A Two Years Retrospective Study on Epidemiology Characteristics of Sexually Transmitted Infections From Malaysian Private Healthcare Perspective

@#Introduction: Sexually transmitted Infections (STIs) are major public health concerns reaching an all-time high, globally. In Malaysia data on the prevalence of STIs remains scarce which limits the understanding of STI transmission dynamics and the role of interventions in the control of STIs. The aim of this study is to determine the epidemiology characteristics of STIs mainly from Malaysian private healthcare institutions. Method: A two years (2016 and 2017) retrospective review was conducted on 160 multiplex RT-PCR STI reports from KPJ hospitals, Malaysia. Results: There were 65 (40.6 %) patients positive STIs [male: 21/65 (32.3 %); female: 44/65 (67.7 %)]. The STIs was prevalent among young adults (56/65; 86.2 %) from the central region (46/65; 70.8 %). Females had 1.7 times greater risk to develop STI (20 per 100) and two times higher chance to have multiple STIs (10 per 100) in comparison to male. The single STIs was caused mainly by U. parvum (N=17). In males, U. urealyticum (N=3) and C. trachomatis (N=3) were prevalent, while U. parvum (N=15) was prevalent in females. There were 19 dual infections of STIs which were commonly caused by U. parvum and M. hominis (N=5). There were seven STIs cases caused by three pathogens concurrently including U. urealyticum, U. parvum and C. trachomatis (N=2) and U. urealyticum, M. genitalium and C. trachomatis (N=2). Females from urban communities have higher risk in comparison to males for developing multiple STIs. Conclusion: This study provides an imperative platform for temporal trends of STIs in Malaysia which reflects the health status of certain populations that warrant immediate public health interventions.

Identifications of drug resistance mutations among antiretroviral treatment naive HIV-1 patients in Peninsular Malaysia

Objective To determine drug resistance mutations and the HIV-1 subtypes among antiretroviral treatment naive HIV-1 patients in Peninsular Malaysia. Methods A total of 45 samples from four hospitals that provide HIV viral load services were subjected to the amplification of the protease and two third of reverse transcriptase regions of the pol gene by RT-PCR and Sanger sequencing. Drug resistance mutation (DRM) interpretation reports the presence of mutations related to protease inhibitors (PIs), Nucleoside reverse-transcriptase inhibitors (NRTI) and Non-nucleoside reverse-transcriptase inhibitors (NNRTI) based on analysis using Stanford HIV database program. Results DRMs were identified in 35% of patients, among which 46.7% of them showed minor resistance to protease inhibitor with A71V and L10l were the commonest DRMs detected. About 21.4% and 50.0% of patients had mutations to NRTIs and NNRTIs, respectively. CRF01_AE was found to be the predominant HIV-1 subtype. Conclusions These findings have served as an initial crucial data in determining the prevalence of transmitted HIV-1 drug resistance for the country. However, more samples from various parts of the country need to be accumulated and analyzed to provide overall HIV-1 drug resistance in the country.

Identifications of drug resistance mutations among antiretroviral treatment naive HIV-1 patients in Peninsular Malaysia

OBJECTIVE@#To determine drug resistance mutations and the HIV-1 subtypes among antiretroviral treatment naive HIV-1 patients in Peninsular Malaysia.@*METHODS@#A total of 45 samples from four hospitals that provide HIV viral load services were subjected to the amplification of the protease and two third of reverse transcriptase regions of the pol gene by RT-PCR and Sanger sequencing. Drug resistance mutation (DRM) interpretation reports the presence of mutations related to protease inhibitors (PIs), Nucleoside reverse-transcriptase inhibitors (NRTI) and Non-nucleoside reverse-transcriptase inhibitors (NNRTI) based on analysis using Stanford HIV database program.@*RESULTS@#DRMs were identified in 35% of patients, among which 46.7% of them showed minor resistance to protease inhibitor with A71V and L10l were the commonest DRMs detected. About 21.4% and 50.0% of patients had mutations to NRTIs and NNRTIs, respectively. CRF01_AE was found to be the predominant HIV-1 subtype.@*CONCLUSIONS@#These findings have served as an initial crucial data in determining the prevalence of transmitted HIV-1 drug resistance for the country. However, more samples from various parts of the country need to be accumulated and analyzed to provide overall HIV-1 drug resistance in the country.

