Descriptive epidemiology of the first wave of COVID-19 in Petaling District, Malaysia: Focus on asymptomatic transmission

@#Background: COVID-19 was first detected in Malaysia on 25 January 2020. Multiple clusters were detected in Petaling District, with the first locally transmitted case reported on 8 February. Descriptive analyses of the epidemiology of the COVID-19 outbreak in Petaling are presented, from the first case to the end of the first wave. Methods: All laboratory-confirmed COVID-19 cases reported to the Petaling District Health Office between 1 February and 26 June 2020 were analysed. Socio-demographic characteristics, symptoms, date of onset, date of exposure, travel history and history of comorbidities were obtained by phone interviews using one of two investigation forms. The descriptive analysis was conducted according to time, place and person. Results: There were 437 COVID-19 cases, for an incidence rate of 24/100 000 population. Ten (2.3%) deaths and 427 recovered cases were recorded. Of the 437 cases, 35.5% remained asymptomatic and 64.5% were symptomatic. Common symptoms included fever (43.8%), cough (31.6%) and sore throat (16.2%); 67.3% had no comorbidities, 62.5% reported close contact with a confirmed case, and 76.7% were local infections. Transmission occurred in four main groups: religious gatherings (20.4%), corporations (15.1%), health facilities (10.3%) and a wholesale wet market (6.4%). In 31.9% of confirmed cases, an epidemiological link to an asymptomatic case was found. Conclusion: Transmission of the disease by asymptomatic cases should be emphasized to ensure continuous wearing of face masks, hand hygiene and social distancing. Further research should be conducted to better understand the transmission of SARS-CoV-2 from asymptomatic cases.

Single centre randomized comparative trial of lateral internal sphincterotomy versus 2% diltiazem in chronic anal fissure

Background: Anal fissures are often encountered in surgical practice with surgery the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. In our study we compare topical 2% diltiazem with lateral sphincterotomy with respect to symptoms such as relief of pain, ulcer healing, and side effects of treatments.Methods: A prospective comparative study, a total of 80 patients were randomized into 2 groups 40 each. Group A patients were subjected to open internal lateral sphincterotomy and group B to 2% topical diltiazem. The patients in both groups were followed up at 1st, 4th, 14th weeks and 6 months in OPD and were assessed for pain, sphincter tone and complications.Results: In group A (lateral anal sphincterotomy), patients achieved a good pain relief with a mean pain score of 1.98 by one week post procedure whereas group B (2% diltiazem) had taken 14 weeks to achieve similar pain relief (pain score of 1.5). At the end of 6 months, healing of fissure was noted in 100% of group A and in 90% of group B. 4 patients (10%) had recurrences in group B. Flatus incontinence was reported in 2 patients (5%) in group A although transient.Conclusions: Lateral anal sphincterotomy is superior to 2% diltiazem especially in healing of fissure, pain relief, quality of life and recurrence. Pharmacologic agents should be reserved for patients who are unfit or unwilling for surgery or can be used as a bridge therapy till sphincterotomy can be planned.

Divergent Resistance Training Programs, Ramification on the Absolute and Relative Strength and Endurance among College Men

The objective of this research was to scrutinize the impact of three resistance-training programs on absolute andreciprocal durability and muscular strength. Forty-three male subjects were assigned to three groups: highresistance-low repetition group (HRLRG, n=15) performed 3 sets of 6-8 RM (repetition maximum) each session,the medium resistance-medium repetition group (MRMRG, n= 16) performed 2 sets of 30-40 RM per session andthe low resistance-high repetition group (LRHRG, n= 12) worked out a set of 100-150 RM per session. Thetraining for the participants was bench press thrice a week for nine weeks. The data revealed an improvement of20% in maximal strength of the HRLRG and this was greater than 8% and 5 % improvements recorded forMRMRG and LRHRG, respectively. Regarding the absolute endurance, the trends however were reversed asLRHRG registered gains of 41%, MRMRG improved by 39% and HRLRG gained only 28%. The results forrelative endurance assessment reported that HRLRG’s accomplishments essentially was declined by 7 % aftertraining and was considerably inferior to the 22 % and 28 % improvements achieved by other two groups. It wasestablished that skeletal muscles make general and specific modifications to a training stimulus and the stabilityof these adaptations is primarily reliant upon the intensity and duration of the training protocol.

