One hundred seventy three stool samples were obtained from workers from Indonesia, Bangladesh, Myanmar, Pakistan and others. The stool samples were examined for Ascaris, Trichuris, Hookworm, Schistosomes, trematodes and cestodes. The protozaon parasites included Bnlantidiirrir coli, Blastocystis honlinis, Cyclospora cryptosporidium, Microsporidiirin, Entamoeeba histolytica, Giardia lamblia, lodamoeba butschilli. Of these 21.9%, 17% and 1% of the population studied had hookworm, Trichuris trichiura and Ascaris lumbricoides infections respectively. There was only one Indonesian reported to have Hymenolepis nana infections. The most common protozoan seen in the faecal sample is Blastocystis hominis (36%) followed by Giardia lamblia (4%). Most of the stools positive with these faecal pathogens were semisolid especially the ones positive for the protozoan. We have also shown Blastocystis from the Indonesian workers show very small forms almost 3-5 in size compared to the normal size of 10-15 pm in the other nationalities. These forms show a distinct growth profile in cultures and appears to be more resistant to temperature changes than Blastocystis seen in the other two nationalities. The high incidence of Hookworm and Trichuris infections is suggestive that if these workers are left unheated their productivity will be hampered by other possible serious complications such as anaemia, weight loss, abdominal pain with diarrhoea1 stools and nausea. There are increasing reports that Blastocystis hominis is pathogenic. Flatulence, abdominal discomfort and the increase in the frequency of the passing watery stool has been noted in patients infected with the parasite. Since most of the workers are generally housed in crowded rooms it is highly likely that this will facilitate transmission through the faecal-oral route of both Giardia and Blastocystis possibly increasing the incidences of these infections among workers.
BACKGROUND: This study assessed the efficacy and safety of the once-daily glucagon-like peptide-1 receptor agonist, lixisenatide, in Asian patients with type 2 diabetes mellitus inadequately controlled on metformin ± sulfonylurea.
METHODS: In this 24-week, double-blind, placebo-controlled, multinational study, patients were randomized to lixisenatide 20 µg once daily or placebo. The primary endpoint was absolute change in glycated haemoglobin (HbA1c ) from baseline to week 24.
RESULTS: A total of 391 patients were randomized. Lixisenatide significantly reduced HbA1c levels compared with placebo (LS mean difference: -0.36%, p = 0.0004). A significantly higher proportion of lixisenatide-treated patients achieved HbA1c targets of <7% (p = 0.003) and ≤6.5% (p = 0.001) versus placebo. Lixisenatide was associated with a statistically significant reduction in 2-h postprandial plasma glucose after a standardized breakfast versus placebo (LS mean difference: -4.28 mmol/L, p nausea (16.3% vs 2.6% with placebo). The incidence of symptomatic hypoglycaemia was 5.6% with lixisenatide treatment and 2.6% with placebo (p = 0.1321), with no severe symptomatic hypoglycaemia events reported.
CONCLUSIONS: In Asian patients with type 2 diabetes mellitus insufficiently controlled on metformin ± sulfonylurea, lixisenatide significantly improved glycaemic control and was well tolerated during the 24-week study.
TRIAL REGISTRATION: ClinicalTrials.gov NCT01169779.
KEYWORDS: Asia; glucagon-like peptide-1 (GLP-1) receptor agonists; lixisenatide; type 2 diabetes mellitus (T2DM)
Orbital apex syndrome (OAS) is a localized orbital cellulitis at the orbital apex that can cause vision loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves. Herein, we report a rare and rapidly progressive case of OAS secondary to fungal pansinusitis caused by Scedosporiumapiospermum in an immunocompromised patient following the extraction of abscessed teeth. A 48-year-old man with diabetes mellitus who had failed to adhere to his treatment presented with complaints of a right-sided headache and toothache for two weeks, with nausea and vomiting for two days prior to presentation. The patient was treated for septic shock secondary to the dental abscesses. Non-contrast brain computed tomography (CT) showed no significant intracranial abnormalities other than pansinusitis. Four days later, dental extraction was performed. The patient reported progressive painless blurring of the vision in his right eye following the dental extractions and was referred to the ophthalmology department. Subsequent examinations revealed decreased optic nerve function and ophthalmoplegia in his right eye and dental caries in the upper molars, with a mucopurulent discharge from the right sphenoid region. The clinical diagnosis was OAS. Pus near the orbital apex was drained surgically. Methicillin-resistant Staphylococcus aureus was isolated from the pus and a nasal swab. Tissue culture from the septal wall yielded S.apiospermum. The patient's condition deteriorated, despite intensive antibiotic and antifungal treatment and repeated surgical debridement. The disease progressed rapidly to his left eye. Sixty-seven days after the inital presentation, his visual acuity (VA) of both eyes was classified as no perception of light (NPL). The patient discharged himself from the hospital (at own risk discharge) and subsequently failed to attend a scheduled appointment in the ophthalmology clinic. If immunocompromised patients present with OAS, fungal infections should be ruled out. Prompt and aggressive treatment using a multidisciplinary approach is mandatory in cases of potentially life-threatening and vision-threatening fungal infections.