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Objective: Perinatal mortality is an important indicator of obstetric and neonatal services and socio-economic status of a country. This study reviewed perinatal mortality in Pasir Mas district for year 1999 to 2003 and its causes and related obstetric and foetal factors.Design: Retrospective studyMaterials and Methods: We retrospectively examined data obtained from the Perinatal Reporting System in Pasir Mas district.Results: The overall five-year perinatal mortality rate was 16.32 per 1,000 births. The causes of perinatal deaths included macerated stillbirth (26.8%), asphyxia (21.9%), congenital malformation (19.6%), immaturity (10.9%) and infection (4.2%). The mean (SD) age of mother was 31.5 (7.2) years with 65.3% aged less than 35 years, 96.6% Malays, 21.1% primigravida and 23.1% grandmultigravida. The rates of maternal morbidity were: 15.8% hypertension, 13.2% anaemia, 7.5% diabetes mellitus, 6.8% ante partum haemorrhage and 3.4% prolonged rupture of membrane. The providers of antenatal care were: 71.3% health clinics, 8.3% hospitals, 1.9% private clinics, 0.8% none and 17.7% several. The foetus was delivered by doctors (56.6%), nurses (27.5%) and midwives (15.5%). The places of delivery were: 92.1% hospital, 5.7% home, 0.8% health clinic, 0.8% private clinic and 0.8% in transit. The mean (SD) gestational age was 33.7 (4.9) weeks with 65.7% preterm. The gestational age was determined by last menstrual period (68.7%), ultrasound (27.2%) and neonatal condition (4.2%). The mean (SD) of birth weight was 1952.8 (1051.7) grams with 65.3% were < 2500 grams.Conclusion: Perinatal mortality rate in Pasir Mas district was moderate compared to other districts in Kelantan but higher than the average Kelantan and Malaysia rates. The causes of perinatal deaths were similar to other areas. There were still unsafe deliveries in terms of attendant and place. This perinatal registry system gives a good overview of local perinatal related problems. [ABSTRACT FROM AUTHOR]

Sulfuric acid is commonly used to electrochemically activate gold electrodes in a variety of electrochemical applications. This work provides the first evaluations of the electrochemical behaviors and a 3D image of an activated screen-printed gold electrode (SPGE, purchased commercially) through electrochemical and imaging analyses. The activated SPGE surface appears rougher than the unactivated SPGE surface when viewed through microtopography images using scanning electron microscopy (SEM) and atomic force microscopy (AFM). Nevertheless, the roughened microscopy structure does not exhibit any substantial changes in roughness factor for the activated SPGE, as indicated by capacitive current analyses. The significant improvement in electrochemical responsiveness of the activated SPGE is mainly attributed to the presence of surface pores created in the microscopic structure as a result of gold oxide layer formation. The presence of surface pores on the activated surface has significantly improved its conductivity by 10-fold. As a result, electron transfer kinetics and mass transports of the activated SPGE are greatly improved. The results presented in this work indicate that the surface of the activated SPGE greatly increased its intrinsic surface pores, and conductivity of the electrode surface and uncovered the electrocatalytic active sites. This significantly improves the activated SPGE's performance in electrochemical applications such as oxygen reduction reaction (ORR). An activated SPGE considerably enhanced limiting current density as well as ∼172 mV versus Ag shifted onset potential to more positive potentials compared to unactivated SPGE.

This paper focuses on exploring the potential solution and opportunity in the development of the Malaysian Army Transformation Plan by using the concept of Cognitive Readiness (CR). Here, the concept of CR equipped the military personnel to be cognitively ready to perform their role in military operations. The main aim of the paper is to highlight the fundamental discourse of 'what is cognitive readiness' in discovering the potential solution and opportunity in the development of the Malaysian Army Transformation Plan. The paper suggests that the strategy for transformation may start at the tactical level by focusing on enhancing the military personnel's CR. The study proposed that the Malaysian Army Organization prepare the military personnel with Knowledge, Skills and Abilities (KSA). KSA are important to boost the military personnel to have a distinctive character such as thinking critically, problem-solving and decision-making to perform effectively during military operations. In this preliminary study, the paper proposed a Framework for Tactical Cognitive Readiness (TCR) as a potential solution and opportunity for the Malaysian Army., (© 2024. The Author(s), under exclusive licence to Marta Olivetti Belardinelli.)

Objective: This study aimed at developing and validating a web application on hypertension management called the D-PATH website., Methods: The website development involved three stages: content analysis, web development, and validation. The model of Internet Intervention was used to guide the development of the website, in addition to other learning and multimedia theories. The content was developed based on literature reviews and clinical guidelines on hypertension. Then, thirteen experts evaluated the website using Fuzzy Delphi Technique., Results: The website was successfully developed and contains six learning units. Thirteen experts rated the website based on content themes, presentation, interactivity, and instructional strategies. All experts reached a consensus that the web is acceptable to be used for nutrition education intervention., Conclusion: D-PATH is a valid web-based educational tool ready to be used to help disseminate information on dietary and physical activity to manage hypertension. This web application was suitable for sharing information on dietary and physical activity recommendations for hypertension patients., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

