Background: Inflammatory bowel disease (IBD) is a chronic inflammatory immune-mediated condition that affects the gastrointestinal system and alters bone growth and bone mineral density (BMD). Here we aimed to study the prevalence and predictors of a low BMD in pediatric patients with IBD. Methods: This retrospective cross-sectional analytical study included pediatric patients with IBD in whom BMD was evaluated using dual energy X-ray absorptiometry of the total body and lumbar spine. Osteoporosis was defined as a BMD Z-score ≤-2, osteopenia as -2 to -1, and normal as >-1. Clinical and laboratory findings were compared between patients with and without osteoporosis. Results: Of the 48 patients, 30 (62.5%) were males, 35 (72.9%) had Crohn’s disease, and 13 (27.1%) had ulcerative colitis. The mean age at diagnosis was 9.9±2.8 years. The median age at the time of the BMD scans was 11.9 (interquartile range, 9.9–14.3) years. Total body BMD scans identified 13 (27.1%) and 16 (33.3%) patients with osteoporosis and osteopenia, respectively. Spinal BMD scans revealed that 17 (39.5%) and 14 (32.6%) patients had osteoporosis and osteopenia, respectively. A low body mass index (BMI) Z-score (p=0.038), ileocolonic disease location (p=0.008), and a low calcium level (p=0.008) were significant predictors of osteoporosis on the total body BMD scans. A low BMI Z-score (p=0.039), decreased hemoglobin level (p=0.018), low calcium level (p=0.033), and infliximab use (p=0.019) were significant predictors of osteoporosis on the spinal BMD scans. Conclusions This study showed a high prevalence of low BMD among pediatric patients with IBD. A low BMI, ileocolonic disease location, low hemoglobin and calcium levels, and infliximab use were significantly associated with osteoporosis.

Trimethoprim-sulfamethoxazole is an active agent against Burkholderia pseudomallei and is being used in intensive and maintenance phases of melioidosis therapy. In this study, we evaluated the bactericidal activities of β-lactams (imipenem, ceftazidime and amoxicillinclavulanate) alone and in combinations with trimethoprim-sulfamethoxazole against B. pseudomallei. Four clinical strains of B. pseudomallei were selected based on different genotypes that are frequently found in Malaysia. The minimum inhibitory concentrations of trimethoprim-sulfamethoxazole, ceftazidime, imipenem and amoxicillin-clavulanate were determined using microdilution broth method. The bactericidal activities and synergy effects of β-lactams and/or trimethoprim-sulfamethoxazole were evaluated by checkerboard and static time-kill analyses at 1×MIC concentration of each antibiotic. Using checkerboard method, the β-lactam/trimethoprim-sulfamethoxazole combinations exhibited ΣFIC of 0.75-4.00. In time-kill analysis, ceftazidime/trimethoprim-sulfamethoxazole combination demonstrated synergy against three strains (less 2.25-2.41 log10CFU/mL compared to the most active antibiotic monotherapy) whereas imipenem/trimethoprim-sulfamethoxazole combination regimen showed synergy against one strain (less 3.32 log10CFU/mL). No antagonist effect or major re-growth was observed in all combination regimens, whereas 11 out of 12 of β-lactam monotherapy regimens were associated with re-growth of bacteria. However, all β-lactam monotherapy regimens exhibited rapid and stronger killing activities against BUPS/07/14, in the initial 12 hours compared to β-lactam/ trimethoprimsulfamethoxazole combination regimens. The combination of β-lactams with trimethoprimsulfamethoxazole demonstrated better killing effect at 24 hours compared to monotherapy and no major bacterial regrowth was observed. Nevertheless, delay in killing activities of β-lactam/trimethoprim-sulfamethoxazole combination regimens against BUPS/07/14 need further examination because this phenomenon can lead to treatment failure in some patients.

Reduced susceptibility in Burkholderia pseudomallei during carbapenem therapy may lead to treatment failure. We isolated a clinical strain that had developed reduced susceptibility to carbapenems while on treatment. After reviewing the patient’s clinical notes, the initial isolate (BUPS01/14) was exposed to carbapenem in vitro to mimic the clinical scenario. The stability of susceptibility of the carbapenem-exposed strain (BUPS01/14R) was examined by serial subculture in antibiotic-free broth. Biochemical and morphological comparison was performed by the VITEK® system and electron microscopy. MICs increased 32-fold following carbapenem exposure and became stable in the antibiotic-free environment. On electron microscopic examination, the BUPS01/14R cells were smoother and less wrinkled compared to BUPS01/14 cells. This report highlights a potential anti-melioidosis treatment failure due to the emergence of resistance while on carbapenem monotherapy. Further study of this strain is necessary to understand the mechanism of resistance at a molecular level.

