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BACKGROUND: Tracheostomy can be performed as an open surgical procedure, percutaneous, or hybrid and forms an important step in the management of patients infected with coronavirus disease 2019 (COVID-19) requiring weaning from mechanical ventilation. The purpose of this article is to share our experience to performing bedside surgical tracheostomy in COVID-19 patients in a safe and effective manner, whilst minimising the risk of viral transmission, to optimise patient outcomes and reduce risk to healthcare professionals. MATERIAL AND METHODS: As recommended by ENT UK, we prospectively established a COVID Airway Team within the ENT department at Birmingham Heartlands Hospital, consisting of four head and neck consultant surgeons to perform either open-bedside, open-theatre or percutaneous tracheostomy in COVID-19 patients. A specific stepwise method for bedside open surgical tracheostomy was based on ENT UK and British Laryngological Society recommendations. RESULTS: Thirty patients underwent tracheostomy during the study period (14 bedside-open, 5 open-theatre, 11 percutaneous). Mean duration of mechanical intubation prior to bedside-open tracheostomy was 14.5 days. The average time for open-bedside tracheostomy was 9 minutes compared to 31 minutes for open-theatre. There were no significant tracheostomy related complications with bedside-open tracheostomy. No healthcare professional involved reported acute COVID-19 infection. CONCLUSIONS: We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic. Our experience demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.

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Drought is one of the most damaging abiotic stress that hinder plant growth and development. The present study aimed to determine the effects of various Ca/Mg quotients under polyethylene glycol (PEG)-induced osmotic stress on growth, uptake and translocation of Ca and Mg in Avena sativa (L). Plants were grown in nutrient solution supplemented with three different Ca/Mg molar quotients (0.18, 2, and 4). After 30 days plants were exposed to two different PEG (Polyethylene glycol) concentrations (0.6 MPa & 0.2 MPa) for 8 days, and solutions were renewed after 4 days. A solution containing Ca and Mg nutrients has mitigated the negative impact caused via osmotic stress on relative growth rate (RGR), absolute growth rate (AGR), crop growth rate (CGR), leaf area ratio (LAR), Leaf index ratio (LAI), root-shoot ratio (RSR), water use efficiency (WUE) and net assimilation rate (NAR). In addition, it adversely affected germination parameters, including final emergence percentage (FEP), mean germination time (MGT), Timson germination Index (TGI), germination rate index (GRI) and percent field capacity (%FC), of oat (Avena sativa L.). Mg and Ca in shoot and root and Ca translocation factor decreased with increasing Ca in solution, while Mg translocation factor increased with increasing Ca in nutrient solution. In this work, the combined effects of various Ca/Mg quotients and osmotic stress produced by polyethylene glycol (PEG) in different concentrations (0.6 MPa, 0.2 MPa) on the growth and element uptake of Avena sativa L. are examined. As a result, the Ca/Mg Quotient may naturally combat the moderate drought stress experienced by field crops.