Comparison of ropivacaine 0.5% [in glucose 5%] with bupivacine 0.5% [in glucose 8%] for spinal anaesthesia for elective surgery

Background: Hyperbaric solutions of ropivacaine have been used successfully to provide spinal aneastehsia. This study was designed to compare the clinical efficacy of hyperbaric ropivacaine with that of the commercially available hyperbaric preparation of bupivacaine

Methods: Forty ASA grade I-II patients undergoing lower-abdominla, perineal or lower-limb surgery under spinal anaesthesia were recuruited and randomized to receive ropivacaine 5 mg ml-1 [with glucose 50 gm ml-1], 3 ml or bupivacline 5 mg ml- 1 [with glocuse 80 mg ml-1], 3 ml. The level and duration of sensory block, intensity and duration of motor block, and time to mobilize and micturate were recorded. Patients were interviewed at 24h and at I week to identify any residual problems

Results: All blocks were adequate for the proposed surgery, but there were significant differences between the two groups in mean time to onset of sensory block at T10 [ropivacaine 5 min; bupivacine 2 min; P<0.05], median maximum extent [ropivacaine T7; bupivacaine T5; P<0.005] and mean duration of sensory block at T10 [ropivacaine 56.5 min; bubpivacine 113 min; P=0.001]. Patients receiving ropivacaine mobilized sooner [ropivacaine mean 253.5 min; bupivacaine 331 min; P=0.002] and passed urine sooner [ropivacaine mean 276 min; bupivacaine 340.5 min P=0.01] then those receiving bupivacine. More patients in the bupivacine group required treatment for hypotension [>30% decrease in systolic pressure; p=0.001]

Conclusions: Ropivacaine 15 mg in glucose 50 mg ml-1 provides reliable spine anaesthesia of shorter duration and with less hypotension than bupivacine. The recovery profile for ropivacaine may be of interest given that more surgery is being performed in the day-case setting

comparison of ondansetrom and cyclizine as prophylaxis against postoperative nausea and vomiting in children

Nausea and vomiting is a relevant and common problem with unfavourable sequelae in children undergoing some plastic surgery procedures. There is a lack of anti-emetic trials performed in children, with only a few investigating the roles of the older anti-emetic agents such as cyclizine compared with newer ones such as ondansetron. This randomised, controlled, double-blind study examined the effectiveness of a single dose of ondansetron [0.1 mg.kg1] and cyclizine [20 mg] in the prevention of postoperative nausea and vomiting in 150 children [mean age 3.6 years] undergoing plastic genitourinary procedures. Rates of previous postoperative nausea and vomiting and motion sickness were comparable across the groups. Postoperative vomiting was significantly reduced with ondansetron prophylaxis [P= 0.006] but there was no detectable antiemetic effect with cyclizine. Furthermore, cyclizine caused pain on injection [P<0.001]

Comparison of remifentanil and atfentanil during anaesthesia for patient undergoing direct laryngoscopy without intubation

Background: Remifentanil and alfentanil are opioids often used during direct laryngoscopy [DL].This prospective, randomized study compared these acents with respect to haemodynamic, glottic visualization, ax rapidity of recovery [spontaneous ventilation, eye opening], in DL without intubation

Methods: A total of 60 patients undergoing DL were randomized into two groups: remifentanil [R] and alfentanil [A]. Anaesthesia was induced with propofol 2.5 mg kg-1 and the opioid was administered 1 min later [R=2 [g kg-1 or A =30 [g kg-1 over 30 s]. DL was commenced 1 min after [corresponding to 3 min after the beginning of induction]. Glottic visualization, opioid and/or propofol re-injection, spontaneous ventilation recovery, and eye opening were recorded

Results: During DL mean arterial pressure [MAP] increased by 6% in the R group vs 20% in the A group [P<0.05] when compared with post-induction values without affecting heart rate. No significant difference was observed between groups with respect to glottic exposure, opioid and/or propofol re-injection, and spontaneous ventilation recovery [mean [SEM] 3.8 [0.6] min, R group vs 3.2 [0.7] min, A group. NS] or eye opening [7.1 [1.1] min. R group vs 7.4 [0.9] min. A group. NS]. Thirty minutes after postanaesthesia care Unit [PACU] admission, MAP returned to its pre- induction value in the R group [104 [3] vs 109 [3] at baseline, NS], whereas in the A group MAP remained significantly lower at this time point [96 [4] vs 106 [3] at baseline, P<0.05]

