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We report a case series of seven patients with nonfermentative Gram‐negative bacteria infections in a single dialysis center; four patients with Ralstonia pickettii and three patients with Stenotrophomonas maltophilia. Two of the seven patients were admitted to hospital for intravenous antibiotic treatment, while the rest were treated with oral antibiotics at home. Both the admitted patients had temporary vascular catheter infections from the aforementioned pathogens. We conclude that the outbreak is due to colonization of treated reverse osmosis water, presumably through contamination via polluted filters and compounded by the usage of reprocessed dialysers in the dialysis center. This is especially relevant because contaminated treated water is directly introduced into the blood compartment of the dialysers during reprocessing. In addition, there seems to be a propensity for both organisms to cause prolonged febrile reactions in patients with temporary vascular catheters, likely through the early development of biofilm. Intensification of general sterilization procedures, servicing and replacement of old decrepit components of the water treatment system and temporary cessation of dialyser reuse practice seem to have halted the outbreak. Due to the virulent nature and difficult resistant profile of nonfermentative Gram‐negative bacteria, we strongly recommend meticulous vigilance in the surveillance of culture isolates in routine microbiological specimens from dialysis centers, especially if there is a senescent water treatment system and a practice of reprocessing dialysers.

Objectives:To determine the average health-related quality of life (HRQOL) score levels and their determinants in patients with predialysis chronic kidney disease (CKD).Methods:A systematic literature search was conducted for relevant observational studies published between April 2007 and April 2017 in MEDLINE, EBSCOhost, and CINAHL databases.Results:Thirteen observational studies with a total sample of 8635 subjects comprising 53.3% male with an aggregate mean age of 59.5 (SD 14.9) years were included in this review. Of the 8 generic HRQOL domains of the Short-Form Health Surveys, Social Functioning had the highest mean score whereas General Health had the lowest mean score in patients with predialysis CKD. Physical component summary (PCS) was more impaired than mental component summary (MCS). The determinants of poor HRQOL in predialysis CKD patients included both modifiable risk factors such as comorbidities (namely anxiety and depression), low serum hemoglobin level, sedentary lifestyle, unemployment and non-modifiable risk factors such as poor glomerular filtration rate, female gender, and older age. The risk factors impeded PCS more than MCS.Conclusion:Several risk factors influence HRQOL impairment in patients with predialysis CKD, with PCS being more impacted than MCS. The risk factors for poor HRQOL are important for future research and for improving renal care in patients with predialysis CKD.PROSPERO registration number: CRD42018093385

Kidney transplant recipients have traditional and nontraditional risk factors which can lead to coronary artery disease and sudden death with a functional graft loss. Aspirin has been used traditionally for prevention of cardiovascular and cerebrovascular accidents. It has beneficial effects in secondary prevention of cardiovascular events in general population. Its use for primary prophylaxis is still disputed. Bleeding and theoretical risk of nephrotoxicity are the major concerns about its use. The data on aspirin in kidney transplant population is sparse. This review will focus on various pros and cons of aspirin use for prevention of cardiovascular events in kidney transplant recipients and a way forward.

BackgroundExclusive breastfeeding (EBF) of infants in their first 6 months postpartum is beneficial. However, maternal employment and short maternity leave impede EBF practice. In 2011, Brunei implemented a new Maternity Leave Regulation to extend paid maternity leave.ObjectivesTo compare the prevalence of EBF between employed and nonworking mothers in Brunei, before and after extending paid maternity leave, to determine its effect on EBF and to determine the effects of maternal and infant sociodemographic characteristics.MethodsCross-sectional review of feeding records for infants born in 2010 (n = 6412, 85.5% all live births) and 2013 (n = 6680, 85.7%).ResultsEBF prevalence at 6 months postpartum increased from 29% in 2010 to 41% in 2013. EBF prevalence was higher among multiparous mothers (P< 0.001), mothers of Malay ethnicity (P< 0.05), and mothers of girls (P< 0.01 only in 2013) in both years. EBF prevalence among government-employed mothers (81.0%, 67.7%, and 57.8%) was greater than it was among nonworking mothers (79.1%, 66.3%, and 56.9%) by 1.9, 1.4, and 0.9 percentage points, respectively, during the first 3 months of active paid maternity leave in 2013. Mothers employed in the government and private sectors showed greater increases in the practice of EBF (15.5 and 10.8 percentage points respectively) than nonworking mothers (8.8 percentage points) from 2010 to 2013.ConclusionsEBF prevalence increased after extending paid maternity leave, with the greatest increases seen among employed mothers. Maternal ethnicity, parity, and the sex of the infant were also correlated with EBF.

