Post-mortem microbiology (PMM) is an important tool in identifying possible causes of sudden unexpected death, as an infectious cause is highly suspected. However, contamination is a major problem in microbiology, and this has increased the difficulty determining the true pathogen that contributes to death in post-mortem cases. Skin commensals are common contaminants in blood cultures. This study was conducted to investigate the skin flora on early deceased bodies and observe the bacteria detected at different post-mortem intervals (PMIs). As blood is usually drawn from the neck and femoral sites for PMM examination, the two body sites were chosen as the sampling sites. Skin swab samples from the neck and femoral (n=80) of each early deceased body were collected by sterile cotton swabs. DNA was extracted from the swabs and then subjected to high-throughput 16S rRNA sequencing by using the Illumina MiSeq platform. Staphylococcus was found to be the most dominant genus in both neck and femoral sites. LEfSe results showed that Cutibacterium is significantly different at the neck site while Corynebacterium is more abundant at femoral site. There are significant differences at genus level between PMI<5H and PMI>5H at both neck and femoral sites. The findings of the present study may act as a reference for microbiologists and forensic pathologists when mixed growth or contamination occurs in post-mortem blood cultures.

INTRODUCTION: There are limited reports on the epidemiology of paediatric intensive care unit (PICU) admissions, deaths and organ donation candidacy. We aimed to describe PICU admission characteristics and outcomes, determine risk factors for mortality, and perform an independent assessment of missed organ donation opportunities. METHOD: We adopted a clinical audit design recruiting consecutive patients admitted to a single-centre multidisciplinary PICU from June 2020 to December 2023. Clinical characteristics and outcomes of survivors and non-survivors were described. Multivariable regression was performed to identify independent risk factors for mortality. Organ donation candidacy was evaluated by an independent team based on the criteria by Singapore's National Organ Transplant Unit. RESULTS: There were 1766 PICU admissions with mean age ± standard deviation of 5.9 ± 6.0 years. Surgical admissions accounted for 707/1766 (40%), while the most common medical admission category was respiratory (416/1766; 23.6%). The majority of 983/1766 (55.7%) had a chronic comorbidity and 312/1766 (17.6%) were dependent on at least 1 medical technology device. Mortality occurred in 99/1766 (5.6%). After adjusting for elective admissions and admission category; comorbidity with adjusted odds ratio (aOR) 95% confidence interval (CI) 3.03 (1.54-5.96); higher Pediatric Index of Mortality 3 (PIM 3) score with aOR 1.06 (95% CI 1.04-1.08); and functional status scale with aOR 1.07 (95% CI 1.00-1.13) were associated with mortality. Among non-survivors, organ donor candidacy was 21/99 (21.2%) but successful organ donation occurred in only 2/99 (2.0%). CONCLUSION In this single-centre audit, comorbidities, PIM 3 score and functional impairment were associated with mortality. Efforts are needed to improve paediatric organ donation rates.
Humans ; Male ; Female ; Tissue and Organ Procurement/statistics & numerical data* ; Intensive Care Units, Pediatric/statistics & numerical data* ; Child, Preschool ; Child ; Infant ; Singapore/epidemiology* ; Risk Factors ; Patient Admission/statistics & numerical data* ; Hospital Mortality ; Adolescent ; Medical Audit ; Comorbidity ; Clinical Audit

Parent-implemented language intervention (PILI) is one of the intervention approaches used in managing late talkers (LTs). Yet, there are few evidence-based PILI programs available for parents of LTs. This scoping review aimed to (a) assess the characteristics of participants depicted in the literature related to PILI programs for parents of LTs, (b) provide an overview of the structure and design of the available PILI programs for parents of LTs, and (c) explore the effectiveness of the programs in relation to the characteristics of reviewed studies. The scoping review was performed by adhering to the general principles prescribed by Arksey and O’Malley (2005). Articles that fulfilled the inclusion criteria and were published from 1980 to 2018 were selected. Two reviewers independently charted the information from the identified articles. A total of 15 articles were selected. The results were reviewed in terms of participant characteristics, intervention characteristics, and effectiveness of PILI programs. Most adult participants in PILI studies were mothers and included child participants with either expressive language delay or receptive and expressive language delay. Moreover, there were different structures and designs of PILI programs for parents of LTs. Preliminary evidence indicated that PILI was more effective than no/delayed intervention and could be as effective as direct therapy provided by clinicians. A discussion related to the findings was also presented.