This study examined the impact of economic uncertainty (EU) on Islamic banks (IBs) and conventional banks' (CBs) efficiency in countries that meet a standard where 1% share of Islamic banking assets is part of their total domestic banking sector assets. In addition, this study explored the moderating effect of country governance (CG) by employing the quantitative methodology based on secondary data from 2006 to 2021. The data analysis was done through ordinary least square, fixed effect model, and the random effect model. EU was found to enhance bank efficiency based on the basic regression results. CG moderated the positive effect of EU on bank efficiency. Additional robustness tests showed that EU was positively related to both types of banks' efficiency. The value of the paper is unique in that few papers have investigated the moderating effect of CG on the impact of EU on banks' efficiency, which enhances comprehension of EU and CG. These results highlight important policy implications whereby banks should continue to invest in and improve their risk management strategies. In addition, governments and regulatory bodies should prioritise good governance practices as these can improve banks' efficiency., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Genosensor-based electrodes mediated with nanoparticles (NPs) have tremendously developed in medical diagnosis. Herein, we report a facile, rapid, low cost and highly sensitive biosensing strategy for early detection of HPV 18 using gold-nanoparticles (AuNPs) deposited on micro-IDEs. This study represents surface charge transduction of micro-interdigitated electrodes (micro-IDE) alumina insulated with silica, independent and mini genosensor modified with colloidal gold NPs (AuNPs), and determination of gene hybridization for early detection of cervical cancer. The surface of AuNPs deposited micro-IDE functionalized with optimized 3-aminopropyl-triethoxysilane (APTES) followed by hybridization with deoxyribonucleic acid (DNA) virus to develop DNA genosensor. The results of ssDNA hybridization with the ssDNA target of human papillomavirus (HPV) 18 have affirmed that micro-IDE functionalized with colloidal AuNPs resulted in the lowest detection at 0.529 aM. Based on coefficient regression, micro-IDE functionalized with AuNPs produces better results in the sensitivity test (R 2  = 0.99793) than unfunctionalized micro-IDE., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: NOR AZIZAH BINTI PARMIN reports financial support was provided by Ministry of Higher Education, Malaysia. NOR AZIZAH BINTI PARMIN reports a relationship with University Malaysia Perlis that includes: employment, non-financial support, and speaking and lecture fees. NOR AZIZAH BINTI PARMIN has patent # LY2021P00579 pending to NOR AZIZAH BINTI PARMIN. The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Research on the impact of childhood nutrition on adult health and human capital has been extensively studied in developed countries, but research in China on this topic is limited. Nowadays, for children's nutritional status, while significant progress has been made in addressing childhood undernutrition in China, regional disparities persist, conversely, the prevalence of childhood overweight continues to rise. For adults' health human capital, the burden of chronic non-communicable diseases among Chinese residents is gradually increasing, over 50% of Chinese residents are overweight or obese, with obesity being one of the risk factors for other chronic diseases. Therefore, this study uses national representative data from 1991 to 2015 China Health and Nutrition Survey (CHNS), matched with individual information from their childhood, to examine the relationship between childhood nutrition and adult health human capital. Based on the two-way fixed effects models and logit models, the study finds that childhood nutrition status measured by height-for-age z score (HAZ) significantly and continuously has been influencing adult health human capital measured by height, BMI, self-rated health (SRH), whether have been sick in last four weeks (SH). BMI-for-age z score (BMIZ) significantly and continuously influence adult health human capital measured by BMI, blood pressure, and perceived stress (PS). Among that, this study places special emphasis on the long-lasting effects of late childhood and adolescence (ages exceeding 6) on the progressive height accumulation and sustained presence of elevated blood pressure. In conclusion, reducing childhood overweight and promoting linear growth and development throughout the whole childhood can reduce the future burden of disease on the nation., Competing Interests: Sa Li, Norashidah Mohamed Nor, Shivee Ranjanee Kaliappen affirm that they do not have any conflicts of interest to disclose., (© 2023 The Authors.)

Objective: This study aims to assess social determinants of stunting among children aged <5 y within the Malay ethnicity in Malaysia., Methods: This study used data from the National Health and Morbidity Survey 2016: Maternal and Child Health. It includes a sample of 10 686 children, ages 0 to 59 mo, of Malay ethnicity. Height-for-age z score was determined based on the World Health Organization Anthro software. A binary logistic regression model was used to examine the association between the selected social determinants and the occurrence of stunting., Results: About 22.5% of children aged <5 y of Malay ethnicity were stunted. For those ages 0 to 23 mo, stunting is more prevalent in boys, in rural areas, and in those who have screen exposure, whereas a reduction of stunting was observed for those children whose mothers work in the private sector and in those who consume formula milk and meat. As for those ages 24 to 59 mo, there was a higher prevalence of stunting for those with self-employed mothers and reduced prevalence in children with hygienic waste disposal practices as well as those who play with toys., Conclusions: The prevalence of stunting among children of Malay ethnicity aged <5 in Malaysia necessitates immediate intervention. It is pertinent to facilitate early identification of those children at risk of stunting for additional care to promote healthy growth., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Multidrug-resistant (MDR) or extensively drug-resistant (XDR) Tuberculosis (TB) is a major challenge to global TB control. Therefore, accurate tracing of in-country MDR-TB transmission are crucial for the development of optimal TB management strategies. This study aimed to investigate the diversity of MTBC in Nigeria. The lineage and drug-resistance patterns of the clinical MTBC isolates of TB patients in Southwestern region of Nigeria were determined using the WGS approach. The phenotypic DST of the isolates was determined for nine anti-TB drugs. The sequencing achieved average genome coverage of 65.99X. The most represented lineages were L4 (n = 52, 83%), L1 (n = 8, 12%), L2 (n = 2, 3%) and L5 (n = 1, 2%), suggesting a diversified MTB population. In term of detection of M/XDR-TB, while mutations in katG and rpoB genes are the strong predictors for the presence of M/XDR-TB, the current study also found the lack of good genetic markers for drug resistance amongst the MTBC in Nigeria which may pose greater problems on local tuberculosis management efforts. This high-resolution molecular epidemiological data provides valuable insights into the mechanistic for M/XDR TB in Lagos, Nigeria., Competing Interests: Declaration of conflicts of interest This study has no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Aims: To investigate the roles of MDR1 ( 1236C>T, 2677G>T/A , and 3435C>T ) and OPRM1 ( 118A>G ) gene polymorphisms on the anesthetic and adverse effects of propofol-remifentanil total intravenous anesthesia in pediatric surgery. Materials & methods: The genotypes were identified through Sanger sequencing. The clinical data including hemodynamics on anesthesia, postanesthesia pain and sedation score and the occurrence of adverse effects were recorded and compared against the genetic data. Results: A total of 72 pediatric patients undergoing surgery were recruited. A weak to no association was found between the genetic polymorphisms of MDR1 and OPRM1 and the anesthetic and adverse effects of propofol-remifentanil. Conclusion: Genetic polymorphisms in OPRM1 , but not in MDR1 , gene polymorphism, demonstrated plausible association with the effects of propofol-remifentanil.

