Polymyxin b therapy for multidrug resistant gram negative infections : outcome and risk factors for treatment failure in critical care

Objective: Polymyxins have re-administered in clinical practice due to the dry antibiotic development pipeline and worldwide increasing infections caused by multi-drug resistant (MDR) gram negative bacteria. The aim of this study is to investigate the use of polymyxin B antibiotic therapy in Intensive Care Unit, Hospital Universiti Sains Malaysia (HUSM) and to identify the risk factors for polymyxin B treatment failure. Outcomes will be classified into clinical cure and clinical failure. Methodology: This was a crossectional study using secondary data done in Intensive Care Unit (ICU) Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. This study involved 96 cases of gram negative infections (blood-stream infection and pneumonia), particularly Acinetobacter spp, Acinetobacter baumanii, Klebsiella pneumonia and Pseudomonas aeruginosa, isolated from blood, endotracheal aspirate (ETA) as well asbronchoalveolar lavage (BAL) sample, all were treated with iv polymyxin B. The patient selections were from pharmacy databank on polymyxin B usage from 1 January 2010- 31 December 2014. Ninety-six cases treated with polymyxin B from ICU were randomly selected and their medical record were traced from Record Office and reviewed. Their demographic profiles, underlying diseases, potential risk factors, antibiotic usage, possible adverse effects, microbiology results and outcome were reviewed. Results: Clinical outcome was evaluated for the 96 samples. Clinical cure contributed to 51% of the cases (49 cases) meanwhile another 47 cases (49%) contributed to clinical failure. Percentage of clinical cure was slightly higher compared to clinical failure for this study. 47 clinical failure subject (49.0%) reported death and all were referred to attributable mortality. Associated risk factors for polymyxin B treatment failure by Multiple Logistic Regression model were primary bacteremia (p=0.005) and inappropriate dose of polymyxin B (p=0.005). Polymyxin B was well tolerated by almost all of our sample, whereby only 7 out of 96 cases experienced deteriorating renal function, and it was not lead to discontinuation of the treatment.. Conclusions: In conclusion, mortality associated with multidrug resistant gram negative pathogens continues to be high. The early susceptibility, prompt and optimal antibiotic such as polymyxin B and also combination of antibiotic in particular with sulperazaone seems to have a survival benefit in this critically ill population

Relationship between Decision-Making Inputs and Productivity among Paddy Farmers‟ in Integrated Agriculture Development Areas (IADAs), in Malaysia

The Malaysian paddy rice industry has always been considered as an industry that produces an important commodity which is the main staple food for the nation. The government, during the Tenth Malaysian Plan (2011-2015) period, set a target for every paddy farmer of 10 mt/ha, to ensure that the availability and accessibility of rice are maintained and sufficient. However, the latest production numbers from 2011 revealed that the average production per farmer from the main granary areas was still only 4.77 mt/ha, while in certain parts of the country - such as in the state of Selangor - farmers achieved up to 12 mt/ha. What is the cause of this disparity in production? Despite similarities in facilities, land area and resources, major differences remain in production. Although a multitude of factors could be relevant to this situation, this study aimed to focus on factors influencing the decisionmaking of farmers in correlation with farmers’ productivity. Nine (9) factors were identified that could contribute towards higher paddy productivity. The findings showed a positive and significant relationship between farmers’ productivity and knowledge about paddy (r = 0.159, p < .01), and a negative relationship with age (r= -0.148, p < .01). Hence, having knowledge about paddy farming and being young were the two factors most highly correlated with higher productivity in paddy. These results are an important first step towards understanding factors that could make the agricultural sector in Malaysia more sustainable by increasing the productivity of paddy farmers and increasing the supply of the national staple food

Relationship between decision-making inputs and productivity among paddy farmers in Integrated Agriculture Development Areas (IADAs), in Malaysia.

The Malaysian paddy rice industry has always been considered as an industry that produces an important commodity which is the main staple food for the nation. The government, during the Tenth Malaysian Plan (2011-2015) period, set a target for every paddy farmer of 10 mt/ha, to ensure that the availability and accessibility of rice are maintained and sufficient. However, the latest production numbers from 2011 revealed that the average production per farmer from the main granary areas was still only 4.77 mt/ha, while in certain parts of the country - such as in the state of Selangor - farmers achieved up to 12 mt/ha. What is the cause of this disparity in production? Despite similarities in facilities, land area and resources, major differences remain in production. Although a multitude of factors could be relevant to this situation, this study aimed to focus on factors influencing the decisionmaking of farmers in correlation with farmers’ productivity. Nine (9) factors were identified that could contribute towards higher paddy productivity. The findings showed a positive and significant relationship between farmers’ productivity and knowledge about paddy (r = 0.159, p < .01), and a negative relationship with age (r= -0.148, p < .01). Hence, having knowledge about paddy farming and being young were the two factors most highly correlated with higher productivity in paddy. These results are an important first step towards understanding factors that could make the agricultural sector in Malaysia more sustainable by increasing the productivity of paddy farmers and increasing the supply of the national staple food

