Aims: The objective of the research was to get the potential cellulolytic bacteria which was caffeine tolerance from Indonesian coffee pulp waste. Methodology and results: The cellulolytic bacteria were isolated from coffee pulp wastes of Coffea arabica and C. canephora. These isolates were selected based on their cellulose hydrolysis, CMCase activity, and caffeine tolerance. The density of cellulolytic bacteria of C. arabica pulp waste was 4.7 ± 3.5 × 106 CFU/g, and that of C. canephora pulp waste was 1.5 ± 1.5 × 106 CFU/g. Among 61 cellulolytic bacterial isolates, 24 isolates formed clear zones on CMC medium with Gram iodine flooding. Three isolates (CRM10, CRM1, and CRM12) from C. canephora pulp waste had the highest cellulolytic activity. Based on the CMCase activity, it was indicated that an isolate of CRM10 showed the highest CMCase activity with 3.38 ± 0.65 U/mL. This bacteria had tolerance ability to caffeine until 0.4% on nutrient agar medium. Isolates of CRM10 had similarity to Bacillus subtilis based on 16S rDNA sequence. Conclusion, significance, and impact of study: CRM10 was identified as Bacillus subtilis and considered as a potential isolate to degrade cellulose of coffee pulp waste that contained caffeine. .

Aims: The objective of this research was to isolate caffeine-degrading bacteria from coffee pulp waste in Indonesia andcharacterize their caffeine degradation activity.Methodology and results: The caffeine-degrading bacteria were isolated from coffee pulp wastes of Coffea arabicaand C. canephora. These isolates were selected based on their caffeine degradation activity. The identification andbiochemical properties of the best isolate were conducted via 16S rDNA sequence analyses and by using the Microbactkit. Meanwhile, caffeine degradation activity of this bacteria was analyzed by using LC-MS/MS. The results indicatedthat fourteen bacterial isolates were able to degrade caffeine. The highest caffeine degradation activity was performedby isolate KRM9 at the rate of 99.26 ± 0.01%, on a caffeine medium after 24 h of incubation. Based on the 16S rDNAanalyses, the KRM9 isolate was identified as Pseudomonas monteilii. Till present, this species has not been reported asa caffeine-degrading bacterium. However, LC-MS/MS analysis indicated that caffeine was degraded by P. monteiliiKRM9 and theobromine was not the secondary metabolite of caffeine degradation.Conclusion, significance and impact of study: Pseudomonas monteilii KRM9 was detected as a new isolate ofcaffeine-degrading bacteria. This bacterium can be introduced as an agent to degrade caffeine from coffee pulp waste. Itis expected that further research can be conducted on the overall mechanism of caffeine degradation by P. monteiliiKRM9

Background: The Cervical Ripening Balloon (CRB) is a novel mechanical method for induction of labour (IOL), reducing the risks of hyperstimulation associated with pharmacological methods. However, there remains a paucity of literature on its application in high risk mothers, who have an elevated risk of uterine rupture, namely those with previous scars and grandmultiparity. Methodology: A retrospective study on IOL using the CRB in women with previous caesarean section or grandmultiparity between January 2014 and March 2015. All cases were identified from the Sarawak General Hospital CRB request registry. Individual admission notes were traced and data extracted using a standardised proforma. Results: The overall success rate of vaginal delivery after IOL was 50%, although this increases to about two-thirds when sub analysis was performed in women with previous tested scars and the unscarred, grandmultiparous woman. There was a significant change in Bishop score prior to insertion and after removal of the CRB. The Bishop score increased by a score of 3.2 (95% CI 2.8-3.6), which was statistically significant (p<0.01) and occurred across both subgroups, not limited to the grandmultipara. There were no cases of hyperstimulation but one case of intrapartum fever and scar dehiscence each (1.4%). Notably, there were two cases of change in lie/presentation after CRB insertion. Conclusion: CRB adds to the obstetricians’ armamentarium and appears to provide a reasonable alternative for the IOL in women at high risk of uterine rupture. Rates of hyperstimulation, maternal infection and scar dehiscence are low and hence appeals to the user.
Pregnant Women

Background: The contemporary obstetrician is increasingly put to the test by rising numbers of pregnancies with morbidly adherent placenta. This study illustrates our experience with prophylactic bilateral internal iliac artery occlusion as part of its management. Methods: Between January 2011 to January 2014, 13 consecutive patients received the intervention prior to scheduled caesarean delivery for placenta accreta. All cases were diagnosed by ultrasonography, color Doppler imaging and supplemented with MRI where necessary. The Wanda balloonTM catheter (Boston Scientific, Natick, MA, U.S.A) were placed in the proximal segment of the internal iliac arteries preceding surgery. This was followed by a midline laparotomy and classical caesarean section, avoiding the placenta. Both internal iliac balloons were inflated just before the delivery of fetus and deflated once haemostasis was secured. Primary outcomes measured were perioperative blood loss, blood transfusion requirement and the need for ICU admission. Results: The mean and median intraoperative blood loss were 1076mls±707 and 800mls (300-2500) respectively while mean perioperative blood loss was 1261mls±946. Just over half of the patients in our series required blood and/or blood products transfusion. Two patients (15.4%) required ICU admission. Conclusion: Our study suggests that preoperative prophylactic balloon occlusion of bilateral internal iliac arteries reduces both blood loss and transfusion requirement in patients with placenta accreta, scheduled to undergo elective caesarean hysterectomy. It is an adjunct to be considered in the management of a modern day obstetric problem, although the authors are cautious about generalizing its benefit without larger, randomized trials.
Placenta Accreta