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AIMS: The aim of this study was to investigate the effects of lactobacilli strains in preventing the recurrences of vaginal candidiasis (VC) in 78 pregnant women with VC (lactobacilli, n = 39; placebo, n = 39) and the potential benefits on quality of life. METHODS AND RESULTS: The lactobacilli putative probiotic (SynForU-HerCare; two capsules/day of 9·5 log CFU per capsule) or placebo was administered for 8-weeks in a randomized, double-blind, placebo-controlled study. Subjects were assessed for vaginal and gut health conditions at baseline, week-4 and week-8 via questionnaires. The vulvovaginal symptom questionnaire not only covered aspects pertaining to vulvovaginal symptoms but also the quality of life impacts such as emotional, social and sexual. The administration of lactobacilli reduced symptoms of irritation (P = 0·023) and discharge (P = 0·011) starting week-4 and continued after week-8 (P < 0·05), accompanied by reduced symptoms for burning after week-8 (P = 0·046) as compared to the placebo. Patients consuming lactobacilli also showed reduced concern about symptoms after week-4 (P = 0·010) and continued after week-8 (P = 0·001), accompanied by reduced impairment of daily activities attributed to vulvovaginal symptoms (P = 0·012) and continued after week-8 (P = 0·026). Insignificant differences were observed for sexual impacts between treatment groups. The administration of lactobacilli also reduced recurrences of both emotional and social stress as compared to the placebo at both week-4 and week-8 (P < 0·05). Patients consuming lactobacilli showed higher defecation times per week at week-4 (P = 0·010) and week-8 (P = 0·001) as compared to the placebo group, indicating the potential to reduce risks of pregnancy-induced constipation. CONCLUSIONS: Lactobacilli probiotics are beneficial towards pregnant women, especially in reducing vulvovaginal symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC. SIGNIFICANCE AND IMPACT OF THE STUDY: The study demonstrated the preventive and modulatory roles of lactobacilli strains against VC in pregnant women. Taken altogether, our present data illustrated that lactobacilli probiotics are beneficial towards pregnant women, especially in reducing vulvovaginal symptoms and recurrences of VC, accompanied by improved emotional and social distress attributed to VC, thus could be a potential strategy for the maintenance of vaginal health during pregnancy.

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This study aims to examine the efficacy of mosquito mat vaporizers on Aedes aegypti and their associated metabolic detoxication mechanisms. For this purpose, Aedes aegypti (Linnaeus) was collected from nine districts in Selangor, Malaysia and tested with mosquito vaporizing mat bioassays. The same populations were also subjected to biochemical assays to investigate activities of detoxifying enzymes, namely non-specific esterase (EST), glutathione-S-transferase (GST) and mixed function oxidase (MFO). The efficacy of Ae. aegypti on the active ingredients tested in decreasing order were d- allethrin > dimefluthrin > prallethrin with PBO > prallethrin. The results further indicated significant enhancement mean levels of EST, GST and MFO in pyrethroid-resistant populations. The mortality rate of Ae. aegypti in response to pyrethroid active ingredients was associated with MFO activity, suggesting it is an important detoxification enzyme for the populations tested. In view of the presence of resistance against household insecticide products, pyrethroid efficacy on Ae. aegypti populations needs to be monitored closely to ensure the implementation of an effective vector control program in Malaysia.

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@#This study aims to examine the efficacy of mosquito mat vaporizers on Aedes aegypti and their associated metabolic detoxication mechanisms. For this purpose, Aedes aegypti (Linnaeus) was collected from nine districts in Selangor, Malaysia and tested with mosquito vaporizing mat bioassays. The same populations were also subjected to biochemical assays to investigate activities of detoxifying enzymes, namely non-specific esterase (EST), glutathione-S-transferase (GST) and mixed function oxidase (MFO). The efficacy of Ae. aegypti on the active ingredients tested in decreasing order were d- allethrin > dimefluthrin > prallethrin with PBO > prallethrin. The results further indicated significant enhancement mean levels of EST, GST and MFO in pyrethroid-resistant populations. The mortality rate of Ae. aegypti in response to pyrethroid active ingredients was associated with MFO activity, suggesting it is an important detoxification enzyme for the populations tested. In view of the presence of resistance against household insecticide products, pyrethroid efficacy on Ae. aegypti populations needs to be monitored closely to ensure the implementation of an effective vector control program in Malaysia.

