Background: Burn injuries are a major global health issue, causing significant morbidity and mortality. Negative-pressure wound therapy (NPWT) is a common treatment that aids fluid drainage and enhances blood flow, thereby promoting wound healing. However, its effects on wound healing parameters like fibroblast growth factor-2 (FGF2) and platelet-derived growth factor (PDGF) in deep dermal burns are not fully elucidated. This study aimed to compare NPWT with conventional treatments, namely 0.9% sodium chloride (NaCl) and silver sulfadiazine (SSD), in terms of their effects on FGF2 and PDGF levels in burn wounds. Methods: Seventy-two fresh tissue samples from Yorkshire pig deep dermal burn models were divided into three treatment groups: NPWT, NaCl, and SSD. Wounds were photographed and observed macroscopically. Tissue samples were collected on days 3, 7, 14, and 21 and analyzed using enzyme-linked immunosorbent assay for further statistical analysis. Results: Macroscopic observation indicated better epithelialization and granulation in the NPWT group, with minimal wound contraction. Although differences across the treatment groups were insignificant, NPWT maintained higher and more stable FGF2 levels, peaking on days 7 and 21 (780.62±353.88 ng/mL and 504.31±254.25 ng/mL), with significant delta (Δ) value increases in the later stages (P=0.042), which were not observed in the NaCl and SSD groups. PDGF concentrations showed insignificant differences across all treatment groups, with notable delta changes in the SSD group (P=0.018). Conclusion NPWT demonstrated superior wound healing performance compared to conventional treatments. In addition to favorable macroscopic findings, NPWT potentially maintained FGF2 levels throughout the wound healing process.

Injuries deeper than the platysma are considered as penetrating neck injuries, constituting approximately 5% - 10% of all trauma. Many vital organs are at risk from a penetrating neck injury. These injuries in zone 1 have the highest mortality, because the injuries are close to the vital organs and difficult to access surgically. A 41-year-old male, a car mechanic by profession, presented to the emergency department with a penetrating neck injury on the right side. CT scan demonstrated a metallic foreign body in zone 1 between the right internal jugular vein and the common carotid artery. The patient was asymptomatic, and the foreign body was removed surgically. This case shows a rare presentation of a penetrating neck injury with a foreign body located in zone 1, where no vital internal structure was injured. As of now, no previous case report has been identified on such presentation. Thus, it will provide a valuable addition to the pre-existing literature.
Humans ; Male ; Adult ; Neck Injuries/diagnostic imaging* ; Wounds, Penetrating/diagnostic imaging* ; Foreign Bodies/diagnostic imaging* ; Jugular Veins ; Tomography, X-Ray Computed ; Carotid Artery Injuries/surgery* ; Carotid Artery, Common

Aims: This study aims to determine the antibacterial potential and identify the bioactive compounds of Hypoxylon monticulosum isolated from marine macroalgae Ulva lactuca. Methodology and results : Ulva lactuca was collected from the Desaru coast, Johor, Malaysia and three endophytes were isolated following surface sterilisation. One fungal isolate was further characterised by the morphology of white, yellowish colonies and fibrous with a waxy structure indicative of a member from the genus Hypoxylon. Molecular identification through internal transcribed spacer (ITS) sequence analysis matches the reference sequence with more than ≥98% homology to Hypoxylon monticulosum AS26-D8. Minimum inhibition concentration (MIC) of the fungal ethyl acetate (EA) extract was determined against five human pathogenic bacteria. Wide spectrum antibacterial activity was noted; with MIC against Escherichia coli was 1.25 ± 0 mg/mL, Bacillus subtilis and Enterobacter faecalis both at 5.00 ± 0 mg/mL, and finally, both Staphylococcus aureus and Klebsiella pneumoniae were 10.00 ± 0 mg/mL, respectively. Bioassay-guided fractionation was performed using solvents of increasing polarities, producing three fractions and analysis by liquid chromatography-mass spectrometry (LC/MS) identified 128 compounds. From these, nine compounds were identified as having biological activities. Dihydrocordoin, D-pantothenoyl-L-cysteine, caffeine and Tumonoic A acid were among the compounds identified as having antibacterial properties. Conclusion, significance and impact of study Hypoxylon monticulosum from marine source has antibacterial potential owing to the compounds previously reported to display antibacterial and other biological properties. The compounds differ from those previously reported in H. monticulosum from terrestrial sources.

Background: Atrial tachycardia poses challenges in patient management due to the associated risks of stroke and systemic embolism. While anticoagulation is recommended in atrial fibrillation (AF), its role in atrial tachycardia remains less defined. This prospective study aimed to evaluate the efficacy and safety of apixaban, a direct oral anticoagulant, in individuals diagnosed with left-sided atrial tachycardias. Methods: Patients diagnosed with left-sided atrial tachycardia (n = 439) were observed over 3 years. Baseline characteristics, medication regimens, and clinical outcomes were assessed. Apixaban-treated individuals (n = 213) received standard or reduced dosages, while the control group (n = 226) received standard care. Primary outcomes included stroke, systemic embolism, bleeding, and mortality rates. Results: Baseline characteristics were comparable between groups. The apixaban cohort showed a lower incidence of stroke (7.0% vs. 9.3%, p = 0.027) and decreased all-cause mortality (11.7% vs. 12.8%, p = 0.012) compared to controls.No significant differences were found in major bleeding or systemic embolization between groups. Conclusion Apixaban demonstrated a potential benefit in reducing stroke and mortality rates in patients with leftsided atrial tachycardia. While requiring further validation, these findings suggest a potential role for apixaban in anticoagulation strategies for atrial tachycardia management.

