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Andrographis paniculata (AP) is an ancient herb known for its medicinal and therapeutic values. In this study, we aimed to evaluate the antibacterial activity and cytotoxicity of AP herbal mouthwash. Aqueous extract of AP was used to prepare the herbal mouthwash. The product was tested against selected oral pathogens namely Actinomyeces viscosus, Staphylococcus aureus, Streptococcus mutans, Streptococcus sobrinus, and Porphyromonas gingivalis for its antibacterial activity using the agar well diffusion method. Toxicity analysis was carried out and subjected to cytotoxicity screening using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, in vivo study using brine shrimp lethality bioassay, and detection of heavy metals using atomic absorption spectroscopy (AAS). Five AP herbal mouthwash concentrations (62.5, 125, 250, 500, 1000 mg/mL) were developed. AP herbal mouthwash exhibited the strongest antibacterial activity against A. viscosus. AP herbal mouthwash (125 to 1000 mg/mL) showed inhibition against P. gingivalis, S. mutans and S. sobrinus, except for S. aureus which did not reflect any sign of antibacterial activity. In brine shrimp lethality bioassay, AP herbal mouthwash has LC50 3255.064 µg/mL. In vitro cytotoxic evaluation was done on L929 mouse fibroblast cell lines using MTT assay with IC50 43.55 mg/mL denotes the mouthwash is non-toxic. Heavy metals content in AP herbal mouthwash falls within the permissible range of plumbum (2.50 ppm) followed by arsenic (1.875 ppm), mercury (0.15 ppm), and cadmium (0.06 ppm). Thus, verifying AP herbal mouthwash is effective in common oral pathogens and has a non-toxic effect.

Congenital cytomegalovirus (cCMV) infection is the leading infectious cause of congenital hearing loss and neurodevelopmental disability. This study aimed to describe the prevalence and clinical manifestations of infants age 12 months and below with CMV infection in Hospital Universiti Sains Malaysia (Hospital USM) and to determine the correlation between CMV PCR with clinical outcomes. A total of 648 hospitalized infants with clinically suspected cases of cytomegalovirus infection admitted to Hospital USM from January 2018 to December 2018 were tested for anti-CMV IgM and IgG by electrochemiluminescence immunoassay method. The results suggestive of CMV infection were requested for the second serum sample at 2-4 weeks’ interval together with plasma samples for CMV DNA viral load quantification by real-time PCR and maternal sample for serological analysis. Correlation of CMV viral load with clinical outcomes was analyzed using the point- biserial correlation. The results showed that the prevalence of acute CMV infection was 6.48 % (42/648) and cCMV infection was 0.3% (n=2/648). The findings were as follows: acute CMV infection (n = 42), passive immunity (n = 113) and inconclusive (n =41).) CMV hepatitis (p-value= 0.018), rash (p-value= 0.043), presumed sepsis (p-value=0.044) and abnormal hearing (p-value 0.031) were significantly associated with CMV status. Significant moderate correlation between CMV viral load and abnormal hearing assessment was observed. As a conclusion, CMV hepatitis, presumed sepsis, rash, and abnormal hearing were associated with the infant's CMV status. A significant correlation was found between CMV viral load and abnormal hearing.

Introduction This study was conducted to assess the efficacy of point-of-care (POC) procalcitonin (PCT) serial measurement in determining the antibiotic treatment duration in patients with ventilator-associated pneumonia (VAP). Material and methods One hundred patients were randomly recruited and then further randomly divided into two groups of 50 patients each. The first group used the POC PCT test along with the standard sepsis parameter monitoring, while the second group had the standard monitoring only (C-reactive protein [CRP] level, total white count, temperature and tracheal aspirate culture). Serial PCT test results and CRP levels were monitored on days 1, 3, 7 and 9. The patients were followed up for 28-day mortality. Results Eighty-five patients completed the trial, of whom 43 were in the PCT group and 42 were in the control group. The PCT group had a significantly lower mean (SD) antibiotic treatment duration (10.28 [2.68] days) than the control group (11.52 [3.06]). The mean (SD) difference was -1.25 (95% confidence interval [CI], -2.48 to 0.01; t-statistic [df] = -1.997 [83]; P = 0.049). The PCT group also had a higher number of antibiotic-free days alive during the 28 days after VAP onset than the control group (mean [SD], 10.79 [7.61] vs. 8.72 [6.41]). The Sequential Organ Failure Assessment score was the sole factor for the decrease in duration after VAP onset (regression coefficient β [95% CI], -0.70 [-1.19 to -0.20]; P = 0.006). Conclusions The POC procalcitonin test can reduce the antibiotic treatment duration in patients with VAP.

Acute hepatitis is an unusual manifestation of listeriosis. Most patients with listeriosis present with fever, flu-like illness and gastroenteritis symptoms due to consumption of contaminated food. Pregnancy-associated Listeria monocytogenes infection commonly occurs during the third trimester of pregnancy compared to early trimesters. We report a case of listeriosis in the first trimester of pregnancy, which presented with the acute onset of jaundice and was successfully treated with ampicillin.