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INTRODUCTION: Chronic rhinosinusitis (CRS) is highly prevalent, affecting 11% of the population. Studies evaluating the socio-economic impact of CRS are mostly limited to the US population. Currently there is no study that has evaluated the socio-economic costs of CRS in the UK. METHODS: A case-control study of patients with CRS and healthy controls was conducted to investigate the wider socio-economic impact of the disease. Data on demographic and socioeconomic characteristics, out-of-pocket expenditure (OOPE), health resource utilisation, productivity losses and health-related quality of life (HRQoL) via the EQ-5D and SNOT-22 instruments, were collected from questionnaires. RESULTS: A total of 139 CRS participants and 67 control participants completed the questionnaires. The average total OOPE per patient extrapolated to a 12-month period was £304.84. Other important findings include significantly higher reported primary care interactions (4.14 vs. 1.16) as well as secondary care interactions (2.61 vs 0.4) in CRS group as compared to controls over three-months. The average total missed workdays was estimated to be 18.7 per patient per year. The estimated incremental healthcare cost of CRS per year is £16.8 billion or £2.8 billion per million inhabitants. Factors predictive of a higher OOPE include higher household occupancy and income and these accounted for only 9.7% of the total variance in total OOPEs. Other socioeconomic, demographic and HRQoL variables were not found to be predictive factors of OOPE. CONCLUSIONS: This study showed that CRS has a significant wider economic burden beyond the immediate direct healthcare costs. CRS participants had a high level of healthcare service use, OOPE and productivity loss. Results from this study will add to the existing limited data both for the UK and abroad and emphasises the need for effective treatments for these patients to reduce the disease impact.

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Probiotics have been reported to exert beneficial effects along the gut-brain axis. This randomised, double-blind and placebo-controlled human study aimed to evaluate such properties of Lactobacillus plantarum DR7 and its accompanying mechanisms in stressed adults. One hundred and eleven (n=111; DR7 n=56, placebo n=55) stressed adults were recruited based on moderate stress levels using the PSS-10 questionnaire. The consumption of DR7 (1×109 cfu/day) for 12 weeks reduced symptoms of stress (P=0.024), anxiety (P=0.001), and total psychological scores (P=0.022) as early as 8 weeks among stressed adults compared to the placebo group as assessed by the DASS-42 questionnaire. Plasma cortisol level was reduced among DR7 subjects as compared to the placebo, accompanied by reduced plasma pro-inflammatory cytokines, such as interferon-γ and transforming growth factor-α and increased plasma anti-inflammatory cytokines, such as interleukin 10 (P<0.05). DR7 better improved cognitive and memory functions in normal adults (>30 years old), such as basic attention, emotional cognition, and associate learning (P<0.05), as compared to the placebo and young adults (<30 years old). The administration of DR7 enhanced the serotonin pathway, as observed by lowered expressions of plasma dopamine ß-hydroxylase (DBH), tyrosine hydroxylase (TH), indoleamine 2,3-dioxygenase and tryptophan 2,3-dioxygenase accompanied by increased expressions of tryptophan hydroxylase-2 and 5-hydroxytryptamine receptor-6, while stabilising the dopamine pathway as observed via stabilised expressions of TH and DBH over 12 weeks as compared to the placebo (P<0.05). Our results indicated that DR7 fulfil the requirement of a probiotic strain as per recommendation of FAO/WHO and could be applicable as a natural strategy to improve psychological functions, cognitive health and memory in stressed adults.

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Fleas are the common cause of skin disorders in cats. They are well-known for transmitting various pathogens to both cats and humans. Accordingly, this study was conducted to gain insights on the risk factors associated with flea infestation on cats. Flea combing conducted on 426 cats from four distinct regions in Peninsular Malaysia revealed a relatively high rate of flea infestation on 306 cats (71.83%). A total of 651 fleas were collected, all of them were identified as Ctenocephalides felis with the total intensity of 2.13 and abundance of 1.53. The sex ratio of fleas was female-biased at 2.5:1 (♀=464, ♂=187). Statistical analysis of the data revealed that flea infestation was significantly (P<0.05) associated with several risk factors including region, age, weight, status (stray, sheltered, pet), body condition, and hair length. Higher flea prevalence was also observed in female cats (77.99%), big-sized cats (91.76%), stray cats (84.94%), cats with clean body condition (73.35%), and cats with long hairs (78.38%) as compared to their contemporaries within the same comparison variables. The high infestation of fleas in this study is indicative of cats as a flea reservoir particularly C. felis. Thus the findings of this study and the knowledge gained on the risk factors can be used to develop and improve control measures and management of flea infestations.

