Antibiotic susceptibility of Staphylococcus epidermidis among undergraduate students in Malaysia Public University Health Campus

Staphylococcus epidermidis (S. epidermidis) has become one of the major concerns in the hospital setting due to its ability to cause hospital-acquired infection particularly from medical device contamination. The management of S. epidermidis infections become more challenging with the increase of antimicrobial resistance cases over the past years. Limited reports on S. epidermidis antibiotic resistance among healthy people leave uncertainty about the magnitude of antimicrobial resistance spreads among the community. Therefore, this study aimed to identify the antibiotic susceptibility pattern of S. epidermidis isolated from healthy undergraduate students in one of Malaysia public universities-health campuses. Ninety-six hand palm swab samples were collected and undergo several tests, including microscopic, biochemical identification tests and antibiotic susceptibility test for erythromycin, oxacillin, gentamicin, penicillin and tetracycline following Kirby-Bauer test. A total of 43 samples showed the presence of S. epidermidis (44.8%), where 72.1% of the isolates showed resistance towards at least one type of antibiotic. The highest and lowest resistance was observed for penicillin and gentamycin, respectively. Although there is no significant difference of antibiotic susceptibility pattern was observed between genders, the presence of high antibiotic resistance in S. epidermidis among these healthy communities should warrant further investigation since the spreading of the resistant strain could occur in the wider community population without notice

Effects of palm oil mill effluent (POME) anaerobic sludge from 500 m3 of closed anaerobic methane digested tank on pressed-shredded empty fruit bunch (EFB) composting process

In this study, co-composting of pressed-shredded empty fruit bunches (EFB) and palm oil mill effluent (POME) anaerobic sludge from 500 m3 closed anaerobic methane digested tank was carried out. High nitrogen and nutrients content were observed in the POME anaerobic sludge. The sludge was subjected to the pressed-shredded EFB to accelerate the co-composting treatment. In the present study, changes in the physicochemical characteristics of co-composting process were recorded and evaluated. The cocomposting treatment was completed in a short time within 40 days with a final C/N ratio of 12.4. The co-composting process exhibited a higher temperature (60 - 67°C) in the thermophilic phase followed by curing phase after four weeks of treatment. Meanwhile, pH of the composting pile (8.1 - 8.6) was almost constant during the process and moisture content was reduced from 64.5% (initial treatment) to52.0% (final matured compost). The use of pressed-shredded EFB as a main carbon source and bulking agent contributed to the optimum oxygen level in the composting piles (10 - 15%). The biodegradation of composting materials is shown by the reduction of cellulose (34.0%) and hemicellulose (27.0%) content towards the end of treatment. In addition, considerable amount of nutrients and low level of heavy metals were detected in the final matured compost. It can be concluded that the addition of POME anaerobic sludge into the pressed-shredded EFB composting process could produce acceptable and consistent quality of compost product in a short time

Main nutrient patterns and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition study.

BACKGROUND: Much of the current literature on diet-colorectal cancer (CRC) associations focused on studies of single foods/nutrients, whereas less is known about nutrient patterns. We investigated the association between major nutrient patterns and CRC risk in participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: Among 477 312 participants, intakes of 23 nutrients were estimated from validated dietary questionnaires. Using results from a previous principal component (PC) analysis, four major nutrient patterns were identified. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed for the association of each of the four patterns and CRC incidence using multivariate Cox proportional hazards models with adjustment for established CRC risk factors. RESULTS: During an average of 11 years of follow-up, 4517 incident cases of CRC were documented. A nutrient pattern characterised by high intakes of vitamins and minerals was inversely associated with CRC (HR per 1 s.d.=0.94, 95% CI: 0.92-0.98) as was a pattern characterised by total protein, riboflavin, phosphorus and calcium (HR (1 s.d.)=0.96, 95% CI: 0.93-0.99). The remaining two patterns were not significantly associated with CRC risk. CONCLUSIONS: Analysing nutrient patterns may improve our understanding of how groups of nutrients relate to CRC

Responsiveness of clinical and ultrasound outcome measures in musculoskeletal systemic lupus erythematosus

