Intensive care in severe malaria: report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine

Severe malaria is common in tropical countries in Africa, Asia, Oceania and South and Central America. It may also occur in travelers returning from endemic areas. Plasmodium falciparum accounts for most cases, although P vivax is increasingly found to cause severe malaria in Asia. Cerebral malaria is common in children in Africa, manifests as coma and seizures, and has a high morbidity and mortality. In other regions, adults may also develop cerebral malaria but neurological sequelae in survivors are rare. Acute kidney injury, liver dysfunction, thrombocytopenia, disseminated intravascular coagulopathy (DIC) and acute respiratory distress syndrome (ARDS) are also common in severe malaria. Metabolic abnormalities include hypoglycemia, hyponatremia and lactic acidosis. Bacterial infection may coexist in patients presenting with shock or ARDS and this along with a high parasite load has a high mortality. Intravenous artesunate has replaced quinine as the antimalarial agent of choice. Critical care management as per severe sepsis is also applicable to severe malaria. Aggressive fluid boluses may not be appropriate in children. Blood transfusions may be required and treatment of seizures and raised intracranial pressure is important in cerebral malaria in children. Mortality in severe disease ranges from 8 to 30% despite treatment

Sepsis in tropical regions: Report from the task force on tropical diseases by the World Federation of Societies of Intensive and Critical Care Medicine

Sepsis and septic shock in the tropics are caused by a wide array of organisms. These infections are encountered mainly in low and middle-income countries (LMIC) where a lack of infrastructure and medical facilities contribute to the high morbidity and mortality. Published sepsis guidelines are based on studies primarily performed in high income countries and as such recommendations may or may not be relevant to practice in the tropics. Failure to adhere to guidelines, particularly among non-intensive care specialists even in high-income countries, is an area of concern for sepsis management. Additionally, inappropriate use of antimicrobials has led to significant antimicrobial resistance. Access to rapid, low-cost, and accurate diagnostic tests is critical in countries where tropical diseases are prevalent to facilitate early diagnosis and treatment. Implementation of performance improvement programs may improve outcomes for patients with sepsis and the addition of resuscitation and treatment bundles may further reduce mortality. Associated co-morbidities such as malnutrition and HIV influence outcomes and must be considered

Are deprivation-specific cancer survival patterns similar according to individual- and area-based measures? A cohort study of patients diagnosed with five malignancies in England & Wales, 2008-2016

Objective: To investigate if measured inequalities in cancer survival differ when using individual- (‘person’) compared to area- (‘place’) based measures of deprivation for three socio-economic dimensions: income, deprivation and occupation Design: Cohort studySetting: Data from the Office for National Statistics (ONS) Longitudinal Study of England and Wales, UK, linked to the National Cancer Registration DatabaseParticipants: Patients diagnosed with cancers of the colorectum, breast, prostate, bladder or with Non-Hodgkin Lymphoma (NHL) during the period 2008-2016Primary and secondary outcome measures: Differentials in net survival between groups defined by individual wage, occupation and education compared to those obtained from corresponding area-level metrics using the English and Welsh Indices of Multiple Deprivation (IMD).Results: Survival was negatively associated with area-based deprivation irrespective of the type analysed, although a trend from least to most deprived was not always observed. Socio-economic differences were present according to individually-measured socio-economic groups although there was an absence of a consistent ‘gradient’ in survival. The magnitude of differentials was similar for area-based and individually-derived measures of deprivation, which was unexpected.Conclusion: These unique data suggest that the socio-economic influence of ‘person’ is different to that of ‘place’ with respect to cancer outcomes. This has implications for health policy aimed at reducing inequalities. Further research could further consider the separate and additional influence of area-based deprivation over individual-level characteristics (contextual effects) as well as investigate the geographic, socio-economic and healthcare related characteristics of areas with poor outcomes in order to inform policy intervention

Penghasilan antibodi PPSP 1 dan PPSP 2 terhadap mononukles darah periferi manusia dengan teknik hibridoma

Dalam kajian ini, teknik hibridoma telah dilakukan untuk menghasilkan antibodi monoklon (mAb) mencit terhadap sel mononukleus darah periferi manusia (SMDP). Selepas hibridisasi sel limpa mencit yang diimunisasi dengan sel mieloma dilakukan sel hibridoma yang diperolehi didapati stabil dan mengeluarkan antibodi (Ab) yang berterusan. Dua hibridoma telah berjaya dihasilkan daripada pengklonan satu kultur awal berdasarkan analisis biot imunodot. Kedua-dua hibridoma ini menghasilkan Ab yang masing-masingnya dikenali sebagai PPSPl dan PPSP2. Analisis selanjutnya melalui flow sitometri menunjukkan bahawa kedua-dua hibridroma ini menghasilkan Ab yang bertindak balas dengan antigen permukaan SMDP. Walau bagaimanapun, intensiti pewarnaan PPSP1 lebih tinggi daripada PPSP2. Lebih daripada 98% SMDP dilabel positif dengan PPSP1 dan PPSP2 iaitu setanding dengan keputusan apabila menggunakan mAb kontrol positif komersial, CD45. Penyelidikan seterusnya untuk menentukan PPSP1 dan PPSP2 adalah antibodi monoklon sedang dalam perancangan

