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@#The HACEK organisms consist of the non-influenzae Haemophilus sp., Aggregatibacter sp., Cardiobacterium sp., Eikenella corrodens and Kingella sp. are responsible for a sizable percentage of infective endocarditis cases worldwide with the mortality rate of 18%. Amongst them, Aggregatibacter actinomycetemcomitans is the most common pathogen strongly associated with infective endocarditis. A. actinomycetemcomitans forms part of the oral microbiota and is also the etiological agent of periodontitis. Here, we present a case of a 37-year-old man with underlying obstructive uropathy, that sought treatment for postural hypotension and symptomatic anaemia with fever. Later, he had developed decompensated congestive cardiac failure with aortic regurgitation. A cardiac echocardiogram revealed the presence of vegetation on the aortic valve. Blood culture grew A. actinomycetemcomitans, and he was treated with furosemide and ceftriaxone. A further dental examination showed the patient is having chronic periodontitis, which could be the possible source of A. actinomycetemcomitans causing infective endocarditis. The patient was then transferred to the National Heart Centre for the first time for further management after completion of 4 weeks of intravenous antibiotics. As the pathogen is fastidious, rapid and newer technology like MALDI-TOF mass spectrometry provides rapid and accurate identification for appropriate patient clinical management.
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@#Introduction: Musical-based education has been linked with improved students’ academic performance and mental wellbeing. This study aimed to evaluate a musical-based anatomy learning module using the combination of music, choreographed movements and 3D anatomy illustrations on muscles of the hand. Methods: A 5-minute duration video on muscles of the hand was developed through series of discussions with expert panels to incorporate the three stated components, emphasizing on the use of catchy music and simple terms to assist memorization skills. A single arm quasi-experimental pilot study was conducted with pre- and post-intervention measurement of knowledge, perception, stress and happy index related to learning anatomy. A total of 157 medical students were recruited and exposed to a total of 20 minutes video duration over three days. The effectiveness of the intervention was investigated using paired t-test and was interpreted based on the pre- and post-measured exposure mean differences. Results: The newly developed musical-based anatomy learning module had effectively improved knowledge and happy index related to learning anatomy, with significant mean differences were observed on the total mean scores for knowledge (MD= 2.707, p< 0.001) and happy index (MD=3.256, p< 0.001), as well as significant reduction of the mean scores for the negative items for perceptions and stress. Conclusion: The improved knowledge and happy index related to learning anatomy reflecting the positive impact of music used in combination choreographed movements and 3D illustrations to strengthen memorizing skills of medical students as well as instilling positive mood.
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@#Introduction: Music has been widely used in teaching and learning due to its observed positive effects. This review aimed to identify the beneficial impacts of music utilization in medical education. Methods: Using four established databases; Scopus, ScienceDirect, JSTOR and PubMed, exhaustive searched of related articles were performed for articles published between January 2010 and January 2020 using combination of keywords. Screening of titles and abstracts were conducted, with removal of duplicates. Results: Five full text articles were finally reviewed, of which one cross-sectional, three intervention and a qualitative studies. Consensus between authors had successfully identified three themes, which were positive effect of music on the well-being and performance of the medical students, as well as improved patient-doctor communication skills. Conclusion: The findings of the review confirmed the positive effects of music utilization on the well-being and performance of medical students, as well as on patient-doctor communication skills.
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@#We present a case of cryptococcal meningitis initially misdiagnosed as stroke. Our patient is a young man on longterm corticosteroid due to gouty arthritis, who presented with acute onset of left-sided body weakness. Computed tomography of the brain revealed multifocal chronic lacunar infarcts with acute communicating hydrocephalus and cerebrospinal fluid culture isolated Cryptococcus neoformans. He was subsequently treated with amphotericin B and fluconazole but passed away due to multiorgan failure. This case report highlights the importance of considering chronic meningitis as a differential diagnosis when encountering stroke in young and immunocompromised patients.
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@#Introduction: Since pharyngitis in adults is one of the most common infectious diseases seen in general practitioner consultations in Malaysia, data on pharyngitis among adults concerning to its prevalence, socio-demographic, risk factors and clinical manifestations is very much lacking. This study aims to determine the prevalence of pharyngitis among adults in Sepang, Selangor, Malaysia from 2016 to 2017 and its associated demographic and risk factors. Methods: We conducted a cross-sectional study on 215 adult patients with a sore throat as the main symptom and who did not receive any antibiotic treatment within two weeks at three Malaysian primary care clinics. The researchers assessed the participants’ clinical manifestations and collected throat swabs for culture to determine the presence of group A streptococcus (GAS). Data on demographic characteristics, clinical manifestation and throat swab culture results were analyzed using chi-square test and multivariate logistic regression. Results: Pharyngitis was diagnosed in 130/215 (65%) adults with a sore throat. Only six isolates (2.8%) were identified as GAS. The overall mean age ± S.D was 36.43 ± 15.7. The majority of the participants were in the age group of 18-28 years. There were 42.3% males and 57.7% females; most participants were Malay 62.8%, followed by 30.2% Indian, 5.1% Chinese, and 1.9% other ethnicities. The most common symptom among the participants was cough 196 (91.2%), followed by rhinorrhea 161 (74.8%), tonsillar swelling or exudates 68 (31.6%), inflamed or reddish of pharynx 62 (28.8%), swollen anterior cervical lymph nodes 50 (23.3%), and fever ≥37.5°C 28 (13.0%). Conclusion: Besides, there was no significant association between pharyngitis and the demographic variables; the current findings emphasized that inflamed or reddish pharynx, tonsillar swelling or exudates were among the factors associated with pharyngitis.
