2.2; P = 0.004). Diabetics on insulin therapy were at the highest risk compared with diabetics on oral hypoglycaemics and diet control (18.9% vs 6.8% vs 3.6%; P = 0.001). Patients who developed CIN had higher mortality at 1 month (14.5% vs 1.1%; P <0.001) and 6 months (17.8% vs 2.2%; P <0.001).

CONCLUSIONSSubgroups of patients with normal baseline Cr undergoing PCI are at risk of developing CIN with resultant higher mortality. Age, female gender, insulin dependent diabetes mellitus, presence of hypotension, anaemia and low LVEF are predictors of CIN. Prophylaxis may be considered in these patients.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anemia ; Angioplasty, Balloon, Coronary ; adverse effects ; Contrast Media ; adverse effects ; Creatinine ; blood ; Diabetes Mellitus ; drug therapy ; Female ; Glomerular Filtration Rate ; Humans ; Hypotension ; Kidney Diseases ; chemically induced ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Sex Factors ; Survival Analysis ; Ventricular Dysfunction, Left

INTRODUCTION: Child sexual abuse (CSA) adversely affects a child's growth and well-being. This study aimed to describe the profile of children presenting to a tertiary paediatric emergency department(ED) with CSA. METHODS: Children 0-16 years old presenting to KK Women's and Children's Hospital ED from June 2016 to August 2020 with sexual abuse were retrospectively reviewed. We performed a secondary analysis on girls and stratified them by age <13 and ≥13 years old. RESULTS: There were 790 patients who made 833 visits for CSA. Victims were predominantly girls (747, 94.8%) and perpetrators were predominantly men (763, 96.6%). The abuse first occurred before the age of 13 years in 315 victims (39.9%). For 468 (59.2%), more than one incident occurred before presentation. Compared to girls ≥13 years old, girls <13 years old were more frequently abused by a family member (47.7% versus 8.0%, CONCLUSION The findings highlight common characteristics of CSA cases, and can aid the future identification and protection of vulnerable children. The fact that most children presented after more than one incident suggests the need to more closely monitor and protect potentially at-risk children.
Adolescent ; Child ; Child Abuse ; Child Abuse, Sexual ; Child, Preschool ; Emergency Service, Hospital ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Parents ; Retrospective Studies

OBJECTIVE: The main objective of this study was to evaluate clinical and radiographic outcomes of computer minimally invasive transforaminal lumbar interbody fusion (CNMIS TLIF). METHODS: Blood loss, operating time, complications, and hospital stay were identified through chart review. Numeric rating scale (NRS) scores for pain were taken during recent follow-ups, and these were compared to the pre-operative scores. Three different examiners assessed the pre-operative lumbosacral spine radiographs. At a 2-years follow-up, the patients were evaluated with NRS and the radiographs reassessed by three other examiners. RESULTS: Seventy-four patients with a mean age of 54 years underwent CNMIS TLIF. Average blood loss was 300 mL, operative time was 4.5 hours, and the average length of hospital stay was 8.5 days. A total of four complications were noted in our study. There was an improvement of mean local lordosis and regional lordosis. The paired-sample t-test showed that the anterior, middle, and posterior disc heights at the cage level were significantly increased compared to the pre-operative values. CONCLUSION: CNMIS TLIF is a safe and efficient method to achieve spinal fusion. There was a significant improvement in clinical outcomes in terms of pain relief. Radiologic parameters such as local lordosis, regional lordosis, and anterior, middle, and posterior disc heights showed significant improvements at 2-years follow-up.
Spinal Fusion ; Minimally Invasive Surgical Procedures ; Computers

