Aims: Basal stem rot (BSR) disease caused by Ganoderma pathogenic fungi, especially Ganoderma boninense is thriving rapidly in both areas with coastal and inland soils. The objectives of this study were to isolate and characterize Ganoderma isolates collected from various locations in Peninsular Malaysia through the comparison of their growth rate in vitroly on conventional and novel palm extract media, and to determine the degree of virulence caused by the isolates in oil palm seedlings. Methodology and results: In this study, 12 Ganoderma isolates were collected from infected oil palm trees, from various locations – Johor, Negeri Sembilan, Kedah, Perak, Pahang, and Kelantan, in Malaysia in year 2011. Twelve Ganoderma isolates were identified using molecular method with primer set that targeted at small-subunit 18S rDNA fragment, and characterized by determining the in vitro growth rate, and degree of virulence in 2-month-old oil palm seedlings in the nursery using both disease incidence (DI) and disease severity index (DSI) as the measurements to quantify the infection. All the Ganoderma isolates were identified as G. boninense and sequences of the respective isolates were deposited in GenBank. In general, all the isolates proliferated faster on oil palm extract medium (OPEM) compared to malt extract agar (MEA). Twelve G. boninense isolates were observed to illustrate different degree of virulence ranging from highly pathogenic to least pathogenic. Conclusion, significance and impact of study: Cultures of 12 G. boninense isolates were observed to show faster growth rate (P < 0.014) on OPEM under in vitro conditions compared to conventional MEA medium, except Bt Lintang G10 and GBA G12 isolates. OPEM medium could provide a better alternative for maintaining and culturing Ganoderma strains. In the current study, both DI and DSI were highly correlated. However, there were low linear relationships (R2 < 0.423) between mycelia growth rate (on MEA and OPEM) and degree of virulence (DI and DSI) at 12-, 14- and 16- weeks after treatments among the G. boninense isolates tested. Furthermore, different degrees of virulence in twelve separate Ganoderma isolates were reported. Therefore, it is crucial to incorporate more than one isolate into any researches on screening for Ganoderma resistance or tolerance planting materials, searching for potential biological control agents, and studying bitrophic or tri-trophic interactions. In addition, this study was aimed to isolate G. boninense strains with various virulence levels for future studies.

Background & Objective: SCN1A gene which encodes for sodium channel alpha 1 subunit has been found to be the most common mutated gene in patients with epilepsy. This study aims to characterize the SCN1A mutations as well as to describe genotype and phenotype association in children with SCN1Arelated infantile-onset epileptic encephalopathies in Malaysia. Methods: Children with infantile-onset epileptic encephalopathy mostly suspected to have Dravet syndrome who had mutational analysis for SCN1A gene from hospitals all over Malaysia were included in the study. Their epilepsy syndrome diagnosis was classified into severe myoclonic epilepsy in infancy and its variants. Polymerase chain reaction and bidirectional sequencing were used to identify SCN1A mutations. Results: A total of 38 children with heterozygous mutations were analysed, 22 (57.9%) of which were novel mutations. Truncated mutations were the most common mutation type (19, 50%). Other mutation types were missense mutations (14, 36.8%), splice site mutations (4, 10.5%) and in-frame deletion (1, 2.6%). The mean age of seizure onset was 4.7 months. Seizure following vaccination was observed in 26.3% of the children. All of them had drug resistant epilepsy. There was no significant association between the type of mutation with the syndromic diagnosis, age of seizure onset, tendency of the seizures to cluster or having status epilepticus, mean age when developmental delay was observed and response to various antiepileptic drugs. Conclusion: This study expands the spectrum of SCN1A mutations and proves the importance of SCN1A gene testing in diagnosing infantile-onset epileptic encephalopathies patients. Although, our study does not support any clinically meaningful genotype-phenotype association for SCN1A-related infantile-onset epileptic encephalopathies, the clinical characteristics of our cohort are similar to those that have been described in previous studies.

Background and Objectives: We compared real-world clinical outcomes of patients receiving intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for heavily calcified coronary lesions. Methods: Fifty-three patients who received IVL from January 2017 to July 2020 were retrospectively compared to 271 patients who received RA from January 2017 to December 2018.Primary endpoints were in-hospital and 30-day major adverse cardiovascular events (MACE). Results: IVL patients had a higher prevalence of acute coronary syndrome (56.6% vs 24.4, p<0.001), multivessel disease (96.2% vs 73.3%, p<0.001) and emergency procedures (17.0% vs 2.2%, p<0.001) compared to RA. In-hospital MACE (11.3% vs 5.9%, p=0.152), MI (7.5% vs 3.3%, p=0.152), and mortality (5.7% vs 3.0%, p=0.319) were not statistically significant. 30-day MACE was higher in the IVL cohort vs RA (17.0% vs 7.4%, p=0.035). Propensity score adjusted regression using IVL was also performed on in-hospital MACE (odds ratio [OR], 1.677; 95% confidence interval [CI], 0.588–4.779) and 30-day MACE (OR, 1.910; 95% CI, 0.774–4.718). Conclusions These findings represent our initial IVL experience in a high-risk, real-world cohort. Although the event rate in the IVL arm was numerically higher compared to RA, the small numbers and retrospective nature of this study preclude definitive conclusions. Theseclinical outcomes are likely to improve with greater experience and better case selection, allowing IVL to effectively treat complex calcified coronary lesions.

part of the duodenum is a rare complication. We report herean 80-year-old woman who presented at the SarawakGeneral Hospital, Kuching, Sarawak, Malaysia with earlysatiety and epigastric fullness for 3 months. She had noprior medical or surgical history other than an uneventfulopen cholecystectomy. Upper endoscopy showed a largesubmucosal mass in the first part of duodenum with pyloricconverging gastric folds. Computed tomography scan of theabdomen showed a gastroduodenal intussusception with a4x6cm mass at the junction between the first and secondpart of duodenum. Laparoscopic transgastric resection wasperformed. Histopathological examination of the resectedspecimen confirmed leiomyoma. She remained well at 43months follow-up.

INTRODUCTIONSingapore experienced its second riot in 40 years on 8 December 2013, in the area known as Little India. A retrospective review of 36 casualties treated at the emergency department was conducted to evaluate injury patterns.

METHODSCharacteristics including the rate of arrival, injury severity, type and location, and disposition of the casualties were analysed.

RESULTSThe injuries were predominantly mild (97.2%), with the most common injuries involving the head (50.0%) and limbs (38.9%). 97.2% of the casualties were managed as outpatient cases.

CONCLUSIONThe majority of the injuries in this incident were mild and could be managed as outpatient cases. Important lessons were learnt from the incident about the utilisation of manpower and safety of staff in the emergency department.

Adult ; Emergency Medical Services ; Emergency Medicine ; methods ; Emergency Service, Hospital ; Female ; Humans ; Injury Severity Score ; Male ; Patient Safety ; Retrospective Studies ; Riots ; Singapore ; Triage