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@#Fleas are the common cause of skin disorders in cats. They are well-known for transmitting various pathogens to both cats and humans. Accordingly, this study was conducted to gain insights on the risk factors associated with flea infestation on cats. Flea combing conducted on 426 cats from four distinct regions in Peninsular Malaysia revealed a relatively high rate of flea infestation on 306 cats (71.83%). A total of 651 fleas were collected, all of them were identified as Ctenocephalides felis with the total intensity of 2.13 and abundance of 1.53. The sex ratio of fleas was female-biased at 2.5:1 (♀=464, ♂=187). Statistical analysis of the data revealed that flea infestation was significantly (P<0.05) associated with several risk factors including region, age, weight, status (stray, sheltered, pet), body condition, and hair length. Higher flea prevalence was also observed in female cats (77.99%), big-sized cats (91.76%), stray cats (84.94%), cats with clean body condition (73.35%), and cats with long hairs (78.38%) as compared to their contemporaries within the same comparison variables. The high infestation of fleas in this study is indicative of cats as a flea reservoir particularly C. felis. Thus the findings of this study and the knowledge gained on the risk factors can be used to develop and improve control measures and management of flea infestations.

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This 10-months randomised, double-blind, parallel and placebo-controlled study evaluated the effects of Bifidobacterium longum BB536 on diarrhoea and/or upper respiratory illnesses in 520 healthy Malaysian pre-school children aged 2-6 years old. The subjects randomly received a one-gram sachet containing either BB536 (5×109 cfu) or placebo daily. Data analysis was performed on 219 subjects who fully complied over 10-months (placebo n=110, BB536 n=109). While BB536 did not exert significant effects against diarrhoea in children, Poisson regression with generalised estimating equations model indicated significant intergroup difference in the mean number of times of respiratory illnesses over 10 months. The duration of sore throat was reduced by 46% (P=0.018), with marginal reduction for duration of fever (reduced by 27%, P=0.084), runny nose (reduced by 15%, P=0.087) and cough (reduced by 16%, P=0.087) as compared to the placebo. Principal coordinate analysis at genus level of the gut microbiota revealed significant differences between 0 and 10 months in the BB536 group (P<0.01) but not in placebo group (P>0.05). The abundance of the genus Faecalibacterium which is associated with anti-inflammatory and immuno-modulatory properties was significantly higher in the BB536 group (P<0.05) compared to the placebo group. Altogether, our present study illustrated the potential protective effects of BB536 against upper respiratory illnesses in pre-school Malaysian children, with gut microbiota modulating properties.

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BACKGROUND: To examine variation in quality report viewing and assess correlation between provider report viewing and neonatal intensive care unit (NICU) quality. METHODS: Variation in report viewing sessions for 129 California Perinatal Quality Care Collaborative NICUs was examined. NICUs were stratified into tertiles based on their antenatal steroid (ANS) use and hospital-acquired infection (HAI) rates to compare report viewing session counts. RESULTS: The number of report viewing sessions initiated by providers varied widely over a 2-year period (median=11; mean=25.5; s.d.=45.19 sessions). Report viewing was not associated with differences in ANS use. Facilities with low HAI rates had less frequent report viewing. Facilities with high report views had significant improvements in HAI rates over time. CONCLUSIONS: Available audit and feedback reports are utilized inconsistently across California NICUs despite evidence that report viewing is associated with improvements in quality of care delivery. Further studies are needed for reports to reach their theoretical potential.

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A study has been conducted to determine the composition of surfactants in runoff water in the semi-urban area of Bandar Baru Bangi, Selangor, Malaysia. Runoff samples were collected from five different locations with contrasting functional activities and the colorimetric method was used to analyze the concentrations of surfactants as methylene blue active substances (MBAS) for anionic surfactants and as disulphine blue active substances (DBAS) for cationic surfactants. The results showed that the highest surfactant concentrations of MBAS and DBAS in runoff water were recorded in the samples collected at the residential area, with the concentrations of 3.192 ± 0.727 and 0.170 ± 0.028 µmol/L, respectively. Anionic surfactants as MBAS were found to dominate the concentration of surfactants in both runoff and rainwater. The concentrations of both anionic and cationic surfactants in runoff water were recorded as being higher than in rainwater.

