Genetic assemblage of Sarcocystis spp. in Malaysian snakes

Abstract Background: Sarcocystis species are protozoan parasites with a wide host range including snakes. Although there were several reports of Sarcocytis species in snakes, their distribution and prevalence are still not fully explored. Methods: In this study, fecal specimens of several snake species in Malaysia were examined for the presence of Sarcocystis by PCR of 18S rDNA sequence. Microscopy examination of the fecal specimens for sporocysts was not carried as it was difficult to determine the species of the infecting Sarcocystis. Results: Of the 28 snake fecal specimens, 7 were positive by PCR. BLASTn and phylogenetic analyses of the amplified 18S rDNA sequences revealed the snakes were infected with either S. nesbitti, S. singaporensis, S. zuoi or undefined Sarcocystis species. Conclusion: This study is the first to report Sarcocystis infection in a cobra, and S. nesbitti in a reticulated python

Morphometric and molecular characterization of Sarcocystis spp. in cattle (Bos spp.) and goats (Capra hircus) collected from the Shah Alam abattoir / Ng Yit Han

Sarcocystosis in meat-producing animals is a major cause of reduced productivity in many countries, especially those that rely on agriculture. Although several diagnostic methods are available to detect sarcocystosis, many are too time-consuming for routine use in abattoirs and meat inspection centres, where large numbers of samples need to be tested. Current establish method (transmission electron microscope) for Sarcocystis spp. identification is expensive and time-consuming. Alternatively, tissue compression technique can rapidly detect sarcocysts in tissue samples. Additionally, cysts measurement in corroboration with genotyping of 18S rDNA allows comprehensive species identification. Sequences of Sarcocystis spp. can also be analysed via phylogenetic tree to provide better understanding of the evolution of Sarcocystis spp. corresponding to the respective intermediate hosts. Furthermore, phylogeny analysis enables effective species differentiation of sarcocyst, especially for those closely related species that are morphologically similar. Tissue samples of cattle and goats were collected from the Shah Alam abattoir, Selangor. Samples were pre-screened for the presence of sarcocysts via tissue compression technique (group of unstained (methylene blue) and stained condition). Positive sample tissues were further confirmed by nested PCR by targeting the 18S rDNA regions. Statistical calculations were done to determine the efficacy of stain-based technique compared to the standard unstained technique of sarcocysts detection in tissue samples. Besides, sarcocysts detected in tissues were measured for morphometric study and then subjected for genotyping to determine the identity. Sequences were then used for phylogenetic tree analysis. A total of 583 tissue samples were collected. Of these, 245 samples were positive under pre-screening phase. Mc Nemar’s and Cohen kappa analysis show that stain-based technique is able to detect three-folds higher sarcocysts and it is statistically in concordance with nested PCR outcome (gold standard). Morphometric study deduced that possibly one Sarcocystis sp. iv infects cattle whereas two species in goats. Molecular BLAST analysis and morphometric findings confirmed that Sarcocystis cruzi was found in cattle, whereas goats were infected by Sarcocystis capracanis and Sarcocystis tenella. Phylogenetic analysis using nine representative sequences confirmed the identity of the two species, in addition of S. tenella where the corresponding sequences were separated from the reference gene and formed a subclade. All Sarcocystis spp. found shared dog as a definitive host. Dogs are often used in cattle farms to monitor the herds. Poor management in the farmlands potentially boosts up the dynamics of disease transmission between the hosts. The “S. tenella-like”, maybe refers to Sarcocystis hircicanis rather than S. tenella where it also uses dogs as a definitive host. Insufficient or lack of the gene information of S. hircicanis in the GenBank explains the failure of BLAST to match the 18S rDNA of the Sarcocystis sp. with S. hircicanis