Removal of H 2 S (hydrogen sulfide) from biogas is anticipated for higher energy conversion of methane (CH 4 ), while reducing the detrimental impacts of corroding the metal parts in the plant and its hazardous effect on humans and the environment. The introduction of microwave (MW) heating and nitrogen-modification could generate superior adsorbent features, contributing to high H 2 S removal. Up to date, there is no work reported on the influence of physicochemical characteristics of nitrogen-modified carbon synthesized via MW and conventional heating (TH) methods and their performance in H 2 S removal. Palm shell activated carbon (PSAC) was functionalized with nitrogen groups via urea impregnation, followed by the synthesis of MW and TH at 950 °C, 500 ml/min of N 2 flow rate and 30 min of heating time. MW and TH heating effects on the modified PSAC adsorbent were analysed and compared towards hydrogen sulfide (H 2 S) removal. PSAC with nitrogen functionalization produced using MW heating (PSAC-MW) demonstrates superior performance, with an adsorption capacity of 356.94 mg/g. The adsorbent sample generated using MW heating exhibited notable properties, including a large surface area and a sponge-like structure, with new pores developed within the current pores. Instead of that, there was an observation of 'hot spot' appearance during the MW heating process, which is believed to be responsible for the development of physical and chemical characteristics of the adsorbent. Thus, it is believed that MW heating was assisted in the development of the adsorbent's properties and at the same time contributed to the high removal of H 2 S at low adsorption temperature. The utilization of biomass-based adsorbent (PSAC) for H 2 S removal can address the lignocellulosic waste disposal problem, while mitigating the H 2 S release from the biogas production plants thus has several environmental merits. This indirectly contributed to zero-waste generation, while overcoming the adverse effects of H 2 S., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This paper presents a modified fatigue life model of the Basquin equation using the stress parameter of the magnetic flux leakage signal. Most pipeline steels experience cyclic loading during service and the influence of the load history makes assessing fatigue behaviour more difficult. The magnetic flux leakage signal's response to a uniaxial cyclic test of API X65 steel was measured with eight levels of ultimate tensile stress loads. The influence of dH(y)/dx on fatigue failure was the main concern in this study, the aim being to represent localised stress parameters in the modified Basquin equation. Both fatigue lives, experimental and predicted from the modified Basquin equation, were validated through reliability analysis, producing a 60% value when approaching 1.8 × 10 5 cycles. The fatigue data from the experiment produced a higher mean-cycle-to-failure value than the prediction data, with slightly different values of 3.37 × 10 5 and 3.28 × 10 5 . Additionally, the modified Basquin equation's predicted and the experimental fatigue lives were found to have a high R 2 correlation value of 0.9022. The Pearson correlation also showed a good relationship between the fatigue lives, with an r value of 0.9801. Finally, the modified Basquin equation based on dH(y)/dx signals provided an accurate and alternative method for durability assessment.

Bacterial Cellulose (BC) derived from local market or symbiotic culture of bacteria and yeast (SCOBY) was employed as the polymer matrix for hydroxyl multi-walled carbon nanotube (MWCNT-OH)-based electrochemical double-layer capacitor (EDLC). Chitosan (CS)-sodium iodide (NaI)-glycerol (Gly) electrolyte systems were used as the polymer electrolyte. CS-NaI-Gly electrolyte possesses conductivity, potential stability and ionic transference number of (1.20 ± 0.26) × 10 -3 S cm -2 , 2.5 V and 0.99, respectively. For the electrodes, MWCNT-OH was observed to be well dispersed in the matrix of BC which was obtained via FESEM analysis. The inclusion of MWCNT-OH reduced the crystallinity of the BC polymeric structure. From EIS measurement, it was verified that the presence of MWCNT-OH decreased the electron transfer resistance of BC-based electrodes. Cyclic voltammetry (CV) showed that the shape of the CV plots changed to a rectangular-like shape plot as more MWCNT were added, thus verifying the capacitive behavior. Various amount of MWCNT-OH was used in the fabrication of the EDLC where it was discovered that more MWCNT-OH leads to a better EDLC performance. The EDLC was tested for 5000 complete charge-discharge cycles. The optimum performance of this low voltage EDLC was obtained with 0.1 g MWCNT where the average specific capacitance was 8.80 F g -1 . The maximum power and energy density of the fabricated EDLC were 300 W kg -1 and 1.6 W h kg -1 , respectively., Competing Interests: The authors declare the following conflict of interests: Norhana binti Abdul Halim reports financial support was provided by 10.13039/501100012322Universiti Pertahanan Nasional Malaysia. Halim has. NA Halim has patent Flexible Conductive Composite Sheet and Method Thereof pending to Universiti Pertahanan Nasional Malaysia. NA Halim has patent Flexible EDLC assembled from modified bacterial cellulose pending to Universiti Pertahanan Nasional Malaysia., (© 2022 The Author(s).)

Insertion of the laryngeal mask airway (LMA) without muscle relaxant requires adequate obtundation of airway reflexes, which may otherwise lead to incorrect or failed LMA placement. This study compared topical lignocaine spray vs. intravenous (IV) fentanyl, during propofol induction for insertion of the ProSeal™ LMA (PLMA). This was a prospective, randomized, double blind study, in ASA I or II patients, for elective or emergency surgery. Seventy patients ( n = 70) who fulfilled the inclusion criteria were randomly assigned to receive IV fentanyl 2 mcg/kg or topical lignocaine spray 40 mg, prior to anesthesia induction with IV propofol (2-2.5 mg/kg). ProSeal™ LMA insertion condition was regarded optimal in the absence of adverse responses (gag, cough, laryngospasm and body movements), and successful LMA placement at the first attempt. Hemodynamic parameters were recorded and patients were assessed for sore throat and hoarseness post operatively. Seventy patients were analyzed. The number of patients with optimal PLMA insertion conditions were comparable between the groups (60% vs. 57%, P = 0.808). All hemodynamic parameters were comparable between groups with the exception of heart rate. Sympathetic obtundation of heart rate was greater with IV fentanyl than topical lignocaine ( P < 0.05). The proportion of patients with postoperative sore throat significantly increased with the number of insertion attempts ( P < 0.05). Topical lignocaine spray to the pharynx is as effective, and may be an alternative to IV fentanyl, during propofol induction for PLMA insertion. Success rate and optimal insertion condition at the first attempt, propofol requirement, blood pressure, adverse events and airway complications were comparable. Heart rate obtundation was less with topical lignocaine spray but remained within clinically acceptable values., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Rahmat Ameen Noorazyze, Nor, Zain, Mohamad Yusof and Yong.)

Shigella is a Gram-negative bacteria that cause shigellosis. Treatment with antibiotics cannot be sustained to control the bacterial infection due to the risk of antibiotic resistance. Vaccine development against the highly prevalent Shigella serotypes could provide a generous benefit in reducing the occurrence of shigellosis. The present study is aimed to identify the peptides that could be the ideal candidates for the Shigella vaccine development. THP-1 human macrophage cell lines were infected with clinical strains of Shigella flexneri 2a. The bacterial peptides bound on HLA class II molecules of infected THP-1 were analyzed and identified using the immunopeptidomics approach. Following mass spectrometry identification, a total of 14 proteins were predicted by PSORTb, CELLO, and Gneg-mPLoc as outer membrane proteins (OMPs) of Shigella. Of which, 12 OMPs were found to be conserved among Shigella species and had no significance with human proteomes. Outer membrane receptor FepA and TonB-dependent receptor were among the OMPs predicted to possess the high number of immunogenic B- and T-cell epitopes. The epitopes with high antigenicity from FepA and TonB were identified as potential peptide candidates for Shigella vaccine development. The immunoreactivity of the constructed recombinant proteins were determined using the Shigella-infected human and rabbit sera, respectively. Their protective efficacy and immune responses in controlling the Shigella infection will further be investigated in experimental animal models., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

