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We are working on areas which have very strong impacts on the lives of many people.

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Antimicrobials

Telehealth Eye Screening

    Antimicrobials

1) Antimicrobials

We aim to develop and market antimicrobial that can overcome antibiotic resistance and effective anti fungi drugs.Many current antibiotics are ineffective against superbugs. Much of this antibiotic resistance is caused by underdosing which exposes a microbe to non lethal quantities not enough to kill the microbe but teaches the microbes how to resist that particular antibiotic.

antimicrobials

2) How do we control microbes

bacteria under control

*Antibiotic resistance is effected through various mechanisms by bacteria.

i) Bacterium changes permeability of its walls and consequently only much less antibiotic in non lethal dose can penetrate into the bacterium cell.

ii) Enzymes produced inside the bacterium cell degrades the antibiotic.

iii) Replication mechanisms inside the bacterium cell which are targeted by the antibiotic mutate and renders the antibiotic ineffective.

iv) The bacterium energizes an efflux pump which effectively regurgitates the antibiotic which has penetrated into the bacterium cell.

*To overcome antibiotic resistance:

i) New antibiotics to destroy bacterial cellular structure on contact or in immediate vicinity.

ii) Inhibit bacterial growth to numbers that cause virulence and uncontrolled binary divisions resulting in massive infections and resistant biofilms.

3) Examples of how antibiotic resistance spreads.

antibiotic resistance

4) How do we control bacteria:

i) New antibiotics that destroy bacterial cell integrity so that the bacteria has no space to mutate or develop resistance tactics. At the same time such antimicrobial must not be harsh    or toxic like alcohol or bleaches. Triclosans and biguanides, currently used for microbial inhibition create environment concerns and possible resistance by bacteria.

ii) Limit bacterial growth so that there is no virulence in the host(plant or mammal).

5) World Health Organisation has published a Global priority list of antibiotic resistant bacteria to guide research and development of new antibiotics.

i) Critical: Priority 1
Acinetobacter baumanii, carbapenem resistant
Psuedomona aeruginosa, carbapenem resistant
Enterobacteriaceae, carbapenem resistant, 3rd generation cephalosporin resistant

ii) High: Priority 2
Enterococcus faecium, vancomycin resistant
Staphylococcus aureus, methicillin resistant,vancomycin resistant.
Helicobacter pylori, clarithromycin resistant
Campylobacter, fluoroquinolone resistant
Salmonella spp, fluoroquinolone resistant
Neisseria gonorrhoeae, 3rd generation cephalosporin resistant, fluoroquinolone resistant.

iii) Medium: Priority 3
Streptococcus pneumoniae, penicillin non susceptible(insensitive)
Haemophilus influenza, ampicillin resistant
Shigella spp(several species) fluoroquinolone resistant.

6) New antibiotics will have extensive applications if that type of antibiotic can kill or destroy cell structures of above antibiotic resistant bacteria or prevent the virulence of the above     bacteria or able to breakdown biofilms caused by above bacteria.

7) WHO has emphasized the need especially for antibiotics against MDR (multi drug resistant) Gram-negative bacteria which express massive endotoxins release on the lysis of such        bacteria.

The spread of such antibiotic resistant bacteria in community and healthcare settings are highlighted.

The cross infection between animals and mammals is also a great concern.

    Telehealth Eye Screening

1) Prevention means early detection

The best prevention in healthcare programs is early detection and treatment with minimal damage to the body. The current health checks which Singaporeans have accepted unfortunately often do not encompass an eye check. The common practice is for persons requiring an eye check to visit an ophthalmologist, have the eye pupils dilated(a process called mydriasis) and undergo a battery of eye tests and examination. There is a subsequent problem with light sensitivity for up to three hours. Many persons find the mydriatic process uncomfortable and time consuming. Costs and clinic waiting time are other issues to some.

2) Why is Eye check as important as Health check ?

Eye disease numbers

3) Risk Groups

The high risk groups in Singapore are those over 40 and those persons who have diabetes(regardless of age).Those over 40 years of age are more prone to Age Related Macular Degeneration(AMD) and Glaucoma,and cataract while the Diabetics have a much higher risk of Diabetic Retinopathy and Macular Edemas, and Glaucoma. Many academic papers also include those who have hypertension(high blood pressure) and hyperlipidemia(high cholesterol and high triglycerides) in the high clusters who may be more prone to develop eye diseases which if not detected early and treated may result in major visual acuity impairment and even blindness.

High Risk Cluster
4) Telehealth

An Astraltec subsidiary ,Astral Ocular, has licensed from Singapore National Eye Centre (SNEC) a protocol to apply telehealth to screen and conduct eye checks for those who require such services.This same protocol is used to screen over 100,000 patients annually under the Singapore Integrated Diabetic Retinopathy Program(SiDRP) by the Singapore Ministry of Health. Diabetic patients have their eye (Fundus) photographs taken in 18 polyclinics nationwide.These photographs are sent wirelessly to Grading Centres. In these centres trained non medical staff(graders or not doctors or nurses) interpret and grade these eye images as belonging to  those

      i. who are Normal (who will be given appointments for future screening) or

      ii. who have symptoms of cataract,DR,Glaucoma or AMD(who will be immediately referred to an eye specialist (ophthalmologist) for immediate treatment and management.

 The eye photographs are taken at the polyclinics by special cameras called fundus cameras and the persons having eye photographs taken normally do not need to have their pupils dilated by medical eyedrops.

eyetess flow chart

Astral Ocular will roll out a membership based website called Eyetess and using the protocol developed by Singapore National Eye Centre offer to the Singapore public an affordable,convenient and comfortable service to have their eyes screened.
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