Objective To assess the responsiveness of clinical outcome measures in musculoskeletal SLE compared with ultrasound. Methods A prospective pilot study was conducted in consecutive SLE patients with inflammatory musculoskeletal symptoms. Clinical assessments including SLEDAI, BILAG, 28-tender and swollen joint counts, physician and patient VAS and ultrasound were performed at 0, 2 and 4 weeks following 120mg intramuscular methylprednisolone acetate. Responsiveness was analysed using changes and effect sizes using Cohen’s criteria. Results 20 patients were recruited. 15/20 had clinical swelling at baseline. All clinical and US parameters were significantly improved at week 4 (all p≤0.01). Musculoskeletal-BILAG score improved in 16/20. Musculoskeletal-SLEDAI improved in 7/20. SRI-4 criteria were assessed in 19 patients with SLEDAI>= 4 at baseline met in 9/19 at 4 weeks. Effect sizes at 4 weeks were large (>0.5) for US, physician VAS and BILAG and medium (>0.3) for joint counts and SLEDAI. Large effect sizes for improvement in US GS and PD were observed in both SRI responders (r=-0.51 and -0.56 respectively) and non-responders (r=-0.62 and -0.59) at 4 weeks. Conclusions This is the first study to measure the responsiveness of clinical outcome measures in musculoskeletal SLE against an objective inflammation measure. BILAG and physician VAS were the most responsive clinical instruments. US was highly responsive in musculoskeletal SLE, while SLEDAI and joint counts appeared suboptimal for detection of improvement. These results suggest that clinical trials based on the SLEDAI and SRI-4 may underestimate the efficacy of therapy in SL

P193 USEFUL I: musculoskeletal ultrasound to identify patients with lupus arthritis with better response to therapy

Background In SLE, musculoskeletal manifestations have an impact on quality of life, disability and clinical trial outcomes, but are harder to assess than in RA and PsA. We previously showed that joint swelling lacks sensitivity, specificity and responsiveness compared to ultrasound. USEFUL was a multicentre longitudinal study to determine clinical features predicting ultrasound synovitis and whether patients with ultrasound synovitis respond better to therapy. Methods SLE patients were recruited if the referring physician deemed they had inflammatory pain warranting treatment. Swollen joints were not required. At baseline, physicians recorded the features that led them to diagnose inflammatory pain and features of concurrent fibromyalgia and osteoarthritis. Stable doses of prednisolone (≤5 mg/day), antimalarials or immunosuppressants were allowed. Participants received depomedrone 120 mg IM then were assessed at 0, 2 and 6 weeks for 66/68 swollen and tender joint counts, BILAG-2004, SLEDAI-2K, physician global and MSK-VAS, inflammatory markers, patient pain and disease activity-VAS, HAQ-DI, LupusQoL, ultrasound of hands and wrists (blinded to patient and clinical assessor). An internal pilot determined the primary endpoint: EMS-VAS at 2 weeks (adjusted for baseline) between patients with ultrasound-synovitis vs. normal ultrasound at baseline. Sensitivity analyses adjusted for prednisolone and immunosuppressants. Results 122/133 patients recruited completed all visits. There was significant disagreement between clinical examination and ultrasound. 78/133 had ultrasound synovitis; 68% of these had ≥1 swollen joint. Of 66/133 patients with ≥ 1 swollen joint, 20% had normal ultrasound. Ultrasound-synovitis was more likely with joint swelling, a symmetrical small joint distribution and active serology. Physician-determined EMS, other lupus features or prior response to therapy were not associated. Fibromyalgia or osteoarthritis did not reduce the probability of ultrasound synovitis. In the full analysis set (n=133) there was no difference in EMS VAS at 2 weeks according to ultrasound synovial status as baseline (difference -8 mm, 95% CI -19, 4 mm, p=0.178). 32 patients had fibromyalgia. After excluding these patients, we found a statistically and clinically significantly better clinical response to depomedrone in patients with ultrasound-synovitis at baseline (baseline-adjusted EMS VAS at 2 weeks -12 mm, 95% CI -24, 0 mm, p=0.049). This difference was greater in the treatment-adjusted sensitivity analysis (-12.8 (95% CI -22, -3 mm), p=0.007) and the per-protocol-adjusted sensitivity analysis (-14.8 mm (95% CI -20.8, -8.8 mm), p<0.001). Patient with ultrasound synovitis had higher rates of improvement in the musculoskeletal BILAG-2004 (56% vs. 26%, p=0.09) and SLEDAI-2K (37% vs. 15%, p=0.03). Conclusions In lupus arthritis distribution and serology, but not other features, help identify ultrasound-synovitis. Ultrasound-synovitis was independent of features of fibromyalgia, but fibromyalgia confounded assessment of response. Excluding fibromyalgia, response to therapy was better in patients with abnormal ultrasound compared to normal. Ultrasound should be used to select patients for therapy and clinical trials, especially when there are inflammatory symptoms without swollen joints

Synthesis of Ceiba pentandra biodiesel using ultrasound and infrared radiation: Comparison and fuel characterisation.

