Prevalence and Distribution of Anti-Amoebic IgG Antibody among Orang Asli (Aborigines) in Peninsular Malaysia.

Entamoeba species are commonly detected in stool samples of Orang Asli due to their substandard living conditions and poor hygiene. Among the Entamoeba spp., Entamoeba histolytica is the only known primary pathogenic species. This study determined the prevalence and distribution of anti-amoebic IgG antibody among Orang Asli in Peninsular Malaysia. The results would reflect the prevalence of amoebiasis in the population. This study analysed a total of 375 serum samples from archives of two Orang Asli projects conducted between 2011 and 2014. They were from six different states in Malaysia, namely Johor, Kedah, Kelantan, Pahang, Perak, and Selangor. Anti-amoebic IgG antibody was detected using an enzymelinked immunosorbent assay (ELISA) with crude soluble antigen produced from axenically grown E. histolytica trophozoites. From the analysis, the overall seropositivity was approximately 71% (266/375), while the seropositivity rates for each of the three Orang Asli tribes i.e. Senoi, Negrito and Proto-Malay, were 66% (137/208), 92% (103/112), and 43% (17/ 41) respectively. Orang Asli from Kedah [95% (52/55)] showed the highest seropositivity, followed by Kelantan [79% (54/68)], Perak [73% (78/107)], Pahang [60% (57/95)], Selangor [56% (14/25)], and Johor [48% (10/21)]. Orang Asli from rural [76% (192/254)] and peripheral urban [65% (69/106)] areas showed significantly higher seropositivity (p=0.002) than those from urban areas [36% (4/11)]. The high prevalences of anti-amoebic IgG antibody in these Orang Asli populations comprised both active and past infections. This study provides current insights of amoebiasis in selected Orang Asli settlements in Peninsular Malaysia. The high seropositivity of anti-amoebic IgG antibody suggests that the settlements are endemic for amoebiasis and there is a high risk of acquiring E. histolytica infection among the dwellers.

Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital.

Following a one-month prospective study of antimicrobial drug use in surgical departments, new guidelines were implemented. The review was repeated after two years. In both study periods, one third of patients were prescribed antimicrobial drugs. Prophylactic antibiotic consumption decreased from 0.75 to 0.53 defined daily doses/operation. Compliance with guidelines improved from 32% to 79%. Duration of prophylaxis > 24 h decreased from 21% to 8%. Single dose prophylaxis increased from 34% to 80%. Quality of the prophylactic courses improved, as evaluated by experts using established criteria. For prophylaxis, cost savings amounted to 57%. Better quality of therapeutic courses was associated with a cost increase of 15%. Indicators of satisfactory outcome with the new policy were a stable median length of stay (5.5 days in the first review and 5.0 days after intervention) and a reduction in the number of nosocomial infections treated with antimicrobial drugs/100 bed days (1.0 before intervention vs 0.77 after intervention).

Infections post-operatoires de plaies a Staphylococcus Xylosus dans les services chirurgicaux du Centre National Hospitalier et Universitaire de Cotonou: aspects bacteriologiques

Les Staphylocoques a coagulase negative representent 14 pour cent des germes isoles des plaies operatoires et 44 pour cent de ceux isoles des prelevements de l'environnement hospitalier. Parmi eux l'espece Staphylococcus xylosus rarement impliquee dans les infections humaines a ete isolee 7 fois dans les plaies operatoires. Elle marque une resistance de 30 a 74 pour cent vis-a-vis des antibiotiques testes. Le lysotype 28/275/459 est le plus frequent. Staphylococcus xylosus a determine des heteoinfections et des autoinfections

Influence of protamine on the in vitro sensitivity of Pseudomonas aeruginosa to antibiotics.

We have studied the influence of protamine on the sensitivity of three strains of Pseudomonas aeruginosa to various antibiotics: streptomycin, gentamicin, polymyxin B, and beta-lactams. While protamine enhanced the antibacterial action of beta-lactams towards P. aeruginosa, it did not alter the effect of aminoglycosides. The antibacterial power of polymyxin B, on the other hand, was drastically reduced. The observed changes in this strain's sensitivity to antibiotics could be due to changes in the permeability of the outer membrane.

