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Fulltext Tele-echocardiography - Made for astronauts, now in hospitals

Balasingam M, Ebrahim J, Ariffin IA

Indian Heart J, 2017 Mar-Apr;69(2):252-254.
PMID: 28460775 DOI: 10.1016/j.ihj.2017.01.010

Telemedicine, ie 'the delivery of healthcare and sharing of medical knowledge using telecommunication systems' has penetrated every field of medicine. As a result, tele-echocardiography, the study of the heart via telemedicine started expanding. Ironically, space became the next frontier for mankind's new innovations and technology pursuit. However, the microgravity environment of space is known to be challenging to astronauts hearts. As such, new tele-echocardiography techniques have evolved. The main aim was to research a system that can be operated by a layperson but still be able to provide high yield diagnostic information in real time to specialists on earth. This spin-off space technology is recognized to have a positive impact, especially in developing countries with vast terrain. It is now utilized in hospitals and other terrestial locations where patients in remote regions can have their hearts analysed and data relayed to specialists in bigger centres for interpretation and further management.
Determinants of Inadequate Empiric Antimicrobial Therapy in ICU Sepsis Patients in Al-Madinah Al-Munawwarah, Saudi Arabia: A Comparison of Artificial Neural Network and Regression Analysis

Dala Ali AHH, Harun SN, Othman N, Ibrahim B, Abdulbagi OE, Abdullah I, et al.

Antibiotics (Basel), 2023 Aug 10;12(8).
PMID: 37627725 DOI: 10.3390/antibiotics12081305

In the management of sepsis, providing adequate empiric antimicrobial therapy is one of the most important pillars of sepsis management. Therefore, it is important to evaluate the adequacy of empiric antimicrobial therapy (EAMT) in sepsis patients admitted to intensive care units (ICU) and to identify the determinants of inadequate EAMT. The aim of this study was to evaluate the adequacy of empiric antimicrobial therapy in patients admitted to the ICU with sepsis or septic shock, and the determinants of inadequate EAMT. The data of patients admitted to the ICU units due to sepsis or septic shock in two tertiary healthcare facilities in Al-Madinah Al-Munawwarah were retrospectively reviewed. The current study used logistic regression analysis and artificial neural network (ANN) analysis to identify determinants of inadequate empiric antimicrobial therapy, and evaluated the performance of these two approaches in predicting the inadequacy of EAMT. The findings of this study showed that fifty-three per cent of patients received inadequate EAMT. Determinants for inadequate EAMT were APACHE II score, multidrug-resistance organism (MDRO) infections, surgical history (lower limb amputation), and comorbidity (coronary artery disease). ANN performed as well as or better than logistic regression in predicating inadequate EAMT, as the receiver operating characteristic area under the curve (ROC-AUC) of the ANN model was higher when compared with the logistic regression model (LRM): 0.895 vs. 0.854. In addition, the ANN model performed better than LRM in predicting inadequate EAMT in terms of classification accuracy. In addition, ANN analysis revealed that the most important determinants of EAMT adequacy were the APACHE II score and MDRO. In conclusion, more than half of the patients received inadequate EAMT. Determinants of inadequate EAMT were APACHE II score, MDRO infections, comorbidity, and surgical history. This provides valuable inputs to improve the prescription of empiric antimicrobials in Saudi Arabia going forward. In addition, our study demonstrated the potential utility of applying artificial neural network analysis in the prediction of outcomes in healthcare research.
Ethyl acetate extract of fungus comb from Malayan termite (Macrotermes gilvus Hagen) mound modulates splenic inflammatory responses in mice

Susanto H, Sudiana K, Nandika D, Karlinasari L, Arinana A, Karim SA, et al.