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This study aims to determine the composition and sources of particulate matter with an aerodynamic diameter of 10 µm or less (PM10) in a semi-urban area. PM10 samples were collected using a high volume sampler. Heavy metals (Fe, Zn, Pb, Mn, Cu, Cd and Ni) and cations (Na(+), K(+), Ca(2+) and Mg(2+)) were detected using inductively coupled plasma mass spectrometry, while anions (SO4 (2-), NO3 (-), Cl(-) and F(-)) were analysed using Ion Chromatography. Principle component analysis and multiple linear regressions were used to identify the source apportionment of PM10. Results showed the average concentration of PM10 was 29.5 ± 5.1 µg/m(3). The heavy metals found were dominated by Fe, followed by Zn, Pb, Cu, Mn, Cd and Ni. Na(+) was the dominant cation, followed by Ca(2+), K(+) and Mg(2+), whereas SO4 (2-) was the dominant anion, followed by NO3 (-), Cl(-) and F(-). The main sources of PM10 were the Earth's crust/road dust, followed by vehicle emissions, industrial emissions/road activity, and construction/biomass burning.

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Phytochemical investigation on the stem bark of Shorea maxwelliana yielded five oligostilbenoids identified as α-viniferin (1), maximol A (2), vaticanol A (3), suffruticosol A (4) and vaticanol G (5). Chemotaxonomy of isolated compounds was discussed briefly. Major compounds were tested for neurotoxic and cytotoxic activities. Neurotoxicity for all tested compounds did not pose any toxic effect against cultured cell (cell viability range ±100-94%). Compounds 2-5 possessed active cyctotoxic activity against HL60 cell line with IC50 values range of 2.7-78 µg mL(-1).

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The Strait of Gibraltar (SG) is reputed for being both a bridge and a geographic barrier to biological exchanges between Europe and Africa. Major genetic breaks associated with this strait have been identified in various taxa, but it is unknown whether these disjunctions have been produced simultaneously or by independent biogeographic processes. Here, the genetic structure of five conifers distributed on both sides of the SG was investigated using mitochondrial (nad1 b/c, nad5-1, nad5-4 and nad7-1) and chloroplast (Pt1254, Pt15169, Pt30204, Pt36480, Pt71936 and Pt87268) DNA markers. The distribution of genetic variation was partially congruent between types of markers within the same species. Across taxa, there was a significant overlapping between the SG and the genetic breaks detected, especially for the four Tertiary species surveyed (Abies pinsapo complex, Pinus nigra, Pinus pinaster and Taxus baccata). For most of these taxa, the divergence of populations across the SG could date back to long before the Pleistocene glaciations. However, their strongly different cpDNA G(ST) and R(ST) values point out that they have had dissimilar population histories, which might include contrasting amounts of pollen-driven gene flow since their initial establishment in the region. The fifth species, Pinus halepensis, was genetically depauperated and homogenous on both sides of the SG. A further analysis of nuclear DNA sequences with coalescent-based isolation with migration models suggests a Pleistocene divergence of P. halepensis populations across the SG, which is in sharp contrast with the pre-Pleistocene divergence dates obtained for P. pinaster. Altogether, these results indicate that the genetic breaks observed across this putative biogeographical barrier have been produced by independent evolutionary processes related to the biological history of each individual species instead of a common vicariant phenomenon.

