Outcome of interim multidrug-resistant tuberculosis treatment in Yemen

Purpose: To assess the interim therapy outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) in Yemen. Methods: This study was performed in four major tuberculosis (TB) centers in Yemen, namely, Alhodidah, Taiz, Sana’a, and Aden. Data were collected between January 1, 2014 and December 31, 2016, and consistent methods were adopted to obtain data from MDR-TB patients. The standardized WHO method of calculating and reporting the interim therapy outcomes patients enrolled in the study was applied, and the relation between dependent and independent variables was obtained by logistic regression. Results: A total of 85 MDR-TB cases were reported between January 1, 2014 and December 31, 2016. Of these cases, 62 reported available interim results. Among the 62 MDR-TB cases, only 40 (64.5 %) were categorized into successful interim therapy outcome group. This study found a baseline weight ≤ 40 kg, comorbidity, and first-line drug (FLD) resistance (> 3) as risk factors influencing unsuccessful interim therapy outcomes. Conclusion: This cohort study reports an alarmingly high rate of unsuccessful interim therapy outcomes among Yemeni MDR-TB patients. Enhancement of the clinical management of patients with a baseline weight ≤ 40 kg, comorbidity, and FLD resistance (>3) may improve TB therapy outcomes

A Content Analysis on Quality for Cad Based Product Design: Developing a Framework for Malaysian Technical Teacher Training Institute

Product design is a complicated process and requires a systematic requirement and specification to produce sufficient quality to remain competitive. One of the most important components in the design process is Computer-Aided Design (CAD), which renders a detailed drawing in either two-dimensional (2D) or three-dimensional modeling (3D). This paper discusses the conception of quality design to produce a creative design product. This study employed a systematic review to produce a framework of quality product design based on Computer-Aided Design (CAD). Out of 210 papers that were identified, 102 were reviewed and also 12 other relevant articles, books, reports, and documents, hence a total of 114 papers were included in this review. The reviews revealed that there are main aspect drivers of the product design, design process, design quality, customer need on the product, product evaluation, and design concept of quality products. The study also showed that the initial stage of idea-generating is an essential phase to produce innovative, creative and quality product design. This framework is useful as a guide for teachers to standardize product design concept and to assist Malaysian design and technology trainee teachers in producing a quality product design. Finally, this research proposes a conceptual framework based on our propositions. The proposed quality product design framework is beneficial to be used as a guideline for the Malaysian Technical Teacher Training Institute and policy makers to enhance the skills in the development of a quality product

The Importance of Quality Product Design Aspect Based on Computer Aided Design (CAD)

Computer-Aided Design (CAD) is the essential tools to create technical documentation and product specification for designing a product. Because of this, a survey conducted to identify the needs and importance of the design aspect such as design requirement, design concept, detailed product design and design evaluation. The result of a descriptive analysis indicated that significance of the elements of designing the quality product was at a high level. Findings also state that there was a positive relationship between the design process among each aspect of the product design, and the correlation shows a moderate level. Keywords: Design Requirement; Design Concept; Detailed Product Design; Design Evaluation. eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bsby e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5iSI3.254

Antimicrobial Susceptibility of Klebsiella pneumoniae and Escherichia coli with Extended-Spectrum β-lactamase associated Genes in Hospital Tengku Ampuan Afzan,Kuantan, Pahang

Background: To assess antimicrobial susceptibility of extended-spectrum β-lactamase- (ESBL-) producing Klebsiella pneumoniae and Escherichia coli isolates from Hospital Tengku Ampuan Afzan (HTAA), as well as to identify ESBL genes. Methods: Non-duplicate K. pneumoniae and E. coli isolates were recovered from various clinical samples. Isolates were screened for antimicrobial resistance by disc diffusion method. Isolates resistant to oxyimino-cephalosporins were subjected to phenotypic ESBL production. Detection of resistance genes was then performed using primers specific for ESBL genes(bla CTX-M,bla SHV and bla TEM). Results: Piperacillin/tazobactam and carbapenems remained the active β-lactam antibioti against K. pneumoniae and E. coli. ESBLs were detected among 35.5%(39/110)of K. pneumoniae and 18.8%(28/149)of E. coli isolates. CTX-M β-lactamase was detected in 90% of all ESBL-positive isolates, whereas bla SHV and bla TEM genes were found among 56% and 52% of them, respectively. Twenty-eight percent(28%)of the total ESBL-positive isolates harboured the three ESBL genes, while 50% carried two of the tested ESBL genes. Conclusion ESBLs encoded by at least one ESBL genes are frequently isolated among K. pneumoniae and E. coli in HTAA. The significant proportion rate of the resistant determinants is alarming, thus monitoring their transmission and dissemination is essential to control it at an early phase

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Review of green building index in Malaysia; existing work and challenges

Energy is becoming one of the most critical and important aspect to the nation, countries with high percentage of energy and resources is considered powerful as nowadays energy and resources of the country is key measurement for its power and development. Economic improvement has now taken an imperative part in the current world as characteristic assets are a rare thing and accessible lodging area is decreasing with the blast of human population. Which increase the need of implementation of Green building construction to ensure sustainable development and reduce the consumption of resources. Green building is the act of building structures and utilizing procedures that are ecologically benevolent and asset productive all through a building's life-cycle from arrangement to outline, development, operation, upkeep, remodel and deconstruction. In Malaysia some world class Green Buildings have built in recent years, yet the idea of green buildings for general masses is in outset stage. During this paper, it will explore the overall of sustainable development with its concept and its importance of this approach and goals of green building. Advantages and elements of the assessment for Green building Index had been discussed with a number of the barriers to application and a review of existing mobile applications. In Malaysia, the dynamic development of practice development by the legislature, non-governmental associations and instruction, foundations in the recent years have demonstrated some empowering advance in this field as it had revealed in this paper