This case report describes a rigid bronchoscopy-assisted placement of a silicone airway Y-stent in a patient who developed tracheobronchomalacia following repeated dilatations for post-tuberculous airway stenosis. This is the first report of an airway Y-stent insertion in Malaysia.
Distant metastasis is a common sequelae of stage III colorectal adenocarcinoma. Liver and lungs are the
most common sites for distant metastases, but, metastases to extremities are very rare. We report a case of rectosigmoid adenocarcinoma, which metastasizes to left first metacarpal bone, which is the first occurrence in our experience. The investigations and management of the patient are discussed.
Introduction: Our objectives are to identify the incidence of hypophosphatemia and the associated risk factors. We also want to establish intravenous replacement therapy that is effective for ICU patients. Methods: A prospective observational study assessing adults admitted to ICU in between March and May 2009. All patients without baseline phosphate level and renal failure were excluded. They were evaluated for the occurrence of common risk factors. Association with independent variables that includes age, gender and BMI were verified. Evaluation of IV replacement therapy was done in the treated patients. Results: From 50 patients that were reviewed, nine were excluded. There were 66% male and 34% female with mean age 46.88±17.89. The mean ICU stay was 8.00±6.41 days. The incidence of hypophosphatemia was 29% (n=12/41). Gender and
creatinine clearance was found to be significantly different between normophosphatemia and
hypophosphatemia patients. There was no significant association for each potential risk factor and the number of risk factors (≥3) with the incidence of hypophosphatemia. Multi-linear regression analysis showed that lactate, creatinine clearance and pH were significant predictors to the serum levels. A significant difference of mean serum phosphate was seen after repletion by total dose of 10, 20 and 40 mmols in the treatment subgroups. Conclusions: The incidence of hypophosphatemia in our ICU was high and comparable to previous studies. None of the commonly reported risk factors is associated with hypophosphatemia in this studied population. Among all significant correlated variables, only pH was found to be a significant predictor for serum phosphate. Baseline phosphate level may guide the initial replacement dose to prevent delay in normalization of serum levels.
MeSH terms: Adult; Creatinine; Female; Humans; Intensive Care Units; Male; Phosphates; Prospective Studies; Regression Analysis; Risk Factors; Body Mass Index; Incidence; Linear Models; Hypophosphatemia; Lactic Acid; Renal Insufficiency
Lispe orientalis Wiedemann, 1824 is recorded for the first time in peninsular Malaysia. Specimens were collected from a mushroom cultivation farm in Genting Highlands, Pahang (3°25’18"N 101°47’48"E). Previously, this species had been recorded from Azerbaijin, India, Russia, Tajikistan, Thailand, Turkey and South Korea. The male of Lispe orientalis can be determined by the following characteristics: body non-metallic, ashy gray, third antennal segment black, R5 cell not narrow apically, hind metatarsus normal, legs entirely black, femora with long bristle-like hairs on av and pv surfaces, hind tibia without av and pv seta and the palpi orangish in colour.
MeSH terms: Agaricales; Agriculture; Color; Femur; Hair; India; Leg; Malaysia; Male; Metatarsal Bones; Metatarsus; Russia; Tajikistan; Thailand; Tibia; Turkey; Bones of Lower Extremity; Republic of Korea
Strongyloidiasis is an infection caused by the intestinal nematode Strongyloides stercoralis. Infected healthy individuals are usually asymptomatic, however it is potentially fatal in immunocompromised hosts due to its capacity to cause an overwhelming hyperinfection. Strongyloidiasis could be missed during routine screening because of low and intermittent larval output in stool and variable manifestations of the symptoms. We present two cases of strongyloidiasis occurring in children with solid organ malignancies suspected to have the infection based on their clinical conditions and treatment history for cancer. Both patients were diagnosed by molecular and serological tests and were successfully treated. Thus, strongyloidiasis in patients undergoing intensive treatment for malignancies should be suspected, properly investigated and treated accordingly.
