The mazEF toxin-antitoxin system as a novel antibacterial target in Acinetobacter baumannii

Although analysis of toxin-antitoxin (TA) systems can be instructive, to date, there is no information on the prevalence and identity of TA systems based on a large panel of Acinetobacter baumannii clinical isolates. The aim of the current study was to screen for functional TA systems among clinical isolates of A. baumannii and to identify the systems' locations. For this purpose, we screened 85 A. baumannii isolates collected from different clinical sources for the presence of the mazEF, relBE and higBA TA genes. The results revealed that the genes coding for the mazEF TA system were commonly present in all clinical isolates of A. baumannii. Reverse transcriptase-polymerase chain reaction analysis showed that transcripts were produced in the clinical isolates. Our findings showed that TA genes are prevalent, harboured by chromosomes and transcribed within A. baumannii. Hence, activation of the toxin proteins in the mazEF TA system should be investigated further as an effective antibacterial strategy against this bacterium

Comparison of Calcofluor White M2R fluorescence and modified Gram chromotrope Kinyoun staining methods for the detection of microsporidial spores from stool samples

Routine diagnosis of intestinal microsporidiosis in clinical diagnostic laboratories relies mostly on detection of microsporidial spores via special staining and microscopic techniques. This paper describes the comparative evaluation of Calcofluor White M2R method, with modified Gram-chromotrope Kinyoun method as the reference standard. One hundred and six stool samples were examined for the presence of microsporidial spores. Sensitivity, specificity, positive and negative predictive values of the Calcofluor White M2R method compared to the reference technique were 95.2%, 4.3%, 78.2% and 20.0%, respectively. The positive predictive value (PPV) was 78.2% and the negative predictive value (NPV) was 20.0%. Despite low specificity of the CFW method due to its ability to stain chitinous wall of microorganisms, the presence of distinct deep-blue horizontal or equitorial stripes in microsporidial spores in modified Gram-chromotrope Kinyoun would likely reduce the false positive results obtained in the Calcofluor White M2R. Hence, the simultaneous use of these two methods would give better performance and accuracy for the detection of microsporidial spores in patients with intestinal microsporidiosis

A casemix: congestive heart failure readmission rate and its associated factors in a tertiary teaching hospital in Kuala Lumpur

Cardiovascular mortality is within the top five causes of death from non-communicable disease based on World Health Organization profile. Around 20% of heart failure patients are readmitted within 30 days worldwide. Readmission within 30 days for congestive heart failure often related to non-compliant to fluid restriction, natural progression of the disease or pre-mature discharge. The study aims to evaluate the 30 days readmission rate of congestive heart failure in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from the year 2016-2017 using casemix data and to determine the associated factors related to it. Based on the data coding, cost of readmission incurred was calculated. The 30-days readmission rate of heart failure to UKMMC in the year 2016-2017 was 53.5% & 43.5%, higher than the developed countries standard but similar to that of local teaching hospitals. After adjustment, age and level of severity are the only significant associated factors for the 30-days readmission rate. Shorter average length of stay (ALOS) & lower extra-tariff were achieved for readmission of heart failure. Total of RM80,329.73 was saved in the year 2017 from prompt treatment and comprehensive care plan of treating 19.3% level 3 severity patients at level 1 ALOS and tariff-cost. The 30-days readmission rate for heart failure in UKMMC was comparable to local teaching hospitals. The reduction of 30-days readmission rate in 2017 saved much cost, shows good clinical governance and advanced treatment strategy. Casemix can be used to guide budget allocation for the cardiology department of UKMMC

AN EXPLORATORY STUDY ON WORKING CAPITAL MANAGEMENT AMONG PETTY TRADERS IN KUALA NERANG, KEDAH

Petty trading is a common economic activity amongst locals in Kuala Nerang, Kedah. Currently, an ironic situation exists where the petty traders in Kuala Nerang claim that their businesses are profitable yet they still face a deficiency in working capital. To explore the situation, this working paper aims to identify the reasons behind the high instances of working capital deficiency amongst the petty traders. To this end, the following research questions are raised. Why does this problem occur? Do the petty traders actually suffer a loss in their businesses? Do they keep their accounting records properly to enable them to ascertain whether their businesses generated a profit or suffered a loss? The findings reported in this paper are based on in-depth interviews drawn from a convenience sample of 20 petty traders in Kuala Nerang. It was revealed that accounting records are not kept in order, and therefore, the profits made cannot be determined accurately. This could be due to a lack of understanding on working capital management among the petty traders. Hence, it is not unusual for them to encounter a shortage in working capital. Keywords: petty traders, working capital, accounting records, rural informal sector, Kuala Neran

Knowledge, attitudes, practices and health beliefs toward Leptospirosis among urban and rural communities in Northeastern Malaysia

