Detection of pathogenic Vibrio species and antibiogram activity in Asian Seabass (Lates calcarifer) in Tumpat, Kelantan

@#Some of Vibrio species is well known as pathogenic bacteria in aquaculture and the marine industry. Its infection is able to generate a massive outbreak and affect the fish population, especially for net caged fish such as seabass. This study was conducted to investigate the prevalence of Vibrio spp. isolated from seabass (Lates calcarifer) in Sri Tujuh Lagoon, Tumpat, Kelantan. Then, to determine the antibiotic resistance in Vibrio isolates. Polymerase chain reaction (PCR) was used to detect Vibrio species using specific primer VR169 and VR744 with estimation base pair size band, 597 bp and further identified by sequencing. On the other hand, antibiotic susceptibility tests were continued by using 13 types of antibiotics; kanamycin (K30), chloramphenicol (C30), neomycin (N10), ampicillin (AMP10), nitrofurantoin (F300), tetracycline (TE30), streptomycin (S10), norfloxacin (NOR10), ciprofloxacin (CIP5), nalidixic acid (NA30), gentamicin (CN10), doxycycline (DO30) and sulfamethoxazole (SXT100). As a result, 14 Vibrio isolates were identified, including Vibrio fluvialis (n=6), Vibrio parahaemolyticus (n=3), Vibrio harveyi (n=2) and each isolate for Vibrio vulnificus, Vibrio alginolyticus and Vibrio spp. The results showed that all isolates were sensitive to most antibiotics except ampicillin, neomycin and streptomycin. The MAR index value was ranging from 0 to 0.31. This study demonstrates the prevalence of Vibrio spp. in seabass and the report on multidrug resistance strains that could be of concern to the fish farmers. In addition, data from this study can be further used in fish disease management plans.

In-vitro activity of β-lactams/trimethoprim-sulfamethoxazole combinations against different strains of Burkholderia pseudomallei

@#Trimethoprim-sulfamethoxazole is an active agent against Burkholderia pseudomallei and is being used in intensive and maintenance phases of melioidosis therapy. In this study, we evaluated the bactericidal activities of β-lactams (imipenem, ceftazidime and amoxicillinclavulanate) alone and in combinations with trimethoprim-sulfamethoxazole against B. pseudomallei. Four clinical strains of B. pseudomallei were selected based on different genotypes that are frequently found in Malaysia. The minimum inhibitory concentrations of trimethoprim-sulfamethoxazole, ceftazidime, imipenem and amoxicillin-clavulanate were determined using microdilution broth method. The bactericidal activities and synergy effects of β-lactams and/or trimethoprim-sulfamethoxazole were evaluated by checkerboard and static time-kill analyses at 1×MIC concentration of each antibiotic. Using checkerboard method, the β-lactam/trimethoprim-sulfamethoxazole combinations exhibited ΣFIC of 0.75-4.00. In time-kill analysis, ceftazidime/trimethoprim-sulfamethoxazole combination demonstrated synergy against three strains (less 2.25-2.41 log10CFU/mL compared to the most active antibiotic monotherapy) whereas imipenem/trimethoprim-sulfamethoxazole combination regimen showed synergy against one strain (less 3.32 log10CFU/mL). No antagonist effect or major re-growth was observed in all combination regimens, whereas 11 out of 12 of β-lactam monotherapy regimens were associated with re-growth of bacteria. However, all β-lactam monotherapy regimens exhibited rapid and stronger killing activities against BUPS/07/14, in the initial 12 hours compared to β-lactam/ trimethoprimsulfamethoxazole combination regimens. The combination of β-lactams with trimethoprimsulfamethoxazole demonstrated better killing effect at 24 hours compared to monotherapy and no major bacterial regrowth was observed. Nevertheless, delay in killing activities of β-lactam/trimethoprim-sulfamethoxazole combination regimens against BUPS/07/14 need further examination because this phenomenon can lead to treatment failure in some patients.

Environmental surface sampling of SARS-CoV-2 in selected hospitals in Malaysia

@#COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals’ strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.