Open Vet J, 2024 Sep;14(9):2269-2279.
PMID: 39553755 DOI: 10.5455/OVJ.2024.v14.i9.15

BACKGROUND: The fungus comb is a unique structure inside termites' nests that facilitates the growth of Termitomyces sp. as a nutrient source for the termites. It is known to possess immunomodulatory properties that boost the immune system.
AIM: The objective of this study was to assess the impact of ethyl acetate extract of fungus comb (EAEFC) on the inflammatory reaction in the spleen of mice induced by intraperitoneal injection of lipopolysaccharide (LPS).
METHODS: An experimental study was conducted using a post-test-only control group design with male BALB/C mice (n = 24). The mice were divided randomly into four groups, each comprising six mice, and administered substances via gavage. Groups I and III were administered a solution of 5% dimethyl sulfoxide (DMSO) in distilled water, while Groups II and IV were given 500 mg/kg BW EAEFC dissolved in 5% DMSO. On the fifteenth day, Groups I and II received intraperitoneal injections of 5 ml/kg BW saline, while Groups III and IV were injected with 10 mg/kg BW LPS dissolved in saline. After three hours, the mice were euthanized and splenic immunohistology was examined under a light microscope. The results were expressed as mean ± standard deviation, while the group differences were assessed statistically.
RESULTS: The expression of interleukin (IL)-1, furin, and activated NK cell was significantly higher in the inflamed model after EAEFC supplementation, while the extract suppressed IL-10.
CONCLUSION: EAEFC was found to alter cytokine expression in the spleen in response to inflammation.
The effects of ω-3 fatty acids on inflammatory and oxidative stress markers in patients with Type 2 diabetes mellitus: A systematic review and meta-analysis of controlled trials

Muzammil K, Khaleel AQ, Merza MS, Kyada A, Ariffin IA, Verma S, et al.

Prostaglandins Other Lipid Mediat, 2024 Sep 05.
PMID: 39243880 DOI: 10.1016/j.prostaglandins.2024.106887

BACKGROUND & AIMS: Taking into account the anti-inflammatory and antioxidant properties of omega-3 fatty acids and the evidence indicating the role of chronic inflammation and oxidative stress in the pathophysiology diabetes, this study aimed to determine the effect of ω-3 fatty acids on oxidative stress and inflammatory markers in Type 2 diabetes mellitus (T2DM) patients.
METHODS: A systematic search up to July 30, 2023 was completed in Scopus, PubMed, Web of Science, and Embase databases, to identify eligible RCTs. Heterogeneity tests of the selected studies were performed using the I2. Random effects models were assessed and pooled data were determined as standardized mean differences (SMD) with a 95% CI.
RESULTS: The meta-analysis of 23 trials, involving 1,523 patients, demonstrated a significant decrease in TNF-α (SMD: -1.62, 95% CI: -2.89 to -0.35, P= 0.013) and increase in TAC (SMD: 0.92, 95% CI: 0.33 to 1.52, P = 0.002) following ω-3 fatty acids administration. Meanwhile, supplementation did not have beneficial effects on malondialdehyde, C-reactive protein (CRP), superoxide dismutase (SOD), and interlukin-6 levels. The subgroup analysis revealed a significant decrease in CRP levels and an increase in SOD levels in studies with durations of less than 12 weeks.
CONCLUSIONS: We found that ω-3 fatty acid intake can significantly decrease TNF-α and increase TAC levels, but this effect was not observed on other markers. Nevertheless, future well-designed with large sample size and long duration RCT studies with precise ω-3 fatty acids dose and ingredients are required to understand better the effects of these compounds and their constituents on oxidative stress and inflammatory markers in T2DM patients.
Fulltext Chemical Composition, Antioxidant, Antibacterial, and Antibiofilm Activities of Backhousia citriodora Essential Oil

Lim AC, Tang SGH, Zin NM, Maisarah AM, Ariffin IA, Ker PJ, et al.