In this work, bacterial cellulose (BC)-based polymer derived from a symbiotic culture of bacteria and yeast (SCOBY) are optimized as both electrodes and electrolytes to fabricate a flexible and free-standing supercapacitor. BC is a multifunction and versatile polymer. Montmorillonite (MMT) and sodium bromide (NaBr) are used to improve mechanical strength and as the ionic source, respectively. From XRD analysis, it is found that the addition of MMT and NaBr has reduced the crystallinity of the electrolyte. Most interaction within the electrolyte happens in the region of the OH band, as verified using FTIR analysis. A maximum room temperature conductivity of (1.09 ± 0.02) × 10 -3 S/cm is achieved with 30 wt.% NaBr. The highest conducting SCOBY-based electrolytes have a decompose voltage and ionic transference number of 1.48 V and 0.97, respectively. The multiwalled carbon nanotube is employed as the active material held by the fibrous network of BC. Cyclic voltammetry shows a rectangular shape CV plot with the absence of a redox peak. The supercapacitor is charged and discharged in a zig-zag-shaped Perspex plate for 1000 cycles with a decent performance.

Background and Objectives: Shivering is a common complication of subarachnoid block (SAB). Magnesium sulphate has been proven to be effective in preventing shivering. The aim of this study was to compare the effectiveness and adverse effects in hemodynamic parameters between 50 mg/kg and 30 mg/kg of intravenous magnesium sulphate for prevention of shivering post-subarachnoid block. Materials and Methods: Eighty-six patients scheduled for surgery under SAB, aged between 18 to 65 years old with American Society of Anesthesiologists physical status I and II were randomised into two groups. Group A received a bolus of 50 mg/kg, while Group B received 30 mg/kg of intravenous magnesium sulphate, given over a 20 min duration following SAB. Shivering grade was recorded intraoperatively according to the Crossley and Mahajan shivering scale. Mean arterial pressure (MAP), heart rate, tympanic temperature, oxygen saturation and the use of vasopressors were recorded. Results: Forty-five percent of patients in Group A and 20% of patients in Group B did not exhibit shivering (p-value < 0.01). High-grade shivering was observed in 12.5% in Group A and 40% in Group B, respectively (p-value 0.02). The MAP trend was lower in Group B (p-value < 0.01), but the incidence of hypotension was not significant in both groups. The use of vasopressors was also similar between groups. Group B showed a lower oxygen saturation trend (p-value 0.04). The trends of heart rate and tympanic temperature were not significant in both groups. No patients had episodes of bradycardia or oxygen desaturation. Conclusions: In this study, intravenous magnesium sulphate 50 mg/kg is the lowest effective dose for prevention and treatment of high-grade shivering post-SAB without significant hemodynamic adverse events.

Vitamin B12, only found naturally in animal-based foods, is essential for brain functions and various chemical reactions in the human body. Insufficient vitamin B12 leads to vitamin B12 deficiency, common among strict vegetarians due to their limited intake of animal-based foods. Nevertheless, extensive studies have demonstrated that macroalgae, specifically the Ulva lactuca species, are rich in vitamin B12 and could be further exploited in future dietary applications. In the current study, the ideal extraction method of vitamin B12 from dried U. lactuca was developed and optimised to achieve the maximum vitamin B12 yield. The effects of several extraction parameters, including the solvent-to-solvent, methanol:water (MeOH:H 2 O), and solute-to-solvent ratios, and pH on the total vitamin B12 content were analysed through a two-level factorial and central composite design. The highest vitamin B12 content, particularly cyanocobalamin (CN-Cbl), was recovered through the ultrasonic-assisted extraction (UAE) of oven-dried U. lactuca at 3 g:60 mL of solute-to-solvent and 25:75% of MeOH to H 2 O ratios at pH 4. The extraction of CN-Cbl from oven-dried U. lactuca that employed the UAE method has elevated CN-Cbl content recovery compared to other extraction methods.

Health financing in Malaysia is intensely subsidised by public funding and is increasingly sourced by household out-of-pocket financing, yet the under-five mortality rate has been gradually increasing in the last decade. In this context, this study aims to investigate the relationship between public, private, and out-of-pocket health expenditures and the under-five mortality rate in Malaysia using the autoregressive distributed lag (ARDL) estimation technique, whereby critical test values are recalculated using the response surface method for a time-series data of 22 years. The findings reveal that out-of-pocket health expenditure deteriorates the under-five mortality rate in Malaysia, while public and private health expenditures are statistically insignificant. Therefore, an effective health financing safety net may be an option to ensure an imperative child health outcome.

