Survival predictors in paraquat intoxification and role of immunosuppression

Paraquat poisoning resulted in multiorgan failure and is associated with high mortality. We audited 83 historical cases of paraquat poisoning in past 2 years treated with conventional decontamination and supportive treatment, followed by enrolling 85 patients over a 2 year period into additional immunosuppression with intravenous (i.v.) methylprednisolone and i.v. cyclophosphamide. Our results showed that age, poor renal function and leucocytosis are the main predictors of fatal outcome. Immunosuppression regime rendered higher survival (6 out of 17 patients (35.3%)) versus historical control (1 out of 18 patients (5.6%)) (p = 0.041) in the cohort with admission eGFR 11,000/μL. In contrast, there was no difference in survival with immunosuppression regime (38 out of 64 patients (59.4%)) compared to historical control (30 out of 52 patients (57.7%)) (p = 0.885) in those with eGFR > 50 ml/min/1.73 m2 or WBC < 11,000/μL at presentation. Multivariable logistic regression showed survival probability = exp(logit)/(1 + exp(logit)), in which logit = 13.962 − (0.233 × ln(age (year))) − (1.344 × ln(creatinine (μmol/L))) − (1.602 × ln(rise in creatinine (μmol/day))) – (0.614 × ln(WBC (,000/μL))) + (2.021 × immunosuppression) and immunosuppression = 1 if given and 0 if not. Immunosuppression therapy yielded odds ratio of 0.132 (95% confidential interval: 0.029–0.603, p = 0.009). In conclusion, immunosuppression therapy with intravenous methylprednisolone and cyclophosphamide may counteract immune mediated inflammation after paraquat poisoning and improve survival of patients with admission eGFR 11,000/μL

A cross-sectional study on the cardiovascular risk factors among residents aged 30 years and above at Rumah Jana and Rumah Runggai in Julau district from 4 September 2000 to 22 October 2000

A cross-sectional study on the cardiovascular risk factors was carried out among residents aged 30 and above at Rumah Jana and Rumah Runggai, Julau from September to October 2000 by fourth year medical students from Universiti Malaysia Sarawak. The cardiovascular risk factors studied were hypertension, smoking, hypercholesterolaemia, (high fasting blood cholesterol), diabetes mellitus (abnormal fasting blood glucose) and overweight. A total of 155 respondents were universally selected for the questionnaire interview and measurements of blood pressure, body mass index, fasting blood glucose and fasting total blood cholesterol. The prevalence of hypertension was found to be 37.4 %, prevalence of smoking was 21.3 %, prevalence of high fasting total blood cholesterol was 17.4 %, prevalence of abnormal fasting blood glucose was 4.5 % and the highest prevalence was of overweight which was found to be 38.7 %. Study on the association between prevalence of cardiovascular risk factors with sociodemographic data revealed four significant associations. The significant associations were male respondents were found to have higher prevalence of smoking than female respondents, prevalence of hypertension rose with the increase in the respondents age, the prevalence of overweight was higher among the lower age group and the prevalence of overweight were higher among respondents with formal education (p<0.05). Results revealed that 74.8% of the respondents have at least 1 cardiovascular risk factor and 31.6% have 2 or more cardiovascular risk factors. A significant association was found between prevalence of overweight and the prevalence of high fasting total blood cholesterol (p<0.05). Generally, the respondents have good knowledge on cardiovascular risk factors. The percentage of respondents with adequate knowledge of each of the studied cardiovascular risk factor ranged from 68.4% for hypertension to 72.9% for hypercholesterolaemia. Study on the association between knowledge on a particular cardiovascular risk factor and the prevalence of that particular cardiovascular risk factor revealed a significant association between knowledge on overweight with the prevalence of overweight (p<0.05). Results revealed that respondents have very good attitude towards cardiovascular risk factors, with the percentage of respondents with positive attitude towards each of the studied cardiovascular risk factor ranged from 80.0% to 93.5%. Significant associations were found between the attitude of respondents towards hypertension with the prevalence of hypertension and between the attitude of respondents towards smoking with the prevalence of smoking (p<0.05)

Burkholderia pseudomallei Isolates from Sarawak Malaysian Borneo Are Predominantly Susceptible to Aminoglycosides and Macrolides

Melioidosis is a potentially fatal disease caused by the saprophytic bacterium Burkholderia pseudomallei. Resistance to gentamicin is generally a hallmark of B. pseudomallei, and gentamicin is a selective agent in media used for diagnosis of melioidosis. In this study, we determined the prevalence and mechanism of gentamicin susceptibility found in B. pseudomallei isolates from Sarawak, Malaysian Borneo. We performed multilocus sequence typing and antibiotic susceptibility testing on 44 B. pseudomallei clinical isolates from melioidosis patients in Sarawak district hospitals. Whole-genome sequencing was used to identify the mechanism of gentamicin susceptibility. A novel allelic-specific PCR was designed to differentiate gentamicin-sensitive isolates from wild-type B. pseudomallei. A reversion assay was performed to confirm the involvement of this mechanism in gentamicin susceptibility. A substantial proportion (86%) of B. pseudomallei clinical isolates in Sarawak, Malaysian Borneo, were found to be susceptible to the aminoglycoside gentamicin, a rare occurrence in other regions where B. pseudomallei is endemic. Gentamicin sensitivity was restricted to genetically related strains belonging to sequence type 881 or its single-locus variant, sequence type 997. Whole-genome sequencing identified a novel nonsynonymous mutation within amrB, encoding an essential component of the AmrAB-OprA multidrug efflux pump. We confirmed the role of this mutation in conferring aminoglycoside and macrolide sensitivity by reversion of this mutation to the wild-type sequence. Our study demonstrates that alternative B. pseudomallei selective media without gentamicin are needed for accurate melioidosis laboratory diagnosis in Sarawak. This finding may also have implications for environmental sampling of other locations to test for B. pseudomallei endemicity