[Non-hysteroscopic thermodestruction of the endometrium using radio waves in the treatment of menorrhagia]. / Niet-hysteroscopische thermodestructie van het endometrium door radiogolven ter behandeling van menorragie.

OBJECTIVE: To test non-hysteroscopic thermodestruction of the endometrium for safety and efficiency. DESIGN: Prospective pilot study from February 1991 to July 1992. SETTING: University Hospital Nijmegen. PATIENTS AND METHOD: There were 68 patients aged 30-55 years with menorrhagia, who did not want children but wished to retain the uterus. There were two patients with a subserous myoma but with a normal uterine cavity. Patients with hypergonadotropism, a markedly enlarged uterus, abnormalities at cytological examination of the cervix, adnexal lesions, prolapse, intrauterine lesions and coagulation disorders were excluded. By way of preparation, danazol was administered for 4 weeks before the intervention (36 patients). Three patients with side effects were given lynestrenol. From January 1992, an LH-RH analogue was administered (29 patients) for 6 weeks prior to the intervention or in the patients with a subserous myoma for 12 weeks. Thermodestruction of the endometrium by means of radio waves was carried out according to a standard protocol under general or epidural spinal anaesthesia. The intracavitary temperature measured was 62-65 degrees C, mean duration of the treatment 20 minutes. RESULTS: The patients were discharged 10-24 hours after the intervention. A non-disturbing watery discharge of 3-6 weeks' duration was reported. Normal activities were resumed after one week. Success (duration of follow-up 3-21 months) was defined as amenorrhoea (6 patients; 9%) or a markedly reduced menstruation or duration of menstruation (48 patients; 70%). Six patients (9%) reported no improvement and of eight patients (12%) with slight, unsatisfactory improvement three were treated again, with success (4%). During the trial period the method was further adjusted and perfected. There were no complications. CONCLUSION: This preliminary experience shows that thermodestruction with radio waves is simple, safe and efficient.

Bactericidal activity of disinfectants on Listeria.

The bactericidal activity on Listeria spp. of nine disinfectants used in the food industry was studied by previously published methods. The disinfectants were diluted to the test concentration in sterile standard hard water. Various types of chemical agents were evaluated, including phenolic compounds, alcohols, quaternary ammonium compounds, surface-active agents, aldehydes and disochlorine tablets. The following strains isolated from cheese were studied: Listeria innocua, L. welshimeri, L. monocytogenes 1/2a, 1/2b, 1/2c and 4b. The results show that the listerias are not particularly resistant to disinfectants but the efficacy of some agents is affected by organic matter.

Phage typing of coagulase-negative staphylococci.

Seventy-nine staphylococcal strains isolated from blood cultures (57 coagulase-negative staphylococci (CNS) and 22 S. aureus) and 308 CNS isolated from the skin of healthy donors were phage typed. S. epidermidis and S. capitis were readily typed with 91 strains out of 124 and 24 strains out of 43 strains being successful. Species such as S. haemolyticus, S. hominis and S. simulans could be moderately phage typed. Others gave only a few strains capable of being typed, such as S. saprophyticus and S. sciuri. Under our experimental conditions the S. warneri, S. xylosus and S. cohnii could not be typed with our set of phages.

Improvement of cervical mucus viscoelasticity and sperm penetration with sodium bicarbonate douching.

The aim of the study was to evaluate the influence of vaginal douching with sodium bicarbonate (NaHCO3) upon cervical mucus viscoelasticity and sperm penetration in vitro and in vivo. Twenty-five couples with primary infertility for greater than 12 months participated in the study. The selection criteria were: (i) semen quality compatible with conception, (ii) regular ovulatory cycles and (iii) repeated negative post-coital test (PCT). After at least one inventory cycle, three consecutive cycles were studied. In the second and third cycles, vaginal douching was performed with either 1.5% (w/v) NaHCO3 or 0.9% (w/v) NaCl (randomized procedure). The viscoelasticity of the cervical mucus, sperm penetration tests (SPT) and PCTs were analysed. The viscoelasticity of mucus samples after NaHCO3 douching was significantly lower than the viscosity after NaCl douching (P less than 0.001, n = 16) and in the control cycles (P = 0.003). The SPT scores were significantly higher in the NaHCO3 cycles than in the NaCl cycles (P = 0.004, n = 22) and in the control cycles (P less than 0.001). The PCT scores proved to be significantly higher after NaHCO3 douching than after NaCl douching (P = 0.002, n = 21). Comparison of NaHCO3 and control cycles also showed a significant improvement of the PCT score after NaHCO3 douching (P less than 0.001).

