C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series

Background

Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention.

Case Summary

We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (<36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (>42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%.

Discussion

Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.

C87. Serial Cases of Cardiovascular Manifestation on Leptospirosis: A Tales of Unfortunate Events

Background

Leptospirosis is a zoonosis disease caused by Leptospira species. It's endemic and has become a major public health issue, especially in tropical regions. Clinical manifestation varies from mild or asymptomatic to severe multiple organ failure. We report cases of severe leptospirosis which complicates supraventricular tachycardia and myoperdicarditis from Universitas Sebelas Maret Academic Hospital.

Case Summary

The first case was a 44-year-old man referred from Internal Medicine Department with Leptospira infection with Weil’s disease. On 5th daycare, the patient was reporting had an episode of tachyarrhythmia, the ECG show SVT-AVNRT, there was no history of arrhythmic events before admitted to the hospital, the echocardiography was normal. The second case was a 67-year-old man who was referred from emergency department with shortness of breath, the ECG reveals diffuse ST-segment elevation in all limb and precordial leads with reciprocal ST-depression at aVR and V1, there was also downsloping of the PR and TP segment on precordial leads (Spodick’s sign), with normal ejection fraction on echocardiographic examination with pericardial thickening. Both patients have hsTroponin levels rose above the normal limit and serological testing found positive leptospira IgM.

Discussion

Severe leptospirosis can cause multi-organ dysfunction including cardiac involvement. The patients, in this case, suffered from leptospirosis with SVT-AVNRT and myopericarditis. The exact pathophysiology is still unclear, but there are several hypotheses, such as cytokine storms and direct damage from leptospira endotoxins. Arrhythmias and cardiac disturbance in leptospirosis patients are associated with poor outcomes and higher mortality rates. 

Bacterial strains integrated with surfactin molecules of Bacillus subtilis MTCC441 enrich nematocidal activity against Meloidogyne incognita

Bacteria secrete lipopeptide (surfactin) molecules, which are known to act as natural antibiotics. Recently, research on lipopeptide molecules has grown because of their role in increasing resistance to plant pathogens. Isolated surfactin molecules at several concentrations, viz. 35, 25, 15 and 5 ppm, were used in an in vitro study for analysis of egg hatching inhibition and second-stage juvenile (J2) mortality of the nematode Meloidogyne incognita. Cell suspensions (1.2 × 10⁸  cfu·ml^-1 ) of both Bacillus subtilis (MTCC-441) and Pseudomonas putida (MTCC-102) were used in J2 inoculated tomato plants. Root-dip treatment of tomato seedlings with the crude lipopeptide (35 ppm) was also performed to analyse biocontrol potential. MALDI-TOF MS analysis was conducted to determine specific lipopeptide molecules. Data showed nematode egg mortality of 85% in the 35 ppm surfactin concentration 96 h after exposure. The maximum ovicidal activity was 83.97% after incubation with 35 ppm surfactin for the same exposure period. Plant growth attributes and biochemical parameters were significantly improved when bacterial cultures were applied before J2 inoculation of tomato seedlings. We also recorded a reduction in egg masses, nematode population and root galling. The J2 penetration into tomato roots was effective in the root-dip experiments. Surfactin mass peak was determined at m/z 1058 [M+Na]⁺ using MALDI-TOF MS. These results indicate that bacterial cell suspensions can be used as a potent and versatile source to deal with nematode infection and provide a rich source of bioactive compounds with antinematode activity.

Bacillus cereus Bacteremia: An Unusual Case Following Food Poisoning

Introduction/Objective

Bacillus cereus is a spore-forming, gram-positive rod, well known for causing food poisoning. In addition, this bacterium often presents as a contaminant of blood cultures. Differentiating true bacteremia from contamination of blood samples is important as it has treatment implications. Early recognition is necessary, as it can cause septic shock if untreated. We present a challenging case of food poisoning with concomitant bacteremia in a young patient with a history of diabetes mellitus (DM), celiac disease, and new-onset chronic kidney disease (CKD).