Objectives: Insulin degludec (IDeg)/insulin aspart (IAsp; IDegAsp) is a co-formulation of 70% IDeg and 30% IAsp. According to several randomized controlled trials, IDegAsp is effective and safe for patients with type 2 diabetes mellitus (T2DM). A subgroup analysis of the ARISE study was conducted to explore the safety and efficacy of IDegAsp among Malaysian patients with T2DM in real-world settings. Methodology: ARISE, an open-label, multicenter, non-interventional, prospective study was conducted between August 2019 and December 2020. Adult Malaysian patients with T2DM who were enrolled from 14 sites received IDegAsp as per the local label for 26 weeks. The primary endpoint was change in glycated hemoglobin (HbA1c) levels from baseline to end of study (EOS). Results: Of the 182 patients included in the full analysis set, 159 (87.4%) completed the study. From baseline to EOS, HbA1c (estimated difference [ED]: –1.3% [95% CI: –1.61 to –0.90]) and fasting plasma glucose levels (ED: –1.8 mmol/L [95% CI: –2.49 to –1.13]) were significantly reduced (p<0.0001). The patient-reported reduced hypoglycemic episodes (overall and nocturnal) during treatment. Overall, 37 adverse events were observed in 23 (12.6%) patients. Conclusion Switching or initiating IDegAsp treatment resulted in significant improvements in glycemic control and a reduction in hypoglycemic episodes.

The HACEK organisms consist of the non-influenzae Haemophilus sp., Aggregatibacter sp., Cardiobacterium sp., Eikenella corrodens and Kingella sp. are responsible for a sizable percentage of infective endocarditis cases worldwide with the mortality rate of 18%. Amongst them, Aggregatibacter actinomycetemcomitans is the most common pathogen strongly associated with infective endocarditis. A. actinomycetemcomitans forms part of the oral microbiota and is also the etiological agent of periodontitis. Here, we present a case of a 37-year-old man with underlying obstructive uropathy, that sought treatment for postural hypotension and symptomatic anaemia with fever. Later, he had developed decompensated congestive cardiac failure with aortic regurgitation. A cardiac echocardiogram revealed the presence of vegetation on the aortic valve. Blood culture grew A. actinomycetemcomitans, and he was treated with furosemide and ceftriaxone. A further dental examination showed the patient is having chronic periodontitis, which could be the possible source of A. actinomycetemcomitans causing infective endocarditis. The patient was then transferred to the National Heart Centre for the first time for further management after completion of 4 weeks of intravenous antibiotics. As the pathogen is fastidious, rapid and newer technology like MALDI-TOF mass spectrometry provides rapid and accurate identification for appropriate patient clinical management.

Aims: Banana peel (BP) waste is still underutilized in Malaysia, which can be used as source of renewable energy. Microbial fuel cell (MFC) is a device that utilizes biomass to convert chemical energy into electrical energy with help of the microbial catalysis. The present study evaluates the current generation of MFC supplemented with BP waste as substrate for Pseudomonas aeruginosa ATCC 27853. Methodology and results: The CHNS result shows that the C:N ratio of BP is 27:1 which is within the optimum C:N ratio for the microbial food requirement. Fluctuation of current increases as concentration of banana peel extract (BPE) decreases from 1:10, 1:20, 1:40 and 1:80, thus making 1:10 BPE optimum. Current fluctuation is related to microbial activity due to the sufficiency of nutrients which subsequently affect the performance of MFC. BPE and banana peel slurry (BPS) comparison shows that BPS is optimum. BPE reaches a maximum current of 3.91 µA in ascending phase which is higher compared to BPS (3.65 µA). In descending phase, BPE current drops to 2.31 µA compared to 2.98 µA of BPS. In stationary phase, BPS able to maintain a higher current compared to BPE. MFC maximum current was doubled to 6.52 µA when PEM was treated priorly. Conclusion, significance and impact of study Besides exploring and improving the ability of MFC as an alternative for power production other than fossil fuel, this research also encourage society to fully utilize waste as a source of renewable energy instead of throwing it into garbage without productivity.