Background: Leptospirosis is a zoonotic disease with a worldwide distribution, especially in developing countries such as Malaysia. This study was designed to explore the knowledge, attitudes, beliefs and practices (KABP) toward leptospirosis among the communities in northeastern Malaysia and to determine the sociodemographic factors associated with the KABP toward leptospirosis. A cross-sectional study using a stratified sampling method was conducted among 214 individuals in four locales in northeastern Malaysia. Methods: A cross-sectional study was conducted among 214 respondents in northeastern Malaysia using a multi-stage stratified random sampling method. The study population was divided into two groups based on geographical locations: urban and rural. All data were entered and analyzed using the IBM Statistics for Social Sciences (SPSS) version 22.0 software for Windows (IBM, Armonk, NY, USA). The continuous variables were presented using mean and standard deviation (SD), whereas the categorical variables were described using frequency and percentage. Multiple logistic regression was performed to determine the associated factors for good KABP toward leptospirosis among the respondents. Results: It was found that 52.8% of respondents had good knowledge, 84.6% had positive attitudes, 59.8% had positive beliefs, and 53.7% had satisfactory practices. There were no significant sociodemographic factors associated with knowledge and practice, except for educational status, which was significant in the attitude and belief domains. Those with higher education exhibited better attitudes (Odds Ratio (OR) 3.329; 95% Coefficient Interval (CI): 1.140, 9.723; p = 0.028) and beliefs (OR 3.748; 95% CI: 1.485, 9.459; p = 0.005). The communities in northeastern Malaysia generally have good knowledge and a high level of positive attitude; however, this attitude cannot be transformed into practice as the number of people with satisfactory practice habits is much lower compared to those with positive attitudes. As for the belief domain, the communities must have positive beliefs to perceive the threat of the disease. Conclusions: Our current health program on preventing leptospirosis is good in creating awareness and a positive attitude among the communities, but is not sufficient in promoting satisfactory practice habits. In conclusion, more attention needs to be paid to promoting satisfactory practice habits among the communities, as they already possess good knowledge and positive attitudes and beliefs

Rapid detection and identification of pathogens in patients with continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis by 16s rRNA gene sequencing

Peritonitis still remains a serious complication with high rate of morbidity and mortality in patients on CAPD. Rapid and accurate identification of pathogens causing peritonitis in a CAPD patient is essential for early and optimal treatment. The aim of this study was to use 16S rRNA and ITS gene sequencing to identify common bacterial and fungal pathogens directly from the peritoneal fluid without culturing. Ninety one peritoneal fluids obtained from 91 different patients on CAPD suspected for peritonitis were investigated for etiological agents by 16S rRNA and ITS gene sequencing. Data obtained by molecular method was compared with the results obtained by culture method. Among the 45 patients confirmed for peritonitis based on international society of peritoneal dialysis (ISPD) guidelines, the etiological agents were identified in 37(82.2%) samples by culture method, while molecular method identified the etiological agents in 40(88.9%) samples. Despite the high potential application of the 16S rRNA and ITS gene sequencing in comparison to culture method to detect the vast majority of etiological agents directly from peritoneal fluids; it could not be used as a standalone test as it lacks sensitivity to identify some bacterial species due to high genetic similarity in some cases and inadequate database in Gene Bank. However, it could be used as a supplementary test to the culture method especially in the diagnosis of culture negative peritonitis

Virulence genes expression among methicillin-resistant staphylococcus aureusisolated form cancer and non-cancer patients

Relative quantitative real-time reverse transcriptase polymerase chain reaction (qPCR) assay was designed and applied in order to study the expression levels of selected genes encoding the adherence and toxins virulent factors. Relative quantification qPCR showed a significant higher expression level of common genes tested among strains isolated from cancer patients not only within the clone but also among different lineages. This study demonstrated that although all MRSA strains studied from cancer and non-cancer patients possessed several virulence determinantsthe expression rather than presence of virulence determinants may mediate higher pathogenicity potential. These data will aid in developing more effective infection control strategy to improve the management of MRSA infection in cancer patients

Seroprevalence of leptospiral antibodies among market workers and food handlers in the central state of Malaysia

Objective:The high prevalence of leptospirosis in humans is of great public health concern, particularly in tropical and subtropical regions. This study aimed to determine the seroprevalence of leptospiral antibodies and distribution of serovars, and to assess the usefulness of enzyme-linked immunosorbent assay (ELISA) as a screening method for leptospiral antibodies in a high-risk healthy community. Methods: Cross-sectional study of 231 market workers and food handlers in wet markets and food premises from two localities in central Malaysia. Respondents' background information was obtained using a questionnaire. Serum samples were tested for leptospiral antibodies using ELISA and microscopic agglutination test (MAT). Results: Seroprevalence of leptospirosis among healthy workers was 46.3%. Detection of seropositivity was higher by MAT (46%) than ELISA (15%). We observed high seropositivity among local workers (49%), food handlers (49.5%), females (60.8%) and those aged 34 years and older (46.3%). Local strain LEP175 was the predominant serovar, followed by WHO strain Patoc. Conclusion: Overall seroprevalence among healthy food handlers and market workers was high in this study. The workplace places susceptible individuals at risk of leptospirosis

FINITE ELEMENT ANALYSIS ON STRUCTURAL BEHAVIOUR OF GEOpOLYMER REINFORCED CONCRETE BEAM USING JOHNSON-COOK DAMAGE IN ABAQUS

This paper details a finite element analysis of the behaviour of Si-Al geopolymer concrete beam reinforced steel bar under an impulsive load and hyper velocity speed up to 1 km/s created by an air blast explosion. The initial torsion stiffness and ultimate torsion strength of the beam increased with increasing compressive strength and decreasing stirrup ratio. The study involves building a finite element model to detail the stress distribution and compute the level of damage, displacement, and cracks development on the geopolymer concrete reinforcement beam. This was done in ABAQUS, where a computational model of the finite element was used to determine the elasticity, plasticity, concrete tension damages, concrete damage plasticity, and the viability of the Johnson-Cook Damage method on the Si-Al geopolymer concrete. The results from the numerical simulation show that an increase in the load magnitude at the midspan of the beam leads to a percentage increase in the ultimate damage of the reinforced geopolymer beams failing in shear plastic deformation. The correlation between the numerical and experimental blasting results confirmed that the damage pattern accurately predicts the response of the steel reinforcement Si-Al geopolymer concrete beams, concluded that decreasing the scaled distance from 0.298 kg/m3 to 0.149 kg/m3 increased the deformation percentage