Cutaneous sporotrichosis (CS) presents as asymptomatic lesions of varied morphology. The most common variant is the lymphocutaneous type which typically progresses from a papule to an ulcer and then forms nodules along the superficial lymphatic channels. Diagnosis CS may be challenging when the lesion presents at an uncommon site where the superficial lymphatic drainage is unfamiliar. We present here a case of sporotrichosis of the abdominal wall which was initially misdiagnosed as an abscess but later confirmed by culture and managed successfully.
Adenomyosis is a common gynaecological condition encountered in clinical practice. Treatment of adenomyosis can present a great challenge to gynaecologists as women often become resistant to hormonal treatment eventually needing surgical intervention. Hysterectomy has long been the definitive treatment for adenomyosis. However, with women currently being diagnosed at an earlier age and still have not completed their family, there is an increasing demand for effective intervention with uterine conservation. We report here two cases of patients who had undergone a combination of hysteroscopic resection of the endomyometrium combined with Mirena insertion with successful outcome.
Globally, vaccination has reduced the prevalence of meningitis caused by Streptococcus pneumoniae Neisseria meningitidis, and Haemophilus influenzae. However, neonatal Group B Streptococcus (GBS) meningitis continues to remain a problematic infection of the central nervous system. Here, we report a case of bacterial meningitis in a 34-day old male baby who presented with fever. A cerebrospinal fluid (CSF) test on the day of admission showed an increase in cell count with decreased glucose level. A rapid latex test of the CSF using a commercial kit diagnosed the causative pathogen as GBS. We administered the antibiotics ampicillin, cefotaxime, gentamicin and panipenem/betamipron to the patient for over 14 days. Partial seizures were frequently observed during the course and were well-controlled with midazolam and phenobarbital. Brain magnetic resonance imaging on day 17 showed subdural hygroma in the frontal region, and 99mTc ethyl-cysteinate dimer-single photon emission computed tomography confirmed a decreased cerebral blood flow predominantly in the left frontal region. After three years of follow-up, the condition of the patient improved without any neurological sequelae. Our report highlights that rapid identification of the causative organism is essential in infantile late-onset meningitis. In addition, we consider that the latex kit-based rapid testing of CSF is beneficial for identifying the causative agent of bacterial meningitis.
Acute pancreatitis (AP) is a serious condition that can occur suddenly in pregnancy. We present a case of sudden onset of epigastric pain with severely deranged serum triglyceride levels in a 32-year-old Vietnamese primigravida with no significant past medical history in the Singapore General Hospital. The patient was managed in the intensive care unit, with plasmapheres and intravenous insulin and was eventually a healthy term foetus was delievered via ceasarian section. This case showcased multidisciplinary co operation between the obstetrics, anaesthetic, endocrinology and intensive care team and serves as a reminder to consider this rare condition for future similar presentations.
Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pneumoperitoneum is commonly associated with perforated viscus but is rarely associated with benign causes. We present a case of 29 years old lady who underwent ERCP, who was found to have benign pneumoperitoneum subsequently. She was treated conservatively and recovered without complication. Although rare, post ERCP pneumoperitoneum of benign causes should be investigated as the course of treatment and outcome differ largely.
Giant splenic cyst is rare disorder affecting the spleen. As the occurrence is so in-frequent that the diagnosis preoperatively remains a challenge. We report a 12-year-old boy who presented to Sarawak General Hospital, Malaysia with left upper abdominal pain initially mistaken as a complex left liver cyst. He underwent surgery which turned out to be a giant splenic cyst and underwent laparotomy and total splenectomy. He was discharged well and remains asymptomatic after 6 months postoperative follow up.
The thyroid gland and its hormones play important roles in organ development and in the homeostatic control of physiological mechanisms in human beings. As a result of embryogenic descent of thyroid gland, it commonly resides along the midline - from tongue to mediastinum (90%). Ectopic thyroid gland is a rare occurrence, with extra-lingual ectopic thyroid gland being even rarer. Thus, there is a concern for malignant metastasis. Madam H, a 56-year-old healthy woman presented to the Hospital Sultanah Nora Ismail, Johor, Malaysia in April 2020 with an increasing size of right axilla mass and history of weight loss. She was having right axilla mass for the previous 7 years but only noticed the increase in size about 1 year ago. She has no other constitutional symptoms. A tru-cut biopsy performed demonstrated a benign ectopic thyroid tissue. Thyroid function test showed primary hypothyroidism. Serum Chromogranin A and other thyroid antibodies were within the normal value. Further radiological imaging showed the normal thyroid gland at neck, with no signs of distant malignancy. There was no other axillary, mediastinal or hilar lymph node enlargement. She was started on regular T. L Thyroxine 100mcg daily and given regular follow-up in endocrine clinic. Benign ectopic thyroid gland is an unusual finding. As such, follow up is needed with possibility of carcinomatous transformation such as papillary carcinoma should be considered.