Introduction: To combat the COVID-19 pandemic, Malaysia started vaccination of front-liners and adults in the community. The latter group might have insufficient knowledge to accept COVID-19 vaccination, therefore this research was to assess the knowledge and acceptance of COVID-19 vaccination among youths, specifically students in a Malaysian college. Methods: A cross-sectional study was conducted among 481 foundation students in Kolej MARA Kulim (KMKU). The minimum sample size, using Epi Info was 214. Students answered an online questionnaire using google form which included demographic data (age, gender) and ten questions on knowledge and acceptance of COVID-19 vaccination. For knowledge questions, students answered “yes”, “no” or “don’t know”, correct answer scoring 1. For acceptance questions, a 5-point Likert scale was used ranging from “strongly disagree” to “strongly agree”. EXCEL and SPSS version 23 were used for analysis with Chi-square test done to test association (significant for p-value <0.05). Results: The response rate was 65.1% with 313 students, (45.4% males, and 54.6% females) aged 18-19 years. The majority (83.7%) had satisfactory to excellent knowledge scores (mean = 6.66 (SD=2.299, 95% CI 6.40-6.91), median = 7 (± IQR =3), while 16.3% obtained poor scores (≤ 4). The majority (90%) accepted vaccination. Higher knowledge scores were associated with higher acceptance rates in both genders (p-value= 0.000). Significantly more females (90.6%) than males (80.3%) had positive attitude towards vaccination (p-value = 0.009). Conclusions: The majority of the foundation students in KMKU were knowledgeable on COVID-19 vaccination and willing to receive the vaccination against the novel coronavirus.

COVID-19/virology* ; Cities ; Environmental Monitoring ; Genome, Viral ; Humans ; Infection Control/methods* ; Pakistan ; RNA, Viral/genetics* ; SARS-CoV-2/genetics* ; Sewage/virology*

Background/Aims: More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB). Methods: A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB. Results: Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%). Conclusion The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

Background: Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients. Methods: We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials (RCTs) and matched cohort studies involving NSS as the control arm and low-chloride solutions as an intervention arm were chosen. The standardized mean difference for continuous variables, the odds ratio (OR) for discrete variables, and a 95% confidence interval (CI) for effect sizes were used. A p-value of <0.05 was considered statistically significant. Analysis was performed using a random-effects model irrespective of heterogeneity, which was evaluated using I2 statistics. Results: Nine RCTs and one cohort study with a total of 726 patients were included. After transplantation, serum potassium was significantly lower in the low-chloride group (standardized mean difference compared to NSS group, –0.38 mEq/L; 95% CI, –0.66 to –0.11; p = 0.007). Similarly, postoperative chloride was lower in the low-chloride group (–2.41 mEq/L [–3.34 to –1.48], p < 0.001). No statistically significance was observed in delayed graft function (OR, 0.98 [0.56–1.69], p = 0.93), day 3 creatinine (–0.14 mg/dL [–0.46 to 0.18], p = 0.38), or day 7 urine output (–0.08 L [–0.29 to 0.12], p = 0.43). Conclusion Use of NSS during renal transplant leads to increased incidence of hyperchloremic acidosis with subsequent hyperkalemia, but clinical significance in the form of delayed graft function or postoperative creatinine remains comparable to that of low-chloride solutions.

Background/Aims: More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB). Methods: A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB. Results: Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%). Conclusion The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

Introduction: Numerous studies have examined both the effect of caries and dental care under general anaesthesia affecting children and children with special needs, but there is still scant information on the relationship between both classes. Thus this project is aimed i) to compare oral health-related quality of life in children and children with special needs undergoing dental care under general anaesthesia (GA) and ii) To compare the impact on oral health-related quality of life in children and children with special needs. Methods: Forty-six children (25 normal children, 21 children with special needs) are recruited. Participating parents completed a brief version of the Perceptions Questionnaire (P-CPQ) and Family Impact Scale (FIS) before the treatment and subsequent follow-up appointments (4 weeks to 8 weeks). Oral symptoms, social health, psychology, functional limitation, and family effect ratings, the mean, standard deviations, and statistical differences between groups were analysed. Results: 52.2% of both parent groups rated the oral health status of their children as low before GA, and it improved considerably, with 69.6% of parents rating post-operatively as healthy. The most recorded impacts at baseline were pain, discomfort, often annoyed and angry among children and parents feeling guilty and upset due to the condition of the child. Conclusion: Oral rehabilitation under GA leads to the immediate improvement of oral health, mental, and social quality among the children in both groups. However, for parents of children with special needs, despite the effort to eradicate dental-related issues, the overall quality of life shows no significant improvements.