Empowering farmers through practice of supportive agro communities

The role of extension agents in facilitating and inspiring farmers of the future is undeniably important in sustaining the agriculture sector globally for years to come. They are the agents that sustain the synergistic working relationship among farmers, government, private organizations, NGOs and the community at large. However, studies on how extension supports farmers are highly needed to develop supportive agro communities of practice. This paper discusses how research and extension collaboration empower farmers to engage themselves in continuing professional development activities and to strategize towards excellence. It explores the career experiences of novice and experienced farmers juggling their various tasks in agricultural work practice. Seven farmers participated in this qualitative study. Analysis of farmers’ career experiences was carried out through a series of interviews, document analysis and a literature review on a situated lifelong learning process undertaken within agriculture. How communities of practice in agriculture provide an educational process for farmers is also discussed. Their stories are valuable in revealing the learning experiences of farmers surviving the challenges in the agricultural world. Farmers, policy makers, researchers, academics and people working in agriculture can learn a great deal about what individuals and institutions need to do to develop farmers, personally and professionally. This paper also discusses strategies towards developing supportive agro communities of practice. The findings of this study aim to contribute to better agricultural work practice through a dynamic and systematic research and extensive collaboration, globally and locally

Improvement model framework of urban agriculture program in Malaysia: PLS-SEM analysis

The Malaysian government has introduced the Urban Agriculture Program to improve the performance of urban and rural agriculture in Malaysia. The Urban Agriculture Program was implemented by the Department of Agriculture (DOA), Malaysia in 2010. Such agricultural extension programs may significantly affect the effectiveness of adopting urban agriculture practices, which eventually help the participants with better living standards and productivity. This study aims to evaluate the effectiveness of urban agriculture programs. Primary data was collected from 230 urban agriculture program participants registered under the DOA Malaysia. The data was analysed using the PLS-SEM analysis method with the help of SMART-PLS software version 3.0. Findings revealed a positive association between all CIPP factors and Effectiveness. These findings showed that the DOA should prioritise process and product as the agriculture extension provider (stakeholders). This study suggests that policymakers should improve the implementation of urban agriculture programs in context, input, process, and product at a community level to improve food security and nutrition by 2030

Factors influencing decision-making of rice farmers towards productivity among Integrated Agricultural Development Areas (IADA) in Malaysia

The Malaysian rice industry is carefully monitored by several relevant agencies as it is a major priority in relation to the nation’s food security agenda. Against this backdrop, the current study focused on factors governing Malaysian rice farmers’ decision-making that contributes to their readiness to employ appropriate crop husbandry practices, which are critical for increasing productivity. Structured questionnaires were administrated to 320 respondents from six (6) Integrated Agricultural Development Areas (IADA) in Malaysia. Demographically, a majority of the respondents were aging farmers and were more interested in participating in hands-on extension clinics, rather than attending structured training sessions. The results further revealed the need for the younger generation to get involved in this area, to replace the aging farmers and to revitalize the sector toward becoming more successful in the years to come. Moreover, regression analysis also demonstrated four additional factors promoting higher paddy productivity: farming knowledge, motivational values, farming experience and trust in extension agents’ capabilities. From this combination of five factors, the current study has shed light on how Malaysian paddy farmers make decisions, which can be used to improve productivity within the IADAs. The study forwards potential approaches to making rice farming more attractive to the youth as a critical ingredient for the future health of the paddy industry

Predictors of polymyxin B treatment failure in Gram-negative healthcare-associated infections among critically ill patients

Background: With increasing prevalence and spread of multidrug resistant Gram-negative infections, parenteral polymyxins resurged in clinical practice. The primary aim of the study was to determine the predictors of treatment failure and in-hospital mortality among critically ill patients treated with polymyxin B. Methods: Demographic data, underlying diseases, procedures and details on polymyxin B therapy were retrospectively analyzed in a cohort of 84 patients who received intravenous polymyxin B in an intensive care unit from 2010 to 2014. Results: Polymyxin B was used to treat bacteremia (46.4% of cases) and pneumonia (53.6%). Majority of the pathogens isolated were Acinetobacter spp. (96.4%). The mortality rate was 48.8%, of which 82.9% was attributed to polymyxin B treatment failure. The independent predictors of treatment failure were low doses of polymyxin B (p = 0.002), shorter duration of therapy (p = 0.009), not combining with cefoperazone/sulbactam (p = 0.030), female gender (p = 0.004), administered for treatment of bacteremia (p = 0.023) and renal impairment (p = 0.021). Low polymyxin B doses (p = 0.007), not combining with cefoperazone/sulbactam (p = 0.024), female gender (p = 0.048) and renal impairment (p = 0.022) were also significant predictors for in-hospital mortality. Conclusions: To the best of our knowledge, this is the first report on the association of inadequate dose of polymyxin B (<15,000 units/kg/day) with poor outcome in critically ill patients. Besides that, further clinical studies are warranted to evaluate the use of cefoperazone/sulbactam as second antibiotic in the combination therapy. Keywords: Polymyxin B, Critically ill patients, Acinetobacter spp., Treatment failure, Adequate dose, Cefoperazone/sulbacta

Struktur data & algoritma menggunakan C++

Buku Struktur Data dan Algoritma Menggunakan C++ ditulis bagi memenuhi keperluan silibus pelajar jurusan Sains Komputer. Buku ini memberi penekanan terhadap struktur data dan keberkesanan algoritma dalam penyelesaian masalah dengan menggunakan bahasa pengaturcaraan C++. Kandungan buku ini juga merangkumi prinsip kejuruteraan perisian dan pengaturcaraan berorientasikan objek. Buku ini sesuai digunakan sebagai bahan pengajaran dan pembelajaran oleh pensyarah, pelajar mahupun orang awam yang ingin mendalami ilmu mengenai Struktur Data dan Algoritma dengan menggunakan Bahasa Pengaturcaraan C++