Crab is an important source of food allergen. Tropomyosin represents the main crab allergen and is responsible for IgE cross-reactivity between various species of crustaceans. Recently, other new crab allergens including arginine kinase have been identified. However, information on allergens of the local Portunidcrab is not available. Thus, the aim of this study was to identify the major allergens of Portunus pelagicus (blue swimming crab) using the allergenomics approach. Raw and cooked extracts of the crab were prepared from the crab meat. Protein profile and IgE binding pattern were demonstrated by sodium dodecyl sulfatepolyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting using sera from 30 patients with crab allergy. The major allergens of the crab were then identified by two-dimensional electrophoresis (2-DE), followed by mass spectrometry analysis of the peptide digests. The SDS-PAGE of raw extract revealed approximately 20 protein fractions over a wide molecular weight range, while cooked extract demonstrated fewer protein bands. The raw extract also demonstrated a higher number of IgE reactive bands than the cooked extract. A heat-resistant protein of 36 kDa has been identified as the major allergen in both raw and cooked extracts. In addition, a heat-sensitive protein of 41 kDa was also recognized as a major allergen in raw crab. The 2-DE gel profile of the raw extract demonstrated about >100 distinct proteins spots
and immunoblotting of the 2-DE profile demonstrated at least 12 different major IgE reactive spots with molecular masses between 13 to 250 kDa and isoelectric point (pI) values ranging from 4.0 to 7.0. The 36 and 41 kDa proteins were identified as the crab tropomyosin and arginine kinase, respectively by mass spectrometry. Therefore, this study confirmed that tropomyosin and arginine kinase are the major allergens of the local Portunid crab, P. pelagicus.
Intestinal parasites are the causative agents of a number of important human infections in developing countries. The objective of this study was to determine the prevalence of selected helminths and protozoan infections among patients admitted with gastrointestinal disorders at Hospital Universiti Sains Malaysia, Kelantan, Malaysia using multiplex real-time PCR. In addition microscopic examination was also performed following direct smear, zinc sulphate concentration and Kato-Katz thick smear techniques; and the presence of protozoan parasites was confirmed using trichrome and acid-fast stains. Of the 225 faecal samples analysed, 26.2% were positive for intestinal parasites by the multiplex real-time PCR, while 5.3% were positive by microscopy. As compared to microscopy, the multiplex real-time PCR detected 5.8 and 4.5 times more positives for the selected helminth and protozoan infections respectively. Among the selected helminths detected in this study, hookworm was the most prevalent by real-time PCR, while Ascaris lumbricoides was detected the most by microscopy. Meanwhile, among the selected protozoa detected in this study, Entamoeba histolytica was the most prevalent by real-time PCR, however microscopy detected equal number of cases with E. histolytica and Giardia lamblia. This study showed that real-time PCR can be used to obtain a more accurate prevalence data on intestinal helminths and protozoa.
We investigated the potential of USA300 MRSA emergence in Malaysia by examining 268 MSSA isolates from both community (110) and healthcare (158) settings. Nine isolates from both the environments were similar to the USA300 MRSA background based on MLST, spa and PFGE type. These results underscore the importance of continued surveillance to monitor the emergence of USA300 MRSA in Malaysia.
Simulium (Nevermannia) chomthongense sp. nov. is described from female, male, pupal and larval specimens collected from Doi Inthanon National Park and Doi Phahompok National Park, Chiang Mai, Thailand. This new species, first reported as S. (Eusimulium) sp. A, and later regarded as S. (N.) caudisclerum Takaoka & Davies, described from peninsular Malaysia, is distinguished from S. (N.) caudisclerum in the male by the number of enlarged upper-eye facets and the relative size of the hind basitarsus against the hind tibia and femur, and in the pupa by the relative length of the stalks of paired filaments against the common basal stalk and the color of the dorsal surface of abdominal segments 1–3 (or 4). Taxonomic and molecular notes are provided to separate this new species from four other known species of the vernum species-group, which share an accessory sclerite on the larval abdomen, a rare characteristic in this species-group.
This paper discusses the colonization of the stratiomyid species Ptecticus melanurus (Walker) (Diptera: Stratiomyidae) in monkey carrion and its potential for the determination of the minimum time since death (PMI). A study was conducted in a tropical forest at Bangi, Malaysia from 13 November 2009 to 8 June 2011. Twelve monkey carcasses (Macaca fascicularis Raffles) were used and divided in equal number into three different field trials. Adults of P. melanurus were first observed on monkey carrions on the second day the carcasses were placed in the field while their penultimate instar larvae were found in the wet soil under and beside carcass from day 8 to 31 days postmortem.