Effect of early clinical skills teaching on 3rd year medical students' learning: the student perspective

The main purpose of the early introduction of Clinical Skills Learning [CSL] to pre-clinical years is to allow medical students to gain experience in clinical examination skills, basic medical procedures, history-taking and clinical communication. The objective of this study was to determine the effectiveness of the early teaching of clinical skills in preparing medical students for their clinical years. A validated questionnaire assessing the value of CSL on students in their first clinical year was distributed to 3rd year medical students. The questionnaire consisted of 8 items with a five-point Likert scale and one open-ended question. The response rate to the questionnaire was approximately 62%. Nearly 97 [70.8%] students suggested that CSL was a favourable teaching strategy. A high percentage of students [90.5%] agreed that CSL was a useful pre-clinical module to prepare them for their clinical years. The students gave positive feedback on the teaching of history-taking and physical examination, exposure to the hospital environment and acquisition of communication skills with supervisors and patients. No student perceived the CSL module as poor. Early CSL was well-perceived by students in preparing them for their clinical years. CSL is a vital part of the pre-clinical curriculum and should be further enriched with frequent hospital visits to enhance students' confidence level and performance when interacting with patients during their clinical years

Obstructive sleep apnea: relationship of some clinical parameters to severity of the disease

Although essential before surgery, in-lab lysomnography and in-hospital sleep studies cannot be done indiscriminately for all patients with potential diagnosis of obstructive sleep apnea [OSA]. Some clinical parameters may be used to select patients for these studies, thus increasing their cost-effectiveness. Studying the relationship of body mass index [BMI], modified Mallampati index [MMI], tonsil size and thyroid-mental distance [TMD] to the grade of OSA. Tertiary referral hospital. Thirty consecutive patients [20 men and 10 women] in the age range of 30 to 60 years with snoring for at least 3 months and observed cessation of respiration during sleep were included. SAM[TM] monitor [Intercare Technologies, Inc, Milwaukee, WI] was used for an eight-hour in-hospital sleep study. There was a statistically significant relationship between BMI, MMI and tonsil grade and the grade of OSA [p=0.01, p=0.036, p=0.05 respectively]. No statistically significant relationship was found between TMD and grade of OSA [p=0.456]. In patients with potential diagnosis of OSA, BMI, MMI and tonsil size grade are helpful in selecting patients for in-hospital sleep studies

Value of calcium gluconate lontophoresis in writer's cramp

This study was designed to evaluate the efficacy of calcium gluconate iontophoresis in patients with writer's cramp. Fifteen patients [with ages range from 22 to 31 years] were randomly assigned into two groups [control and study; 7 and 8 respectively]. Electromyographic activity was recorded from flexor carpi ulnaris muscle before and after treatment. Also, hand dexterity was assessed via Purdue Pegboard Test. Both groups received physical therapy program. In addition, the study group received iontophoresis with calcium gluconate for 20 minutes and the control group received placebo iontophoresis. Treatment program was given for 12 sessions every other day. The results revealed significant decrease in the electromyographic activity of the flexor carpi ulnaris muscle in the study group [p=0.0001] and significant improvement in the hand dexterity and manipulative skills [p=0.03]. Calcium gluconate iontophoresis was effective in improving hand functions in writer's cramp

Biopsy in cases of mediastinal lymphomas via mediastinotomy versus scalene lymph node biopsy

To assess the feasibility and accuracy of mediastinal lymph node biopsy via mediastinotomy incision and compare its accuracy with scalene lymph node biopsy in cases of mediastinal lymphomas with no palpable relevant lymph nodes. We received 20 patients with a picture suggestive of mediastinal lymphomas during the period between March, 2003 and April, 2006 at the Department of Cardiothoracic Surgery-Suez Canal University Hospitals. We received 9 male patients [45%] and 11 females [55%]. The age ranged between 18 and 56 years with average age of 31+2.1 years. Eight patients [group A] had been operated upon via mediastinotomy incisions alone to shorten the time of anaesthesia. In the other group B, 12 patients had both mediastinotomy incisions and scalene lymph node biopsies as the general condition was good in all patients. The results in both groups were compared. In group A, all the 8 patients were histopathologically diagnosed after mediastinal lymph node biopsies. The material of the biopsy was enough to help the pathologist to give the accurate diagnosis. Five patients had local intercostal nerve block and sedation but the other three tolerated short term general anaesthesia no single mortality but only one had severe chest infection which was treated successfully. In group B: All patients had biopsies of both mediastinal lymph nodes and scalene lymph nodes under general anaesthesia. No mortalities but there were excessive bleeding and wound infection-related to scalene biopsy in one patient. All samples taken from mediastinal lymph nodes were diagnostic. Scalene lymph node biopsies: Only in four cases we get the same histopathological report for the scalene LN biopsy as that of mediastinal L.N. These four patients had splenomegaly and enlarged abdominal para-aortic LN thus, we selected left-sided scalene LN biopsy. The remaining 8 reports of scalene biopsies were non-specific and non-diagnostic. Mediastinal lymph node biopsy via a mediastinotomy incision in the 2[nd] or 3[rd] left intercostal space is a safe and accurate approach to diagnose cases of mediastinal lymphadenopathy. Scalene lymph node biopsy is less specific and gives a lower diagnostic yield [40% Vs 100%]. Evaluation of sensitivity of left-sided scalene LN biopsy in cases with enlarged abdominal LN needs further studies

