bacteremia continues to be one of the major causes of morbidity and mortality despite the existence of numerous antimicrobial agents. this study aimed to provide a Malaysian perspective on paediatric community-acquired bacteraemia based on the documentation of epidemiology and antimicrobial profile of the isolated pathogens.

Introduction: bacteremia continues to be one of the major causes of morbidity and mortality despite the existence of numerous antimicrobial agents. this study aimed to provide a Malaysian perspective on paediatric community-acquired bacteraemia based on the documentation of epidemiology and antimicrobial profile of the isolated pathogens. Method: A retrospective study was conducted by analysing clinical details, blood cultures and antimicrobial susceptibility testing results in children between the ages of 0 to 13 years old, who were admitted to selayang Hospital over an 11-year period from 2001 until 2011. there were 222 bacteraemia cases and the median age was 11.7 months. the highest number (39%) of bacteraemia cases occurred between ages one month to one year. the three most commonly isolated aetiological agents were Staphylococcus aureus (17.1%), nontyphoidal Salmonella (16.2%), and Streptococcus pneumoniae (12.6%). Almost 8% of the Staphylococcus aureus isolates were methicillin resistant, while nontyphoidal Salmonella (Nts) isolates demonstrated 18.4%, 10.5% and 2.6% resistance towards ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin respectively. All Nts isolates were sensitive to ceftriaxone. Streptococcus pneumoniae isolates showed 17.9% resistance to penicillin. skin and soft tissue infections as well as lower respiratory tract infections (63.2%) were the main foci of infections in Staphylococcus aureus bacteraemia. Acute gastroenteritis (80.0%) and pneumonia (60.8%) were the main presentations of Nts and Streptococcus pneumoniae bacteraemia respectively. Overall mortality rate was 8.1%. Conclusion: Knowledge on the local epidemiology and antibiotic resistance pattern serves as a significant platform in improving the empiric antibiotic therapy for patients with community acquired bacteraemia.
Anti-Infective Agents ; Bacteremia

Percutaneous transvenous mitral annuloplasty (PTMA) has evolved as a latest procedure for the treatment of functional mitral regurgitation. It reduces mitral valve annulus (MVA) size and increases valve leaflet coaptation via compression of coronary sinus (CS). Anatomical considerations for this procedure were elucidated in the present study. In 40 formalin fixed adult cadaveric human hearts, relation of the venous channel formed by CS and great cardiac vein (GCV) to MVA and the adjacent arteries was described, at 6 points by making longitudinal sections perpendicular to the plane of MVA, numbered 1–6 starting from CS ostium. CS/GCV formed a semicircular venous channel on the atrial side of MVA. Based on the distance of CS/GCV from MVA, two patterns were identified. In 37 hearts, the venous channel at point 2 was widely separated from the MVA compared to the two ends and in three hearts a nonconsistent pattern was observed. GCV crossed circumflex artery superficially. GCV or CS crossed the left marginal artery and ventricular branches of circumflex artery superficially in 17 and 23 hearts, respectively. As the venous channel was related more to the left atrial wall, PTMA devices probably exert an indirect traction on MVA. The arteries crossing deep to the venous channel may be compressed by PTMA device leading to myocardial ischemia. Knowledge of the spatial relations of MVA and a preoperative and postoperative angiogram may help to reduce such complications during PTMA.
Adult ; Arteries ; Cadaver ; Coronary Sinus ; Formaldehyde ; Heart ; Humans ; Mitral Valve ; Mitral Valve Annuloplasty* ; Mitral Valve Insufficiency* ; Myocardial Ischemia ; Traction ; Veins

Anatomical variations of the colon are described by various authors, but the occurrence of right sided descending and sigmoid colon is rare and has not been reported. We found that the anomalous right-sided descending and sigmoid colon had four parts. The proximal segment of the first part consisted of the descending colon extending across the midline from the splenic flexure to the portion supplied by the left colic artery. The distal segment was supplied by the superior sigmoid artery. The second and third parts formed a loop in the right lumbar region anterior to the lumbar cecum. The fourth part was in the lesser pelvis, extending from right sacroiliac joint to the third sacral body. Parts two, three, and four were supplied by the inferior sigmoid artery, which arose from the right side of the inferior mesenteric artery. The ascending and transverse colon was normally placed. This is a rare anomaly that has not been reported so far in adults and is of immense importance to interventional radiologists and colorectal surgeons. The embryological basis of such an anomaly is defective fixation occurring as early as the 12th-17th week of intrauterine life.
Adult ; Arteries ; Cecum ; Colic ; Colon ; Colon, Descending ; Colon, Sigmoid* ; Colon, Transverse ; Humans ; Lesser Pelvis ; Lumbosacral Region ; Mesenteric Artery, Inferior ; Sacroiliac Joint