Trichuris dysentery syndrome is caused by Trichuris trichiura which contributes to one of the most common helminthic infections in the world. It is associated with heavy colonic infection that manifests as mucoid diarrhoea, rectal bleeding, rectal prolapse, iron deficiency anaemia, and finger clubbing. Here, we report a case of trichuris dysentery syndrome complicated with severe chronic iron deficiency anaemia in a 4-year-old girl who required blood transfusion. The nematode was visualized on stool microscopic and colonoscopic examination. A longer duration of anti-helminthic treatment is required to achieve effective and better outcome.
Clinical utilization of carbapenems remains under threat with the emergence of acquired carbapenemase-producing bacteria, particularly metallo-β-lactamases (MBL). Rapid detection of MBL-producing Gram-negative bacilli is essential to prevent their widespread
dissemination. However, no standardized detection method is available for routine laboratory use. The purpose of the study was to evaluate a chelating-agent based double disk synergic test and disk potentiation test for MBL-producing strain detection and to determine the isolation rate of MBL-producing Pseudomonas aeruginosa and Acinetobacter from clinical samples in our tertiary teaching hospital. A total of 22 and 66 imipenem-resistant P. aeruginosa and Acinetobacter isolates respectively were tested with ceftazidime (CAZ) disk by modified double disk synergic test and disk potentiation test using ethylenediaminetetraacetic acid (EDTA) and 2-mercaptopropionic acid (as chelating agents) to detect MBL production. The tests were compared with EDTA-phenanthroline-imipenem (EPI) microdilution MIC test as gold standard. MBL positive strains were detected in 17 (77.3%) P. aeruginosa and 2 (3.5%) Acinetobacter isolates. The disk potentiation test with 2-mercaptopropionic acid (2-MPA) dilution of 1:12 provided the most acceptable sensitivities and specificities (88.2% sensitivity and 100% specificity in P. aeruginosa; 100% sensitivity and specificity in Acinetobacter) compared to other screening methods used in this study. This study provided useful information on the local prevalence of MBL-producing P. aeruginosa and Acinetobacter in our hospital. Disc potentiation test with CAZ/2-MPA disc appears to be reliable and convenient MBL detection method in the routine clinical laboratory.
Snake bite has been regarded as an important health problem in Myanmar since early 1960’s. In the recent years, there has been growing interest in alternative therapies and therapeutic use of natural products, especially those derive from plants. In Myanmar and
Indian traditional medicine, various plants have used as a remedy for treating snake bite. The present study was carried out to evaluate the effects of alcohol extract of Tamarind
(Tamarindus indica Linn.) seed on some biologic properties of Russell’s viper (Daboia russelli siamensis) venom (RVV). The Phospholipase A2 (PLA2) enzyme, coagulase enzyme and caseinolytic enzyme activities of Russell’s viper venom (RVV) were reduced when mixed and incubated with the extract. When the RVV and the different amount of extracts were
preincubated and injected intramuscularly into mice, all of them survived, but all the mice in the control group died. On the other hand, when RVV were injected first followed by the
extract into mice, all of them died. If the extract was injected near the site where Russell’s
viper venom was injected, all the mice survived for more than 24 hours and the survival time
prolonged but they all died within 96 hours. In conclusion, according to the results obtained,
the extract neutralizes some biologic properties of the Russell’s viper venom and prolonged
the survival time if the extract was injected near the site where the Russell’s viper venom was
injected.