Methods/Case Report

A 23-year-old adult male with a history of DM, new-onset CKD, and celiac disease presented with nausea, intermittent vomiting, and lower abdominal pain for 2 weeks. On initial evaluation, he had normal blood pressure but tachypnea and tachycardia. Physical examination was significant for left lower quadrant and flank tenderness. The symptoms were persistent and progressed to point that he could not tolerate meals due to vomiting. Two weeks earlier, he presented with similar complaints along with dysuria and was treated for suspected urinary tract infection with Co-trimoxazole. This time, further workup revealed normal white blood cell count (11.8 k/µL) with 81% neutrophils, elevated creatinine (3.56 mg/dL), blood urea nitrogen (49 mg/dL), and procalcitonin (0.39 ng/mL), with abnormal urinalysis showing increased turbidity, pyuria, and nitrituria. He was started on ceftriaxone, fluids, antiemetics and was admitted to the hospital for further management. The urine culture had no bacterial growth. Two sets of peripheral blood cultures (different sites at different times) had gram-positive rods which eventually turned out to be B. cereus, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Levofloxacin was started, and he reported improvement in nausea and vomiting by the next day of admission and was discharged.

Results (if a Case Study enter NA)

NA

Conclusion

Differentiating true B. cereus bacteremia from blood sample contamination is important. Additionally, no symptoms are specific for B. cereus-associated food poisoning, and the presence of risk factors doesn’t always favor this entity over other entities, hence adding difficulty to the diagnosis. A high index of suspicion is needed, as early intervention can prevent the development of life-threatening complications.

Prevalence of Hepatitis B Virus Infection among Children with Liver Disease Admitted In Mymensingh Medical College Hospital

Hepatitis B virus infection is an important cause of liver disease. Hepatitis B Virus may present with varying degree of severity. In older children, 5-10% cases leading to chronic liver disease, cirrhosis and hepatocellular carcinoma. This descriptive cross sectional study was done to assess the prevalence of Hepatitis B Virus infection among hospitalized children with liver disease in pediatric department of Mymensingh Medical College Hospital, Bangladesh from December 2015 to October 2016. All the children of both sexes having age between six months to twelve years admitted in the pediatric ward with acute or chronic liver disease were included in this study by purposive sampling. A written consent was obtained from legal guardian of children before inclusion. Ethical clearance was obtained from competent authority. A detailed history was taken from parents in each case according to pre-designed questionnaire about demography of the patients and the risk factors of the liver disease. A thorough clinical examination and available relevant investigations like serological testing for HBV infection was done in all patients. We had figure out the seropositivity of HBV among patients having liver disease by doing HBsAg and Anti-HBc IgM. Progress of the patient was monitored by daily clinical examinations and by investigating HBsAg and Anti-HBc IgM. Finally data analysis was done by SPSS version 21.0. Among total 100 patients most (44%) patients were in 7-10 years old and most (62%) of the participants were male. Acute liver disease was 58% cases and chronic liver disease was 42% cases. HBsAg was positive in 1 case among acute liver disease and 5 cases among chronic cases. Total 6 (six) patients were found positive for HBsAg. Anti HBc IgM was positive in 4 patients among acute liver disease. Among these Anti HBc IgM positive (4) patients only one had both HBsAg and Anti HBc IgM positive. So, four patients were confirming suffered from acute viral hepatitis because they had anti HBc IgM positive. On the contrary 5 patients suffered from chronic hepatitis by hepatitis B because they were only HBsAg positive. So, in this study 9 patients (9%) were confirming suffered from HBV infection. Possible transmission factors of hepatitis B were history of (H/O) blood transfusion/trauma/parenteral injection, H/O umbilical sepsis, H/O maternal illness/infection during pregnancy. HBV still is a major cause of morbidity. All the children with liver disease should be routinely tested for HBV.