As industrial globalisation and waste output continue to grow, solid waste management is one of the most pressing worldwide environmental challenges. Solid wastes include both the heterogeneous mass of urban throwaways and the homogeneous accumulations of agricultural, industrial, and mineral wastes. Clinical waste (CW) has a significant negative influence on both human health and the environment. To dispose hazardous CW, a proper waste management system should be necessary, and incineration should be the best possible option for reducing the volume of this hazardous waste. Incineration is being developed in Malaysia as a means of disposing clinical and hazardous waste. Currently, 170 common CW treatment facilities with 140 incinerators are accessible around the country. The combustion procedure kills pathogens and reduces waste volume and weight, but it leaves a solid residue known as clinical waste ash (CWA), which raises heavy metal, inorganic salt, and organic compound levels in the environment. Because metals are not eliminated during incineration, dumping CWA in a landfill could contaminate groundwater. Leachate is the liquid created when waste decomposes in a landfill and water filters through it. The most common method of disposing of CW ashes is to transfer them to a landfill. Landfills should install a top cover after closure for hazardous waste landfills. Due to a lack of space and the high expense of land disposal, recycling technologies and the reuse of ash in various systems have developed. Clinical waste incineration fly ash (CWIFA), a solid waste substance from CW incineration, typically includes mobile heavy metals and can cause significant pollution when reused. The standard requirement for removing CWIFA in dumpsites should be below the metal limit stated by the U.S. Environmental Protection Agency (USEPA). Much recent research on the usage of CWIFA has concentrated on mitigating their effects on the environment. Several studies have confirmed the utilisation of CWIFA in the construction field and agriculture to reduce the leaching of its hazardous components into the environment. Compressive strength decreased with the percentage amount of CWIFA due to the substitution of cement with CWIFA. CWIFA mix with 20% cement is the broad-scale application of CWIFA for geotechnical constructions. Heavy metals (Cd, Cu, Ni, Pb, and Zn) are strongly immobilised by the cementitious matrix. Solidification/stabilisation (S/S) materials can be dumped in landfills with less environmental protection than untreated waste. When utilising a CWIFA in mortar, the primary environmental concern is if any harmful materials leach out during the initial curing process or throughout the life of the mortar. Toxicity characteristic of leaching procedure (TCLP) analysis of all CWIFA specimens found amounts of heavy metals below regulatory limits. Solidification of waste with cement and solidified waste has become a popular way of minimising the atmosphere's emissions. The amount of CWIFA generated is expected to increase nationally and globally. There is an immediate need for further evaluation of ash leachate investigations for proper disposal and usage of ash in construction materials., Competing Interests: Competing interestsThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© University of Tehran 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Nutritional knowledge, attitudes and practice (KAP) may guide healthy meal choices. Here, nutritional KAP was compared across school students in Sabah based on locality and gender. A cross-sectional survey of students aged 15-19 years was conducted using multistage sampling. Nutritional KAP was measured via questionnaire. Anthropometric measures of weight and height were taken in person to calculate body mass index (BMI). Among the 994 participants, 80% were urban and 60% were female (mean age 16.5 ± 0.6 yr). Most were of Kadazan-Dusun (23%) ethnicity. Measured height for age Z score (HAZ) and BMI for age Z score (BAZ) differed between urban and rural students (-1.2 ± 0.8 versus -1.5 ± 0.7 for HAZ; p < 0.001; 0.2 ± 1.4 versus -0.1 ± 1.3; p = 0.02, respectively). No difference in nutritional knowledge was found, although urban students prioritized having a healthy/balanced diet (59.55% versus 48.50%, p = 0.03) and ate daily breakfast (57.4% versus 10.2%, p < 0.001) compared to rural. Females scored higher on nutritional knowledge than males (18.9 ± 2.8 vs. 18.1 ± 3.4, respectively, p = 0.0001), yet males selected more healthy/balanced foods (63.3% versus 53.3%, p = 0.041). The gap remains between nutritional KAP and translating this to healthy eating among adolescents, related to locality and gender.

Background: Hepatitis B infection is a significant worldwide health issue, predispose to the development of liver cirrhosis and hepatocellular carcinoma. Entecavir is a potent oral antiviral agent of high genetic barrier for the treatment of chronic hepatitis B infection. Cutaneous adverse reaction associated with entecavir has rarely been reported in literature. As our knowledge, this case was the first case reported on entecavir induced lichenoid drug eruption., Case Presentation: 55 year old gentlemen presented with generalised pruritic erythematous rash on trunk and extremities. Six weeks prior to his consultation, antiviral agent entecavir was commenced for his chronic hepatitis B infection. Skin biopsy revealed acanthosis and focal lymphocytes with moderate perivascular lymphocyte infiltration. Skin condition recovered completely after caesation of offending drug and short course of oral corticosteroids., Conclusion: This case highlight the awareness of clinicians on the spectrum of cutaneous drug reaction related to entecavir therapy.

Background: There is limited evidence detailing the cost-effectiveness of psoriasis treatments in the Asian region. Therefore, this study is aimed to evaluate the cost-effectiveness of 3 psoriasis treatments tailored for moderate to severe psoriasis, namely topical and phototherapy (TP), topical and systemic (TS), and topical and biologic (TB) regimens, respectively., Methods: This has been achieved by the participation of a prospective cohort involving a total of 90 moderate to severe psoriasis patients, which has been conducted at 5 public hospitals in Malaysia. The main outcome measures have been evaluated via cost and effectiveness psoriasis area severity index (PASI)-75 and/or body surface area (BSA) <5 and/or dermatology life quality index (DLQI) ≤5), estimated from the societal perspective over a 6-months duration. All costs are based on 2015's recorded Malaysian Ringgit (RM) currency., Results: Consequently, TS has been found to be the most cost-effective treatment with the lowest cost/PASI-75/and/or BSA <5 and/or DLQI ≤5, valued at RM9034.56 (US$2582.55). This is followed by TP, which is valued at RM28 080.71 (US$8026.93) and TB, valued at RM54 287.02 (US$15 518.06). Furthermore, one-way sensitivity analysis has highlighted the cost of medication as the most sensitive parameter., Conclusion: Thus, the input from this study is helpful for policy-makers in determining the first line treatment for moderate to severe psoriasis with consideration of the costs and its effectiveness in Malaysia. This will consequently allow hospitals to justify and provide the essential resources for further research and development, as well as the adoption of better treatment options., (© 2019 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Nutrition has always been associated with eating behaviour. The eating behaviour can impact not only the normal population but also athletes' population including disabled athletes too. Athletes have a higher tendency to unhealthy eating behaviour due to intense pressure and competitive environment in sports. It is important to identify the types of eating behaviour among disabled athletes to prevent eating disorder that could affect their performance. Thus, this study aims to identify the types of eating behaviour among disabled athletes in Malaysia., Methods: This study involved 93 disabled athletes in Malaysia. The setting of the study is at National Sports Council, Malaysia. The data obtained are analysed using chi-square test using SPSS., Results: This study shows that the most common types of eating behaviour among disabled athletes are emotional eating (37.6%), followed by uncontrolled eating (34.3%) and cognitive restraint (28%). Most of the overweight and obese disabled athletes are prone to emotional eating (19.4%) as compared to non-overweight athletes (18.3%)., Conclusion: As a conclusion, recognising the eating behaviour in disabled athletes is important as more effective and innovative interventions and measures can be undertaken to prevent eating disorder which can enhance sports performance., Competing Interests: Conflict of Interest None.

Macrophage apoptosis exerts an efficient mechanism in controlling intracellular infection during innate immune response against various pathogens including malaria parasites. This study was carried out to determine the apoptosis activity in mouse macrophage cell line J774A.1 infected with a Mycobacterium bovis bacille Calmette-Guerin (BCG) clone and a recombinant BCG clone expressing the C-terminus of merozoite surface protein-1 (BCG-MSP1C) of Plasmodium falciparum for 48 h. In this study, a parent BCG cells was used as a control. The nuclear staining with Hoechst 33342 showed that the BCG-MSP1C cells was capable of increasing the nuclear condensation and morphological stages of apoptosis in the infected cells compared to the BCG-infected cells and the lipopolysaccharide (LPS)-stimulated cells. The flow cytometric analysis using Annexin-V and Propidium iodide (PI) staining confirmed that the BCG-MSP1C cells significantly increased the percentage of early apoptotic activity in the infected macrophage higher than the one stimulated by the parent BCG cells and LPS. This apoptotic response corresponded with the reduction of the anti-apoptotic Bcl-2 protein expression and higher p53 expression. The colorimetric assay demonstrated that the BCG cells capable of stimulating higher production of caspase-1, -3, -8 and -9 while the BCG-MSP1C cells stimulated the expression of caspase-1 and -9 in the infected macrophages, suggesting the involvement of mitochondrial-mediated (intrinsic) pathway of apoptosis. In conclusion, both the BCG and BCG-MSP1C cells are capable of inducing macrophage apoptosis activity in the mouse macrophage cell line J774A.1. This mechanism is important for the elimination of pathogens such as malaria parasite during the phagocytosis activity of macrophage. However, the BCG-MSP1C cells showed higher apoptosis activity than those produced by the parent BCG cells.