An investigation was undertaken for screening and isolating nematophagous-fungi from the faecal samples of various grazing animals and soils in Malaysia. Total of 111 faeces and 50 soil samples were collected and the samples were cultured on 2% water agar plates. The growth of nematophagous-fungi was stimulated by sprinkling-baiting technique. The conidia of suspected nematophagous-fungi were inoculated on 2% water agar plates. All isolated were maintained on 2% cornmeal agar plates. Verticillium spp., Fusarium spp. and Arthrobotrys spp. were identified from the faecal and soil samples. 62.5% of the faecal samples and 100% of the soil samples were shown to be positive with nematophagous-fungi. This study highlights the present of nematophagous-fungi population in faecal and soil samples. Much study remains to be done to better understanding some fungi especially their mode of action and their predatory behaviour against parasitic nematodes.

Aims:Thisstudy aimed to assess the risk of reproductive tract contamination in Aceh cattle by Escherichia fergusoniias revealed by 16S rRNA gene sequencing of preputial swab samples.Methodology and results:Preputial swabs taken from 50 breeding bulls at the Indrapuri Breeding and Forage Center of Aceh Cattle, Banda Aceh, Indonesia, were examined for the presence of bacteria. Samples were streaked on MacConkey agar and incubated under aerobic conditions at 37°C for 24 h. Smooth,yellow-or rose-colored colonies were selected for their characteristic appearance andsubjected to further analysis. Genetic identification was based on 16S rRNA gene sequencing and PCR analysis. We conducted a 16S rRNA sequence similarity search with GenBank using BLAST and constructed neighbour-joining dendrogramsusing MEGA. From among closely related species of the genus Enterobacteriaceae, we identified the enteric bacterium E. fergusoniias having the highest sequence similarity.Conclusion, significance and impact of study:We concluded that the E. fergusoniibacterium positively presence in preputial swab samples of clinically healthyAceh cattle population. Accordingly, it is potentially allowing the bacterium to be spread during natural mating or semen collection processing for artificial insemination in cattle breeding farm

BACKGROUND: Bone marrow involvement (BMI) affects the lymphoma stage, survival, and treatment. Bone marrow biopsy (BMB) and fluorodeoxyglucose (FDG) positron emission tomography- computed tomography (PET/CT) are useful techniques to detect BMI. Both have advantages and disadvantages. We aimed to identify factors that could be used to predict BMI with positive and negative results on PET/CT compare them with BMB in newly diagnosed patients with lymphoma. METHODS: We included 22 non-Hodgkin and 16 Hodgkin lymphoma patients in this single center study. All patients had PET/CT examination and BMB before treatment. BMI in BMB was reported as negative or positive. Bone marrow was classified into 3 types by FDG uptake on PT/CT; diffuse involvement, focal involvement, and normal bone marrow. RESULTS: PET/CT and BMB results were concordant (7 positive, 15 negative) in 22 patients (57%). We evaluated concordant and discordant patient characteristics and risk-stratified patients for BMI. Our findings suggest that patients with diffuse FDG uptake on PET/CT, especially patients with advanced age and low platelet and white blood cell counts, are likely to have BMI and could potentially forego BMB. Patients with negative PET/CT findings and no significant laboratory abnormalities are very unlikely to have BMI. CONCLUSION: Our results suggest that BMI should not be decided solely based PET/CT or BMB findings. It is reasonable to use both diagnostic assays along with clinical and laboratory findings. PET/CT result, clinical and laboratory findings could be useful for predicting BMI in patient for whom BMB is contraindicated.
Biopsy ; Blood Platelets ; Bone Marrow* ; Electrons ; Hodgkin Disease ; Humans ; Leukocyte Count ; Lymphoma* ; Positron-Emission Tomography and Computed Tomography*

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients. Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in treatment by loss of preoperative symptoms and radiological union on plain radiographs of the ankle. Results: Fusion was achieved in all patients (100%). Immediate post-operative ambulation was with full weight bearing (FWB) in 16 (83%) of the participants and non-weight bearing (NWB) in 3 patients (17%). Postprocedure 11 patients (67%) of the participants who were full weight bearing required some form of support for walking for 2-3 weeks. Post-operatively three patients had pin tract infection requiring intravenous antibiotics. Radiological union took range of 6-12 weeks, mean union time was 8 weeks. Only one patient required bone grafting due to bone loss. Average follow-up period was 10-45 months. Conclusion: The Ilizarov technique has a high union rate and leads to general favourable clinical outcome and may be considered for any ankle arthrodesis but is especially useful in complex cases such as for revisions, soft-tissue compromise, infection and in patients with risk for non-union. Early weight bearing is an extra benefit.