Covid rehabilitation in two Malaysian Tertiary Hospitals

Research Objectives To investigate the severity of COVID-19 infections and complications experienced during inpatient admission. To study the patient outcomes after a 12 week outpatient rehabilitation program. Design A retrospective cohort study was conducted for a 12 month period from January 1st, 2021, to December 31st, 2021. COVID-19 patients who were referred to Rehabilitation Medicine team as inpatient or outpatient were included. Patient symptoms and outcome at 1 month and 3 month post initial contact were analysed. Setting Sultan Ahmad Shah Medical Centre@IIUM) and Penang General Hospital are both tertiary hospitals and referral centers. Participants 184 patients were selected for this study. By using IBM SPSS version 24, descriptive analysis was done to elaborate the demographic data and patient outcomes up to 3 months after the first contact with the Rehabilitation Medicine team. Interventions Pulmonary rehabilitation by telerehabilitation or face to face method. Main Outcome Measures Residual symptom report and Medical Research Council Dyspnea Scale. Results The mean age of patients in the study was 51.8 years (SD 16.0). Out of 184 patients, majority were male (58.7%), from Malay ethnicity (74.5%) and hypertensive (51.6%). 25.5% of patients received telerehabilitation review. Most patients were classified as category 4 and 5 COVID-19 infection (78.8 %). During inpatient admission, many patients received treatment with steroids (77.2%) and antibiotics (69.0%). 30.5% of patients received antiviral treatment. Three commonest COVID-19 complications were pulmonary complications (59.8%), pressure injury (28.8%), and nosocomial infections (23.4%). Dyspnea and fatigue were the main reported symptoms during initial rehabilitation contact and all outpatient follow ups. The mean Medical Research Council Dyspnea scale improved from 2.7 at baseline to 1.7 at 3 months follow up. 32.1% of patients were diagnosed with Long COVID syndrome. Default rates increased from 26.1% at 1 month to 36.4% at 3 month follow up. Conclusions COVID 19 patients who received inpatient rehabilitation input, followed by a 12 week outpatient follow up showed symptom improvement. Future studies need to establish long term outcomes of COVID-19 survivors in this region

Obstructive sleep apnoea syndrome (OSAS) as a risk factor for secondary osteoporosis in children

Abstract Repetitive hypoxia seen in obstructive sleep apnoea syndrome (OSAS) may affect bone metabolism increasing the risk for secondary osteoporosis. This study investigates the association between OSAS in children and secondary osteoporosis. This cross-sectional study included 150 children aged 10–17 years: 86 with OSAS and 64 with no OSAS. OSAS was confirmed by polysomnography. Quantitative ultrasound (QUS) of calcaneum measuring speed of sound (SoS) and broadband ultrasound attenuation (BUA) were collected. Other parameters collected including bone profile, vitamin D levels, physical activity scoring and dietary calcium intake. Majority were male and Malay ethnicity. OSAS children were mostly obese (84%) and 57% had moderate to severe OSAS. Most had lower physical activities scores. Mean (SD) phosphate and Alkaline phosphatase were lower in OSA children compared to controls: PO4, p = 0.039 and ALP, p < 0.001. Using both single and multivariate analysis, children with OSAS had a lower mean SoS value, p < 0.001 and p = 0.004 respectively after adjusting for age, BMI and bone profile. Children with OSAS had lower SoS suggesting risk for secondary osteoporosis. QUS calcaneus is a non-invasive, feasible tool and can be used to screen risk of osteoporosis in children. Further bone mineral density assessment is needed in these groups of children to confirm diagnosis of osteoporosis

Religious Coping, Religiosity, Depression and Anxiety among Medical Students in a Multi-Religious Setting

Medical students are vulnerable to depression and anxiety due to the nature of their academic life. This study aimed to determine the prevalence of depressive and anxiety symptoms among medical students and the association between religious coping, religiosity and socio-demographic factors with anxiety and depressive symptoms. A cross sectional design was used for this study. Scales used were the Malay version of the Duke Religious Index (DUREL-M), the Malay version of the Brief Religious Coping Scale (Brief RCOPE) and the Malay version Hospital and Anxiety Depression Scale (HADS-M). 622 students participated in this study. They scored moderately on the organized (mean: 3.51) and non-organized religious (mean: 3.85) subscales of the DUREL, but had high intrinsic religiosity (mean: 12.18). The prevalence of anxiety and depressive symptoms were 4.7% and 17.4% respectively, which is lower than local as well as international data. Islam, negative religious coping and the presence of depressive symptoms were significantly associated with anxiety symptoms. Only the presence of anxiety symptoms was significantly associated with depressive symptoms. Negative religious coping, rather than positive religious coping, has significant association with depressive and anxiety symptoms. Redirecting focus towards negative religious coping is imperative to boost mental health outcomes among medical students