Feasibility of the TARGET-EFT trial in frail and pre-frail cardiovascular inpatients

Funding Acknowledgements

Type of funding sources: None.

Background

Older adults are at risk for hospital-acquired disability and deconditioning, often leading to the "post-hospitalization syndrome" of accelerated functional decline. We hypothesized that this syndrome could be prevented by a pragmatic multi-faceted intervention, and now report the initial experience and feasibility of our ongoing randomized clinical trial.

Methods

Patients admitted to the cardiovascular ward at a single academic center are screened with the Essential Frailty Toolset (EFT). Those ≥65 years with frailty (EFT: 3-5) or pre-frailty (EFT: 1-2) are eligible for the TARGET-EFT trial, in which they are randomly allocated to usual care or intervention. The intervention is targeted such that patients with physical weakness receive supervised exercise sessions (in addition to clinically-indicated physiotherapy), those with cognitive impairment receive stimulation activities, those with iron deficiency anemia receive intravenous iron sucrose, and those with malnutrition-related hypoalbuminemia receive protein supplements. The outcome is a composite score representing mobility, disability, activity, discomfort, and mood (EQ-5D-5L) ascertained by a blinded observer on the day of discharge and at 30 days post-hospitalization.

Results

To date, 77 out of a planned 144 patients have been randomized. The most common reasons for exclusion are age <65 years, expected discharge within <3 days and patient refusal. The median age is 80 years and length of stay is 8 days. In each group, 1 patient withdrew and 1 died. There were no intervention-related adverse events. Of the 39 intervention patients, 36 qualified for exercise and received an average of 6 sessions (46% of sessions were deferred because patients were away for tests, were bedrest post-procedures, or refused), 18 received cognitive stimulation, 15 received intravenous iron sucrose, and 16 received protein supplements.

Conclusion

The TARGET-EFT intervention is feasible and appears safe for frail and pre-frail patients hospitalized with acute cardiovascular disease. Given that nursing staff, physiotherapists, nutritionists and clinicians already address basic cognitive orientation, mobilization and nutritional/iron supplementation needs, it appears that adding targeted interventions for patients’ specific frailty deficits is feasible when shared amongst allied health professionals.

Socio-demographic Profile of COVID-19 Patients and Difficulties Faced by Them while Testing RT-PCR: A Multi-center Cross-sectional Study

This study was aimed to find out the socio-demographic profiles as well as difficulties of Reverse transcription polymerase chain reaction (RT-PCR) testing faced by Coronavirus Disease 2019 (COVID-19) patients. This cross-sectional study was conducted from 10th August to 7th September 2020. Data were collected by telephone interview using a pre-designed questionnaire after taking verbal consent from the participants. Out of 281 COVID-19 patients, 279 were diagnosed by RT-PCR; 10.3% were asymptomatic. Off them 67.6%were males, 24% were hospital staffs. Majority (66.2%) were from the non-city corporation area. History of recent contact with known COVID-19 patients was present in 56.9% cases. Fever (78.3%) and cough (58%) were the most common symptoms. One third of the patients faced difficulty to test RT-PCR for COVID-19. Sixteen percent patients complained of difficulty of getting serial for testing, the maximum waiting time was one week before giving samples. Thirty patients (10.8%) had to wait longer than usual time after reaching the center before giving sample. Hospital staffs were unable to co-operate in 2.5% of the patients while difficulty of managing transport to the hospital for suspected COVID-19 patient was an issue in 2.2% of the patients. Though testing was more difficult in city corporation areas (p=0.028), delay of getting test result was less (p<0.001). Maximum delay of getting test result was 10 days. Finding out the difficulties of COVID-19 testing will help to point out the issues behind these and will help to take necessary steps to tackle this matter. Testing rate can be increased to contain this highly contagious virus in this densely populated country.

