Background: Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen, capable of causing a wide spectrum of infections. Treatment is difficult because it is resistant to many antimicrobial agents, thus reducing the treatment options. The aims of this study were to describe the antimicrobial susceptibility patterns and synergistic effect of selected antimicrobial combinations against S. maltophilia isolates. Methods: This was a descriptive cross-sectional study undertaken in the Hospital Universiti Sains Malaysia from April 2011 to March 2012. S. maltophilia isolated from various clinical specimens were included in the study. Antimicrobial susceptibility testing was done using the epsilometer test (E-test) and interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. In the synergy test, the isolates were tested against six different antimicrobial combinations. Results: In total, 84 S. maltophilia isolates were collected and analysed. According to the E-test, the antimicrobial susceptibility of trimethoprim-sulfamethoxazole (TMP-SMX), tigecycline, and ciprofloxacin was 100%, 91.1%, and 88.9% respectively. The antimicrobial combination of TMP-SMX and ceftazidime showed the highest synergistic effect. Conclusion: TMP-SMX remains the antimicrobial of choice to treat S. maltophilia infection. TMP-SMX and ceftazidime was the most effective combination in vitro.

The potential of ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, in preventing central sensitization has led to numerous studies. Ketamine is increasingly used in the clinical setting to provide analgesia and prevent the development of central sensitization at subanaesthetic doses. However, few studies have looked into the potential of ketamine in combination with stress-induced analgesia. This study looks at the effects of swim stress, which is mediated by opioid receptor, on ketamine analgesia using formalin test. Morphine is used as the standard analgesic for comparison. Adult male Sprague-Dawley rats were assigned to 6 groups: 3 groups (stressed groups) were given saline 1ml/kg intraperitoneally (ip), morphine 10mg/kg ip or ketamine 5mg/kg ip and subjected to swim stress; 3 more groups (non-stressed groups) were given the same drugs without swim stress. Formalin test, which involved formalin injection as the pain stimulus and the pain score recorded over time, was performed on all rats ten minutes after cessation of swimming or 30 minutes after injection of drugs. Combination of swim stress and ketamine resulted in complete analgesia in the formalin test which was significantly different from ketamine alone (p<0.05) and saline with stress (p<0.01). There is no significant difference between ketamine stressed and morphine stressed. These results indicate that ketamine and swim stress act synergistically to produce profound analgesia in the formalin test. This suggests that in the clinical setting, under stressful situations such as operative stress, ketamine is capable of producing profound analgesia at a subanaesthetic dose.

A six-month-old baby with congenital patent ductus arteriosus (PDA), bilateral microtia and canal atresia was referred for hearing assessment. The audiology assessment revealed bilateral profound hearing loss, which is atypical for a case of pure canal atresia. Imaging was performed much earlier than usual and, as suspected, the patient also had bilateral severe inner ear anomaly. It is extremely rare for a person to have both external and inner ear anomaly because of the different embryological origin. The only suitable hearing rehabilitation option for this kind of patients is brainstem implant. However, the parents had opted for sign language as a form of communication. KEY WORDS: Microtia; canal atresia; cochleovestibular nerve aplasia; inner ear anomaly
Congenital Microtia

Introduction: Microbial keratitis is one of the most challenging complications of contact lens (CL) wear. Proper CL practice plays an important role to reduce the risk for contact lens related microbial keratitis (CLRMK). Methods: This multi-centre case-control study was conducted from January 2008 until June 2009 to determine the risk factors associated with CLRMK. Cases were defined as respondents who were treated for CLRMK, whilst controls were respondents who were contact lens wearers without microbial keratitis. Ninety four cases were compared to 94 controls to determine the risk factors for CLRMK. Results: The predictors for CLRMK were: Not washing hands with soap before handling CL (aOR 2.979, CI 1.020, 8.701 p=0.046), not performing rubbing technique whilst cleaning the CL (aOR 3.006, CI 1.198, 7.538 p=0.019) and, not cleaning the lens case with multipurpose solution daily (aOR 3.242 CI 1.463, 7.186 p=0.004). Sleeping overnight with the CL in the eye (aOR 2.864, CI 0.978, 8.386 p=0.049) and overall non-compliance with lens care procedures (aOR 2.590, CI 1.003, 6.689 p=0.049) contributed significantly to CLRMK. Conclusion: Health education and promotion in contact lens care are important and should be conducted by eye care practitioners to reduce the occurrence of CLRMK.
Contact Lenses

