Knowledge, attitude and practice on food higiene among the homemakers in Bukit Aup, Sibu, Sarawak from 8th July 2013 to 20th September 2013

Background: Foodborne diseases are a potential threat to the public health. Despite all the Food Act and Regulation, the problem of foodbome diseases is still not uncommon in Malaysia. Objective: The purpose of this study is to determine the level of knowledge, attitude, and practice (KAP) with regards to food hygiene among homemakers of Bukit Aup in Sibu, Sarawak. Methods: This was a cross-sectional study done among 101 homemakers in Bukit Aup, Sibu, Sarawak. A Non-probability sampling method was adopted to select at least one homemaker from each household in the village. An interviewer-guided style of data collection was used. The data was analysed for descriptive data of mean and median, frequencies and standard deviation using SPSS. Results: Among the respondents, the level of good KAP are 53.5%, 39.6% and 58.4% respectively. A significant positive correlation is noted between attitude score and practice score (r=0.203, p<0.05) using Pearson correlation analysis. Out of a total number of 457 villagers, 33 of them (7.2%) had gastrointestinal health complaints in the past six months. There were 36 episodes (7.9%) of abdominal cramp or pain, followed by 18 episodes (3.9%) of diarrhoea and three episodes (0.7%) of vomiting. Conclusion: Generally, it was observed that the respondents had a satisfactory level of knowledge and practices of food hygiene. However some of the respondents had some lapses in their responses to queries on food hygiene attitude

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Improved high sensitivity screen for Huntington disease using a one-step triplet-primed PCR and melting curve assay

<div><p>Molecular diagnosis of Huntington disease (HD) is currently performed by fluorescent repeat-flanking or triplet-primed PCR (TP-PCR) with capillary electrophoresis (CE). However, CE requires multiple post-PCR steps and may result in high cost in high-throughput settings. We previously described a cost-effective single-step molecular screening strategy employing the use of melting curve analysis (MCA). However, because it relies on repeat-flanking PCR, its efficiency in detecting expansion mutations decreases with increasing size of the repeat, which could lead to false-negative results. To address this pitfall, we have developed an improved screening assay coupling TP-PCR, which has been shown in CE-based assays to detect all expanded alleles regardless of size, with MCA in a rapid one-step assay. A companion protocol for rapid size confirmation of expansion-positive samples is also described. The assay was optimized on 30 genotype-known DNAs, and two plasmids p<i>HTT</i>(CAG)₂₆ and p<i>HTT</i>(CAG)₃₃ were used to establish the threshold temperatures (TTs) distinguishing normal from expansion-positive samples. In contrast to repeat-flanking PCR MCA, TP-PCR MCA displayed much higher sensitivity for detecting large expansions. All 30 DNAs generated distinct melt peak T_ms which correlated well with each sample’s larger allele. Normal samples were clearly distinguished from affected samples. The companion sizing protocol accurately sized even the largest expanded allele of ~180 CAGs. Blinded analysis of 69 clinical samples enriched for HD demonstrated 100% assay sensitivity and specificity in sample segregation. The assay targets the <i>HTT</i> CAG repeat specifically, tolerates a wide range of input DNA, and works well using DNA from saliva and buccal swab in addition to blood. Therefore, rapid, accurate, reliable, and high-throughput detection/exclusion of HD can be achieved using this one-step screening assay, at less than half the cost of fluorescent PCR with CE.</p></div

FMR1 CGG repeat expansion mutation detection and linked haplotype analysis for reliable and accurate preimplantation genetic diagnosis of fragile X syndrome

10.1017/erm.2017.10EXPERT REVIEWS IN MOLECULAR MEDICINE1

TP-PCR melt peaks and capillary electropherograms of genotype-known CCR (Coriell Cell Repositories) samples.

<p>For all samples, melt peak temperature correlated well with repeat length of the larger allele. Verified or CCR-provided genotypes are indicated at the upper right corner of each electropherogram. Allele sizes determined from TP-PCR capillary electrophoresis are indicated by arrows. Insets show magnified view of expanded alleles. For all samples, the allele sizes and genotypes determined using TP-PCR assay were concordant with the verified allele sizes.</p

TP-PCR MCA profiles of 69 clinical samples enriched for Huntington disease.

<p>Samples harboring normal-only, intermediate and expanded alleles are plotted in blue, grey and red lines, respectively. The T_ms and corresponding capillary electropherograms of two normal, two IA and two HD-affected samples are shown. Based on the T_ms of the samples relative to the threshold temperatures generated by p<i>HTT</i>(CAG)₂₆ and p<i>HTT</i>(CAG)₃₃, all 69 clinical samples were correctly classified.</p

Correlation of TP-PCR melt peak temperature with CAG repeat size of the larger allele.

<p>NL, sample carrying only normal alleles; IA, sample carrying an intermediate allele; EX, sample carrying an expanded allele. A good correlation was observed between the TP-PCR melt peak T_m and the CAG repeat size of the larger allele among the samples, allowing unambiguous discrimination between normal and HD-affected samples.</p

Reproducibility of repeat-flanking PCR and TP-PCR melt peaks.

<p>Sample GM09197, which carries an expanded allele of ~180 CAG repeats, was assayed in parallel by repeat-flanking PCR MCA and TP-PCR MCA. Forty-eight replicates of each assay were performed. Melt peaks of replicates are plotted in red, while the melt peaks of the control plasmids p<i>HTT</i>(CAG)₂₆ and p<i>HTT</i>(CAG)₃₃ are in black. <b>Top</b>, using repeat-flanking PCR MCA, the expanded allele melt peak is much weaker than the normal allele and is almost flat, making result interpretation ambiguous. <b>Bottom</b>, using TP-PCR MCA, a highly reproducible and distinct single melt peak is observed, with a T_m clearly in the HD-affected range.</p