Acute compartment syndrome (ACS) is a surgical emergency that requires timely recognition and early management for a good outcome. We report a case of a 71- year-old male seen at the Emergency Department of Universiti Sains Malaysia (USM), Malaysia, on anticoagulant therapy for valvular atrial fibrillation, who had sustained a closed fracture of the left distal end radius following a fall. Examination of the left upper limb showed deformity and tenderness over the left wrist, associated with swelling and a tense anterior compartment with blisters formation and rapid expansion of hematoma at the cubital fossa away from the fracture site. Both radial and brachial pulses were absent and confirmed with the absence of a doppler signal over the brachial and radial artery and CT angiography of the left upper limb showed there was a vascular injury of the brachial artery. Fasciotomy of the left upper limb and revascularization of the left brachial artery was done. Intraoperative findings showed a tight anterior compartment with muscle bulging upon compartment release with a complete cut of the left distal brachial artery. The primary end-to-end vascular anastomosis was done and distal circulation was restored. The distal end radius fracture was treated conservatively. The patient underwent split skin grafting of the left forearm after 6 weeks post-injury and went home well. It is critical to recognize a concomitant vascular injury in fracture-related ACS as the clinical feature may overlap. Failure in detection of concomitant vascular injury may lead to emergency fasciotomy without vascular exploration and repair.
Madam LPS, a 69 years old lady complained of left eye blurring of vision since January 2017. It was associated with left orbital swelling with chemosis, eye redness, epiphora, several episodes of self-limiting epistaxis and bilateral ophthalmoplegia. Other neurological examinations and cerebellar systems were intact. Magnetic Resonance Imaging (MRI) Brain and Orbit were performed, depicting a sellar mass with suprasellar extension with blood investigations results showed panhypopituitarism. She underwent bilateral orbital decompression. Trans-nasal endoscopic biopsy showed suppurative granulomatous lesion, which cultured Candida Albicans and Candida Galbrata. She was started on antifungal and hormonal replacement therapy for panhypopituitarism. Unfortunately, she did not respond well to treatment as repeated MRI Brain on December 2018 showed increase in size of sellar mass causing obstructive hydrocephalus and increasing size of left orbital lesion. She was counselled for another debulking surgery with a ventriculoperitoneal (VP) shunt. HPE taken were reported as chronic inflammatory process in favour to fungal infection. Pituitary infections may mimic pituitary mass. Some may exhibit symptoms of panhypopituitarism as well. Thus, physical examination, MRI brain imaging as well as HPE of biopsy are important aids to achieve diagnosis. Optimal treatment of fungal pituitary abscess includes transsphenoidal surgery combined with antifungal therapy.
At the very beginning of the new decade, the COVID-19 pandemic has badly hit modern human societies. SARS-CoV-2, the causative agent of COVID-19 acquiring mutations and circulating as new variants. Herein, we have found three new antiviral peptides (AVPs) against the SARS-CoV-2. These AVPs are analogous to the spike glycoprotein of the SARS-CoV-2. Antiviral peptides, i.e., Seq12, Seq12m, and Seq13m, can block the receptor-binding domain (RBD) of the SARS-CoV-2, which is necessary for communicating with the angiotensin-converting enzyme 2 (ACE2). Also, these AVPs sustain their antiviral properties, even after the insertion of 25 mutations in the RBD (Rosetta and FoldX based). Further, Seq12 and Seq12m showed negligible cytotoxicity. Besides, the binding free energies calculated using MM-PB/GBSA method are also in agreement with the molecular docking studies. The molecular interactions between AVPs and the viral membrane protein (M) also showed a favorable interaction suggesting it could inhibit the viral re-packaging process. In conclusion, this study suggests Seq12, Seq12m, and Seq13m could be helpful to fight against SARS-CoV-2. These AVPs could also aid virus diagnostic tools and nasal spray against SARS-CoV-2 in the future.