Molecules, 2022 Jul 31;27(15).
PMID: 35956846 DOI: 10.3390/molecules27154895

The essential oil of Backhousia citriodora, commonly known as lemon myrtle oil, possesses various beneficial properties due to its richness in bioactive compounds. This study aimed to characterize the chemical profile of the essential oil isolated from leaves of Backhousia citriodora (BCEO) and its biological properties, including antioxidant, antibacterial, and antibiofilm activities. Using gas chromatography-mass spectrometry, 21 compounds were identified in BCEO, representing 98.50% of the total oil content. The isomers of citral, geranial (52.13%), and neral (37.65%) were detected as the main constituents. The evaluation of DPPH radical scavenging activity and ferric reducing antioxidant power showed that BCEO exhibited strong antioxidant activity at IC50 of 42.57 μg/mL and EC50 of 20.03 μg/mL, respectively. The antibacterial activity results showed that BCEO exhibited stronger antibacterial activity against Gram-positive bacteria (Staphylococcus aureus and Staphylococcus epidermidis) than against Gram-negative bacteria (Escherichia coli and Klebsiella pneumoniae). For the agar disk diffusion method, S. epidermidis was the most sensitive to BCEO with an inhibition zone diameter of 50.17 mm, followed by S. aureus (31.13 mm), E. coli (20.33 mm), and K. pneumoniae (12.67 mm). The results from the microdilution method showed that BCEO exhibited the highest activity against S. epidermidis and S. aureus, with the minimal inhibitory concentration (MIC) value of 6.25 μL/mL. BCEO acts as a potent antibiofilm agent with dual actions, inhibiting (85.10% to 96.44%) and eradicating (70.92% to 90.73%) of the biofilms formed by the four tested bacteria strains, compared with streptomycin (biofilm inhibition, 67.65% to 94.29% and biofilm eradication, 49.97% to 89.73%). This study highlights that BCEO can potentially be a natural antioxidant agent, antibacterial agent, and antibiofilm agent that could be applied in the pharmaceutical and food industries. To the best of the authors' knowledge, this is the first report, on the antibiofilm activity of BCEO against four common nosocomial pathogens.
Fulltext Factors influencing parents' hesitancy to vaccinate their children aged 5-11 years old against COVID-19: results from a cross-sectional study in Malaysia

Marzo RR, Chakraborty R, Soh SY, Thew HZ, Chong C, Siau CS, et al.

Front Public Health, 2023;11:1091015.
PMID: 37261237 DOI: 10.3389/fpubh.2023.1091015

INTRODUCTION: Vaccination programs have been rolled out across the globe to contain and mitigate the spread of the COVID-19 infection. Until recently, such programs were limited to adults and the older population, thereby limiting children from getting vaccinated. Recently, the Malaysian government rolled out vaccination for children aged 5-11 years. However, there are certain factors that might affect vaccination uptake among children. This study explores factors influencing parents' hesitancy to vaccinate children in Malaysia.
METHOD: A nationwide online cross-sectional convenience sampling survey from April 21, 2022 to June 3, 2022 was conducted. The study used descriptive statistics to inform about vaccine hesitancy among parents. Cross-tabulation was performed to calculate the frequency and percentage of vaccine hesitancy, quality of life, e-health literacy, and the 5C psychological antecedents of vaccination among parents with children 5-11 years in Malaysia. Graphical methods were used to portray the levels of e-health literacy and levels of 5C psychological antecedents of vaccination. The study used both bi-variate and multivariate analysis to understand the relationship between vaccine hesitancy and the socio-demo-economic factors, quality of life, e-health literacy and 5C psychological antecedents.
RESULTS: Of 382 participants, almost one-third (33%) of participants reported vaccine hesitancy for their children. For 5C's psychological antecedents of vaccination, around one quarter (26.96%) reported disagreement for confidence in vaccination, almost half (52.36%) reported disagreement for vaccination complacency, three-fifths (60.99%) reported vaccination constraint, one quarter (25.92%) reported calculation antecedent, and almost one-third reported disagreement over collective responsibility antecedent (25.92%). Chi-square test revealed that gender, employment status, and parents' COVID-19 vaccination status were significantly associated (p<0.05) with vaccine hesitancy among parents. Assessing the influence of transactional e-health literacy, only the communication component contained a significant association (p<0.05). Among the 5C psychological antecedents, confidence, calculation, and collective responsibility were significantly associated (p<0.05) with vaccine hesitancy. Parents with secondary [OR: 8.80; CI: 2.44-31.79, (p<0.05)], post-secondary [OR: 5.21; CI: 2.10-13.41, (p<0.05)], and tertiary education [OR: 6.77; CI: 2.25-20.35, (p<0.05)] had significantly higher likelihood of vaccine hesitancy than those with primary education.
CONCLUSION: Highly educated parents are more skeptical and are more likely to perceive the vaccine as unsafe and ineffective for their children. It is critical to disseminate the required information about the vaccine safety to the educated group.
Targeting notch-related lncRNAs in cancer: Insights into molecular regulation and therapeutic potential