Somatic Embryogenesis and Plantlet Regeneration in the Carica papaya L. cv. Eksotika

A highly efficient protocol for regeneration of Carica papaya L. cv. Eksotika somatic embryos from immature zygotic embryos was developed. This study was designed to overcome the obstacles in regeneration of somatic embryos from immature zygotic embryos of “Eksotika”, especially problems associated with formation of better root quality and callus formation at the base of somatic embryos. Somatic embryos were generated by incubation of immature zygotic embryos in half-strength salt Murashige and Skoog (MS) medium with full-strength vitamins supplemented with 7.5 mg L−1 2,4-D, 100 mg L−1 L-glutamine, 50 mg L−1 myo-inositol, 45 mg L−1 adenine sulphate, 0.33% gelrite, and 6% sucrose, followed by transfer to maturation medium consisting of ½ MS medium supplemented with 5 mg L−1 phloroglucinol, 100 mg L−1 L-glutamine, 100 mg L−1 myoinositol, 68 mg L−1 adenine sulphate, 0.38% gelrite, and 3% sucrose. After that, well-formed somatic embryos were transferred to MS medium containing 3% sucrose and 0.8% agar for shoot production. The embryos were elongated in MS medium supplemented with 1 mg L−1 gibberellic acid, 0.5 mg L−1 indole-3-butyric acid, 100 mg L−1 myo-inositol, and 3.76 mg L−1 riboflavin. Root regeneration was achieved on MS medium containing 7.9 mg L−1 phloroglucinol and supported with vermiculite after 4 days of cultivation on ½ MS medium with 2 mg L−1 indole-3-butyric acid. After the rooting phase, in vitro plantlets were acclimatized in peat moss soil

Global modeling of tropospheric iodine aerosol

Natural aerosols play a central role in the Earth system. The conversion of dimethyl sulfide to sulfuric acid is the dominant source of oceanic secondary aerosol. Ocean emitted iodine can also produce aerosol. Using a GEOS-Chem model, we present a simulation of iodine aerosol. The simulation compares well with the limited observational data set. Iodine aerosol concentrations are highest in the tropical marine boundary layer (MBL) averaging 5.2 ng (I) m −3 with monthly maximum concentrations of 90 ng (I) m −3. These masses are small compared to sulfate (0.75% of MBL burden, up to 11% regionally) but are more significant compared to dimethyl sulfide sourced sulfate (3% of the MBL burden, up to 101% regionally). In the preindustrial, iodine aerosol makes up 0.88% of the MBL burden sulfate mass and regionally up to 21%. Iodine aerosol may be an important regional mechanism for ocean-atmosphere interaction

Correction: Metal complexes as a promising source for new antibiotics

Correction for ‘Metal complexes as a promising source for new antibiotics’ by Angelo Frei et al., Chem. Sci., 2020, 11, 2627–2639

No More Starving with Food Delivery Applications, But Why Should I?

Food delivery applications are rapidly expanding and have become popular and successful in many countries. However, this sector is still in its initial stage, particularly in developed and emerging markets. This research aims to evaluate factors that affect consumers’ intention to use food delivery applications in Malaysia. First, create customer encounters with food delivery by smartphone devices by introducing a diffusion of the innovation model. Five characteristics: relative advantage, compatibility, observability, complexity, and trialability, were used to assess consumer intention in food delivery applications. A total of 218 valid samples were obtained from Malaysian consumers. This research shows a positive influence on the intention. A five-attribute perception was used to determine the intention to use food delivery applications. Together, these results have a critical managerial impact on core players, for example, food delivery companies or restaurants. One of the main implications is that food delivery companies must make their applications easy to access, smooth, and enjoyable

Involving psychological therapy stakeholders in responsible research to develop an automated feedback tool: Learnings from the ExTRAPPOLATE project

Understanding stakeholders’ views on novel autonomous systems in healthcare is essential to ensure these are not abandoned after substantial investment has been made. The ExTRAPPOLATE project applied the principles of Responsible Research and Innovation (RRI) in the development of an automated feedback system for psychological therapists, ‘AutoCICS’. A Patient and Practitioner Reference Group (PPRG) was convened over three online workshops to inform the system's development. Iterative workshops allowed proposed changes to the system (based on stakeholder comments) to be scrutinized. The PPRG reference group provided valuable insights, differentiated by role, including concerns and suggestions related to the applicability and acceptability of the system to different patients, as well as ethical considerations. The RRI approach enabled the anticipation of barriers to use, reflection on stakeholders’ views, effective engagement with stakeholders, and action to revise the design and proposed use of the system prior to testing in future planned feasibility and effectiveness studies. Many best practices and learnings can be taken from the application of RRI in the development of the AutoCICS system