Risk Factors of Neonatal Sepsis in Neonatal Intensive Care Unit (NICU) of Mymensingh Medical College Hospital

Neonatal sepsis is associated with increased mortality and morbidity including prolonged hospital stay. Management of such cases is difficult, costly and need expert centers in many cases. Therefore, continued surveillance is mandatory to identify risk factors of neonatal sepsis which help optimizing its management. With the above idea, this cross-sectional descriptive study was conducted at the neonatal intensive care unit (NICU) in the department of Neonatology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from July 2017 to December 2017 to observe the effects of maternal and neonatal risk factors in the development of neonatal sepsis and to determine risk factors of neonatal sepsis. Ninety four neonates (0-28 days) who were admitted in NICU with suspected sepsis were included in this study by purposive sampling technique. After admission written informed consent from parents or guardians obtained and histories were obtained including perinatal history and full physical examination of the infants were done and septic screening were sent. All the relevant information was recorded in a pre-designed questionnaire and all data were compiled, tabulated and then analyzed by SPSS version 21.0. Among 94 cases, 72.3% were preterm and 27.6% were term. There was male predominance and male/ female ratio was 1.9:1. Most (76.6%) of the patient admitted within 72 hours of birth. Most (83%) had low birth weight (<2500gm). Most came from rural area 61(64.9%) and also from low income family 59(62.8%). Premature onset of labour 40(42.6%), PROM >18 hours 36(38.3%), vaginal route of delivery 52(55.3%), instrumental resuscitation 15(16%), prelacteal feeding 11(11.7%), bottle feeding 15(16%) were the antenatal, natal and postnatal risk factors in this study. Also the neonatal factors, like prematurity, resuscitation at birth and low APGAR score carried the significant risk of developing sepsis. Poor feeding, lethargy, respiratory distress, jaundice were more common presenting symptoms. Tachycardia, tachypnea, chest indrawing, cyanosis hypothermia, hyperthermia and apnoea were found as more common presenting sign of sepsis in this study. Based on result it is concluded that prolonged rupture of membrane>18 hours, vaginal route of delivery, preterm birth, instrumental resuscitation, prelacteal feeding, bottle feeding were the major perinatal risk factors in this study.

Sustainable production and waste management policies for COVID-19 medical equipment under uncertainty: A case study analysis

Unfortunately, an abrupt corona-virus disease (COVID-19) outbreak brought a drastic change in human lives. Almost every sector of human-beings and their related activities are severely infected and affected by this COVID-19 pandemic. As days are passing, the impact of the COVID-19 epidemic is going to be more severe. The fundamental needs for personal protective equipment (PPEs) are rising drastically all over the world. In India, many non-pharmaceutical companies or organizations such as automobile companies are engaged in producing the PPEs at a very marginal rate. Thus this paper proposes a modeling and optimization framework for sustainable production and waste management (SPWM) decision-making model for COVID-19 medical equipment under uncertainty. To quantify the uncertainties among parameter values, we have taken advantage of the intuitionistic fuzzy set theory. A robust ranking function is presented to obtain a crisp version of it. Furthermore, a novel interactive intuitionistic fuzzy programming approach is developed to solve the proposed SPWM model. An ample opportunity to generate the desired solution sets are also depicted. The performance analysis based on multiple criteria such as savings from baseline, co-efficient of variations, and desirability degrees is also introduced. Practical managerial implications are also discussed based on the significant findings after applying to the real case study data-set. Finally, conclusive remarks and the future research direction are also addressed on behalf of the current contributing study.

Multiple Optical Features In Binary-Transition-Metal Borate Glasses.. [DOI: 10.21203/rs.3.rs-583999/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Glasses doped with transition metal (TM) ions exhibit rich optical transitions spanning the entire ultraviolet, visible, and infrared spectral regimes. Here we utilize the melt-quenching techniques to synthesis binary-TM-doped borate glasses of composition xCuO-(75-x)B2O3-24.7Li2O-0.3Cr2O3, with x = 0, 0.2, 1.0 and 2.0 mol %. We identify several optical transitions from Cr3+, Cr6+, and Cu2+ ions, the latter manifests at longer wavelengths and gains higher intensity with Cu additives. Despite Cr concentration being fixed, the Cr6+ peaks are quenched and Cr3+ signals are barely attenuated. This behavior rules out possible phase separation and suggests non-trivial interplay between the two TM ions and ligand, as supported by probing their oxidation states from electron spin resonance. The crystal field and Racah parameters followed an opposite behavior, while the optical band gap is reduced upon doping. These changes are correlated with structural modifications introduced by Cu additives, where we anticipate homogenous and preferential proximity of Cu-Cr ions within the network.