Human has been evolving in a natural environment over a long time; thus, he is habitual to adapt it. Green spaces are obligatory landscapes in an urban structure that provide a natural environment and accelerate other life events. In contrast, unplanned urbanization, and conversion from green to grey structures have damaged natural environmental resources. Studies through different angles have highlighted the importance of urban green spaces for human well-being but now need to identify their role according to the potential. The demands of urban green spaces may differ with the change of population size, types of grey structure, urban expansion, the altitude of the place, and geographical location. Therefore, this systematic review aims to analyse the significance of urban green spaces for human well-being. The study opted for a systematic process during the selection and organization of studies for this review. After analysing, 46 studies were finalized with the consensus of three review authors. Accordingly, literature was analysed under the central theme of "Urban Green Spaces for Human Well-being." Human Well-being was assessed under six sub-themes; physical, psychological, mental, social, subjective, and environmental well-being. The review concluded that urban green spaces are the primary pillar for a sustainable urban place and human well-being due to highly positive and positive correlations. Moreover, the study did not find any demarcation line between green spaces and grey structures according to any specific need. Therefore, the study suggested that the role of urban green spaces for human well-being should be analysed according to their potential and required optimal ratio under different communities' urban specific environments and social behaviour.
The total number of cumulative cases and deaths from the COVID-19 pandemic caused by SARS-CoV-2 is still increasing worldwide. Although many countries have actively implemented vaccination strategies to curb the epidemic, there is no specific efficient therapeutic drug for this virus to effectively reduce deaths. Therefore, the underappreciated macromolecular compounds have become the spotlight of research. Furthermore, the medicinal compounds in plants that provide myriad possibilities to treat human diseases have become of utmost importance. Experience indicates that Traditional Chinese medicine effectively treats SARS and has been used for treating patients with COVID-19 in China. As one of the world's oldest herbal remedies, licorice is used for treating patients with all stages of COVID-19. Glycyrrhizic acid (GA), the main active compound in licorice, has been proven effective in killing the SARS virus. Meanwhile, as a natural plant molecule, GA can also directly target important protein structures of the SARS-CoV-2 virus and inhibit the replication of SARS-CoV-2. In this review, we summarized the immune synergy of GA and its potential role in treating COVID-19 complications. Besides, we reviewed its anti-inflammatory effects on the immune system and its positive effects in cooperation with various drugs to fight against COVID-19 and its comorbidities. The purpose of this review is to elucidate and suggest that GA can be used as a potential drug during COVID-19 treatment.
Aiming to reduce the difficulty of managing and motivating knowledge workers (k-workers), and promote the psychological well-being of them in Chinese hospitals, this study examines how k-workers' leader-member exchange (LMX) influences their task performance and the mediation effect of organizational citizenship behavior (OCB). Through a self-administered survey, valid questionnaires were collected from 384 k-workers in Chinese hospitals, and partial least squares structural equation modeling was employed for data analysis. The findings show that LMX is positively related to OCB and task performance, and that OCB mediates the relationship between LMX and task performance. This research has theoretical implications and also provides practical suggestions on how to manage, motivate, and inspire k-workers, and promote the psychological well-being of them, and finally enhance the organizational performance in Chinese hospitals.
The COVID-19 pandemic has caused (and continues to cause) severe disruption in global and local economies and has forced countries, societies, and individuals to adapt quickly to the unprecedented and unpredictable situations. Despite the obvious negative consequences of the pandemic, many have called for efforts to identify transformative opportunities for sustainable development throughout this disorderly time. In the present paper, we explore such potential opportunities in the context of an interdisciplinary, international research project, which is focusing on sustainable marine management in biosphere reserves and marine parks in Southeast Asia. During a virtual workshop conducted as part of the GCRF (Government's Global Challenges Research Fund) Blue Communities Project, future scenarios were developed depicting the potential effects of the COVID-19 pandemic on five case study sites. All of these sites are in areas of internationally recognized outstanding ecological value (Taka Bonerate Kepulauan-Selayar Biosphere Reserve, Indonesia; Tun Mustapha Park, Sabah, Malaysia; Palawan Biosphere Reserve, Philippines; North Devon Biosphere Reserve, United Kingdom; Cu Lao Cham-Hoi An Biosphere Reserve, Vietnam). At the macro-level, economies, governance structures, and societal norms are undergoing big changes. At the micro-level, the livelihoods, lifestyles, and backyards of local residents have to adapt. Collaboratively, we explored how COVID-19 posed challenges in our five case study sites, but we also focused on the potential COVID-19-related windows of opportunity for future sustainable development. Opportunities could be identified in all three pillars of sustainable development: the environment, the society, and the economy. Although remarkable similarities can be found across all five sites, we conclude that there cannot be a "one-size-fits-all" solution to turn the tide toward achieving sustainable development. Just as before the pandemic, sustainable development starts with engaging with and understanding local environments, challenges, and situations; building on local knowledge; and developing tailor-made solutions for the communities in situ.