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BACKGROUND AND OBJECTIVE: Tobacco smoking has been shown to be a major risk factor for tooth loss. The present study was designed to examine tooth mortality and the patterns of tooth loss in smokers and nonsmokers over a wide age range in a selected population from Sana'a, Yemen. MATERIAL AND METHODS: A total of 2506 persons between the ages of 15 and 64 years were examined, and every permanent tooth was assessed. Missing teeth included both extracted and missing teeth. Individuals currently smoking one or more boxes of cigarettes (20 cigarettes) a day for 5 years were considered as smokers, whereas individuals with no smoking history were considered as nonsmokers. RESULTS: Smokers had a higher mean tooth loss than nonsmokers. The difference was statistically significant at p < 0.001. Mean tooth loss was significantly higher in smokers across all age groups, except for those in the 45-54 years age group. Smokers had a significantly higher mean upper tooth loss than nonsmokers. Tooth loss decreased from the incisors to the canines and then increased, with peak loss in the first molars. CONCLUSION: Tooth loss among smokers is significantly higher than among nonsmokers. The central incisors, lateral incisors and first molars were the most commonly missing teeth in smokers, compared with nonsmokers.

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Coronary heart disease (CHD) and cancers of the breast, prostate, and colon are more common in industrialized countries than in the developing world, and to some degree, these conditions appear to share risk factors. To investigate whether there is an association between these cancers and a prior history of CHD, a hospital-based case-control study was conducted at Columbia-Presbyterian Medical Center in New York. The study was based on 252 breast cancer cases, 256 colorectal cancer cases, and 322 benign surgical controls, all of whom underwent biopsy or surgery between January 1989 and December 1992, and on 319 prostate cancer cases and 189 benign prostatic hypertrophy controls diagnosed between January 1984 and December 1986 (prior to widespread use of prostate-specific antigen screening). Medical records were reviewed on each, focusing on the preoperative anesthesia and surgical clearances. No association was found between a history of CHD and breast or colorectal cancer, but an elevated risk was found for prostate cancer (odds ratio, 2.00; 95% confidence interval, 1.18-3.39), using unconditional logistic regression with adjustment for appropriate confounders. No association was found between cigarette smoking and any of the three cancers. Aspirin use was protective for colorectal cancer (odds ratio, 0.35; 95% confidence interval, 0.17-0.73) but had no association with breast or prostate cancer. The study suggests that individuals with CHD are at elevated risk for prostate cancer but not breast or colorectal cancer. Etiological risk factors associated with CHD should be investigated with regard to prostate cancer. Patients with CHD may represent a high-risk group for prostate cancer and potential future targets for prostate cancer screening interventions.

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The prevalence of vaginal yeast species has been studied in 140 women (41 pregnant, 66 infertile and 33 healthy controls) attending a gynaecological private clinic in Amman, Jordan. Yeast species were isolated from pregnant (68.2%), infertile (51.5%) and healthy control (48.4%) women. Patients manifesting one, two or three symptoms of vulvovaginitis were 22.1%, 26.8% or 24.2% respectively. Asymptomatic cases and cases with more than three symptoms were 22.4% and 4.5% respectively. Candida albicans was the dominant species (in 51.3% of the patients) followed by C. glabrata (17.9%). The percentage occurrence as well as the pattern of Candida species differed among the different groups of patients. Candida kefyr was found to be significantly higher in the infertile women. In vitro sensitivity tests using amphotericin B, nystatin, miconazole nitrate and chlorhexidine were carried out; amphotericin B was the most effective and miconazole nitrate the least.

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Small cell carcinoma of the pancreas is a very rare malignancy with 18 cases reported in the literature, of which only 3 were treated with chemotherapy. A 52-year-old man was diagnosed with small cell carcinoma originating in the head of the pancreas and invading the duodenum. He was treated with a similar approach as for localized small cell lung cancer, with six cycles of combination chemotherapy and local radiotherapy, and went into complete remission. After 3 months, he developed liver metastases along with an enlarged left supraclavicular lymph node. He was treated with two cycles of CVA, but developed lung metastases and was treated with ifosfamide/mesna. However, his overall condition deteriorated and hospice care was instituted until the patient's demise. The patient survived 14 months following diagnosis, significantly longer than the 15 reported patients with small cell pancreatic carcinomas not treated with chemotherapy. Combination chemotherapy and radiation therapy as it is utilized for small cell lung cancer appear to be beneficial for small cell carcinoma of the pancreas.

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