Relative effectiveness of aminosalicylates in the management of acute ulcerative colitis – Mesalamine vs Sulfasalazine

Introduction: Inflammatory bowel disease (IBD) is not a single condition. It is the term for a group of disorders that cause prolonged inflammation of the digestive tract. The most common types of inflammatory bowel disease (IBD) are ulcerative colitis and Crohn’s disease. Aim: The study was designed to compare the efficacy, safety, incidence of ADR’S in patients of inflammatory bowel disease with regard to the use of mesalamine, sulfasalazine and using combination of mesalamine and steroids. Materials and methods: This observational, non interventional study conducted in General Medicine Department and Gastroenterology department, Princess Esra hospital, shahali banda, within 6 months of duration. Patients selected randomly according to inclusion and exclusion criteria. A 110 patients aged 18 to 90 years, and presenting with complaints of abdomen pain, diarrhoea, bloody diarrhoea, painful defecation, altered appetite, bleeding per rectum were screened for the study after taking their informed consent. Patients were categorized into 4 groups; group I (control), group II (Mesalamine), group III (sulfasalazine), and group IV (Mesalamine + steroids) Results: Patients with age group from 18-80yrs were included in the study. The age group of 31- 50age was found more prone to disease. The total percentage of male and female in 110 patients was found to be 40% (male) and 60% (female). Patients with percentage of 60% male and 40% female underwent treatment with mesalamine (Group-I), 36.6%male and 63.3%female with mesalamine + steroids (Group-II), and 30% male and 70% female with sulfasalazine (Group-III) respectively. The Syed Ibrahim Hassan, Syed Mohd Akbar Hassan, Haleema Begum. Relative effectiveness of aminosalicylates in the management of acute ulcerative colitis - Mesalamine vs Sulfasalazine. IAIM, 2016; 3(12): 137-147. Page 138 most common symptom was abdomen pain present in 74% patients and rectal bleeding was the next common symptom (67.21%) and other symptoms include vomiting (55.2%), loose stools (52.3%), painful defecation (44%), and reduced appetite (43.3%). The adverse effects observed during sulfasalazine treatment was abdominal pain (50%), nausea (35%), dizziness (21.6%), anorexia (16.6%), rashes (10%), gastric distress (10%), sleeping disorders (3.30%), cyanosis (3.3), hemolytic anaemia (1.60%) and mesalamine treatment was abdominal pain 21.08%, nausea 3.50%, heartburn 22%, bloated stomach 7.7% and weakness 6.64% and with mesalamine + steroids was abdomen pain 48.3%, rectal bleeding 33.3%, painful defecation 18.3%, loose tools 45%, vomiting 50% and reduced appetite 28.3%. The percentage recovery of symptoms with sulfasalazine was 60% abdomen pain, 30% rectal bleeding, 15% painful defecation, 44% loose stools, 65% vomiting, and 0% reduced appetite, with mesalamine was 40% abdomen pain, 20% rectal bleeding, 0% painful defecation, 15% loose stools, 0% vomiting, 10% reduced appetite and mesalamine + steroids was 21.6% abdomen pain, 13.3 rectal bleeding, 8.3% painful defecation, 26.6% loose stools, 15% vomiting, 18.3% reduced appetite. Conclusion: Patients of acute IBD- acute ulcerative colitis of mild type respond faster to mesalamine with or without steroids compared to sulfasalazine alone although both drugs showed good response

Age-associated changes in erythrocyte glutathione peroxidase activity: Correlation with total antioxidant potential.

Oxidative stress is believed to play a central role in aging and age-associated diseases. It leads to oxidative changes in human red blood cells (RBCs) in vivo and in vitro. In this study, we evaluated the oxidative damage to the erythrocytes during aging in the humans using RBC as a model, by measuring the cytosolic antioxidant enzyme glutathione peroxidase (GPx) activity. GPx activity was found to be significantly decreased as a function of human age and positively correlated with total antioxidant capacity, while negatively correlated with SOD activity. Thus, results of the present study showed involvement of oxidative stress as one of the risk factors, which can initiate and/or promote human aging.