This study aimed to estimate the point prevalence and 1-year period prevalence of skin disorder symptoms (SDS) among health care workers (HCWs) and to explore the possible risk factors. A random sample of 400 HCWs from 13 government health centers in Brunei Darussalam self-administered an adapted Nordic Occupational Skin Questionnaire (NOSQ-2002/SHORT). The point and 1-year prevalence of SDS were 12% and 19%, respectively. Having a history of SDS before the current job, exposure to SDS-exacerbating materials at the workplace, and having clinical roles were correlated for both prevalence estimates. Frequent handwashing and moderate use of latex gloves were associated with higher risk of SDS at 1-year. Female HCWs were more likely to report SDS. In multivariate analyses, only contact with SDS-exacerbating materials at the workplace, prejob SDS, and moderate glove usage were significant predictors of SDS.

This study sought to map and review validated health-based survey instruments in Brunei Darussalam. A scoping search of relevant articles was carried out. Six health-based survey tools have been psychometrically evaluated in Brunei Darussalam, 4 in Brunei-Malay (SF-36v2, EQ-5D/VAS, CPQ [11][12][13][14] , and m-SEQ-12) and 2 in English (OFER and WPBA) languages. Two studies (m-SEQ-12, CPQ 11-14 ) translated tools in English into Brunei-Malay. Two studies (SF-36v2, EQ-5D) cross-culturally adapted the Malaysian and Singaporean versions of the tools into BruneiMalay. Four studies were adult-and hospital-based, among healthcare workers (OFER, WPBA) and patients with chronic diseases (SF-36v2, EQ-5D); and 2 studies (m-SEQ-12, CPQ 11-14 ) were non-adult-and secondary school-based. Pretesting was carried out in 4 studies (SF-36v2, EQ-5D, CPQ [11][12][13][14] , and m-SEQ-12) on a sample of 5 to 20 volunteers. The sample size for validation ranged from 40 to 457. Reliability tests, Cronbach's alpha and intra-class coefficient (n=3), Cohen's Kappa (n=1), and 5-point scale qualitative assessment (n=1) were measured. Validity tests included face validity (n=2), discriminant validity (n=2), convergent validity (n=2), construct validity (n=2), factorial validity (n=2), and 5-point scale qualitative assessment (n=1). There is a need for more psychometric evaluation of questionnaires in Brunei Darussalam. Importantly, large heterogeneous participants, more languages, and varied psychometric tests should be considered.

The increasing prevalence and high morbidity of the SARS-CoV-2 virus during the COVID-19 pandemic drew widespread global attention. Surface contact is among the most common ways for the infection to spread within people, especially in buildings and the built environment. The roughness characteristics of finishing materials used in buildings vary, affecting the surface's ability to deposit and resuspend any particles that come into contact with these interfaces. Resuspension of particles indoors may increase the risk of consequent exposure through inhalation. However, little is known about surface roughness characteristics' role in airborne transmission of virus-laden particles in building indoor environments. The study examines the impact of surface roughness characteristics on the airborne transmission of the SARS-CoV-2 virus, considering indoor aerodynamic forces and their influence on particle contact with surfaces, deposition, and resuspension. The study applies Ansys Fluent CFD simulation tools to investigate the effect of volumetric flow rates and air velocity on concentration, deposition, and resuspension. The study also employs an empirical model to estimate surface roughness characteristics' impacts on particle resuspension rate. The results indicate that particle concentration and deposition rates indoors increase with increasing volumetric airflow rates. The particle resuspension rates also decreased with the increasing surface roughness of indoor surface materials. The highest resuspension rate recorded was 3.3 x 10-6, and the lowest was 1.6 x 10-6 s-1. Therefore, the outcome provides information on the implications of surface material selection and its effects on indoor air quality, health, and virus transmission. The study will offer valuable information for building engineering and design professionals in combating airborne disease transmission due to indoor surface characteristics.