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@#A case of a toxigenic strain of Corynebacterium diphtheriae in an immunocompetent adult is presented, with the possibility of the adult acquiring the infection from her unvaccinated child. The abovementioned adult is a 29-year-old housewife who was previously immunised with diphtheria, tetanus, and pertussis (DTaP) vaccination in childhood, who presented fever, cough, sore throat, hoarseness of voice, odynophagia, and bilaterally enlarged tonsils. A throat swab confirmed the presence of toxigenic Corynebacterium diphtheriae. The patient was given 80,000 international units (IU) dose of diphtheria antitoxin (DAT) and treated with 2.4 million units (MU) QID intravenous penicillin and oral erythromycin 800 mg twice daily for two weeks. The patient responded well to the treatment and recovered with no cardiovascular or neurotoxicity.
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@#Introduction: Diabetes-associated autoantibodies (DAA) is the hallmark of T1DM and LADA which are frequently tested in young diabetes patients. It was noted that up to 10-15% of patients with initial diagnosis of T2DM also exhibit DAA. Regardless of the classification, the presence of DAA suggests an underlying islet autoimmunity which lead to progressive pancreatic β-cell failure. There is limited data reported on DAA in young diabetes patients in Malaysia. This study aims to determine the frequency of DAA positivity and its association with demographic and clinical characteristics among this cohort. Methods: A retrospective study using secondary data obtained from Allergy and Immunology Research Centre, Institute for Medical Research, Malaysia. This study included 194 diabetes patients who were diagnosed before the age of 40 years old and tested for GADA, ICA, IA2A and IAA. Results: From 194 patients, 91 (46.9%) were positive for least one of the following DAA: ICA (79, 40.7%), GADA (61, 31.4%), IA2A (37, 19.1%) and IAA (9, 4.6%). Multiple positivity was higher (73.6%) compared to single positivity. Highest combination of double positivity was ICA+GADA (54, 59.3%) and triple positivity was ICA+GADA+IA2A (25, 27.5%). Simultaneous positivity of four autoantibodies was seen in only one (1.1%) patient. ICA, GADA and IA2A were associated with age group and ethnicity (all p < 0.001). Only IA2A was associated with gender (p = 0.012). Conclusions: GADA, ICA ad IA2A are more significant in young Malaysian diabetes patients. IAA has a very low frequency in this studied population.
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@#We present a unique case of pneumococcal meningitis caused by serotype 15C, a non-vaccine serotype, which is long thought to be non-virulent. Our patient is a young lady with a known case of plaque psoriasis, presented with sudden onset of left oculomotor nerve palsy and severe headache two days prior to admission. The clinical features were initially mimicking of brain tumour and brain aneurysm. The diagnosis of pneumococcal meningitis was confirmed by the bacterial antigen test and genome detection using multiplex PCR from the CSF. The blood culture also grew Streptococcus pneumoniae. Serotyping was performed on the isolate using Neufeld's Quellung method and it was identified as serotype 15C. Psoriatic skin disease was identified as a potential source of this invasive infection.
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@#We report a rare case of Ochrobactrum anthropi bacteremia in a previously healthy young man who was admitted for severe dengue. O. anthropi is a rarely encountered Gram negative organism which is resistant to commonly used beta-lactam antibiotics. This organism is usually interpreted as a contaminant as it is ubiquitous in the environment. Isolation of this organism upon admission suggested a community-acquired infection. He had persistent bacteremia and had to be treated with a prolonged course of meropenem and ciprofloxacin. This case report highlights the importance of early diagnosis and prompt treatment of this otherwise contaminant as previous reports showed this organism can be an opportunistic pathogen which may lead to severe infection.
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@#Group B streptococcus (GBS) is generally known to cause severe disease in the neonate and immunocompromised adults. GBS in the pregnant mother is rare and can potentially be fatal. Clinical presentation can be as mild as an uncomplicated urinary tract infection or serious invasive disease in the form of bacteremia, chorioamnionitis, endometritis and septic abortion. We report a case of a 46-year-old Para 3 lady, post-partum day 12, whom was found dead at home. Prior to her death, she had intermittent fever and abnormal lochia. Autopsy findings indicate GBS endometritis and bacteraemia. She was never screened for GBS. The cost-effectiveness of universal GBS screening needs to be explored to reduce maternal and neonatal morbidity due to GBS.