Erythrocyte plasma membrane redox system in first degree relatives of type 2 diabetic patients

Diabetes mellitus [TDM] is strongly associated with oxidative stress. Human erythrocytes contain a plasma membrane redox system [PMRS] which transfers electrons from intracellular donors [NADH, ascorbate] to extracellular acceptors outside the cell. We show that the activity of erythrocyte PMRS and APR reductase becomes elevated in first degree relatives of type 2 diabetics and in TDM subjects. The increase in PMRS and APR reductase signifies compensatory mechanisms to mitigate increased oxidative stress. These findings show that an impaired redox balance may be a cause the disturbance of homeostasis in type 2 diabetic families, even before the development of the disease

Alterations in plasma nitric oxide during aging in humans.

Nitric oxide (NO) is relatively harmless, but along with superoxide radical becomes precursor of many toxic species, such as peroxy and hydroxyl radicals, hydrogen peroxide, and peroxynitrite. In the present study, we determined plasma NO as a function of human age and correlated NO levels with total antioxidant capacity of the plasma. Results showed significant increase in NO level as a function of human age and plasma NO level positively correlated with total antioxidant potential. Increased NO may contribute to the development of oxidative stress during aging.

Oxidative stress in first degree relatives of type 2 diabetic patients

Epidemiological studies on twins and families have provided a strong correlation for genetic factors contributing to etiology of type 2 diabetes mellitus [T2DM]. Diabetes mellitus is strongly associated with oxidative stress, which can be a consequence of either increased production of free radicals, reduced antioxidant defense or both. The present work was undertaken to study known markers of erythrocyte oxidative stress: malondialdehyde [MDA] and reduced glutathione [GSH] in first degree relatives of T2DM patients, and plasma antioxidant status in an effort to understand the role of oxidative stress in the etiology of type 2 diabetes. Our results show that the antioxidant potential of the plasma is 14% lower in first degree relatives, the intracellular GSH is lower by 9% and lipid peroxidation measured in terms of MDA is elevated by 20%, compared to normal controls. These findings show that an impaired redox balance may be a cause for disturbance of homeostasis in type 2 diabetic families even before the development of the disease. We hypothesize that that oxidative stress precedes the development of overt diabetic state

Esophageal stricture following electrical injury.

Esophageal injury resulting from electrical shock is rare. Stricture of esophagus following external electrical injury has not been reported yet. We report a 24-year-old electric lineman who developed esophageal stricture following external electrical shock. He responded to dilatation with Savary-Gilliard dilators.

Altered Redox Status in Erythrocytes From Hypertensive Subjects: Effect of (-)Epicatechin / 生物化学与生物物理进展

Hypertension is a major problem worldwide. There is much evidence to suggest that reactive oxygen species (ROS) radical may play a role in the development of organ damage associated with cardiovascular disease and hypertension. (-)Epicatechin, a member of tea catechins belonging to flavonoid group, is known to be a potent anti-oxidant.The study has been undertaken to evaluate the effect of (-)epicatechin on markers of oxidative stress: reduced glutathione (GSH) and membrane sulfhydryl (-SH) groups in erythrocytes from hypertensive patients. The effect of (-)epicatechin was also compared with a known anti-oxidant L-ascorbic acid. The erythrocyte intracellular GSH content and membrane -SH group content were significantly (P<0.01) decreased in hypertensive subjects. In vitro incubation with (-)epicatechin caused an increase in GSH and -SH content, the effect was more pronounced in hypertensive erythrocytes. Similar results were obtained with L-ascorbic acid. The observed decrease in the level of GSH and -SH groups in hypertension is an indicator of oxidative stress condition. Observation of an increase in red cell GSH content and the protection of membrane -SH group oxidation by (-)epicatechin in hypertensive subjects is a convincing reason to suggest that high dietary intake of foods rich in catechins may help to reduce oxidative stress and concomitant free radical damage in hypertensive patients.