Background and Objective: Keloid is conventionally treated with intra-lesional (IL) triamcinolone, which is highly operator dependent and has its own adverse effects. Topical steroid and silicone dressings are a patient friendly and non-invasive treatment alternative. We therefore sought to determine the efficacy and safety of topical clobetasol propionate (Dermovate ® ) 0.05% cream under occlusion with Mepiform ® silicone dressing compared to IL triamcinolone in the treatment of keloid., Methods: This was a prospective, randomised, observer-blinded study. Two keloids on the same site were randomly assigned to receive either daily topical clobetasol propionate 0.05% cream under occlusion with silicone dressing (Scar 1) or monthly IL triamcinolone injection (Scar 2). Efficacy was assessed using patient and observer scar assessment scale (POSAS) at 4-weekly intervals up to 12 weeks. Dimension of keloid and adverse effects were also assessed., Results: A total of 34 scars from 17 patients completed the study. There was significant improvement of POSAS at 12 weeks compared to baseline within each treatment group. However, there was no statistically significant difference in POSAS at 12 weeks between the two treatments. Keloid dimensions showed a similar trend of improvement by week 12 with either treatment (p = 0.002 in Scar 1, p = 0.005 for Scar 2). However, there was no significant difference between the treatment. In the IL triamcinolone group, all patients reported pain and 70.6% observed necrotic skin reaction. There was a significantly higher rate of adverse effects such as erythema (41.2 vs. 17.6%), hypopigmentation (35.3 vs. 23.5%), telangiectasia (41.2 vs. 17.6%) and skin atrophy (23.5 vs. 5.9%) documented in the IL triamcinolone group when compared to clobetasol propionate 0.05% cream under occlusion with silicone dressing., Conclusion: Clobetasol propionate 0.05% cream under occlusion with silicone dressing is equally effective and has fewer adverse effects compared to IL triamcinolone. Hence, it may be used as an alternative treatment for keloid particularly in patients with low pain threshold, needle phobia and those who prefers home-based treatment.

Experience of treatment of chronic wounds in 11 patients in 2014 – 2016 yrs was analyzed. The impact of negative pressure, using domestically manufactured apparatus «АGАТ- Dnepr», in complex of treatment as a local therapy, was applied. Vacuum-therapy was conducted preoperatively and postoperatively together with autodermoplasty. The injection material for the skin regeneration “lacerta” was applied subcutaneously intraoperatively. The Ialuset-cream bandages were used in 10 - 12 days postoperatively during 2-3 weeks. Еfficacy of vacuum-therapy was estimated, basing on analysis of the wound process course dynamics, clinic-laboratory criteria, terms of the wound defect complete closure. The patients’ stationary treatment duration have constituted 38.3 days at average. Complex treatment of chronic wounds have had guaranteed complete healing of the wound defect in 7 (63%) patients in terms up to 1 - 5 weeks, and in 3 (26%) - 6 weeks.

Background: In the past few decades, a significant volume of work has been carried out on various aspects of the state estimation problem to estimate an optimum state vector of the power system. This problem has been focused on, in previous studies regarding the computational efficiency and numerical robustness in view to find point estimates for system state parameters. This current investigation, constructed confidence intervals for the unknown state parameters of the system. The research indicates that confidence intervals can yield addition useful information about the estimated parameters., Methods: The feasible interval estimates for the system state parameters have been modelled in this study by considering the random uncertainty in the processing measurements. The statistical assumptions of the measurement errors have been utilized to characterize the probabilistic behavior of the estimated parameters in terms of confidence intervals. The Gauss-Newton algorithm has been adopted for maximizing the likelihood function of the processing measurements and obtaining the confidence intervals., Results: The usage of the confidence intervals was demonstrated through Monte Carlo experiments on a real dataset of the 6-bus and IEEE 14-bus power systems for both small and large sample sizes. The confidence intervals were constructed for the test networks for the sample of measurements 18, 28, 44 and 68 based on the redundancy ratio R. The proposed interval estimates outperformed for the sample sizes of 28 in the 6 bus and 68 in the IEEE 14-bus systems, respectively. The poor performance for the constructed interval estimates have been reported even for the large sample sizes in the existence of contaminated measurements., Conclusions: The results of the study show that the method is effective and practically applicable in the state estimation of a power system. The constructed confidence intervals for the system state parameters adequately perform for the lager sample size. However, the existence of the gross errors in the processing measurements had severe effect on the performance of the proposed interval estimates.

Background: Developing countries have witnessed economic growth as their GDP keeps increasing steadily over the years. The growth led to higher energy consumption which eventually leads to increase in air pollutions that pose a danger to human health. People's healthcare demand, in turn, increase due to the changes in the socioeconomic life and improvement in the health technology. This study is an attempt to investigate the impact of environmental quality on per capital health expenditure in 125 developing countries within a panel cointegration framework from 1995 to 2012., Results: We found out that a long-run relationship exists between per capita health expenditure and all explanatory variables as they were panel cointegrated. The explanatory variables were found to be statistically significant in explaining the per capita health expenditure. The result further revealed that CO2 has the highest explanatory power on the per capita health expenditure. The impact of the explanatory power of the variables is greater in the long-run compared to the short-run. Based on this result, we conclude that environmental quality is a powerful determinant of health expenditure in developing countries., Conclusion: Therefore, developing countries should as a matter of health care policy give provision of healthy air a priority via effective policy implementation on environmental management and control measures to lessen the pressure on health care expenditure. Moreover more environmental proxies with alternative methods should be considered in the future research.