Treatment of vaginal vault prolapse.

Vaginal vault prolapse is mostly a preventable complication of hysterectomy. Adequate suspension of the vaginal apex after hysterectomy with use of shortened cardinal and uterosacral ligaments will draw the proximal vagina over the levator plate. This results in support for the distal vagina. The essence of surgical repair of vaginal vault prolapse is to create a new suspension with the same vaginal support. Transvaginal sacrospinous fixation and transabdominal sacrocolpo-suspension accomplish this.

Disinfectants prepared in a hospital pharmacy--assessment of their microbiological purity and antimicrobial effectiveness.

The microbial contamination and antimicrobial effectiveness of seven topical disinfectants prepared at the hospital pharmacy were studied. These products were controlled throughout storage and use. The manufacturing routine investigated was able to deliver larger batch sizes and quality products that allowed increased storage time. The formulations chosen by the pharmacists were effective against bacteria for their intended uses. For chloramine only, loss of effectiveness required reduced storage time. No significant modification in the microbial quality of these products was observed during use in our hospital.

[Microbial contamination of raw materials of plant origin: incidence in cosmetic preparations]. / Contamination microbienne des produits bruts d'origine végétale: incidence pour les préparations cosmétiques.

The authors discuss their data on quantitative and qualitative microbial contamination of vegetal raw materials and some cosmetics. Microbial limits are proposed for the cosmetics.

[Fecal incontinence following obstetrical injury; significance of damaged pelvic floor innervation and results of surgical treatment]. / Incontinentie voor faeces na obstetrisch letsel; betekenis van beschadigde bekkenbodeminnervatie en resultaten van chirurgische behandeling.

During the last 5 years 33 patients with faecal incontinence due to childbirth were investigated. Ages varied from 23 to 61 and duration of symptoms from 0.3 to 25 years. Anal manometry was performed in all patients and electromyography was performed in 21 cases. Twenty-seven patients underwent delayed sphincter repair. Continence was restored in 21 (81%). Post-operatively performed EMG in the patients who remained incontinent demonstrated severe denervation but sphincter mapping did not demonstrate muscle discontinuity. Continence improved in three patients within one year as results of reinnervation. Faecal incontinence after childbirth may be due to either obstetric rupture or denervation. Both disorders may coexist. Sphincter repair gives excellent results provided denervation is not present. Preoperative assessment by EMG is mandatory.

Prevention of group B streptococci transmission during delivery by vaginal application of chlorhexidine gel.

In a prospective study in 227 parturients, carriership of group B streptococci was established to be 25%. In carriers, transmission of streptococci to the newborn occurred in 50%. 10 ml of a chlorhexidine gel containing hydroxypropylmethylcellulose was introduced into the vagina during labor in 17 parturients, who were known to be carriers of group B streptococci from the first trimester of pregnancy. In none of the newborns from these mothers colonization by group B streptococci did occur. Vaginal application of chlorhexidine may prevent transmission of group B streptococci, and serve as an alternative to intrapartum prophylaxis using antibiotics. A large multicenter randomized controlled study should be performed to confirm this hypothesis.

Maternal survival after acute haemorrhagic pancreatitis complicating late pregnancy.

In the 41st week of her first pregnancy, a 25-year-old woman presented abdominal complaints. After the Caesarean delivery of an healthy child, the mother developed a severe hypoglycaemia and septic shock. Although normal serum and urine amylase values were obtained, an exploratory laparotomy disclosed acute haemorrhagic pancreatitis. Clinical treatment was complicated by repeated sepsis, multiple organ failure and ARDS, requiring the patient to receive intensive care for 3.5 months. To control abdominal sepsis and bleeding complications, an additional ten laparotomies were carried out. During this period the abdomen was kept closed by means of a nylon mesh. Although according to present day criteria the prognosis was fatal, the patient ultimately fully recovered. By exclusion, the cause of the pancreatitis was ascribed to the pregnancy itself. The medical, obstetric and surgical aspects of the management of acute pancreatitis complicating pregnancy and puerperium are reviewed.