Obesity has become a worldwide health concern among the pediatric population. The prevalence of non-alcoholic fatty liver disease (NAFLD) is growing rapidly, alongside the high prevalence of obesity. NAFLD refers to a multifactorial disorder that includes simple steatosis to non-alcoholic steatohepatitis (NASH) with or devoid of fibrosis. NAFLD is regarded as a systemic disorder that influences glucose, lipid, and energy metabolism with hepatic manifestations. A sedentary lifestyle and poor choice of food remain the major contributors to the disease. Prompt and timely diagnosis of NAFLD among overweight children is crucial to prevent the progression of the condition. Yet, there has been no approved pharmacological treatment for NAFLD in adults or children. As indicated by clinical evidence, lifestyle modification plays a vital role as a primary form of therapy for managing and treating NAFLD. Emphasis is on the significance of caloric restriction, particularly macronutrients (fats, carbohydrates, and proteins) in altering the disease consequences. A growing number of studies are now focusing on establishing a link between vitamins and NAFLD. Different types of vitamin supplements have been shown to be effective in treating NAFLD. In this review, we elaborate on the potential role of vitamin E with a high content of tocotrienol as a therapeutic alternative in treating NAFLD in obese children.
Virtual reality (VR) is one of the state-of-the-art technological applications in the healthcare domain. One major aspect of VR applications in this domain includes virtual reality-based training (VRT), which simplifies the complicated visualization process of diagnosis, treatment, disease analysis, and prevention. However, not much is known on how well the domain knowledge is shared and considered in the development of VRT applications. A pertinent mechanism, known as ontology, has acted as an enabler toward making the domain knowledge more explicit. Hence, this paper presents an overview to reveal the basic concepts and explores the extent to which ontologies are used in VRT development for medical education and training in the healthcare domain. From this overview, a base of knowledge for VRT development is proposed to initiate a comprehensive strategy in creating an effective ontology design for VRT applications in the healthcare domain.
The COVID-19 pandemic has affected not only human health and economies but also the environment due to the large volume of waste in the form of discarded personal protective equipment. The remarkable increase in the global usage of face masks, which mainly contain polypropylene, and improper waste management have led to a serious environmental challenge called microplastic pollution. Potential practices for waste management related to waste valorization of discarded face masks as the major type of waste during the COVID-19 pandemic are explored in this study. Recommendations based on governmental practices, situation of state facilities, and societal awareness and engagement applicable to emergency (including COVID-19 pandemic) and postpandemic scenarios are offered while considering potential solutions and available waste management practices in different countries during emergency conditions. However, multicriteria decision making for a country must determine the optimal solution for waste management on the basis of all affecting factors. Awareness of scientific, governments, and communities worldwide will successfully eradicate this important environmental issue.
The solar receiver is considered the cornerstone of the solar tower power system. In particular, it receives high-temperature heat flux rays, and extracts the maximum heat energy to be transferred to the heat transfer fluid, while minimising any thermal and mechanical stresses. Reducing the solar receiver size helps to reduce the loss of spillage; consequently, the thermal stress increases. Using a solar receiver with inserted triangular longitudinal fins enhances the heat transfer as well as strengthens the receiver tube. This study aims to optimise the number of fins, heat flux aiming point, heat transfer fluid, nanoparticle effect with molten salt as the base fluid, and type of receiver material. Non-uniform heat flux with the cosine and Gaussian effects have been considered. When the number of fins (N) increases, the maximum temperature (Tmax) decreases and the heat transfer is enhanced. When N = 20, Tmax = 656.4 K and when N = 1, Tmax = 683.55, while the efficiency for N = 1 is greater by 3% compared to when N = 20. The cosine distribution of heat flux has a higher maximum temperature than the Gaussian distribution by 29% and is 102% higher in receiver efficiency. The thermal efficiency when the heat flux is aimed at the middle point of the receiver is higher by 10% compared with a lower or upper aiming point. Using Al2O3 nanoparticles with a concentration of 0.5 wt.% increases the thermal efficiency by 14% more than when using pure molten salt when Re = 38000. Using liquid sodium is not required to monitor the peak heat flux, and by adding triangular fins the displacement and thermal stress are 6.5 % lower compared to a smooth receiver.
This study estimates agricultural land resource allocation to develop food-crop commodities in order to safeguard food security in Indonesia in the middle of the coronavirus pandemic. The recommended commodities to be developed in Indonesia are corn, soybean, mungbean, peanut, and rice that are produced with advanced technology and input-output coefficient. There are five introduced scenarios namely, basic scenario, I, II, III, and IV. There are problems related to resource allocation such as limited resources, the ways of using it, and time constraints. In order to maintain and improve the comparative advantage of agricultural production as well as to broaden the agricultural activities, agricultural development is directed to increase business efficiency, improvements in agricultural science, technology, and human resource quality. The utilization of agricultural land resources should be well-planned for better development.