Thoracoscopic biopsy versus ultrasound guided biopsy to diagnose peripheral intrathoracic lesions

Now, thoracoscopy is a well-defined technique of proven value in the investigation, diagnosis and staging of different intrathoracic lesions. Also, ultrasound guided biopsy is a new diagnostic modality in this field. To document the feasibility, safety and reproducibility of thoracoscopic biopsy and compare its results with the ultrasound-guided biopsy to diagnose peripheral intrathoracic lesions. This prospective study included all patients admitted with undiagnosed intrathoracic mass lesion during the period between March 2003 to April 2005. Group A included 45 patients for whom 56 biopsy samples were taken as ultrasound- guided biopsy [11 repeated procedures]. Group B included 30 patients for whom 30 samples were taken thoracoscopically, these included 7 patients from group A who had failed ultrasound-guided biopsy. The results were compared. Group A: 45 patients, 21 males and 24 females the age ranged between 23 and 67 years, mean age was 45+6.14 years ultrasound-guided biopsy was done but repeated for 9 patients then repeated for two of the last group the diagnosis was confirmed in each case by the postoperative pathological examination of the whole resected mass. Ultrasound-guided biopsy showed sensitivity of 57%, it yielded diagnosis in 80% of the patients. The yield increased when more than one attempt was made. Also, pneumothorax occurred in 9% of cases [5 patients], heamoptysis in 3 patients and hemothorax in only one patient. Group B: 30 patients 18 males and 12 females, mean age was 42+3.12 years 7 of them had previously failed ultrasound-guided biopsy. The diagnostic yield was 100%, sensitivity 100% and specificity was 100% as well. The only complication was prolonged air leak [in 2 patients] and one case converted into thoracotomy for excessive bleeding. Thoracoscopy is highly feasible, safe and having a high diagnostic yield. Both the sensitivity and specificity of thoracoscopy are much higher than those of the ultrasound-guided biopsy. Recent technologic advances including specially designed ultrasound needles will allow more precise needle placement and will lead to a higher diagnostic lead when recent equipments become available to us. In most of the cases, both ultrasound-scanning, CT-scanning and thoracoscopy are complementary to each other to diagnose peripheral intrathoracic masses

Manometric and ultrasonographic assessment of anal sphincter function following forceps or vacuum assisted vaginal delivery

To compare differences in anal sphincter function following vacuum or forceps assisted vaginal delivery. Prospective, r and omized controlled trial. Al-Azhar University Hospitals in Damietta and Cairo.One hundred and thirty primiparous women were recruited antenatally and if an instrumental delivery was indicated, were r and omized to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow-up consisted of a symptom questionnaire, anal manometry, and endoanal ultrasonography. Faecal continence scores, anal manometry and endoanal ultrasonography. Sixty-one women delivered with forceps assistance [42 for failure to progress in the second stage] and 69 with vacuum assistance [50 for failure to progress]; 16/69 vacuum deliveries proceeded to a forceps assisted delivery [23%]. There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 7 [11%] forceps and 3 [4%] vacuum deliveries. Based on intention-to-treat analysis, 32 [52%] women complained of altered faecal continence after forceps delivery compared with 21 [30%] following vacuum delivery three months postpartum. Endoanal ultrasonography was reported as abnormal following 34 [56%] forceps deliveries and 34 [49%] vacuum deliveries. After exclusion of 'failed vacuum', median anal canal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone [p<0.001]. There were no significant differences in degree of ultrasound abnormality between the two groups. Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery

