Ongoing surveillance of Pseudomonas aeruginosa resistance against antimicrobial agents is fundamental to monitor trends in susceptibility patterns and to appropriately guide clinicians in choosing empirical or directed therapy. The in vitro activity level of eight antimicrobial drugs was assessed against 97 clinical isolates of P. aeruginosa collected consecutively for three months in 2007 from a Malaysian hospital. Antimicrobial susceptibility was determined using the E-test method in addition to the hospital's routine diagnostic testing by the disk diffusion method. Respiratory and wound swab isolates were the most frequently encountered isolates. The E-test and disk diffusion methods showed high concordance in determining the in vitro activity of the antimicrobial agents against the P. aeruginosa isolates. Piperacillin-tazobactam was the most active antimicrobial agent with 91.8% susceptibility, followed by the aminoglycosides (amikacin, 86.6% and gentamicin, 84.5%), the quinolone (ciprofloxacin, 83.5%) and the beta-lactams (cefepime, 80.4%, ceftazidime, 80.4%, imipenem, 79.4% and meropenem, 77.3%). Incidence of multidrug resistance was 19.6% (19 out of 97 isolates). Periodic antibiotic resistance surveillance is fundamental to monitor changes in susceptibility patterns in a hospital setting.

Objectives Chronic hepatitis C virus (HCV) infection is often asymptomatic until the occurrence of severe liver disease such as liver cirrhosis and liver cancer. These HCV-related clinical sequalae can cause significant clinical and financial implication. This study aims to describe the clinical characteristics of HCV-infected patients during initial presentation to tertiary care in Malaysia, a middle-income Asian country, to inform the development of a national guideline. Methods A descriptive cross-sectional study of a hospital-based case-series on consecutive HCV patients who presented in 2014 at the national referral centre was conducted. All patients with active viremia (detectable HCV RNA) during initial presentation were included. Results There were 741 HCV patients treated by the hepatology specialty in 2014 (n=741/5865). Mean age at initial presentation was 48 years (SD=11.5; median=49) with 541 (73%) being male. Prior known exposure to various HCV risk factors included: intravenous drug use (n=271/737), blood or blood products transfusion (n=237/737), multiple sexual partners (n=123/737), high-risk practices such as tattooing, cupping therapy, acupuncture and sharing of personal items with infected individuals (n=68/737), dialysis (n=38/737) and organ transplantation (n=13/737). Based on histology, fibroscan findings or aspartate aminotransferase-to-platelet ratio index (APRI), 327 (44.1%) patients had cirrhosis at initial presentation, with mean age 52 years (SD=8.86) compared to 44 years (SD=12.0) for non-cirrhotic patients. Decompensated cirrhosis was seen in 118 (36%) and HCC in 45 (13%) of the 327 cirrhotic patients. Only 262 (44%) of 595 patients who were clinically eligible for interferon-based therapy (patients with no cirrhosis or with compensated cirrhosis) received interferon-based HCV treatment. Conclusions HCV-infected patients at initial presentation to tertiary care in Malaysia reflected delayed presentation to clinical care with disproportionately high number of cirrhotic patients. The low proportion of clinically eligible patients receiving HCV treatment need to be investigated further and addressed accordingly in future guidelines.

Clinical manifestations of sickle cell disease (SCD) arise from the tendency of the sickle haemoglobin to polymerize and deform red blood cells into the characteristic sickle shape. Sickle cell crisis is a devastating complication that may occur in patients with SCD. If not managed properly permanent organ damage and even death may be the final outcome. A case of a 32-year-old Nigerian lady, Gravida 1 Para 0 in her first trimester, with SCD who developed signs and symptoms of delayed haemolytic transfusion reaction after receiving packed red cell transfusion is demonstrated. Multiple red cell alloantibodies were detected in the patient’s plasma; anti-Fy a, anti-Jk b and anti-E. The patient miscarriaged and succumbed to complications of hyperhaemolysis with delayed haemolytic transfusion reaction, acute chest syndrome and renal failure. There is an urgent need for mandatory red cell antibody screen and identification especially in high-risk cases. Prevention of alloimmunization by supplying phenotype-specific red cells is also required.

Hepatitis C infection and chronic kidney disease are major health burden worldwide. Hepatitis C infection is associated with a wide range of extra-hepatic manifestations in various organs including the kidneys. A strong association between hepatitis C and chronic kidney disease has come to light. Hemodialysis in supporting the end stage renal disease patients unfortunately carries a risk for hepatitis C infection. Despite much improvement in the care of this group of patients, the prevalence of hepatitis C infection in hemodialysis patients is still higher than the general population. Hepatitis C infection has a negative effect on the survival of hemodialysis and renal transplant patients. Treatment of hepatitis C in end stage renal disease patients using conventional or pegylated interferon with or without ribavirin remains a clinical challenge with low response rate, high dropout rate due to poor tolerability and many unmet needs. The approval of new direct acting antiviral agents for hepatitis C may dramatically change the treatment approach in hepatitis C infected patients with mild to moderate renal impairment. However it remains to be confirmed if the newer Hepatitis C therapies are safe in individuals with severe renal impairment. This review article discusses the relationship between hepatitis C and chronic kidney disease, describe the various types of renal diseases associated with hepatitis C and the newer as well as the existing treatments for hepatitis C in the context of this subpopulation of hepatitis C patients. � The Author(s) 2015.

[No abstract available]

Kretschmann-based surface plasmon resonance (K-SPR) sensing approach using planar thin metal films offer distinct advantages over other label-free sensing techniques in the visible region. SPR phenomenon occurs due to the propagation of electromagnetic waves along the surface of the thin metal layers. Practically, some refractive index changes on the dielectric sample layer will cause changes in surface plasmon polaritons (SPP). The main purpose of using this coupling technique is to match the light-wave vector wave with the SPP vector wave. This paper will give an overview of the design and development of SPR-based sensors utilizing the angular interrogation Kretschmann configuration for detecting the presence of various analytes such as urea, creatinine, glucose, ethanol and uric acid in the visible region. Various sensor layers such as 50-nm thick gold (Au), MoS2/graphene, Au/graphene oxide, Ag/ITO and Au/Ag/ZnO thin films were used to detect the analytes at 633 nm, 670 nm and 785 nm visible electromagnetic wavelengths. Output characteristics such as the reflectivity, full width at half maximum (FWHM), sensitivity, Q factor and Figure of merit (FOM) of the sensors were analyzed. Results of this study was obtained using Lumerical's Finite Difference Time Domain (FDTD) and experimental characterization was obtained using Bionavis SPR equipment; available at IMEN, UKM. � 2019 IEEE.

The natural history of chronic hepatitis B is characterized by different phases of infection, and patients may evolve from one phase to another or may revert to a previous phase. The hepatitis B e antigen (HBeAg)-negative form is the predominant infection worldwide, which consists of individuals with a range of viral replication and liver disease severity. Although alanine transaminase (ALT) remains the most accessible test available to clinicians for monitoring the liver disease status, further evaluations are required for some patients to assess if treatment is warranted. Guidance from practice guidelines together with thorough investigations and classifications of patients ensure recognition of who needs which level of care. This article aims to assist physicians in the assessment of HBeAg-negative individuals using liver biopsy or non-invasive tools such as hepatitis B s antigen quantification and transient elastography in addition to ALT and hepatitis B virus DNA, to identify who will remain stable, who will reactivate or at risk of disease progression hence will benefit from timely initiation of anti-viral therapy. � 2014 Baishideng Publishing Group Inc. All rights reserved.