Background: This prospective, randomized, single blind, single operator study was conducted to compare hemodynamic responses when endotracheal intubation was performed using the Bonfils intubation fibrescope versus the C-MAC videolaryngoscope., Method: Forty-four ASA I patients aged between 18 and 60 years, scheduled for elective surgery requiring endotracheal intubation were recruited. They were randomized into the Bonfils group or C-MAC group. Hemodynamic changes, laryngeal view, duration of intubation and post intubation complications were evaluated. Mean arterial pressure, heart rate and oxygen saturation were monitored pre and post-induction, pre and post-intubation, and at 1 minute intervals thereafter for 10 minutes., Results: Endotracheal intubation was successful at first attempt in 90.9% in both groups. Heart rate was significantly higher in the Bonfils group (p < 0.05) compared to the C-MAC group and values were sustained throughout the study. There was no difference in the mean arterial pressure (MAP) between the two groups. Mean time to intubation was significantly longer in the Bonfils group (28.8 vs. 24.7 seconds, p = 0.02). There were no significant differences in laryngeal view and post intubation complications between the groups., Conclusion: Intubation using the Bonfils intubation fibrescope took longer, and resulted in significantly higher heart rate when compared with the C-MAC videolaryngoscope.

Phylogenetic and taxonomic characterization was performed for bacterium RB-25T, which was isolated from a soil sample collected in a former municipal landfill site in Puchong, Malaysia. Growth occurred at 20-37 °C at pH 5-8 but not in the presence of 9 % (w/v) NaCl or higher. The principal fatty acids were C16:0, C18:1ω7c and summed feature 3 (C16:1ω7c and/or iso-C15:0 2-OH). Ubiquinone-8 was the only isoprenoid quinone detected. Polar lipid analysis revealed the presence of phospholipid, phosphoaminolipid, phosphatidylethanolamine, phosphatidylglycerol and one unidentified aminolipid. DNA G+C content was 50.9 mol% phylogenetic analysis based on 16S rRNA gene sequence showed that strain RB-25T formed a distinct lineage within the family Enterobacteriaceae of the class Gammaproteobacteria. It exhibited a low level of 16S rRNA gene sequence similarity with its phylogenetic neighbours Pantoea rwandensis LMG 26275T (96.6 %), Rahnella aquatilis CIP 78.65T (96.5 %), Pectobacterium betavasculorum ATCC 43762T (96.4 %), Pantoea rodasii LMG 26273T (96.3 %), Gibbsiella dentisursi NUM 1720T (96.3 %) and Serratia glossinae C1T (96.2 %). Multilocus sequence analyses based on fusA, pyrG, rplB, rpoB and sucA sequences showed a clear distinction of strain RB-25T from the most closely related genera. Isolate RB-25T could also be distinguished from members of these genera by a combination of the DNA G+C content, respiratory quinone system, fatty acid profile, polar lipid composition and other phenotypic features. Strain RB-25T represents a novel species of a new genus, for which the name Chaniamultitudinisentens gen. nov., sp. nov. is proposed. The type strain is RB-25T (=DSM 28811T=LMG 28304T).

Background and Objectives: Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome., Methods: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non-CSE (n=55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared., Results: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups., Conclusion: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Isolates of Fusarium were discovered in peat soil samples collected from peat swamp forest, waterlogged peat soil, and peat soil from oil palm plantations. Morphological characteristics were used to tentatively identify the isolates, and species confirmation was based on the sequence of translation elongation factor-1α (TEF-1α) and phylogenetic analysis. Based on the closest match of Basic Local Alignment Search Tool (BLAST) searches against the GenBank and Fusarium-ID databases, five Fusarium species were identified, namely F. oxysporum (60%), F. solani (23%), F. proliferatum (14%), F. semitectum (1%), and F. verticillioides (1%). From a neighbour-joining tree of combined TEF-1α and β-tubulin sequences, isolates from the same species were clustered in the same clade, though intraspecies variations were observed from the phylogenetic analysis. The Fusarium species isolated in the present study are soil inhabitants and are widely distributed worldwide. These species can act as saprophytes and decomposers as well as plant pathogens. The presence of Fusarium species in peat soils suggested that peat soils could be a reservoir of plant pathogens, as well-known plant pathogenic species such F. oxysporum, F. solani, F. proliferatum, and F. verticillioides were identified. The results of the present study provide knowledge on the survival and distribution of Fusarium species.

Here, we report the draft genome sequence and annotation of a multidrug resistant Mycobacterium tuberculosis strain PR10 (MDR-TB PR10) isolated from a patient diagnosed with tuberculosis. The size of the draft genome MDR-TB PR10 is 4.34 Mbp with 65.6% of G + C content and consists of 4637 predicted genes. The determinants were categorized by RAST into 400 subsystems with 4286 coding sequences and 50 RNAs. The whole genome shotgun project has been deposited at DDBJ/EMBL/GenBank under the accession number CP010968.

Mycobacterium tuberculosis is an acid fast bacterial species in the family Mycobacteriaceae and is the causative agent of most cases of tuberculosis. Here, we report the genomic features of Mycobacterium tuberculosis isolated from the cerebrospinal fluid (CSF) of a patient diagnosed with both pulmonary and extrapulmonary tuberculosis (TB). The isolated strain was identified as Mycobacterium tuberculosis PR08 (MTB PR08). Genomic DNA of the MTB PR08 strain was extracted and subjected to whole genome sequencing using MiSeq (Illumina, CA,USA). The draft genome size of MTB PR08 strain is 4,292,364 bp with a G + C content of 65.2%. This strain was annotated to have 4723 genes and 48 RNAs. This whole genome shotgun project has been deposited at DDBJ/EMBL/GenBank under the accession number CP010895.

Cresol Red belongs to the triphenylmethane (TPM) class of dyes which are potentially carcinogenic or mutagenic. However, very few studies on biodegradation of Cresol Red were investigated as compared to other type dyes such as azo and anthraquinone dye. The aim of this work is to evaluate triphenylmethane dye Cresol Red degradation by fungal strain isolated from the decayed wood in Johor Bahru, Malaysia. Detailed taxonomic studies identified the organisms as Trichoderma species and designated as strain Trichoderma harzianum M06. In this study, Cresol Red was decolorized up to 88% within 30 days under agitation condition by Trichoderma harzianum M06. Data analysis revealed that a pH value of 3 yielded a highest degradation rate among pH concentrations (73%), salinity concentrations of 100 g/L (73%), and a volume of 0.1 mL of Tween 80 (79%). Induction in the enzyme activities of manganese peroxidase, lignin peroxidase, laccase, 1,2- and 2,3-dioxygenase indicates their involvement in Cresol Red removal. Various analytical studies such as Thin-Layer Chromatography (TLC), UV-Vis spectrophotometer, and Gas chromatography mass spectrometry (GC-MS) confirmed the biotransformation of Cresol Red by the fungus. Two metabolites were identified in the treated medium: 2,4-dihydroxybenzoic acid (t R 7.3 min and m/z 355) and 2-hydroxybenzoic acid (t R 8.6 min and m/z 267). Based on these products, a probable pathway has been proposed for the degradation of Cresol Red by Trichoderma harzianum M06.