Aims: Symbiotic bee fungus associated with the stingless bee larval food has been revealed to play a major role in performing a mutual relationship with the host. The fungus is believed capable to produce crucial nutrients that are required for larval pupation. However, detailed information on the fungus identification isolated from the larval food of our native Indo-Malaya stingless bee, Heterotrigona itama (Hymenoptera: Apidae), is poorly understood. Hence, this study was conducted to determine the effect of fungus isolated from the stingless bee larval food on the survival of H. itama larvae and identify the isolated fungus using both morphological and molecular analyses. Methodology and results: Elisa plates designed with F-bottom type were used as artificial brood cells in a controlled condition. The eggs transferred to Elisa plates were kept in the incubator with 75%-100% humidity and 25 ± 2.5 °C of temperature. This study carried out in three different treatments: (1) microbes-free larval food, (2) fresh larval food and (3) microbes-free larval food with fungus supplement. Results showed that the survival of H. itama larvae depends on the presence of beneficial fungus with the highest survival rate (Treatment 2 = 85.71%). The absence of the beneficial fungus in the fluid food of H. itama showed the lowest survival rate (Treatment 1 = 37.14%). Microscopy analysis showed that the fungus had various forms, including unconjugated asci, round-shaped ascospore and pseudohyphae. The molecular characterisation of the isolated fungi was performed using 23S rRNA gene sequencing using universal primers ITS1 and ITS4. DNA barcoding of three isolated fungi confirmed all isolated fungi matched Panus lecomtei (Basidiomycetes; Poriales; Polyporaceae) with 99.70% of similarity. Conclusion, significance and impact of study This study provides information on the importance of whitish fungus in appearance that existed in the brood cell, which is proposed to be the crucial component of in-vitro stingless bee queen rearing protocol.
Bees--microbiology

Introduction: The emergence of a novel Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic. Rapid and accurate diagnosis method is crucial to reduce the disease burden and to improve early diagnosis approaches to control of the disease. Real time Reverse transcriptase PCR (qRT-PCR) has been identified by the World Health Organization as the most sensitive and specific method of detection. However, the success of this assay relies on the quantity and quality of the extracted viral RNA. Methods: Various methods have been developed for nucleic acid extraction however, the methods have not been assessed. RNA extraction was performed from 24 nasopharyngeal swab samples using a manual extraction kit (GF-1) and an automated extraction kit (Genolution). The concentration and purity of the extracted RNA samples were measured, and its performance were tested using qRT-PCR. Results: The average concentration and purity of the RNA samples extracted using GF-1 kit was higher compared to Genolution. Similarly, the qRT-PCR assay using the RNA samples extracted using manual extraction was better compared to automated kit. Conclusion: Both the manual and automated extraction kits have its advantages and disadvantages in terms of yield and purity. However, with proper optimization, both methods may be used for routine molecular diagnostic of COVID-19 in laboratories.

Introduction: Preclinical studies on mesenchymal stromal cells (MSC) have allowed the cells to be considered as a promising candidate for cellular therapy. In recent years, conflicting data have been reported regarding various aspects of their characteristics, development and differentiation potential, which may be due to arrange of factors. Among the factors worth investigating is the culture medium formulation. Methods: Here we have made a comparative characterization of mouse bone marrow mesenchymal stromal cells (mBM-MSC) that were cultured using two common supplements, MesenCult™ Stimulatory Supplement (MSS) and fetal bovine serum (FBS), under the same experimental conditions at different passages. Clonogenic potential, cumulative population doubling level (CPDL), population doubling time (PDT), immunophenotyping, differentiation, immunosuppression potentials and chromosome analysis of early and late passages mBM-MSC were assessed. Results: Our findings showed that the CPDL, immunophenotype and immunosuppression potential of mBM-MSC were similar. However, variations were seen in their clonogenicity, population doubling time and differentiation efficacy whereby all of these were enhanced in DMSS. These observations suggest that their genetic make-up may be affected by both supplements upon prolonged culture. Interestingly, this conjecture was supported when chromosomal analysis revealed genetic instability of mBM-MSCs cultured in both supplements. Conclusion: In conclusion, culture medium formulation was shown to cause variations and spontaneous transformation in mBM-MSCs raising concerns on the usage of late passages mBMMSCs in fundamental and preclinical downstream experiments.

Rheumatoid arthritis (RA) is a multisystemic autoimmune disease which can be associated with visual threatening ocular manifestations. Common ocular associations with RA include necrotising scleritis and peripheral ulcerative keratitis (PUK). Optic nerve involvement otherwise is uncommon, especially as a presenting feature of RA. We report a rare case of recurrent bilateral retrobulbar optic neuritis (ON) with progressive visual deterioration as an early manifestation of seronegative RA. This case posed diagnostic and management challenges due to its unusual presentation and initially inconclusive investigations. The patient was diagnosed with seronegative RA three years after the first eye presentation. Her RA disease activity score (DAS-28) improved after treatment with a disease-modifying anti-rheumatic drugs (DMARDs), and her ON attacks have been controlled since then. However, her visual acuity, visual field and colour vision remained poor after multiple ON attacks. Multidisciplinary care is key to managing such a patient’s condition and its potential disease complications.