Introduction: A hospital based case control study was conducted in government hospitals on contact lens patients diagnosed with microbial keratitis. Methods: The objective of this study is to determine the visual outcomes of contact lens related microbial keratitis. The visual outcomes which comprised of visual acuity, keratometry readings, corneal topography findings and contrast sensitivity examinations was determined after three months from the first presentation at the hospitals. Results: The mean LogMAR visual acuity during presentation was 0.96 ± 0.73 or a Snellen equivalent 6/60 (n=76) and mean LogMAR visual acuity after three months was 0.10 ± 0.48 or a Snellen equivalent 6/7.5 (n=76) with a significant difference (t=11.22, df=78, p=0.001). Best fit curve for the cases had a regression coefficient, r=0.350 ± 0.063 (95% CI = 0.224, 0.447, df=78, p=0.001. The visual acuity in cases and controls was 0.10 ± 0.48 and -0.10 ± 0.14 respectively (t= -3.61, df=154 p=0.001) after three months which showed improvement. There was a reduction in the corneal uniformity index and corneal asphericity in the cases. The Corneal Uniformity Index (CU index) in cases was 63.03 ± 26.38 (n=76) and in controls, 80.13 ± 11.30 (n=77), (t= -5.22, df=151, p=0.001). There was also a reduction in the contrast sensitivity function at all spatial frequencies in the cases which was significantly different. Conclusion: Microbial keratitis reduced the vision, corneal uniformity index, asphericity and contrast sensitivity after three months in eyes of patients diagnosed with the condition.
Keratitis ; Eye

Hearing impairment in adolescents is a major public health problem. According to the World Health Organization (WHO) deafness and hearing impairment are common health problems throughout the world. Hearing impairment generally impairs emotional, social, communication and educational function. The aim of this study was to determine the correlation between duration of hearing aid use and improvements in the quality of life. The cross sectional study was conducted at Jalan Peel Primary Special School and Universiti Kebangsaan Malaysia Medical Center (UKMMC) from July 2010 until June 2011. A total of 21 students with hearing impairment involved in this study with mean age of 12.57 (10 to 19 years old). The subjects were divided into 2 groups: first-time hearing aid users and long standing hearing aid users. The hearing assessment was conducted in the first group and hearing aids were fitted. After 1 month hearing aid fitting, the questionnaires were distributed to both groups. Statistical analysis had showed no relation (p>0.05) between duration of hearing aid use and the improvement in the quality of life. However, regardless of the duration of hearing aid usage, there was improvement in the quality of life as shown by the scores of the questionnaires. In conclusion there was no significant relation between duration of hearing aid use and the improvement in the quality of life. Hearing aids were beneficial for hearing loss students regardless of the duration of the hearing aid usage.

Aim: Despite the endemicity of typhoid in Kelantan, epidemiological data showing typhoid association to age, sex, ethnicity and district of patients is limited. This retrospective study investigated the statistical association of these variables from a retrieved registry. Methodology and results: Cross-tabulation using SPSS was used to analyze 1394 cases of confirmed typhoid patients admitted to various hospitals in Kelantan state over a six-year period. Fourteen age groups with a five-year range interval were generated. There was a significant association between typhoid infection and sex of subjects, whereby females were generally more susceptible than males. Ethnicity and district of typhoid patients did not show significant association. Conclusion, significance and impact of study: The observation of an increased number of typhoid cases with a male predominance in the age group 5-14 and female predominance in the 20-60 age group calls for improved hygiene, continued public health education, together with better laboratory diagnostics to identify carriers, are some measures to control this disease.

film quality and the quantity of secretion. This low quality of tear secretion can lead to the rapid breakup of tears. In recent times, particularly since the COVID-19 pandemic, the prevalence of dry eye has increased. Relevant studies found that the prevalence of dry eye is higher in females than males. This research work is based only on symptoms of dry eye disease in Malaysia to determine its prevalence among students at the UCSI University KL campus because of the increase in reported cases of dry eyes especially post Movement Control Order (MCO). Methods: A total of 199 students, ranging in age 17 to 30, were included in this research. This is a cross-sectional study that was conducted on participants who fulfilled the inclusion criteria. Demographic questionnaires and Ocular Surface Disease Index (OSDI) results were collected. Results: On the UCSI KL Campus, students who suffer from dry eye are 82% of the population. The Pearson Chi-Square test showed a significant difference between gender and dry eye, X2 (1, N= 199) = 8.64, p < 0.0033. Female students are more likely to develop dry eye than male students. Conclusion: The prevalence of dry eyes among UCSI students is high. This could be attributable to prolonged or improper mask-wearing. It is suggested that researchers and health policymakers should take heed to these emerging risk factors related to wearing of mask.

Abstract Introduction: Computed tomography (CT) has been widely used for postoperative spine assessment. However, the effectiveness of CT is limited by the presence of multiple artefacts surrounding metal implants. An artefact causes degradation of image quality and obscures the interpretation of spine CT images by a radiologist. The purpose of this study was to evaluate the optimum angle of gantry tilt and metal rod placement which produced the least metal artefact on CT images. Methods: A customised phantom was developed with different transverse angles of metal placement. The transverse angles of metal placement inside the phantom varied at 20°, 30°, 40° and 45°. The phantom was scanned with CT scanner at 0° axial scan angle. It was followed by acquisitions at different gantry tilt angles ranging from −12° to 20°. Quantitative and qualitative assessment by determining the signal-to-noise ratios (SNRs) of the CT images was performed. Results: The severity of the metal streak artefact increased as the metal insertion angles became wider up to 45° due to the widespread of streaking area. The severity of artefacts was reduced with the increment of the gantry tilt angle, which was observed in images acquired at 20°. Conclusion: For the gantry tilt angulation technique, the optimum gantry angle for metal artefact reduction is at the widest angle, which is +20° angulation. Although the gantry tilt technique did not eliminate the metal artefacts, it enabled a significant reduction of metal artefacts and improved image quality.