Cases of lingual thyroid are rare. The Johns Hopkins Hospital, New York, reported three cases of lingual thyroid in 800,000 admissions. We report here a case of lingual thyroid associated with hypothyroidism. The embryology, clinical features and principals of management are discussed.
Gentamicin is an aminoglycoside antibiotic which is commonly used in the treatment of serious Gram-negative infections. However, gentamicin like other aminoglycosides, has a narrow therapeutic index and is potentially ototoxic and nephrotoxic. Blood levels following administration of gentamicin has been shown to be highly unpredictable and monitoring of gentamicin levels is necessary to ensure effective therapeutic levels as well as to avoid toxicity. The Department of Microbiology, Universiti Kebangsaan Malaysia offers such a monitoring service. This paper analyses the results of 135 such estimations performed between August 1979 and May 1981. It is shown that a significant proportion of patients were receiving either too much or too little gentamicin. Empirical determinations of dosages is unsatisfactory and as the microbiological assay method of determining gentamicin levels is both easy to perform and inexpensive, such a service should be offered by all general hospitals in Malaysia.
Nonfermentative Gram-negative bacilli were commonly isolated from clinical material in a Malaysian hospital over a two year period of study. Pseudomonas aeruginosa, Acinetobacter sp and other Pseudomonas were the most common organisms seen. Although these bacteria occurred regularly in clinical specimens their pathogenetic role could be established in only a small proportion of cases. Most 01 these organism were either contaminants or
commensals 01 the normal bacterial flora. It is important to interpret the isolation of a nonfermentative Gram-negative bacillus with caution, and in the light of clinical findings. Failure to do so may result in the unnecessary use of antibiotics.
Laryngeal foreign bodies, especially in children, mostly present as an acute emergency. Few cases of long-standing laryngeal foreign bodies have been reported in the literature. This case illustrates one of the sequelae of a neglected laryngeal foreign body, resulting in significant granulation tissue formation in the larynx, and its management.
The in vitro activity of sulperazon (cefoperazone/sulbactam) was tested against 94 ceftazidime-resistant strains of bacteria isolated from mostly seriously ill patients in critical care units. Acinetobacter baumanii, Pseudomonas aeruginosa and Klebsiella pneumoniae made up 80% of the pathogens studied; 90% of the Klebsiella strains were producers of extended-spectrum beta-lactamases (ESBL). The MIC90 of sulperazon for Klebsiella was 12 mg/l (range 1.5-16 mg/l), indicating that this drug may be a useful alternative for the treatment of ceftazidime-resistant, ESBL-producing Klebsiella.
A 25 year old woman developed a right pleural effusion 6 weeks after commencement of short course chemotherapy for left sided tuberculous pleural effusion. Since the patient improved following continuation of the same treatment, it is presumed to be a case of paradoxical response to anti-tuberculosis treatment.
Over 100 viruses have been associated with acute central nervous system infections. The present review focuses on some of the most common agents of viral encephalitis, as well as important emerging viral encephalitides. In this context, the initial detection of West Nile virus in the Western Hemisphere during the 1999 New York City outbreak, the first description of Nipah virus in Malaysia, and the appearance in Asia of a new neurovirulent enterovirus 71 strain that causes severe neurologic disease are highlighted. In addition, advances regarding diagnosis, neuroimaging and treatment of Japanese and herpes simplex encephalitis are presented.
Cefepime is a new cephalosporin antibiotic which is highly active against both Gram-positive and Gram-negative organisms. The purpose of this study was to establish the in-vitro activity of cefepime and three other cephalosporins against recent clinical isolates from patients at the General Hospital Kuala Lumpur. A total of 334 strains comprising Enterobacteriaceae, non-fermentative Gram-negative bacilli and Staphylococcus aureus were tested for their sensitivity to cefepime, cefotaxime, ceftriaxone and ceftazidime. Minimum inhibitory concentrations of the antibiotics were established using an agar dilution method. With the exception of some strains of Flavobacterium meningosepticum, Xanthomonas maltophilia and other non-fermentative Gram-negative bacilli, cefepime was found to be active against a wide range of Gram-negative organisms. Cefepime was as or more active than the other cephalosporins against Acinetobacter, Enterobacteriaceae and methicillin-sensitive Staphylococcus aureus. Strains of Klebsiella and Salmonella that were resistant to the third generation cephalosporins were sensitive to cefepime. Cefepime could be a valuable alternative for the treatment of nosocomial infections due to multiply resistant organisms.
A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.
Beta-lactamase production is one of the major mechanisms of resistance amongst bacteria especially the enteric bacilli. The purpose of this study is to assess the in-vitro activity of Sulperazon, a combination of cefoperazone and an irreversible beta-lactamase inhibitor, sulbactam, against the cefoperazone resistant isolates of aerobic gram-negative bacilli. A total of 92 such strains were tested. It was found that at a concentration of < or = 8 mg/l of sulbactam added to cefoperazone 82% of Klebsiella spp, 100% of E. coli, 100% of Enterobacter spp, 33% of Pseudomonas aeruginosa, 67% of Pseudomonas spp and 62% of Acinetobacter spp that were resistant to cefoperazone alone were susceptible to the combination. Hence it is concluded that the addition of sulbactam to cefoperazone does expand the spectrum of the in-vitro activity of cefoperazone.
A turnaround time study was conducted for bacteriological culture tests in seven Malaysian general hospitals. The turnaround times were determined using a specially designed form that was completed by the ward staff. Doctors at these hospitals were also polled to find out whether they were satisfied with the promptness of bacteriological test reporting in their hospitals. The turnaround times obtained from this survey were found to be satisfactory taking into account the constraints of laboratory methods employed. Nevertheless only about a third of doctors expressed satisfaction with the timeliness of the bacteriological test reporting. Doctors and microbiologists should get together and agree on acceptable standards of turnaround times that are practical and reasonable.
One hundred and eight consecutive previously untreated males with gonococcal urethritis were treated with single-dose oral ampicillin under supervision. A high failure-rate of 41.5 percent was obtained. The main cause of failure was the high incidence of penicillinase-producing Neisseria gonorrhoeae - an overall incidence of 37.2 percent was obtained.
One hundred and thirty-eight male patients presented unth. a total of 146 episodes of urethritis at a Kuala Lumpur STD clinic over a period of six months. Gonorrhoea accounted for almost 4 out of 5 cases of male urethritis. The incidence of betalactamase producing strains of Neisseria gonorrhoeae was 36 percent. Furthermore nearly 3 out of 10 cases of gonococcal urethritis developed post-gonococcal urethritis.
A case of neonatal meningitis caused by an unusual organism, Acinetobacter calcoaceticus var anitratus is reported. The source of the meningitis is probably a scalp abscess caused by the same organism. This patient was successfully treated with cotrimoxazole. Infections caused by Acinetobacter are rare and are briefly reviewed in this article
31 cases of ocular toxoplasmosis were seen at the Ophthalmology Clinic, Uniuersiti Kebangsaan Malaysia, Kuala Lumpur during a one-and-a-half year period. All these cases were diagnosed as congenital ocular toxoplasmosis. As this condition appears not to be uncommon in. Malaysia, greater effort should be made towards its prevention especially among pregnant women.
Study site: Ophthalmology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)