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Background Although first- and second-generation EGFR TKIs are considered first-line treatment in EGFRm+ NSCLC, most patients develop resistance and progress, commonly, EGFR T790M mutation. The third-generation EGFR-TKI has demonstrated efficacy in patients with progressive disease harboring the T790M mutation and in the first-line setting, bypassing this mode of resistance. The primary objectives of this study are to describe the proportion of EGFR m+ NSCLC patients treated with first-, second- and third-generation EGFR TKIs, and cytotoxic chemotherapy in the first-line setting, and the time on treatment for each category. Secondary objectives are to determine the dropout rate, the rates for T790M mutation testing at disease progression and the type of subsequent treatment. Methods This multicenter retrospective study utilized data from the Malaysian Lung Cancer Registry that actively registers all lung cancer patients ≥18 years, with primary lung cancer confirmed histologically or cytologically. All patients diagnosed with advanced stages (ie stages IIIB, IIIC and IV) EGFR m+ NSCLC from 1st of January 2015 to 31st December 2019 were included. Results Of 406 patients with EGFR m+ NCSLC, 351 were treated. Types of first-line treatment were as follows: EGFR-TKIs (first generation – 54.1%, second generation – 25.6% and third-generation – 12.5%) and chemotherapy (7.7%). The median time of treatment for each generation of EGFR-TKI was 12 months, 12 months and 24 months, and 2 months for chemotherapy. The dropout rate was 28.7% (n = 101). Nearly half (49.4%) of patients who were on first- or second-generation EGFR-TKI had further genetic testing via liquid or tissue biopsies upon disease progression. About 24.9% of those who developed disease progression after first- or second-generation EGFR TKI were started on a third-generation EGFR TKI. Conclusion In the real-world, the management of EGFR m+ advanced NSCLC patients in an Asian cost-restrictive setting may adversely affect the choice of first-line therapy, time on each line of treatment and subsequently the overall survival of patients.

Glycemic variability (GV) confers a significantly higher risk of diabetic-related complications, especially cardiovascular. Despite extensive research in this area, data on end-stage kidney disease (ESKD) patients on chronic hemodialysis are scarce. This study aims to determine the magnitude of GV among ESKD (diabetic vs nondiabetic) patients and its associated factors on hemodialysis days (HDD) and non-hemodialysis days (NHDD) where postulation of a higher GV observed among diabetic on HDD.We recruited 150 patients on hemodialysis, 93 patients with type 2 diabetic (DM-ESKD), and 57 with nondiabetic (NDM-ESKD). The GV indices (standard deviation [SD] and percentage coefficient variant [%CV]) were obtained from 11-point and 7-point selfmonitoring blood glucose (fasting to post-meal) (SMBG) profiles on HDD and NHDD. The GV indices and its associated factors of both DM-ESKD and NDM-ESKD were analyzed to compare HDD vs NHDD.Mean blood glucose on HDD was 9.33 [SD 2.7, %CV 30.6%] mmol/L in DM-ESKD compared with 6.07 [SD 0.85, %CV 21.3%] mmol/L in NDM-ESKD (P = <.01). The DM-ESKD group experienced significantly above target GV indices compared to NDM-ESKD on both HDD and NHDD, particularly in the subgroup with HbA1c 8-10% (P = <.01). Presence of diabetes, older age, hyperlipidemia, HbA1c, ferritin levels, and albumin were identified as factors associated with GV.DM-ESKD patients have above-target GV indices, especially on HDD, therefore increasing their risk of developing future complications. We identified high HbA1c, older age group, presence of hyperlipidemia, ferritin levels, and albumin as factors associated with GV indices that may be used as surrogate markers for GV. Since these groups of patients are vulnerable to CVD mortality, urgent attention is needed to rectify it. Abbreviations: % CV = percentage coefficient variant, ALP = alkaline phosphatase, BMI = body mass index, CGMS = continuous glucose monitoring system, DM-ESKD = diabetic end-stage kidney disease, ESKD = end-stage kidney disease, GV = glycemic variability, HB = hemoglobin, HbA1c = hemoglobin A1c, HDD = hemodialysis day, HDL = high-density lipoprotein, Hs-CRP = highly sensitive C-reactive protein, IHD = ischemic heart disease, iPTH = intact parathyroid hormone, LDL = low-density lipoprotein, MAGE = mean amplitude of glycemic excursion, NDM-ESKD = nondiabetic end-stage kidney disease, NHDD = nonhemodialysis day, SD = standard deviation, SMBG = self-monitoring blood glucose, T2DM = Type 2 diabetes mellitus, TG = triglycerides.

Here, we present two 7.1- and 7.3-bp near-complete genome sequences of Burkholderia pseudomallei strains of HTAA077 and HRPB058, isolated from a pus culture from a confirmed melioidosis patient at Hospital Tengku Ampuan Afzan, Kuantan, Malaysia, and from blood culture from a patient at Hospital Raja Permaisuri Bainun, Ipoh, Malaysia, using a Nanopore MinION instrument.

BACKGROUND: Wound management is one of the significant health problems throughout the world. Medicinal plants have been used widely in wound management. Eurycoma longifolia Jack which is known as Tongkat Ali (TA) is a tropical medicinal plant in South East Asian countries. AIM: The aim of the study was to investigate the effect of (TA) hydrogel on wound contraction and re-epithelialization in excisional wound model in rats. METHODS: Twenty male Sprague Dawley rats were divided into four groups each group contained five rats (n = 5). Animal treatment groups are formed as: Untreated (−ve) control, Hydrocyn® aqua gel (+ve), vehicle hydrogel, and (TA) hydrogel. A full-thickness circular excisional wound was created on the dorsal back of each rat. The wounded area was measured and photographed on days 3, 6, 9, 12, 15, and 18 post wounding to determine the percentage of wound contraction and re-epithelialization. RESULTS: (TA) hydrogel showed significant increase in the percentage of wound contraction by 43.38% compared with the other groups (p = 0.032, p < 0.050) during the first interval (inflammatory phase). Although in the later healing stages (proliferative and remodeling) and re-epithelialization, our test group (TA) hydrogel did not show statistically difference with the other groups yet it was comparable to medically certified wound healing agent. CONCLUSION: (TA) hydrogel significantly accelerated the wound healing process during the early stage, the inflammatory stage. Whereas during the later healing stages and re-epithelialization, it showed almost the same effect of Hydrocyn® aqua gel.