Aims: The kelch13 gene mutations of Plasmodium falciparum is associated with delayed parasite clearance after artemisinin-based combination therapy (ACT). It is unclear for P. knowlesi that is predominantly reported in Sabah. Therefore, this study aims to analyse the diversity of the P. knowlesi kelch13 gene in five divisions of Sabah. Methodology and results: : Ninety-five blood samples infected with P. knowlesi were obtained. The DNA of P. knowlesi samples was extracted and the kelch13 gene was amplified. The amplicons were cloned and sequenced. The sequencing data were aligned and analysed using MEGA 11 and DnaSP v6 software. A phylogenetic tree was constructed using the Neighbour-joining approach, which showed a diverse clade of P. knowlesi in Sabah, with a nucleotide diversity (π) of 0.451 and a haplotype diversity of 0.947. The deduced amino acid sequences were classified into 14 haplotypes, providing evidence of distinct P. knowlesi lineages in Sabah. When compared to P. falciparum, the kelch13 sequences of P. knowlesi exhibited a higher π of 0.490 and haplotype diversity of 1.000, and similar mutations that conferred drug resistance to ACT in P. falciparum were detected in P. knowlesi in this study. Conclusion, significance and impact of study: The kelch13 gene of P. knowlesi isolates in Sabah has high nucleotide and haplotype diversities. Additionally, mutations conferring drug resistance to ACT in P. falciparum were identified in P. knowlesi in Sabah. The findings in this study can be used to better understand the emergence of drug resistance of P. knowlesi in Sabah.

INTRODUCTIONRemote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network.

METHODSPatients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians.

RESULTSA total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported.

CONCLUSIONRemote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life.

Aged ; Arrhythmias, Cardiac ; diagnosis ; Defibrillators, Implantable ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; Pacemaker, Artificial ; Patient Safety ; Pilot Projects ; Prospective Studies ; Quality of Life ; Remote Consultation ; methods ; Singapore ; Surveys and Questionnaires

BACKGROUND

Coronary artery disease is the leading cause of death in the Philippines and can present as acute coronary syndrome. Hospitalization for ACS has epidemiologic and economic burden. In fact, last 2017, there were 1.52% or 152 admissions for every 10,000 hospitalized patients for medical conditions in PhilHealth-accredited hospitals locally. However, coronary angioplasty was performed in only less than 1% of these cases mainly because of its cost and the out-of-pocket expense that the treatment entail, when primary percutaneous intervention has been proven to be effective in reducing mortality in STEMI and early invasive intervention performed during index hospitalization for NSTEMI is likewise recommended. Moreover, there is a big disparity between the current case rates for ACS for medical therapy alone and for invasive intervention compared to the actual ACS hospitalization cost.

OBJECTIVES

1) To propose revisions to the current PhilHealth case rates for acute coronary syndrome (ACS); and 2) To determine the budget impact of the proposed ACS case rates.

METHODS

The Philippine Heart Association with the assistance of a technical working group undertook the study. A panel of experts composed of general and invasive cardiologists from Luzon, Visayas, and Mindanao was formed. The ACS hospitalization costs based on the recent study by Mendoza were presented and discussed during the focus group discussions with the panelists. Issues pertinent to their localities that may affect the costs were discussed. The proposed revised costs on the particular ACS conditions and therapeutic regimens were then voted and agreed upon. A budget impact analysis of the proposed case rates was then performed.

RESULTS

The proposed case rates for ACS ranged from Php 80,000 (for low risk unstable angina given medical treatment) to Php 530,000 (for ST-elevation myocardial infarction initially given a thrombolytic agent then underwent PCI which necessitated the use of three stents). The budget impact analysis showed that the proposed ACS rates would require an additional PHP 1.5 billion to 2.3 billion during the first year of a 3- versus 5-year implementation period, respectively. The period of implementation will be affected by budgetary constraints as well as the availability of cardiac catheterization facilities in the country.

CONCLUSION

The proposed revised PhilHealth hospitalization coverage for ACS is more reflective or realistic of the ACS hospitalization costs in contrast with the current PhilHealth case rates. The corresponding budget impact analysis of these proposed case rates showed that PHP 7.6 billion is needed for full implementation. However, given the budget constraints, the percentage of the total costs for the first and subsequent years of implementation may be modified.