Asthma, remains symptomatic despite ongoing treatment with high doses of inhaled corticosteroids (ICS) in conjunction with long-acting beta-agonists (LABA), is classified as “severe” asthma. In the course of caring for those patients diagnosed with severe asthma, stepping up from ICS/LABA to more aggressive therapeutic measures would be justified, though several aspects have to be checked in advance (including inhaler technique, adherence to therapy, and possible associated comorbidities). That accomplished, it would be advisable to step up care in accordance with the Global Initiative for Asthma (GINA) recommendations. Possible strategies include the addition of a leukotriene receptor antagonist or tiotropium (to the treatment regimen). The latter has been shown to be effective in the management of several subgroups of asthma. Oral corticosteroids have commonly been used for the treatment of patients with severe asthma in the past; however, the use of oral corticosteroids is commonly associated with corticosteroid-related adverse events and comorbidities. Therefore, according to GINA 2017 these patients should be referred to experts who specialize in the treatment of severe asthma to check further therapeutic options including biologics before starting treatment with oral corticosteroids.

OBJECTIVES: The cholera outbreak in Yemen has become the largest in the recent history of cholera records, having reached more than 1.4 million cases since it started in late 2016. This study aimed to identify risk factors for cholera in this outbreak. METHODS: A case-control study was conducted in Aden in 2018 to investigate risk factors for cholera in this still-ongoing outbreak. In total, 59 cholera cases and 118 community controls were studied. RESULTS: The following risk factors were associated with being a cholera case in the bivariate analysis: a history of travelling and having had visitors from outside Aden Province; eating outside the house; not washing fruit, vegetables, and khat (a local herbal stimulant) before consumption; using common-source water; and not using chlorine or soap in the household. In the multivariate analysis, not washing khat and the use of common-source water remained significant risk factors for being a cholera case. CONCLUSIONS Behavioural factors and unsafe water appear to be the major risk factors in the recent cholera outbreak in Yemen. In order to reduce the risk of cholera, hygiene practices for washing khat and vegetables and the use and accessibility of safe drinking water should be promoted at the community level.

Endophytic fungi are a unique group in the Fungi kingdom as they spend the majority of their life cycles within the livingtissue of the host organism without causing apparent harm. The endophyte-host relationship is typically commensalismor mutualistic, with pathogenicity an issue only when either party is under stressed. The contribution of endophytic fungito the host is mostly in the form of chemical protection – secondary metabolites with bioactivities against invadingorganisms which may harm the host and consequentially threaten the survival of the endophyte. Many of these chemicalcompounds have been found to be pigments. Due to easy visual identification, many pigments from fungal sources havebeen isolated and characterised. This review highlights the potential of endophytic fungi as a source of pigments; withadditional focus on significant bioactivity, major chemical classes and biosynthesis. Existing and potential commercialapplications of natural pigments by endophytes are also discussed.

Aims:This research aims to investigate the potential of biohythane (biohydrogen and biomethane) production from palm oil mill effluent (POME) in a two-stage anaerobic digestion (AD) system.Methodology and results:A two-stage AD system was configured with a thermophilic dark fermenter (TDF) for biohydrogen (H2) production and a thermophilic anaerobic contact digester (TACD) for biomethane (CH4) production. To adjust pH 5.5 for dark fermentation, the settled sludge was recirculated from TACD to TDF. The hydraulic retention time (HRT) applied in TDF and TACD was 3.75 and 6.25 day, respectively.Conclusion, significance and impact of study:The sludge recirculation from TACD was able to adjust the pH in TDF to the optimum value of 5.5. The total COD and TSSdegradation were 63.12 and 77.94 %, respectively. The H2production in TDF was 1.54 L H2/L POME and the CH4production in TACD was 19.87 L CH4/L POME. The H2and CH4yielded 0.085 L/g CODremovedand 0.339 L/g CODremoved, respectively, with total energy recovery equivalent to 661.02 MJ/m3POME. Only 2.28 % of this energy was contributed by H2and the remaining was dominated by CH4.

Aims: A study on biosorption ability using encapsulated endophytic fungi has been carried out to investigate its biosorption potential in removing heavy metals. Biosorption has emerged as an alternative bioremediation process to remove and sequester heavy metal ions from polluted water. An endophytic Pestalotiopsis sp. (isolated from Nypa fruticans) was found to be able to resist copper (Cu), chromium (Cr), lead (Pb) and zinc (Zn) up to 1,000 ppm and thus the aim of this study was to investigate the biosorption ability using encapsulated live and dead Pestalotiopsis sp. biomass (at pH 4-6) to remove heavy metals. Additionally, a proteomic study was conducted to investigate down- and up-regulation expression levels of proteins under the treatment of the heavy metals. Methodology and results: Encapsulated live fungal biomass displayed higher efficiency in removing chromium at pH 5 and 6, while both encapsulated live and dead biomass were able to remove lead at pH 4 and 5 and copper at pH 5. Five (5) proteins of interest were identified via MALDI-ToF analysis. Among the proteins identified, multidrug resistance protein (MRP homolog) was up-regulated in the presence of lead. Conclusion, significance and impact of study The data obtained in this study provides an initial understanding of the biosorptive and defensive mechanisms of Pestalotiopsis sp. under heavy metal stress.

Aims: Pseudomonas has been associated with diseases occurring in people with weakened or compromised immune system after exposure to contaminated water. The diseases are commonly treated with antibiotics. However, the bacteria had developed resistances to commonly used antibiotics making treatment a difficult task. Therefore, the continuous surveillance of susceptibility of Pseudomonas especially for the human pathogen P. aeruginosa to commonly clinical and aquaculture farming used antibiotics is important to ensure that serious infections remain susceptible to those antibiotics. Methodology and results: In this study, the bacteria were screened from water, sediment and fish from rivers and aquaculture farms around Kuching, Sarawak. A total number of 38 presumptive P. aeruginosa were isolated using CHROMagar TM Pseudomonas and subjected to a series of biochemical tests. Out of all the isolates tested, only two isolates designated as AS-R10(S) and BK2-OLT2(S) fulfilled the biochemical characteristics of P. aeruginosa. 16S rRNA gene sequencing further confirmed these two isolates as P. aeruginosa based on their 100% similarity with P. aeruginosa strain GD1 and P. aeruginosa strain PA1201 in NCBI database. These two isolates were tested for their susceptibilities against nine common antibiotics used in both clinical and aquaculture farming nowadays: imipenem, piperacillin, meropenem, amikacin, gentamicin, ciprofloxacin, ceftazidime, tobramycin and norfloxacin according to CLSI standard using disk diffusion method. Conclusion, significance and impact of study The two isolates exhibited total susceptibility to all the antibiotics analysed, suggesting the effectiveness of the antimicrobial agents towards P. aeruginosa isolated from aquaculture and water environment in the study area.

New technologies to generate, store and retrieve medical and research data are inducing a rapid change in clinical and translational research and health care. Systems medicine is the interdisciplinary approach wherein physicians and clinical investigators team up with experts from biology, biostatistics, informatics, mathematics and computational modeling to develop methods to use new and stored data to the benefit of the patient. We here provide a critical assessment of the opportunities and challenges arising out of systems approaches in medicine and from this provide a definition of what systems medicine entails. Based on our analysis of current developments in medicine and healthcare and associated research needs, we emphasize the role of systems medicine as a multilevel and multidisciplinary methodological framework for informed data acquisition and interdisciplinary data analysis to extract previously inaccessible knowledge for the benefit of patients.