Aims: The aim of this study was to investigate the genetic relatedness of the most prevalent Candida bloodstream infection (BSI) species in in a Malaysian population via Randomly Amplified Polymorphic DNA-Polymerase Chain Reaction (RAPD-PCR) fingerprinting. Methodology and results: The genomic DNA of 43 Candida BSI blood culture samples obtained from Universiti Malaya Medical Centre (UMMC) was isolated, after which species identification was carried out using PCR with ITS-1 and ITS-4 pan-fungal primers in conjunction with CHROMagar™ Candida. The predominant Candida species in the BSI samples is Candida albicans (14 out of 43 isolates). RAPD-PCR on these 14 C. albicans clinical isolates was performed using PST as the arbitrary primer. Data analysis using MEGA found an overall non-relatedness of these 14 clinical isolates [average similarity coefficient (SAB) value 0.733±0.172]. Following in-depth analysis, five of the 14 isolates were observed to be identical (SAB values of 1.00 each), four isolates had SAB values of 0.80-0.99, indicating that they are highly similar, but are non-identical, while five isolates are unrelated (SAB lower than 0.80). This suggests that microevolution might have occurred and that these clinical isolates may possibly belong to different strains. Conclusion, significance and impact of study: A fair degree of genetic heterogeneity was found among the 14 C. albicans isolates from UMMC. To our knowledge, this is the first report on the genetic profiles of C. albicans bloodstream infection isolates from Malaysia, warranting further studies in the possible evolutionary trends within this Candida species in Malaysia. Keywords: Randomly Amplified Polymorphic DNA PCR (RAPD-PCR), Candida albicans, Candida bloodstream infections, Genetic relatedness, DNA fingerprinting
Candida albicans

A young lady presented with recurrent abdominal distention and pain. Over the past few years, she had been admitted several times with similar complaints. Each time the symptoms settled with conservative management. Abdominal radiography (Panel) on admission is shown above. What does the radiograph show and what is the syndrome ? Answer: refer to page 187 Images of Interest Brunei Int Med J. 2011; 7 (3): 165 Correspondence

(Refer to page 165) Answer: Chilaiditi’s sign and Chilaiditi’s syndrome Chilaiditi’s sign is defined by the asymptomatic interposition of part of the intestine (commonly the hepatic flexure of the colon) between the right hemi-diaphragm and the liver. It is usually an incidental finding. When symptomatic, it is referred to as the Chilaiditi’s syndrome. Presentations may range from intermittent recurrent mild abdominal pain to acute intestinal volvulus, though the symptoms reported so far have been inconsistent between different patients and can be nonspecific.

A young lady was evaluated for chronic iron deficiency anaemia and a long history of intermittent dysphagia especially to solids. The dysphagia had been more prominent in the previous few months. There was no history of menorrhagia. Apart from pallor and mild koilonychias, physical examination was unremarkable. She underwent a barium swallow (panel) and an abnormality was detected. What is the diagnosis? Answer: refer to page 236

(Refer to page 208) Answer: Plummer-Vinson or Patterson-Kelly-Brown Syndrome Plummer-Vinson syndrome (PVS) is defined as a triad of upper oesophageal web (or ring), dysphagia and iron deficiency anaemia (IDA). It was first reported in the early twentieth century, and is also widely known as the Patterson- Kelly-Brown syndrome (PKBS) or sideropenic anaemia with epithelial lesions.

Objective: To optimize the processing technology of stir-fried Euodiae Fructus with the water decoction of Coptidis Rhizoma by L9(34) orthogonal design. Methods: The factors including the dosage of Coptidis Rhizoma, stir-frying temperature and stir-frying time, and phenolic acids (neochlorogenic acid, chlorogenic acid, caffeic acid, and cryptochlorogenic acid), flavonoids (rutin, hyperin, and narcissoside), alkaloids (dehydroevodiamine, evodiamine, rutaecarpine, evocarpine, and dihydroevocarpine), and volatile oils in Euodiae Fructus were taken as evaluation indexes to optimize the processing technology. Results: The best processing technology for stir-fried Euodiae Fructus with the water decoction of Coptidis Rhizoma was as follows: the dosage ratio of Euodiae Fructus to Coptidis Rhizoma 10:1, stir-frying temperature 150 ℃, and stir-frying time 8 min. Conclusion: Simultaneously, taking the content of four kinds of components as the indexes, the method for optimizing the optimal processing technology of stir-fried Euodiae Fructus with the water decoction of Coptidis Rhizoma is stable, reliable and feasible.