Green synthesis of silver nanoclusters via Melia azedarach plant and their potential towards catalytic reduction of 4-nitrophenol

Biomolecules present in the plant extracts have potential to reduce metal ions to nanoclusters by a single-step green synthesis approach. In the current study, we have synthesized the silver nanoclusters (AgNCs) from a medicinal plant, Melia azedarach and studied their catalytic activity toward the reduction of 4-nitophenol to 4-aminophenol and organic dyes. Morover, the phytochemical analysis of the plant extract was carried out in order to determine the bioactive compounds present in it. Metallic nature of the synthesized AgNCs was verified by X-ray diffraction study, while their morphology and size of was confirmed by transmission electron microscopy and Zetasizer, respectively. The study revealed that they were 56±2 nm in size and formed clusters. Fourier transformed infrared spectroscopy gives information about the different functional groups present in synthesized these NCs. Furthermore, the important catalytic applications, such as catalytic reduction of 4-nitrophenol in the presence of mild reducing agent NaBH4 and the catalytic degradation of organic dyes was monitored by FTIR. Therefore, these results indicate that the obtained nanomaterials have important applications in industrial areas.                     KEY WORDS: Green synthesis, Silver nanoclusters, Catalytic reduction, Characterization   Bull. Chem. Soc. Ethiop. 2021, 35(1), 197-206. DOI: https://dx.doi.org/10.4314/bcse.v35i1.17

Seed priming with gibberellic acid induces high salinity tolerance in Pisum sativum through antioxidants, secondary metabolites and up-regulation of antiporter genes

Salinity is one of the major abiotic stresses that limit productivity of pulse crops all over the world. Seed priming with phytohormone(s) is one of the most promising, authentic and cost-effective methods to mitigate the deleterious effect of salinity. The study was conducted to investigate potential of seed priming with gibberellic acid (GA3 ) to cope up with the adverse effects of salinity (0, 100, 200 and 300 mm NaCl) in pea (Pisum sativum L.) seedlings. There were different responses to salinity, which induced oxidative stress, higher accumulation of Na+ in shoots and roots and inhibition of photosynthetic traits. However, seed priming with GA3 showed promising effects on physiological traits under salinity stress and alleviated the adverse effects of salinity by inducing the antioxidant system, proline production, total phenol and flavonoid content and regulating ion homeostasis, along with up-regulation of Na+ /H+ antiporters (SOS1 and NHX1). Plants adapt and prevent high salt accumulation by inducing expression of Na+ /H+  antiporter (SOS1 and NHX1) proteins that enhance Na+ sequestration. Thus, seed priming with GA3 is important in alleviation of high salinity stress and can be used as a criterion for developing salt-tolerant cultivars.

Mammals of northeastern India: an updated checklist

A systematic review was carried out to prepare a checklist of the mammalian species of northeastern India.  The region is located between two prominent biodiversity hotspots, Himalaya and Indo-Burma. Though it is only 8% of the country, it supports almost half of the country’s total wild flora and fauna.  Ongoing developmental activities such as the construction of roads, electrification, and mining in and around the wildlife habitats have threatened the survival of many species of wildlife.  A lot of literature has been checked to understand the status and distribution of wildlife in the region and the present manuscript is prepared from existing literature.  A total of 267 species representing 11 orders and 38 families from the region have been reported.  A state-wise updated list of species along with their status as per IUCN, WPA (Wildlife Protection Act) of India, 1972 and CITES has been provided which is intended to serve as a baseline data for further research in mammalian fauna of the region.

Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion

PURPOSE

There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals' lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry.

METHODS

Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant.

RESULTS

Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008).

CONCLUSION

The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities.

LEVEL OF EVIDENCE

Level III.

A novel intuitionistic fuzzy preference relations for multiobjective goal programming problems

This paper investigates novel intuitionistic fuzzy preferences relations to determine the imprecise linguistic terms with fuzzy goals. The proposed intuitionistic fuzzy goal programming (IFGP) considers the degree of vagueness and hesitations simultaneously. Different sorts of membership functions such as linear, exponential, parabolic, and hyperbolic have been introduced to depict the linguistic importance term. The overall satisfaction level is achieved by maximizing the convex combination of each fuzzy goals and the preference relations simultaneously. To verify and validate the proposed IFGP model, a numerical example is presented with the comparative study. Further, it is also applied to a banking financial statement management system problem. The proposed IFGP approach outperforms over others. At last, the conclusion and future research direction are suggested based on the performed study.

Particulate β-glucan activates early and delayed phagosomal maturation and autophagy within macrophage in a NOX-2 dependent manner

AIMS

Macrophage is known to readily engulf any particulate material they encounter, including invading microbes and nano- or micro-particles. While recent studies show that some microparticles (MP) are immunogenic even without drug-cargo, the mechanism underlying this phenomenon is yet unclear. Phagocytosis induces NADPH oxidase-2 (NOX-2) mediated ROS generation that is reported to regulate antibacterial autophagy. We therefore, investigated the role of NOX-2 derived ROS in phagosomal maturation and autophagy induction in response to phagocytic uptake of two kinds of polymeric biodegradable and biocompatible microparticles: yeast-derived β-glucan particles (YDGP) and poly-(D, L-Lactic Acid) microparticles (PMP).

MAIN METHODS

J774A.1 macrophage wereas exposed to polymeric particles and the immune responses: ROS, phagosomal maturation and autophagy induction, were examined by assays including NBT, DCFH-DA, NADPH-Oxidase activity, Lysotracker and Acridine Orange. Further, the LC3 and NOX-2 expression were validated by RT-PCR, immunofluorescence assay and Western blotting. Antimicrobial activity of both MP was examined by CFU counting after administration to Mycobacterium tuberculosis and Salmonella typhimurium infected macrophage.

KEY FINDINGS

YDGP induces phagosomal maturation and acidic vesicle accumulation at 30 min and 24 h post-exposure, much more proficiently than that by PMP. YDGP exposure also induced NOX-2 dependent expression of light chain 3 (LC3-II), further confirmed as autophagy activation via autophagic flux assay with autophagolysosome inhibitor bafilomycin A1. Additionally, YDGP displayed superior anti-microbial activity than that by PMP.

SIGNIFICANCE

The induction of NOX-2-dependent autophagy and antimicrobial activity exhibited by particulate glucans has significant implications in harnessing these drug delivery vehicles as potential 'value-added' autophagy-mediated therapeutics in future.

Endoscopic retrograde cholangiopancreatography for acute gallstone pancreatitis: Implementation of an institution safety protocol during the COVID-19 outbreak in Malaysia

Coronavirus disease 2019 (COVID-19) is a highly contagious, severe acute respiratory syndrome that poses significant health risks to healthcare providers. A delicate balance is needed between timely intervention for ill patients without apparent COVID-19 infection and the safety of healthcare personnel who provide essential treatment in the midst of the pandemic. We report our experience managing a 70-year-old man who presented with acute gallstone pancreatitis at our hospital during the COVID-19 outbreak in Malaysia. We also describe the safety protocol measures that have been implemented in our institution to protect the healthcare personnel from this disease during endoscopic retrograde cholangiopancreatography. This case illustrates the importance of meticulous planning, risk assessment, effective team communication and strict adherence to recommendations when providing treatment during an unprecedented pandemic.