RESULTS: A distinctive new species of Pittosporum (P. peridoticola J.B.Sugau and Ent, sp. nov.) was discovered on Mount Tambuyukon in the north of Kinabalu Park during ecological fieldwork. The diagnostic morphological characters of this taxon are discussed and information about the habitat in which it grows is provided. The soil chemistry in the rooting zone of P. peridoticola has high magnesium to calcium quotients, high extractable nickel and manganese concentrations, but low potassium and phosphorus concentrations, as is typical for ultramafic soils. Analysis of foliar samples of various Pittosporum-species originating from ultramafic and non-ultramafic soils showed a comparable foliar elemental stoichiometry that is suggestive of 'Excluder-type' ecophysiology.
CONCLUSION: Pittosporum peridoticola is an ultramafic obligate species restricted to Kinabalu Park with only two known populations within the boundaries of the protected area. It is vulnerable to any future stochastic landscape disturbance events, such as forest fires or severe droughts, and therefore its conservation status is 'Near Threatened'.
METHODS: Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy.
RESULTS: Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy.
CONCLUSIONS: Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.
METHODS: The Asia-Pacific and Middle East Working Group on Nutrition in the ICU has identified major areas of uncertainty in clinical practice for healthcare professionals providing nutrition therapy in Asia-Pacific and the Middle East and developed a series of consensus statements to guide nutrition therapy in the ICU in these regions.
RESULTS: Accordingly, consensus statements have been provided on nutrition risk assessment and parenteral and enteral feeding strategies in the ICU, monitoring adequacy of, and tolerance to, nutrition in the ICU and institutional processes for nutrition therapy in the ICU. Furthermore, the Working Group has noted areas requiring additional research, including the most appropriate use of hypocaloric feeding in the ICU.
CONCLUSIONS: The objective of the Working Group in formulating these statements is to guide healthcare professionals in practicing appropriate clinical nutrition in the ICU, with a focus on improving quality of care, which will translate into improved patient outcomes.