MeSH terms: Alcohols; Complementary Therapies; Animals; Biological Products; Myanmar; Coagulase; Medicine, Traditional; Seeds; Snake Bites; Viper Venoms; Russell's Viper; Tamarindus; Control Groups; Mice; Phospholipases A2; Group IV Phospholipases A2
The disease melioidosis, caused by the soil bacteria Burkholderia pseudomallei, often manifests as acute septicemia with high fatality. Glycogen synthase kinase-3β (GSK3β) plays a key role during the inflammatory response induced by bacteria. We used a murine model of acute melioidosis to investigate the effects of LiCl, a GSK3 inhibitor on experimental animal survivability as well as TNF-α, IL-1β, IFN-γ, IL-10 and IL-1Ra cytokine levels in blood,
lung, liver and spleen of B. pseudomallei-infected mice. Our results showed that administration of 100 µg/g LiCl improved survivability of mice infected with 5 X LD50
of B. pseudomallei. Bacterial counts in spleen, liver and lungs of infected mice administered with LiCl were lower than non-treated controls. Our data also revealed that GSK3β is phosphorylated in the spleen, liver and lung of animals infected with B. pseudomallei. However in infected animals administered with LiCl, higher levels of pGSK3 were detected in the organs. Levels of proinflammatory cytokines (TNF-α, IL-1β and IFN-γ) and anti-inflammatory cytokines (IL-10 and IL-1Ra) in sera and organs tested were elevated significantly following B. pseudomallei infection. With GSK3β inhibition, pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1β) were significantly decreased in all the samples tested whilst the levels of anti-inflammatory cytokines, IL-10 (spleen and lung) and IL-1Ra (spleen, liver and sera) were further elevated. This study represents the first report implicating GSK3β in the modulation of cytokine production during B. pseudomallei infection thus reiterating the important role of GSK3β in the inflammatory response caused by bacterial pathogens.
A study was carried out to isolate Brucella melitensis using established bacteriological and PCR techniques in Brucella seropositive goats in farms in Selangor, Negeri Sembilan, Melaka and Pulau Pinang. Brucella melitensis was isolated from 7 of 134 reactors with the highest isolation from the vaginal swabs (57.14%) followed by the spleen (28.57%), uterine fluid (14.29%). No Brucella was isolated from the lymph nodes. PCR confirmed all the seven isolates as B. melitensis and isolates were phylogenetically related to other isolates from India, Iran, and Israel but most closely related to isolates from Singapore.
The purpose of this study is to see the anthelmintic activity potential of papaya seeds against Hymenolepis diminuta in rats. The objectives of this study were: (1) to determine the effectiveness of papaya seeds on helminths especially H. diminuta in rats and (2) to determine the effective dose level on helminths in rats. Thirty six male rats from strain Sprague-Dawley were chosen as samples in this experiment. Two types of dose level were
used for papaya seeds treatments such as 0.6 g kg-1 and 1.2 g kg-1. The geometric mean (GEM) was used to calculate mean for eggs per gram (EPG) before and after the treatment to be included in the reduction percentage calculation. After 21 days post treatment, necropsies were done to get the worm count and the GEM was used to calculate the efficacy percentage for the treatment. Results from this study showed that the reduction percentages in EPG for papaya seeds treatment for both doses level were very high which is 96.8% for 0.6g kg -1 dose level and 96.2% for 1.2 g kg-1 dose level. Whereas the efficacy percentage based on the worm counts for both doses level were also very high that was 90.77% for 0.6 g kg-1 dose level and 93.85% for 1.2 g kg-1.
In recent surveys of black flies in Arunachal Pradesh, North-East India, five species are newly recorded from Arunachal Pradesh: Simulium (Montisimulium) nemorivagum Datta, 1973, Simulium (Gomphostilbia) darjeelingense Datta, 1973, Simulium (Gomphostilbia) decuplum Takaoka & Davies, 1995, Simulium (Simulium) barnesi Takaoka & Suzuki, 1984 and Simulium (Simulium) pradyai Takaoka & Somboon, 2008, of which the latter three species also represent new records from India. Taxonomic reviews of two species of black flies reported from Assam show that Simulium (Gomphostilbia) unum Datta, 1975 is a junior synonym of Simulium (Gomphostilbia) darjeelingense, and the larva of Simulium (Gomphostilbia) sp. nr. varicorne Edwards is identifiable as Simulium (Gomphostilbia) parahiyangum Takaoka & Sigit, 1992.