Objectives: The objectives of our study were to determine the mean age of onset of thelarche and menarche, to determine the ages of each stage of puberty and to investigate if there are any ethnic differences in these ages amongst female adolescents in Kuala Lumpur, Malaysia. Methods: This was a cross-sectional study involving three secondary schools in Cheras, Kuala Lumpur. A total of 730 students were recruited via stratified random sampling. Self-administered survey forms on menstruation and puberty were used. Results: Out of 730 recruited respondents, 385 (52.74%) completed the survey and informed consents were obtained from their parents/legal guardians. Our respondents’ ages ranged between 13 to 17 years old with the median (IQR) age of 14.00(2.00) years. With regards to ethnicity, 329 (85.50%) were Malay, 46 (11.90%) were Chinese, 9 (2.30%) were Indian and 1(0.30%) was a Bajau. The mean age for breast development (thelarche) and menarche were 11.72 ±1.10 and 11.97±1.11 years respectively. The majority, 363 (94.30%), out of 385 respondents had attained menarche. There appeared to be a later onset of puberty amongst Malays comparatively. Conclusion: The mean ages of pubertal onset and menarche amongst female adolescents in the Cheras area are similar to those reported worldwide.

OBJECTIVETo test the in vitro antimicrobial efficacy of water and methanol extracts of 23 plant species that are commonly used in Libyan folk medicine.

METHODSThe antimicrobial activity was determined using the well-diffusion method. Four test microorganisms were used namely, Escherichia coli, Salmonella species, Staphylococcus aureus and Bacillus subtilis. The minimum inhibitory concentration (MIC) was determined for the high biologically active crude plant extracts.

RESULTSAmong 23 medicinal plants used in the study, only 5 methanolic extracts [Rosmarinus offcinalis L., Carduus marianium L., Lantana camara L., Rhus tripartite (ueria) Grande, and Thymus capitatus (L.) Hoffm (link)] showed the highest antimicrobial activity against Staphylococcus aureus, Bacillus subtilis and Salmonella species, while 22 methanolic and aqueous extracts showed moderate to weak antimicrobial activity on all tested organisms. However 19 of the extracts showed no activity at all against Gram-ve and Gram +ve microorganisms. MIC was found to be 1.25 mg/mL (Thymus capitatus), 3 mg/mL (Rhus tripartite), 4 mg/mL (Carduus marianium), 5 mg/mL (Rosamarinus officinalis) and 5 mg/mL (Lantana camara), respectively.

CONCLUSIONSThe present results revealed that, crude methanolic extracts of the investigated Libyan folk medicinal plants exhibited mild to high in vitro antibacterial activities against Gram-positive and Gram-negative microorganisms.

Anti-Infective Agents ; pharmacology ; Bacteria ; drug effects ; Chromatography, Thin Layer ; Libya ; Microbial Sensitivity Tests ; Plant Extracts ; pharmacology ; Plants, Medicinal ; chemistry

OBJECTIVE: Migraine, a highly prevelant headache disorder, is regarded as a polygenic multifactorial disease. Serotonin (5-HT) and their respective receptors have been implicated in the patogenesis. METHODS: We investigated the 5-HT1A, 5-HT1B, 5-HT2A, and 5-HT2C receptor gene polymorphisms and their association with migraine in Turkish patients. The rs6295, rs1300060, rs1228814, rs6311, rs6313, rs6314, rs6318, rs3813929 (−759C/T) and rs518147 polymorphisms were analyzed in 135 patients with migraine and 139 healthy subjects, using a BioMark 96.96 dynamic array system. RESULTS: We found no difference in the frequency of the analyzed eight out of nine polymorpisms between migraine and control groups. However, a significant association was found between the rs3813929 polymorphism in the promoter region of 5-HTR2C gene and migraine. Also, the allele of rs3813929 was more common in the migraine group. CONCLUSION: This result suggests that the 5-HTR2C rs3813929 polymorphism can be a genetic risk factor for migraine in a Turkish population.
Alleles ; Genetic Association Studies ; Headache ; Headache Disorders ; Healthy Volunteers ; Humans ; Migraine Disorders* ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Receptor, Serotonin, 5-HT2C ; Risk Factors ; Serotonin*