A novel coronavirus disease (COVID-19) or severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), transmitted from person to person, has quickly emerged as the pandemic responsible for the current global health crisis. This infection has been declared a global pandemic, resulting in a concerning number of deaths as well as complications post-infection, primarily among vulnerable groups particularly older people and those with multiple comorbidities. In this article, we review the most recent research on the role of date palm (Phoenix dactylifera L.) fruits (DPFs) to prevent or treat COVID-19 infection. The mechanisms underlying this preventive or therapeutic effect are also discussed in terms of bioactivity potentials in date palm, e.g., antimicrobial, antioxidant, anticancer, anti-diabetic, anti-inflammatory, neuroprotective, and hemolytic potential, as well as prospect against COVID-19 disease and the potential product development. Therefore, it can be concluded that regular consumption of DPFs may be associated with a lower risk of some chronic diseases. Indeed, DPFs have been widely used in folk medicine since ancient times to treat a variety of health conditions, demonstrating the importance of DPFs as a nutraceutical and source of functional nourishment. This comprehensive review aims to summarize the majority of the research on DPFs in terms of nutrient content and biologically active components such as phenolic compounds, with an emphasis on their roles in improving overall health as well as the potential product development to ensure consumers' satisfaction in a current pandemic situation. In conclusion, DPFs can be given to COVID-19 patients as a safe and effective add-on medication or supplement in addition to routine treatments.

Melioidosis can happen in humans and animals. It has a wide range of clinical presentations that include asymptomatic infection, ulcers or abscesses of the skin, pneumonia, and multiple internal organ abscesses that may lead to fulminant septic shock. The organism presence in soil and surface of the water. We present a case of a non-diabetic chronic kidney disease patient presented with multiple carbuncles and respiratory melioidosis in which we are able to isolate B. pseudomallei after prolonging the plate incubation for 48-hours. We also suggested available tests in most diagnostic microbiology laboratory for identification of the organism. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.456-458

Cytomegalovirus (CMV) is a virus under the Herpesviridae family. We describe two case reports on different manifestations of infants with CMV infection presented with neonatal jaundice, small for gestational age (SGA) and congenital cataract. Congenital CMV (cCMV) was diagnosed in a neonate presented with jaundice and SGA. cCMV cannot be excluded in another case as no CMV PCR done within 3 weeks of life. Only one cCMV infection was treated with 6 weeks of ganciclovir anti-viral therapy, which presented with neonatal jaundice, SGA with a very high CMV viral load. All cases were under multidisciplinary follow[1]up, including pediatric for developmental assessments, audiologist for hearing assessment, and ophthalmology for vision assessment. These case reports describe the importance of thorough clinical examination and early screening of CMV infection in infants to rule out cCMV as CMV is the commonest congenital treatable viral infection in Malaysia. Early treatment and intervention can be planned for child wellbeing.

We present an atypical presentation of melioidosis, which was an appendicular abscess in a man with newly diagnosed Type 2 diabetes mellitus, which has never been reported before worldwide.

Introduction: Influenza-like illnesses (ILI) were defined as a triad of cough, sore throat and fever. The aim of this study is to determine the changes in knowledge, perceptions and practices towards preventive measures of succumbing to ILI before and after hajj among Malaysian hajj pilgrims. Methodology: An openlabeled randomized control trial study performed on five hundred Malaysian hajj pilgrims in the year 2013. After validated pre-hajj questionnaires completed, 250 subjects were given health education, benzalkonium -based handrub and demonstration of the handrub usage together with pamphlets and labelled as an intervention group. Another 250 subjects from another flight batch were given the same questionnaires without health education with unmedicated hand lotion as a control group. The knowledge, perception, practices and compliances to the handrub practice in both groups were compared with the pre-hajj results. Results: No significant difference between pre and post hajj knowledge and practice among hajj pilgrims in intervention group. Pre hajj perception score [ M (IQR) = 30 (5.00), Z= -2.441, p < 0.05 ] is much higher compared to post hajj perception [ M (IQR) = 29 (6.00), Z = -2.441, p < O.O5 ]. No significant difference between pre and post hajj knowledge, perception and practices among hajj pilgrims in control group. Hand hygiene compliance was not improved with provision of health education and free handrub supply. Conclusion: No significant changes in knowledge, perceptions and practices of Malaysian hajj pilgrims pre and post-hajj in both groups. Provision of handrub did not improved hajj pilgrims compliance.

Infection to the meningeal layer causing meningitis is one of the most feared complications of spinal anaesthesia. Anaesthetists will avoid spinal anaesthesia for those who are having skin infection at the puncture site. However in obstetric population, anaesthetist will try their best to avoid general anaesthesia due to its unwanted effects and complications. Strict and appropriate antiseptic measures such as chlorhexidine 0.5% with 70% alcohol has been suggested to reduce risk of transmission of microorganisms into subarachnoid space. We reported a parturient who had generalized tinea versicolor at the lumbar area, safely anaesthetized under spinal anaesthesia through meticulous antiseptic skin preparation who required delivery by caesarean section. Keywords: Tinea versicolor, Spinal anaesthesia, Caesarean section

BackgroundCarpanenamase-producingEnterobacteriaceae(CPE) has emerged as a threat to hospitalized patients. Phenotypic test such as Modified hodge test was less sensitive and specific especially to detectblaNDM-1 which is the most predominant genotype in this region. Nucleic acid amplification technology offers improved specificity and sensitivity. However, there is limitation in this method which is failed amplification due to the presence of inhibitors. In this study, we try to use previous method described by Villumseen et al with some modification using another DNA extraction kit.Methodology/Principle findingsThree confirmed isolates ofblaNDM-1 carbapenamase-producingKlebsiella pneumoniaewas spiked with 10 mls sterile whole blood in an aerobic Bactec Plus until the growth was detected. The blood specimen was taken and was subjected to DNA extraction method using two commercialized kits followed with multiplex PCR. All the three isolates revealedblaNDM-1 genotypes. Internal control was amplified in all three isolates.Conclusion/significanceThis study proved that we can get a specific and early diagnosis of CPE by using nucleic acid amplification technique directly from blood culture bottle and eliminate the effect of inhibitors.