The experience of "distressed" (problematic) flaps application in 33 patients with soft tissue defects over 2010-2014 years were analysed. It was proposed to use the local negative pressure for the prevention and treatment of complications associated with venous insufficiency or trombosis in using of plastics with vascularised complexes of tissues. Vacuum-therapy was conducted with the help of negative pressure apparatus "AGATE-Dnepr" (Ukraine) by attaching silver-containing polyurethane sponge on the operating zone, covering the flap with the surrounding skin netting band "Grassolind". The recommended standard of negative pressure of 75-125 mm Hg, both in impulse and in continuous mode was used. The high efficiency of vacuum-therapy for survival of grafts has been demonstrated. Thus, it might be considered as an effective element of prevention and treatment of complications associated with venous insufficiency or trombosis using of vascularised tissue complex plastics of defects.

Purpose of Review: We reviewed current literature on four different skin and subcutaneous infections which are often touted as 'emerging diseases' of south-east Asia, namely melioidosis, penicilliosis, sporotrichosis and Mycobacterium marinum infection. Lack of consensus treatment guidelines, high treatment costs and limited investigative capability in certain endemic areas are among the challenges faced by managing physicians. With the increase in borderless travelling, it is hoped that this review will facilitate better understanding and heighten the clinical suspicion of such infections for clinicians in other parts of the world., Recent Findings: An increasing number of cases of melioidosis and penicilliosis have been reported within and outside its endemic areas, but epidemiological data on sporotrichosis and M. marinum infections are still sparse. The clinical features of these infections remain historically unchanged and more disseminated infections are seen particularly amongst immunocompromised patients. Although tissue culture is still the gold standard, PCR provides more rapid and accurate diagnosis. Advances in therapeutics have improved outcome in certain diseases., Summary: The described spectrum of cutaneous infection in south-east Asia can be imported to other areas due to increases in worldwide travel. Clinicians from other parts of the world should be aware of the common presentations of these diseases.

Studies in type 1 diabetes indicate potential disease heterogeneity, notably in the rate of β-cell loss, responsiveness to immunotherapies, and, in limited studies, islet pathology. We sought evidence for different immunological phenotypes using two approaches. First, we defined blood autoimmune response phenotypes by combinatorial, multiparameter analysis of autoantibodies and autoreactive T-cell responses in 33 children/adolescents with newly diagnosed diabetes. Multidimensional cluster analysis showed two equal-sized patient agglomerations characterized by proinflammatory (interferon-γ-positive, multiautoantibody-positive) and partially regulated (interleukin-10-positive, pauci-autoantibody-positive) responses. Multiautoantibody-positive nondiabetic siblings at high risk of disease progression showed similar clustering. Additionally, pancreas samples obtained post mortem from a separate cohort of 21 children/adolescents with recently diagnosed type 1 diabetes were examined immunohistologically. This revealed two distinct types of insulitic lesions distinguishable by the degree of cellular infiltrate and presence of B cells that we termed "hyper-immune CD20Hi" and "pauci-immune CD20Lo." Of note, subjects had only one infiltration phenotype and were partitioned by this into two equal-sized groups that differed significantly by age at diagnosis, with hyper-immune CD20Hi subjects being 5 years younger. These data indicate potentially related islet and blood autoimmune response phenotypes that coincide with and precede disease. We conclude that different immunopathological processes (endotypes) may underlie type 1 diabetes, carrying important implications for treatment and prevention strategies., (© 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.)

Polyporus sp. S133 decolorized the Amaranth in 72 h (30 mg L(-1)) under static and shaking conditions. Liquid medium containing glucose has shown the highest decolorization of Amaranth by Polyporus sp. S133. When the effect of increasing inoculum concentration on decolorization of Amaranth was studied, maximum decolorization was observed with 15 % inoculum concentration. Significant increase in the enzyme production of laccase (102.2 U L(-1)) was observed over the period of Amaranth decolorization compared to lignin peroxidase and manganese peroxidase. Germination rate of Sorghum vulgare and Triticum aestivum was less with Amaranth treatment as compared to metabolites obtained after its decolorization. Based on the metabolites detected by GC-MS, it was proposed that Amaranth was bio-transformed into two intermediates, 1-hydroxy-2-naphthoic acid and 1,4-naphthaquinone. Overall findings suggested the ability of Polyporus sp. S133 for the decolorization of azo dye and ensured the ecofriendly degradation of Amaranth.

This paper presents a locomotion control based on central pattern generator (CPG) of a snake-like robot. The main point addressed in this paper is a method that produces a smooth transition of the body shape of a snake-like robot. Body shape transition is important for snake-like robot locomotion to adapt to different space widths and also for obstacle avoidance. By manipulating the phase difference of the CPG outputs instantly, it will results in a sharp point or discontinuity which lead to an unstable movement of the snake-like robot. To tackle the problem, we propose a way of controlling the body shape: by incorporating activation function in the phase oscillator CPG model. The simplicity of the method promises an easy implementation and simple control. Simulation results and torque analysis confirm the effectiveness of the proposed control method and thus, can be used as a locomotion control in various potential applications of a snake-like robot.

Optimising the number of replacement heifers needed will have positive economic and environmental consequences on herds that rear their own young stock. The number of heifers needed to be kept is closely related with the number of culled dairy cows in the herd. This study therefore looked at the variation that exists in culling rate and herd level factors associated with it. A dataset from 1903 dairy herds available included information at animal level (dates of culling, slaughter/death) and herd level (characteristics of reproduction, performance, health) over the years 2007 to 2010. The average culling rate for slaughter/death was used and was defined for each year as percentage of the herd size that died within 30 d after they were culled. The analysis of the association between average culling rate for slaughter/death and the characteristics of the herd was performed using a mixed model. The results showed that the average culling rate for slaughter/death was 25·4% and varied between 23% (2007) and 28% (2010). More than 70% of the herds have an average culling rate for slaughter/death of less than 30%, showing that there is room for lowering the average culling rate for slaughter/death. A higher average culling rate for slaughter/death is associated with a longer average calving interval, a higher average 305-d protein production, a higher average somatic cell count (SCC), a higher percentage of new high SCC, a more than 5% decrease in herd size, and herds that bought more than 1% of animals per year. A lower average culling rate for slaughter/death is associated with a longer average age, herds that bought less than 1% of animals per year and a more than 5% increase in herd size. In conclusion, the average culling rate for slaughter/death is associated with fertility, udder health and openness of the herd.