Introduction: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM. Objective: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia. Methodology: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio. Results: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant. conclusion: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.
Diabetes, Gestational

This case report discusses dumping syndrome in the postbariatric mother. Diagnostically a challenge, the symptoms of postprandial hypoglycaemia mimic common early gestation complaints and may go undiagnosed, thus requiring a high index of suspicion. As weight-loss surgery gains traction, it is pertinent to note at booking and followups. The pregnancy is at-risk and multidisciplinary team management is central. The mainstay of management remains diet modification. There have been case reports of successful medical treatment of dumping syndrome in pregnancy with good maternal and fetal outcomes. However, more data is needed regarding the usage of these medical treatments in pregnancy.
Dumping Syndrome ; pregnancy

Background: In the course of managing preterm labour, increasing trends of total white cell count raises concern for the obstetrician, suggesting a possible underlying infectious aetiology. Although mild leukocytosis is expected in pregnancy, the patterns of increment after corticosteroid administration are not well described beyond animal models and in a small number of human studies. Methods: Seventy-three consecutive patients who required antenatal corticosteroids for either preterm labour or prelabour caesarean section were recruited and given a standard course of 12mg dexamethasone phosphate, twelve hours apart. Venous blood samples were taken before administration, at six hours and 36 hours after the first dose of dexamethasone. Results: The total white count trend was 10.31±2.62 at baseline, 11.44±3.05 at six hours and 12.20±3.49 at 36 hours. Neutrophil-lymphocyte ratio was 3.60±1.31, 8.73±3.63 and 3.24±1.49 respectively, reflecting relative neutrophilia and lymphopenia which normalised by 36 hours. Conclusion: In contrast to previous studies, we found only a slight increment in total white cell count of about 10%. The marginal changes described in our study would not normally raise any clinical concern, although vigilance should be exercised if higher levels were observed.
Leukocytosis ; Pregnancy

Severe sepsis with multi-organ failure is associated with ahigh mortality rate. This case report highlights thechallenges and modalities available in the management of alady with refractory shock and disseminated intravascularcoagulation (DIC) due to toxic shock syndrome (TSS) fromgenital tract sepsis. Early surgical intervention to removethe source of infection, the use of recombinant activatedfactor VII to treat intractable disseminated intravascularcoagulation and intravenous immunoglobulin to neutralisethe circulating exotoxins, have been employed and shown todrastically improve outcomes.

OBJECTIVETo investigate the toxicity of indigenous Bacillus thuringiensis (B. thuringiensis)isolates from Malang City for controlling Aedes aegypti (Ae. aegypti) larvae.

METHODSSoil samples were taken from Purwantoro and Sawojajar sub-districts. Bacterial isolation was performed using B. thuringiensis selective media. Phenotypic characteristics of the isolates were obtained with the simple matching method. The growth and prevalence of spores were determined by the Total Plate Count method, and toxicity tests were also performed on the third instar larval stage of Ae. aegypti. The percentage of larval mortality was analysed using probit regression. The LC50 was analysed by ANOVA, and the Tukey HSD interval was 95%.

RESULTSAmong the 33 selected bacterial isolates, six were obtained (PWR4-31, PWR4-32, SWJ4-2b, SWJ4-4b, SWJ-4k and SWJ5-1) that had a similar phenotype to reference B. thuringiensis. Based on the dendrogram, all of the bacterial isolates were 71% similar. Three isolates that had a higher prevalence of reference B. thuringiensis were PWR4-32, SWJ4-4b and SW5-1, of which the spore prevalence was 52.44%, 23.59%, 34.46%, respectively. These three indigenous isolates from Malang City successfully killed Ae. aegypti larvae. The PWR4-32 isolates were the most effective at killing the larvae.

CONCLUSIONSSix indigenous B. thuringiensis isolates among the 33 bacterial isolates found in the Sawojajar and Purwantoro sub-districts were toxic to the third instar larvae of Ae. aegypti. The PWR4-32 isolates were identical to the reference B. thuringiensis and had 88% phenotype similarity. The PWR4-32 isolates had the highest spore prevalence (52.44%), and the early stationary phase occurred at 36 h. The PWR4-32 isolates were the most effective at killing Ae. aegypti larvae (LC50-72 h=2.3×10(8) cells/mL).

Aedes ; microbiology ; Animals ; Bacillus thuringiensis ; isolation & purification ; physiology ; Biological Control Agents ; Indonesia ; Insecticides ; Larva ; microbiology ; Lethal Dose 50 ; Mosquito Control

Objective: To isolate, characterize and evaluate toxicity of Bacillus sphaericus (B. sphaericus) from beach area of Lombok Island. Methods: Soil was collected from determined locations and suspended in sterile physiological saline water. After heat shock was applied, suspension was spread on NYSM agar medium. Colonies grown were then observed and isolated. Colony, cell morphology, and biochemical/physiological characteristics were tested and compared to B. sphaericus 2362 as standard. Initial toxicity testing was done against three species of mosquito larvae (Culex quinquefasciatus, Anopheles aconitus and Aedes aegypti) and isolates that showed more than 50% larvae killing will be assayed to obtain LC