During the period 1979-1982, 70 strains of atypical mycobacteria isolated from clinical material were identified as belonging to species or species complex. Twenty-eight out of 61 strains isolated from pulmonary specimens were identified as M. avium-intracellulare. This frequency of association of M. avium-intracellulare with sputa of patients with pulmonary symptoms points to its potential importance and the need for further investigation.
Enterobacteriaceae isolated from clinical sources were examined for antibiotic resistance and the ability to transfer resistance to Escherichia coli. Twenty-nine out of 80 strains tested transferred part or all oftheir resistance genes. The strains carrying R plasmids included the genera Escherichia, Klebsiella, Salmonella, Enterobacter, Proteus, Providencia and Citrobacter. These results indicate that R plasmids possibly play a major role in the emergence of antibiotic resistance among clinical isolates of Enterobacteriaceae.
Four strains of S. typhi isolated in Malaysia were found to show resistance to chloramphenicol and other antibiotics. In two of these strains it was possible to show that this resistance was transferable.
This problem which is widespread in neighbouring countries and undetected in Malaysia till recently has now been shown to exist in this country. Fears that the incidence of such strains will increase in the future are expressed and the need for vigilance is emphasised.
Forty samples of Malaysian cooked foods were examined for the presence of antibiotic-resistant coliforms and R plasmids. Twenty seven (68%) of the foods had antibiotic-resistant coliforms and 5 (13%) had R plasmids. Nineteen samples (48%) had total bacterial counts over 10(6) per gm and in 5 samples, no coliforms were detected. Our findings show that cooked food may be one possible way by which R plasmids are spread. The control of the spread of R plasmids is discussed.
Hypertriglyceridemic pancreatitis (HTGP) is well-known but it is extremely rare, especially in younger patients. The main treatment modalities for HTGP are apheresis and intravenous insulin. However, apheresis in severe HTGP is not well established and the efficacy of the treatment is lacking. Herein, we discuss a case of a 17-year-old female patient with no significant past medical history who initially presented to the emergency department with severe diabetic ketoacidosis (DKA) and was intubated due to severe metabolic acidosis and impending respiratory failure on arrival. Further investigation showed evidence of HTGP. Initially, her condition did not improve with intravenous insulin. However, a course of apheresis along with supportive care improved her condition drastically. Hence, this is a case report which showed the efficacy of concomitant use of insulin infusion and plasmapheresis in regard to treating HTGP. Outcomes of HTGP based on different treatment modalities are discussed in this literature as well. However, to date, there are no randomized studies to draw a solid treatment algorithm, thus further research on the most efficient treatment regimes is required for the management of HTGP.
Between June 1977 and May 1982, 2,291 samples of raw, cooked and dried foods were examined for the presence of Salmonella. Of these samples, 43 were positive, isolations being made from raw foods (4.8%) and cooked foods (0.4%) but not from dried foods. 14 Salmonella seratypes were isolated, Salmonella anatum being the most predominant. The significance of these isolations is discussed and the need for consumer education to reduce the incidence of human salmonellosis is emphasised.
Thrombotic microangiopathy (TMA) is a serious complication that may affect post-renal transplant recipients. De novo TMA has been linked to the use of transplant immunosuppressive agents, including calcineurin inhibitors (CNI) and mammalian target of rapamycin inhibitors (mTORi). We report a case of a 41-year-old female renal transplant recipient who presented with hemolytic anemia, thrombocytopenia, and acute allograft dysfunction. Before her presentation, she was on immunosuppression with oral tacrolimus, oral prednisolone, and oral everolimus. Her renal biopsy showed features of TMA, which led to extensive workup to identify the underlying cause. Eventually, everolimus was recognized as the cause of secondary TMA as her hemolytic parameters and renal allograft function recovered following discontinuation of this drug. This case report highlights the association of everolimus with TMA in a post-renal transplant patient. Early recognition and drug withdrawal can prevent allograft loss.
Quality of life after acute coronary heart disease amongst patients is important outcome factor in deliberations of patient's care. The main aim of the study was to examine the quality of life amongst acute CHD patients.
Hormone receptor status is determined primarily to identify breast cancer patients who may benefit from hormonal therapy. The current clinical practice for the testing using either Allred score or H-score is still based on laborious manual counting and estimation of the amount and intensity of positively stained cancer cells in immunohistochemistry (IHC)-stained slides. This work integrates cell detection and classification workflow for breast carcinoma estrogen receptor (ER)-IHC-stained images and presents an automated evaluation system. The system first detects all cells within the specific regions and classifies them into negatively, weakly, moderately, and strongly stained, followed by Allred scoring for ER status evaluation. The generated Allred score relies heavily on accurate cell detection and classification and is compared against pathologists' manual estimation. Experiments on 40 whole-slide images show 82.5% agreement on hormonal treatment recommendation, which we believe could be further improved with an advanced learning model and enhancement to address the cases with 0% ER status. This promising system can automate the exhaustive exercise to provide fast and reliable assistance to pathologists and medical personnel. The system has the potential to improve the overall standards of prognostic reporting for cancer patients, benefiting pathologists, patients, and also the public at large.