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In this review, we highlight recent insight into the function of eosinophil extracellular traps in patients with severe asthma. In addition, the role of eosinophil extracellular vesicles in severe asthma is also proposed. Finally, current biologics are suggested as a potential strategy for effective management of severe eosinophilic asthma.Objective Endometrial fibrosis, the primary pathological feature of intrauterine adhesion, may lead to disruption of endometrial tissue structure, menstrual abnormalities, infertility, and recurrent pregnancy loss. At present, no ideal therapeutic strategy exists for this fibrotic disease. Eupatilin, a major pharmacologically active flavone from Artemisia, has been previously reported to act as a potent inducer of dedifferentiation of fibrotic tissue in the liver and lung. However, the effects of eupatilin on endometrial fibrosis have not yet been investigated. In this study, we present the first report on the impact of eupatilin treatment on transforming growth factor beta (TGF-β)-induced endometrial fibrosis. Methods The efficacy of eupatilin on TGF-β-induced endometrial fibrosis was assessed by examining changes in morphology and the expression levels of fibrosis markers using immunofluorescence staining and quantitative real-time reverse-transcription polymerase chain reaction. Results Eupatilin treatment significantly reduced the fibrotic activity of TGF-β-induced endometrial fibrosis in Ishikawa cells, which displayed more circular shapes and formed more colonies. Additionally, the effects of eupatilin on fibrotic markers including alpha-smooth muscle actin, hypoxia-inducible factor 1 alpha, collagen type I alpha 1 chain, and matrix metalloproteinase-2, were evaluated in TGF-β-induced endometrial fibrosis. The expression of these markers was highly upregulated by TGF-β pretreatment and recovered to the levels of control cells in response to eupatilin treatment. Desferrioxamine B Conclusion Our findings suggest that suppression of TGF-β-induced signaling by eupatilin might be an effective therapeutic strategy for the treatment of endometrial fibrosis.As the coronavirus disease 2019 (COVID-19) pandemic worsens, early case detection is vital to limiting community spread. We describe our experiences with four COVID-19 cases at the polyclinics in January and February 2020. This retrospective case series highlights the challenges primary care clinicians face in the early identification of suspect cases based on clinical criteria only. To improve case detection, clinicians can sharpen their clinical acumen by keeping abreast with the latest COVID-19 developments and by maintaining a high state of vigilance.Introduction In our national emergency dispatch centre, the standard protocol for dispatcher-assisted cardiopulmonary resuscitation (DACPR) in out-of-hospital cardiac arrests (OHCAs) involves the instruction "push 100 times a minute 5 cm deep". As part of quality improvement, the instruction was simplified to "push hard and fast". Methods We analysed all dispatcher-diagnosed OHCAs over four months in 2018 January to February ("push 100 times a minute 5 cm deep") and August to September ("push hard and fast"). We also performed secondary per-protocol analysis based on the protocol used (a) standard (n = 48); (b) simplified (n = 227); and (c) own words (n = 231). Results 506 cases were included, 282 in the 'before' group and 224 in the 'after' group. Adherence to the protocol was 15.2% in the 'before' phase and 72.8% in the 'after' phase (p less then 0.001). The mean time between instruction and first compression for the 'before' and 'after' groups was 34.36 seconds and 26.83 seconds, respectively (p less then 0.001). Time to first compression was 238.62 seconds and 218.83 seconds in the 'before' and 'after' groups, respectively (p = 0.016). In the per-protocol analysis, the interval between instruction and compression was 37.19 seconds, 28.31 seconds and 32.40 seconds in the standard protocol, simplified protocol and 'own words' groups, respectively (p = 0.005). The need for paraphrasing was 60.4% in the standard protocol group and 81.5% in the simplified group (p less then 0.001). Conclusion Simplified instructions were associated with a shorter interval between instruction and first compression. Efforts should be directed at simplifying DACPR instructions.Introduction Clinical depression is a known consequence of acute coronary syndrome (ACS), and carries an adverse outcome among these patients, although this is often under-recognised. We investigated the incidence of depression in post-ACS patients and its associated factors. Methods We conducted a prospective cohort study in 95 ACS patients admitted to University Malaya Medical Centre. Clinical depression was assessed during the index admission and at 30 days post discharge using the Patient Health Questionnaire-9 (PHQ-9). Data was analysed using IBM SPSS Statistics, and binary logistic regression was used to determine the independent factors associated with depression, after adjusting for significant demographic variables and clinical characteristics. The strength of this association was presented in odds ratio and 95% confidence interval, and the significance level was set at 0.05. Results Mean age of the study population was 60 years, and 72.6% were male. Symptoms of depression were present in 88.4% of patients at baseline. Depression at 30 days was more likely in women, diabetics and patients on dialysis (p = 0.024, p less then 0.001, p = 0.008, respectively). Patients with baseline moderate to severe depression were more likely to have moderate to severe depression at 30 days (p less then 0.001). Baseline depression was the strongest predictor of depression at 30 days. An increment of one unit of PHQ-9 baseline score increases the risk of developing severe depression at 30 days by 31%. Conclusion Depression was prevalent in our post-ACS patients. The associated factors were female gender, diabetes mellitus and dialysis treatment.Introduction Patients receiving intravenous iodinated contrast media (IOCM) for CT are predisposed to contrast-induced nephropathy. Chronic kidney disease is an important risk factor, and hydration is the mainstay of prevention. While inpatients can undergo intravenous hydration, there is a knowledge deficit regarding regimens for outpatients. We employed a rapid outpatient hydration protocol to reduce postponement of scan appointments for patients with suboptimal estimated glomerular filtration rate (eGFR). Methods From June 2015, we amended our CT preparation protocol to mandate rapid hydration (oral, intravenous or both) for patients with an eGFR of 30-60 mL/min/1.73 m2. Patients receiving this hydration protocol from June to November 2015 were followed up for one month to monitor any admissions for fluid overload, and up to one year to determine the long-term effect on eGFR. Results 226 outpatients received the hydration protocol, which correlated with a 95% reduction in postponement of imaging appointments.