Siddique R, Gupta G, Mgm J, Kumar A, Kaur H, Ariffin IA, et al.

Pathol Res Pract, 2024 May;257:155282.
PMID: 38608371 DOI: 10.1016/j.prp.2024.155282

Cancer is a group of diseases marked by unchecked cell proliferation and the ability for the disease to metastasize to different body areas. Enhancements in treatment and early detection are crucial for improved outcomes. LncRNAs are RNA molecules that encode proteins and have a length of more than 200 nucleotides. LncRNAs are crucial for chromatin architecture, gene regulation, and other cellular activities that impact both normal growth & pathological processes, even though they are unable to code for proteins. LncRNAs have emerged as significant regulators in the study of cancer biology, with a focus on their intricate function in the Notch signaling pathway. The imbalance of this pathway is often linked to a variety of malignancies. Notch signaling is essential for cellular functions like proliferation, differentiation, and death. The cellular response is shaped by these lncRNAs through their modulation of essential Notch pathway constituents such as receptors, ligands, and downstream effectors around it. Furthermore, a variety of cancer types exhibit irregular expression of Notch-related lncRNAs, underscoring their potential use as therapeutic targets and diagnostic markers. Gaining an understanding of the molecular processes behind the interaction between the Notch pathway and lncRNAs will help you better understand the intricate regulatory networks that control the development of cancer. This can open up new possibilities for individualized treatment plans and focused therapeutic interventions. The intricate relationships between lncRNAs & the Notch pathway in cancer are examined in this review.
Targeting the lung tumor microenvironment by phytochemicals and their nanoformulations

Obaidur Rab S, Altalbawy FMA, Chandra M, Ariffin IA, Kaur P, Rathore G, et al.

Pathol Res Pract, 2024 Dec;264:155679.
PMID: 39500198 DOI: 10.1016/j.prp.2024.155679

Lung malignancies are among the most prevalent and foremost causes of tumor-related deaths. Despite significant advancements in the understanding and management of lung cancer, resistance to traditional treatments remains a significant challenge. Understanding and targeting tumor microenvironment (TME) have attracted interest in the recent decade for eliminating various solid tumors. The lung TME has a crucial position in tumor expansion and therapy failure, driving it an engaging target for novel medicinal interventions. Plant-derived products offer a promising avenue for targeting TME due to their diverse chemical structures and biological activities. However, their clinical use is hindered by insufficient bioavailability and also possible systemic toxicity. The use of nanoparticles as delivery vehicles for natural products can overcome these challenges and enhance their therapeutic efficacy. This review article explores the potential of plant-derived products as medicinal agents for targeting lung TME. We provide an outline of the present knowledge of lung TME and explain the mechanisms by which plant-derived products can modulate key components of this microenvironment. The promising impacts and properties of nanoparticles for the delivery of these derivatives into lung tumors will also be discussed. We also review the preclinical and clinical findings for supporting the usefulness of these agents in targeting lung TME. Additionally, we highlight the challenges and forthcoming trends in the development of plant-derived products as targeted therapies for lung cancer, with a particular focus on combination therapies.