Conclusion: This study showed that only remifentanil prevented MAP increase without adverse effects such as bradycardia during DL and prevented MAP decrease 30 min after PACU admission

Comparison between succinyle choline and rocuronium for endotracheal intubation

The Present study was the on fourty patients middle aged, A.S.A. grade I. II under going elective operation. After induction of anaesthesia were randomized to receive either succinyl choline 1 mg/kg or rocuronium 0.6 mg/Kg 60 seconds after muscle relaxant administration tracheal intubation attempted and assessed according to Krey's et al. Score [1]. The resulted revealed that the intubation condition was excellent in 60% and good in 40%.On the other hand the intubation score in succinyl choline group was excellent in 80% and good in 20%, we have concluded rocuronium appears to be suitable agent for use as part of rapid sequence induction of anaesthesia when succinylecholine is contraindicated

Minimum dose of intrathecal diamorphine required to prevent intraoiperative supplementation of spinal anaesthesia for caesarean section

Background. Intraoperative discomfort during spinal anaesthesia for Caesarean section is the commonest cited anaesthetic cause of litigation in obstetric practice. Intrathecal opioids are used to improve intraoperative comfort and postoperative analgesia for these operations. The minimum intrathecal diamorphine dose that prevents intraoperative supplementation requires determination

Method: After ethics committee approval, 200 ASA I, II women with 37 weeks gestation and planned for elective Caesarean section under combined spinal epidural anaesthesia were recruited. They were randomize into four groups to receive 1 hyperbaric bupivacaine 0.5% 12.5mg with diamorphine 0.2, 0.3, 0.4 or 0.5 mg by intrathecal injection. The need for intraoperative i.v. supplementation with alfentanil, time to first requests for postoperative analgesia, incidence of nausea and vomiting and requirement for antiemetic and antipruricic were noted

Results: Intraoperative supplementation was inversely proportional to the dose of diamorphine used [P=0.004]. The ED95 value for intrathecal diamorphine to prevent intraoperative supplementation was 0.39 mg. Mean time interval for request for postoperative analgesia was 446 min in the 0.2mg group, 489 min in the 0.3 mg group, 601 min in the 0.4 mg group and 687 min in the 0.5 mg group [P=0.003 for trend]. Incidence of nausea, vomiting and pruritus increased with dose of diamorphine used [P values for trend: nausea, 0.04, vomiting, 0.008; pruritus, 0.004]. Requests for antiemetic increased with dose but achieved significance only for requirement for second antiemetic [P = 0.03]. Request for antipruritic did not achieve significance

Conclusion. The ED95 for the amount of intrathecal diamorphine required to prevent intraoperative supplemnentation during spinal anaesthesia for Caesarean section is 0.4 mg in clinical terms. Times to first requests for analgesia, incidence of nausea, vomiting and pruritus increase with dose

Comparative studies on histology, histochemistry and ultrastructure of the adrenal medulla of carnivore fennicus, vulpes zerda and herbivore rabbit, oryctolagus cuniculus

The present study of the adrenal medulla of two examined animals, carnivore Vulpes zerda and herbivore Oryctolagus cuniculus demonstrated that they have differences in the form of medulla. Both have two populations of medullary cells. Norepinephrine cells [NE] exhibited intense staining with hematoxylin or toluidine blue [basic dyes] and they have specific characteristic morphological features, arrangement and location. The other population, the epinephrine cells [E] that represent most of the medullary cells stained faintly and distributed homogenously through the medulla. The histochemical techniques illustrated the existance of acid mucopolysaccharides in the medullary cells in both types animals being more pronounced in carnivore than herbivore. The carbohydrates are present in a fair amount in Vulpes medullary cells although they are found in weak amounts in Oryctolagus. The total proteins are displayed in most of the medullary epinephrine cells in moderate amounts, and more in norepinephrine cells of both types of examined animals. TEM examination revealed many differences between the two types of studied animals. They are summarized as mitochondrial shape, nuclei of epinephrine and norepinephrine cells, and the distribution of vacuoles

Mixed ligand complexes of some lanthanides with N, hydrazinediacetic and malic acids

The formation constants of mixed ligand complexes of hydrazinediacetic [H[2]Z] and malic [H[2]L] acids have been determined potentiometrically in 0.1 M KN03 and 30 +/- 0.1°C. The stoichiometry of the formed complexes was evaluated by conductimetric method and found to be 1:1:1 [LnZL]