Presence of SARS-CoV-2-like coronaviruses in bats from east coast Malaysia

@#Most of the public health importance coronaviruses, such as Severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV-2 are likely originated from bats and spread to humans through intermediate hosts; civet cats, dromedary camel and Malayan pangolin, respectively. SARS-CoV-2-like coronaviruses were detected in Thailand, which is neighbouring with Kelantan in East Coast Malaysia. To date, there is no report on the presence of public health concerns (SARS-CoV, SARS-CoV-2 and MERS-CoV) coronaviruses in bats from Malaysia. This study was aimed to elucidate the presence of these coronaviruses in bat samples from East Coast, Malaysia. A total of hundred seventy oropharyngeal swab samples were collected from three states of East Coast Malaysia. Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was conducted based on partial 3’ Untranslated region (3’UTR) or ORF10 gene and the products were sequenced. The sequences were compared with all coronavirus sequences from the National Center for Biotechnology Information-GenBank (NCBI-GenBank) using NCBI-Basic Local Alignment Search Tool (NCBI-BLAST) software. A phylogenetic tree was constructed to determine the genetic relationship among the detected coronaviruses with the reference coronaviruses from the NCBI-GenBank. Our results showed that SARSCoV-2-like viruses were present in 3% (5/170) of the bats from East Coast Malaysia that have 98-99% sequence identities and are genetically related to SARS-CoV-2 from humans. This finding indicates the presence of SARS-CoV-2-like viruses in bats from East Coast Malaysia that may become a public health concern in the future.

Hemophilia: the changing role of the orthopedic surgeon in the era of HIV infection.

HIV infection and AIDS have posed additional challenges to the orthopedic surgeon and they are discussed in this paper. The acute hemarthrosis. 1. Undertreatment has resulted in further joint degeneration 2. A hemarthrosis with an unusual pain pattern or an elevated temperature may be a pyarthrosis and aspiration and culture are necessary for diagnosis. This complication was very rare prior to HIV infection. Synovitis. 1. In the past we suggested factor replacement and steroids as the primary method of treatment. The use of steroids may be contraindicated in the HIV positive patient. 2. Radioactive synovectomy should be considered in the immune compromised patient. 3. The risks to the surgical team of arthroscopic synovectomy are discussed. Advanced arthropathy. 1. A late infection rate of 10.4% in HIV positive patients with total knee replacements has changed the indications for this procedure. 2. Lesser procedures such as arthrotomy and osteotomy should be considered. Pseudotumor. 1. The indications for pseudotumor surgery must include an evaluation of the risk-benefit ratio in the patient with HIV infection. 2. The orthopedic surgeon must accept the challenge of stimulating and training his students and residents in the principles of orthopedic care of the person with hemophilia.

Tratamento cirúrgico de "bola fúngica" em leucemia linfóide aguda (LLA) / Surgical treatment of fungal bolus in acute lymphoid leukemia

Case report of a 24 year old female patient with ALL that developed pulmonary invasive aspergillosis during aplastic phase of induction chemotherapy. She was treated with antibiotics and amphotericin B. After recovering from neutropenia, she developed a mycetoma in the inferior lobe of the right lung, which required lobectomy. Nine months after surgery the patient is well, in complete remission of ALL and with no evidence of infection. One month after lobectomy, chemotherapy had been reintroduced. Attention should be called to this form of therapy of Aspergillosis, as a successful way to eradicate this fungal infection that responds poorly to antifungal drugs currently used.