The objective of this work is to evaluate the usefulness of a standardized clinical classification of hydroceles in lymphatic filariasis endemic countries to guide their surgical
management. 64 patients with hydroceles were operated in 2009-2010, in Level II hospitals
(WHO classification), during two visits to Fiji, by the same mobile surgical team. The number
of hydroceles treated was 83. We developed and evaluated a much needed clinical classification of hydroceles based on four criteria: Type (uni/bilateral); Side (left/right); Stage
of enlargement of the scrotum rated from I to VI; Grade of burial of the penis rated from 0 to
4. It lead to the conclusion that 1) A Stage I or II hydrocele, associated with Grade 0 or 1 penis burial could be considered a “Simple Hydrocele”. The surgical treatment is simple with no anticipated early complication. WHO Level II of health care structure seems adapted. 2) A Stage III or IV hydrocele associated with Grade 2, 3 or 4 penis burial could be considered a “Complicated Hydrocele”. The operation is longer, more complicated and the possibility of
occurrence of complications seems greater. A level III health care facility would be more
adapted under the normal functioning of the health system. We conclude that a standardized clinical classification of hydroceles based on the Stage of enlargement of the scrotum and the Grade of burial of the penis appears to be a useful tool to guide the decision about the level of care and the surgical technique required. We use the same classification for penoscrotal lymphoedema. A decision tree is presented for the management of hydroceles in lymphatic filariasis endemic countries which could usefully complement the “Algorithm for management of scrotal swelling” proposed by WHO in 2002. An international classification system of hydroceles would also allow standardization and facilitate study design and comparisons of their results.
Purpose - An outbreak of food poisoning had occurred in Health Institute A on 1st June 2010 which involved twenty four staffs. Six of them were hospitalized and eighteen received outpatient treatment. A case control study was done to describe the epidemiological characteristics of the outbreak and to determine the source of infection.
Design/methodology/approach - Food samples, rectal swab from cases, environmental and hand swab from the food handlers were also taken and sent for microbiological analysis.
Finding- The outbreak was explosive, and the prominent clinical features were abdominal pain (62.2%), fever (51.4%), and diarrhea (56.8%). The onset time was between 9-24 hours and the median incubation period was at 15 hours. The possible source of the outbreak was durian gravy (OR= 14.00,95%CI: 2.72-92.55, p<0.001, food attack rate: 100%) and rotijala (OR= 6.69, 95%CI: LB5-24.23, p<0.001, food attack rate: 95%), The microbiological investigation revealed that various microorganisms including Salmonella spp, The food was supplied by the same food supplier from Caterer B since 2006 and the assessment of the kitchen showed that the cleanliness rate was only 54,3% with positive results of Coliform in all utensils and areas investigated in the kitchen.
Conclusion- In conclusion, the most probable causative organism based on signs and symptoms, epidemiological analysis and microbiological results was Salmonella spp. from contaminated food seryed during the ceremony. Education on food safety and food hygiene especially personal hygiene and hand washing should be emphasized continuously for prevention of future outbreak,
Purpose – Evidences have shown that participation in a cardiac rehabilitation programme improves outcomes and quality of life for cardiac patients. Hospital Serdang has conducted this programme since 2007 and it is the first to be run by the Rehabilitation Medicine Department. The purpose of this survey is to find out whether the programme is suitable, informative and useful from the patient’s perspective as well as to determine whether the 6 weeks duration is sufficient.
Design/ methodology/approach - A patient feedback survey using a self-administered questionnaire on the programme was conducted from January 2008 to December 2010 in Hospital Serdang.
Findings - A total of 323 patients were invited to join the programme but only 182 completed the programme and took part in this survey. 30% of the patients thought that the six weeks programme was not enough for them. 100% of the respondents agreed that the programme was beneficial, well suited to their problems and were willing to promote the programme to their friends. Therefore, it is recommended that this programme be extended to the community level.
Conclusion - In conclusion, this programme is beneficial, suitable, informative and adequate from the patient’s point of view. Extension of this programme into the community as a continuation of the hospital-based programme is likely to improve the outcome further.
MeSH terms: Humans; Physical and Rehabilitation Medicine; Quality of Life; Surveys and Questionnaires; Residence Characteristics; Thinking; Friends