The use of antibiotics agents in ocular infection

Eye disease can cause discomfort and anxiety in patients, with the ultimate risk of loss of vision or even facial disfigurement. The unique structure of the human eye as well as exposure of the eye directly to the environment renders it vulnerable to a number of uncommon infectious diseases caused by bacteria, fungi and parasites. The driving force for the development of newer anti-infectives is almost always the inevitable emergence of bacterial resistance to antibiotics following widespread clinical, veterinary, and agricultural (growth promoter in chickens, pigs, and feedlot cattle) usage. The pharmaceutical industry has continuously met this need by modifying existing antibiotics and developing newer antibiotics. These successful efforts have produced the wide variety of currently available drug classes of antibiotics beta lactams (penicillins, carbapenems, cepahalosporins), glycopeptides, macrolides, ketolides, aminoglycosides, fluoroquinolones, oxazolidinones, and others . There are, however, still several serious and potentially blinding eye diseases that lack adequate and effective treatment. Despite coverage with broad-spectrum antibiotics, visual loss remains a common result (1,2). The outcome of the most severe infections is determined by several factors, such as the responsible pathogen, the patient's age, the therapy chosen, or the condition of the eye upon presentation (3). The most important factor, however, seems to be the duration between infection and treatment. Clinical and experimental studies have firmly established that delay in therapy increases the risk of poor visual outcome, especially in severe cases. Early and accurate diagnosis of the responsible pathogen is, therefore, essential for effective treatment. However, when ocular infection is suspected, the pathogen is typically not known, so the choice of antimicrobial agent must be made empirically. Unfortunately, clinical features of infection and culture results do frequently not correlate adequately to guide the choice of antibiotics upon presentation (4). The objective of the present work was therefore to compile and review the available information on bacterial eye diseases as well as the current drugs and therapies and their limitations. It is hoped that this may assist both clinicians and research scientists in improving the diagnosis and treatment of these diseases. To this end, the present study : 1- presents an overview of the eye's physiology and of the current knowledge of microbes infecting the eye 2- reviews the currently available therapies for eye infections 3- introduces a handbook for ophthalmologists on antimicrobial drugs including dosage, ingredient and possible drug-drug interaction 4- examines two promising avenues for overcoming the present medical challenges posed by eye infections: more sensitive tools for early and more accurate diagnosis of microbial infections and better delivery systems for drug targeting

Co-curricular importance in secondary school

Co-curricular is a group activity where the planned activities more advanced than teaching and learning in the classroom that provide the opportunity to add, strengthen and practice the knowledge, skills and values learned in the classroom. It is a physical, emotional and spiritual construction platform in line with the aims of the National Education Philosophy aimed at forming a balanced generation. Hence, referring to the Letter of Professional Circular No. 1/1985 dated 2 January 1985, each student either government or non-government school is required to take at least one activity of the Uniform Body Team, an association or club activity and a sports or game activity. The main goal of co-curriculum’s implementation in education is to achieving the National Education Philosophy in distributing awareness of religion and belief in god. Balancing spiritual, physical, intellectual and emotional development and also strengthening relationships and interactions among students; Build and increase interest and talent; Building and improving discipline; Creating a healthy school culture; Building and improving cooperation and create a school of character. The curriculum plays an important role in education. Among them is the importance of cultivating the character and the unity of creation. This is in line with the second core of the Education Development Master Plan (PIPP), namely Developing Human Capital. Participation in co-curricular activities can also increase the level of student’s discipline. Based on some studies, it found that the co-curricular activity was able to reduce the disciplinary problem to a minimum level. However, in this effort, teachers, parents and communities need to work together and strengthen relationships with one another. Negative perceptions of co-curricular implementation in schools should eradicated. Schools and parents need to be more open-minded. © 2017 Elixir All rights reserved

Structural performance of precast foamed concrete sandwich panel subjected to axial load

In this paper, experimental and simple analytical studies on the structural behavior of Precast Foamed Concrete Sandwich Panel (PFCSP) were reported. Full-scale tests on six PFCSP panels varying in thickness were performed under axial load applications. Axial load-bearing capacity, load-deflection profiles, load-strain relationships, slenderness ratio, load-displacement, load-deformation, typical modes of failure and cracking patterns under constantly increasing axial loads were discussed. Nonlinear Finite Element Analysis (FEA) using LUSAS software to investigate the structural behavior of PFCSP was contacted. The computed ultimate strength values using American Concrete Institute equation (ACI318) and other empirical formulas developed by pervious researchers which applicable to predict the ultimate strength capacity of sandwich panels were compared with the experimental test results and FEA data obtained; therefore, very conservative values resulted, a significant agreement with the FEA data that presented a high degree of accuracy with experiments and an increase in slenderness function

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Process evaluation of enhancing primary health care for non-communicable disease management in Malaysia: Uncovering the fidelity & feasibility elements.

BackgroundIn combating the increasing trend of non-communicable diseases (NCDs) over the last two decades in the country, the Ministry of Health Malaysia developed the Enhanced Primary Health Care (EnPHC) initiative to improve care management across different levels of the public service delivery network. An evaluation research component was embedded to explore the implementation issues in terms of fidelity, feasibility, adaptation and benefit of the initiative's components which were triage, care coordination, screening, risk management and referral system.MethodsA mixed methods study was conducted at 20 participating EnPHC clinics in Johor and Selangor, two months after the intervention was initiated. Data collected from self-reported forms and a structured observation checklist were descriptively analysed. In-depth interviews were also conducted with 20 participants across the clinics selected to clarify any information gaps observed in each clinic, and data were thematically analysed.ResultsEvaluation showed that all components of EnPHC intervention had been successfully implemented except for the primary triage counter and visit checklist. The challenges were mainly discovered in terms of human resource and physical structure. Although human resource was a common implementation challenge across all interventions, clinic-specific issues could still be identified. Among the adaptive measures taken were task sharing among staff and workflow modification to match the clinic's capacity. Despite the challenges, early benefits of implementation were highlighted especially in terms of service outcomes.ConclusionsThe evaluation study disclosed issues of human resource and physical infrastructure when a supplementary intervention is implemented. To successfully achieve a scaled-up PHC service delivery model based on comprehensive management of NCDs patient-centred care, the adaptive measures in local clinic context highlight the importance of collaboration between good organisational process and good clinical practice and process

All tables are provided in Annexes 1–5.

IntroductionColorectal cancer is a growing global health concern and the number of reported cases has increased over the years. Early detection through screening is critical to improve outcomes for patients with colorectal cancer. In Malaysia, there is an urgent need to optimize the colorectal cancer screening program as uptake is limited by multiple challenges. This study aims to systematically identify and address gaps in screening service delivery to optimize the Malaysian colorectal cancer screening program.MethodsThis study uses a mixed methods design. It focuses primarily on qualitative data to understand processes and strategies and to identify specific areas that can be improved through stakeholder engagement in the screening program. Quantitative data play a dual role in supporting the selection of participants for the qualitative study based on program monitoring data and assessing inequalities in screening and program implementation in healthcare facilities in Malaysia. Meanwhile, literature review identifies existing strategies to improve colorectal cancer screening. Additionally, the knowledge-to-action framework is integrated to ensure that the research findings lead to practical improvements to the colorectal cancer screening program.DiscussionThrough this complex mix of qualitative and quantitative methods, this study will explore the complex interplay of population- and systems-level factors that influence screening rates. It involves identifying barriers to effective colorectal cancer screening in Malaysia, comparing current strategies with international best practices, and providing evidence-based recommendations to improve the local screening program.</div