Prevalence and elimination of cataract in a rural setting in Yemen

A pilot observational study was conducted from 17 to 30 March 1996 in three locations in Yemen, namely Shabwa, Mukalla and Mahweet. The study population included 5341 people who came voluntarily to selected government hospitals for eye care. To determine the prevalence of the different eye diseases, especially cataract, among the study population, the team applied a case study form to collect the necessary data. The team examined patients and performed any surgery required. The findings are analyzed, the limitations of the study discussed and recommendations formulated

Lymph node metastasis in breast carcinoma: clinicopathologic correlations in 3747 patients

Histological axillary node involvement [ANI] evaluated by axillary dissection remains the most accurate predictive factor for patients with invasive breast cancer. Axillary node involvement implies the necessity of systemic adjuvant treatment and locoregional irradiation. Is to detect the relative frequency of node positivity in relation to histopathology through studying a large mastectomy series. This study included 3747 mastectomy specimens performed al NCI Cairo in the period 1993-2003. In each case we assesed the age at time of diagnosis. pathologic tumor size and number, histologic subtype [including grade], tumor location, number of lymph nodes dissected and number of positive nodes [burden of node positivity]. Females constituted 96.8% of cases, 60.7% of them were premenopausal. The mean age was 47.1 +/- 10.5 years. Tumor size ranged from 0.5 to 20 cm. The global ANI rate in the entire cohort was 70.6%. In univariate analysis. five variables were significantly correlated to ANI, these were laterality, multiplicity, tumor size, histologic subtype and grade, while multiplicity, tumor size, histologic subtype and grade correlated significantly with metastatic burden, Multivariate analysis showed that older women [40-60 and> 60 years] have at least half the risk of developing LN metastasis compared to those < 40 years with the odds of 0.51[0.35-0.73] and 0.31[0.18-0.55], respectively. Tumor size >2cm put the women with breast cancer at 3 [if 2-5cm] to 9 [if> 5cm] folds of developing lymph node [LN] metastasis. Tumor size> 5 cm increases the likelihood of higher metastatic burden [> 3 +ve nodes] with odds of 1.5 [1.24-1.9]. Unfavorable histology also, increases the liklihood of more positive nodes to the double when compared to favourable histology. The results of this study reflected the unfortunate presentation of breast cancer patients. In addition, some factors could be used as useful guidlines in the management of those patients. These factors include age, tumor size and histologic type of the tumor

Prevalence and elimination of cataract in a rural setting in Yemen

A pilot observational study was conducted from 17 to 30 March 1996 in three locations in Yemen, namely Shabwa, Mukalla and Mahweet. The study population included 5341 people who came voluntarily to selected government hospitals for eye care. To determine the prevalence of the different eye diseases, especially cataract, among the study population, the team applied a case study form to collect the necessary data. The team examined patients and performed any surgery required. The findings are analysed, the limitations of the study discussed and recommendations formulated

Study of respiratory symptoms and lung function in Polyvinyl chloride fabrication workers

To study the chronic effect of exposure to polyvinyl chloride [PVC] dust on workers in the production and maintenance areas in plastic factories. A structured questionnaire was administered to all control and exposed workers. Forced spirometer testing was performed using a standard spirometer. A total of 204 male workers was examined to study the chronic effect of exposure to PVC dust. A group of 228 workers not exposed to noxious substances or aerosols from other factories was selected randomly to serve as controls. The exposed and control workers were matched by gender, socioeconomic status, ethnic and smoking habits. The prevalence of respiratory symptoms, such as chronic cough chronic, production of phlegm and shortness of breath on exertion, were significantly higher in the factory workers exposed to PVC compared with the controls. Factory workers exposed to PVC had significantly lower values for FVC, FEV1.0, FEV1.0%, PEFR, FEF200-1200, FEF25-75, Vmax75, and Vmax50 compared with the controls. These effects were independent of age, height and smoking habits of the workers. The total duration of employment in the workers exposed to PVC was significant when associated with a decline in adjusted FEV1.0%, PEFR, FEV1.0, FEF25-75, Vmax75 and Vmax50. it was concluded that employees in these plants are associated with patterns of obstructive air-flow limitation and respiratory symptoms consistent with exposure to pulmonary irritants. It is recommended that more environmental control measures should be applied to reduce respiratory health problems among exposed workers