Pontine infarct is a rare but clinically significant cause of an isolated facial nerve palsy. Prompt diagnosis with the use of magnetic resonance imaging (MRI) allows early initiation of treatment for such patients. We report a 62-year-old gentleman with diabetes, hypertension, and gout, presenting with lower motor neuron facial nerve palsy. This report highlights that isolated facial nerve palsy is not always associated with Bell's palsy, which remains the commonest cause of facial nerve paralysis. A thorough neurological examination and good clinical correlation with the patient's history and physical findings, coupled with the use of facial nerve anatomical knowledge and early employment of MRI, are imperative in clinching the diagnosis.
Coagulation and flocculation using bittern coagulant are effective methods for processing batik industrial wastewater containing heavy metals and high turbidity. Bittern as residual seawater product from salt production can be used as a natural coagulant as it contains magnesium (Mg2+), chloride (Cl-), and sulfate ions (SO4 2-) which can react with Pb2+ and turbidity to produce precipitation. This study focused on Pb2+ and turbidity removal from batik wastewater by introducing different variations of coagulant doses and variations in fast-stirring speed. Bittern coagulant dosage (v/v) of 5%, 15%, 25%, and 35% were used while fast-stirring speed were 55 rpm, 90 rpm, and 125 rpm. Results of this experiment showed that variations of coagulants and stirring speed to give Pb2+ maximum removal of 99.3% happened when coagulant dose and stirring speed at 35% and 55 rpm, while maximum turbidity removal at 97% happened when coagulant dose and stirring speed was 15 % and 125 rpm, respectively. Optimum dose using Response Surface Methodology (RSM) was at coagulant dose of 25% with 55 rpm, of which Pb2+ and turbidity removal were 99% and 93%, respectively.
The emergence of antibiotic resistance among multidrug-resistant (MDR) microbes is of growing concern, and threatens public health globally. A total of 129 Escherichia coli isolates were recovered from lowland aqueous environments near hospitals and medical service centers in the vicinity of Kuala Lumpur, Malaysia. Among the eleven antibacterial agents tested, the isolates were highly resistant to trimethoprim-sulfamethoxazole (83.7%) and nalidixic acid (71.3%) and moderately resistant to ampicillin and chloramphenicol (66.7%), tetracycline (65.1%), fosfomycin (57.4%), cefotaxime (57.4%), and ciprofloxacin (57.4%), while low resistance levels were found with aminoglycosides (kanamycin, 22.5%; gentamicin, 21.7%). The presence of relevant resistance determinants was evaluated, and the genotypic resistance determinants were as follows: sulfonamides (sulI, sulII, and sulIII), trimethoprim (dfrA1 and dfrA5), quinolones (qnrS), β-lactams (ampC and blaCTX-M), chloramphenicol (cmlA1 and cat2), tetracycline (tetA and tetM), fosfomycin (fosA and fosA3), and aminoglycosides (aphA1 and aacC2). Our data suggest that multidrug-resistant E. coli strains are ubiquitous in the aquatic systems of tropical countries and indicate that hospital wastewater may contribute to this phenomenon.
Antibiotic resistance has become a major public health problem throughout the world. The presence of antibiotic-resistant bacteria such as Staphylococcus aureus and antibiotic resistance genes (ARGs) in hospital wastewater is a cause for great concern today. In this study, 276 Staph. aureus isolates were recovered from hospital wastewater samples in Malaysia. All of the isolates were screened for susceptibility to nine different classes of antibiotics: ampicillin, ciprofloxacin, gentamicin, kanamycin, erythromycin, vancomycin, trimethoprim and sulfamethoxazole, chloramphenicol, tetracycline and nalidixic acid. Screening tests showed that 100 % of Staph.aureus isolates exhibited resistance against kanamycin, vancomycin, trimethoprim and sulfamethoxazole and nalidixic acid. Additionally, 91, 87, 50, 43, 11 and 8.7 % of isolates showed resistance against erythromycin, gentamicin, ciprofloxacin, ampicillin, chloramphenicol and tetracycline, respectively. Based on these results, 100 % of isolates demonstrated multidrug-resistant (MDR) characteristics, displaying resistance against more than three classes of antibiotics. Of 276 isolates, nine exhibited resistance to more than nine classes of tested antibiotics; these were selected for antibiotic susceptibility testing and examined for the presence of conserved ARGs. Interestingly, a high percentage of the selected MDR Staph.aureus isolates did not contain conserved ARGs. These results indicate that non-conserved MDR gene elements may have already spread into the environment in the tropics of Southeast Asia, and unique resistance mechanisms against several antibiotics may have evolved due to stable, moderate temperatures that support growth of bacteria throughout the year.