The continuous expending of the economy and population in modern society has caused an increase in energy usage. Currently, fossil fuels and renewable energy are used to generate energy, contributing to greenhouse gas emissions. A significant effort has been made globally to address the issue of rising emissions by boosting the usage of renewable energy. In comparison to fossil fuels, biodiesel has many benefits, including the ability to be produced from a wide range of feedstocks, the ability to be renewable, and the reduction of atmospheric pollution emissions. Besides, advanced technologies can help the biodiesel sector meet the energy demand while producing high-quality biodiesel. The Ceiba pentandra was used for biodiesel production using ultrasound-infrared applications in the present research work. The study aims to produce biodiesel for a better conversion rate and improve fuel properties. Comparisons were conducted using a combination of infrared ultrasound versus ultrasound irradiation. The results show that ultrasound produced the highest yield of 98.76% when the conditions were as follows: methanol/oil ratio: 60%, KOH: 1%, reaction time: 50 minutes. Yet, the addition of infrared on ultrasound has also produced a high conversion yield in a shorter time than ultrasound. A 98.42% biodiesel yield option when using infrared-ultrasound irradiation with conditions as follows: methanol/oil ratio: 60%, KOH: 1%, reaction time: 30 minutes. As both applications were examined, the ultrasound-infrared application was preferable in saving time and energy constraints for biodiesel production. The fuel properties were found to be equivalent to ASTM D6751 and EN 14214 biodiesel standards

The place and barriers of evidence based practice: knowledge and perceptions of medical, nursing and allied health practitioners in malaysia

<p>Abstract</p> <p>Background</p> <p>Despite a recent increase in activities to promote evidence-based practice (EBP), it was unclear how Malaysian hospital practitioners received this new approach in medicine. This study examines their confidence and perceptions on EBP.</p> <p>Findings</p> <p>We conducted cross-sectional surveys using a self-administered questionnaire during two EBP training courses in two Malaysian hospitals in January and June 2007. Our subjects (n = 144) were doctors and nursing and allied health staff (NAH) participating in the EBP courses. Our questionnaire covered three domains: confidence and understanding (six items), attitude (five items) and barriers to practice (four items). We presented simple descriptive statistics, including the sum ratings and the proportions with different responses for each item, and compared different groups using Mann-Whitney U test for scaled ratings and Chi-square test for dichotomous responses.</p> <p>Ninety-two doctors and 52 NAH staff completed the surveys. Overall, doctors expressed slightly higher confidence on EBP compared to NAH staff. Out of a maximum sum rating of 27 over six items, doctors reported an average of 18.3 (SD 3.2) and NAH staff reported an average of 16.0 (SD 3.4), p = 0.002. Doctors were also more positive in their views on EBP. For example, 67.4% of doctors disagreed, but 61% of NAH staff agreed that "the importance of EBP in patient care is exaggerated", and 79.3% of doctors disagreed, but 46.2% of NAH staff agreed that "EBP is too tedious and impractical". Similar responses were observed for other items in the domain.</p> <p>Doctors and NAH staff shared similar concerns on barriers to evidence-based practice. The highest proportions considered poor facilities to access evidence a barrier (76% of doctors and 90% of NAH), followed by poor awareness of evidence (62% of doctors and 70% of NAH) and time constraints (63% of doctors and 68% of NAH), p = 0.09 for the combined rating of four items in the domain.</p> <p>Conclusions</p> <p>The findings of our survey suggest a need for greater efforts in promoting EBP among Malaysian hospital practitioners especially for NAH staff. From the responses based on the barriers to EBP, improving facilities for accessing evidence and promoting more user-friendly resources to address time constraints appear to be the priorities.</p