Hepatitis C virus infection and anaesthesia practice: A narrative review.

This paper reviews the natural and treated history of hepatitis C virus infection, the interactions between current therapies and anaesthesia medications, and the implications of occupational exposure and infection to anaesthetists in light of significant changes in treatment. In the past decade, the introduction of new direct acting antiviral medications has seen high cure rates with a sustained viral response across all virus genotypes. These medications are well tolerated with minimal side-effects. Should a patient on these medications require anaesthesia, there are few clinically significant interactions with commonly used anaesthesia medications, and minimal perioperative investigations are required, although delaying elective surgery until after the completion of treatment regimens should be considered to maximise treatment success. As anaesthetists may practise exposure-prone procedures, regular screening for hepatitis C virus infection remains recommended to enable both patient protection and treatment of the anaesthetist prior to the development of any long-term complications of hepatitis C virus infection. Similarly, early diagnosis and treatment of occupationally acquired hepatitis C virus infection after body fluid exposure is associated with high cure rates with minimal risk of long-term liver damage. Although hepatitis C virus infection remains a significant public health issue in Australia and New Zealand, improvements in outcomes as a result of new treatment regimens have allowed the World Health Organization to target the elimination of hepatitis C virus infection as a public health threat by 2030, and public health strategies are being implemented to achieve this goal.

From Picoscale Pathology to Decascale Disease: Image Registration with a Scattering Transform and Varifolds for Manipulating Multiscale Data.

Advances in neuroimaging have yielded extensive variety in the scale and type of data available. Effective integration of such data promises deeper understanding of anatomy and disease-with consequences for both diagnosis and treatment. Often catered to particular datatypes or scales, current computational tools and mathematical frameworks remain inadequate for simultaneously registering these multiple modes of "images" and statistically analyzing the ensuing menagerie of data. Here, we present (1) a registration algorithm using a "scattering transform" to align high and low resolution images and (2) a varifold-based modeling framework to compute 3D spatial statistics of multiscale data. We use our methods to quantify microscopic tau pathology across macroscopic 3D regions of the medial temporal lobe to address a major challenge in the diagnosis of Alzheimer's Disease-the reliance on invasive methods to detect microscopic pathology.

Interstitial pneumonia with autoimmune features.

BACKGROUND: Cardiac tamponade is a medical emergency. This study was carried out to determine the etiologies of cardiac tamponade and review the management and outcomes. METHODS: We retrospectively analysed case records of patients who underwent pericardiocentesis for cardiac tamponade during the two consecutive years (1 January 2018 to 31 December 2019) at Hospital Sultanah Nora Ismail, Batu Pahat, in Johor, Malaysia. RESULTS: There were ten patients (eight males, two females; age range 20 to 70 years old, mean age 36 years old) who underwent pericardiocentesis for cardiac tamponade during the said period. Malignancy (40%), tuberculosis (30%), idiopathic (20%), and bacterial (10%) were among the common causes of the pericardial effusion in this center. The commonest symptoms were breathlessness (90%), chest pain (60%), cough (50%), and unexplained fever (20%). Pulsus paradoxus was the most speciÿ c sign (100%) for the presence of echocardiographic feature of cardiac tamponade. Two of the patients with tuberculous pericarditis had retroviral disease; one patient had bacterial pericarditis due to salmonella typhi. CONCLUSION: This study has conÿ rmed that there are many etiologies and presentation of cardiac tamponade; clinicians should be alert as urgent pericardiocentesis is lifesaving.

Dilemma in the management of methanol poisoning at a district hospital in Malaysia

@#There are increasing reports of methanol poisoning (MP) incidence worldwide. In Malaysia, the largest first methanol poisoning was reported in Selangor in 2013 with a total of 41 patients and cluster of cases been reported from the country since then. Often MP involved adulterated alcohol containing more than the legal permissible concentration of methanol. Methanol is rapidly absorbed and metabolised into formic acid which causes variable symptoms of the central nervous system such as blindness, seizure, coma and gastrointestinal disturbances. Mortality could reach up to 83% as reported using the coma state, pH and pCO2 level in the worst-case scenario.

Antimicrobial resistance in urine and skin isolates in Timor-Leste.

OBJECTIVES: High rates of antimicrobial resistance (AMR) are seen throughout Southeast Asia. However, limited AMR data exist for Timor-Leste, which is situated on the south-eastern portion of the Malay Archipelago. The purpose of this study was to identify AMR in bacteria isolated from urine and skin swabs from patients in Dili, the capital of Timor-Leste. METHODS: Urine and skin swabs were collected from symptomatic patients in Timor-Leste and were processed for bacterial culture. Isolates were processed in Australia using a VITEK®2 system for bacterial identification and to determine antimicrobial susceptibility according to Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: A total of 154 urine isolates and 57 skin isolates were analysed. Of the Enterobacteriaceae, 35% were resistant to ceftriaxone with an extended-spectrum ß-lactamase (ESBL)-producing phenotype. Carbapenem resistance was not observed in any of the Gram-negative isolates. Of the Staphylococcus aureus isolates, 11% were of the community-associated methicillin-resistant S. aureus (CA-MRSA) phenotype. CONCLUSIONS: A moderately high proportion of Gram-negative urine isolates in Timor-Leste demonstrate phenotypic ESBL production, and a relatively low proportion of S. aureus isolates were methicillin-resistant. Improved understanding of AMR rates in Timor-Leste can help guide antimicrobial prescribing and inform antimicrobial stewardship strategies.