Retrocaval ureter is a relatively rare anomaly where ureteric obstruction may occur as a result of ureter passes behind the inferior vena cava (IVC), hence, compressing it between the IVC and the vertebrae. We report 2 cases of retrocaval ureter with different presentations. One patient was managed surgically with minimally invasive approach and the other was managed conservatively.
Retrocaval Ureter

This study reports the vision status of a presbyopic patient who has undergone a corneal inlay procedure. The study hopes to provide optometrists more insight on the procedure and the co-management involved in such a patient. The patient, a 48 years-old Chinese woman with presbyopia underwent the corneal inlay procedure three years ago. She had the inlay implanted in the non-dominant eye to aid near vision i.e. her left eye. The pre and post-operative evaluations include distance and near visual acuity, fundoscopy, tonometry, Schirmer’s test, slit lamp evaluation, corneal topography and corneal pachymetry. Near visual acuity for the left eye improved from N14 to N5 immediately after the procedure. Even after 3 years of post-operative followup, the patient was still able to maintain her near vision. In conclusion, the corneal inlay procedure helped to improve near vision of this presbyopic patient. Optometrist plays a very important role in the co-management of such patients alongside with the ophthalmologist in terms of visual functional assessments pre and post-surgery, counseling of the procedure and managing patients’ expectations.
Corneal Injuries

Dengue is an increasing threat in Malaysia, particularly in the more densely populated regions of the country. We present an Artificial Intelligence driven model in predicting Aedes outbreak, using predictors of weather variables and vector indices sourced from the Ministry of Health. Analysis and predictions to estimate Aedes populations were conducted, with its results being used to infer the possibility of dengue outbreaks at pre-determined localities around the Klang Valley, Malaysia. A Bayesian Network machine learning technique was employed, with the model being trained using predictor variables such as temperature, rainfall, date of onset and notification, and vector indices such as the Ae. albopictus count, Ae. aegypti count and larval count. The interfaces of the system were developed using the C# language for Server-side configuration and programming, and HTML, CSS and JavaScript for the Client Side programming. The model was then used to predict the population of Aedes at periods of 7, 14, and 30 days. Using the Bayesian Network technique utilising the above predictor variables we proposed a finalised model with predictive accuracy ranging from 79%-84%. This model was developed into a Graphical User Interface, which was purposed to assist and educate the general public of regions at risk of developing dengue outbreak. This remains a valuable case-study on the importance of public data in the context of combating a public health risk via the development of models for predicting outbreaks of dengue which will hopefully spur further sharing of data by all parties in combating public health threats.

INTRODUCTIONWith the potential threat of an avian influenza (AI) pandemic, healthcare workers (HCWs) are expected to play important roles, and they encounter significant stress levels from an expected increase in workload. We compared the concerns, perceived impact and preparedness for an AI pandemic between HCWs working in public primary care clinics and a tertiary healthcare setting.

MATERIALS AND METHODSAn anonymous, self-administered questionnaire was given to 2459 HCWs working at 18 public polyclinics (PCs) and a tertiary hospital (TH) in Singapore from March to June 2006. The questionnaire assessed work-related and non-work-related concerns, perceived impact on personal life and work as well as workplace preparedness.

RESULTSWe obtained responses from 986 PC and 873 TH HCWs (response rate: 74.6% and 76.7%). The majority in both groups were concerned about the high AI risk from their occupation (82.7%) and falling ill with AI (75.9%). 71.9% accepted the risk but 25.5% felt that they should not be looking after AI patients with 15.0% consider resigning. HCWs also felt that people would avoid them (63.5%) and their families (54.1%) during a pandemic. The majority expected an increased workload and to feel more stressed at work. For preparedness, 74.2% felt personally prepared and 83.7% felt that their workplaces were prepared for an outbreak. TH HCWs were more likely to be involved in infection-control activities but the perception of infection-control preparedness in both groups was high (>80.0%).

CONCLUSIONSHCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic. Their main concerns were risks of falling ill from exposure and the possibility of social ostracism of themselves and their families. Preparedness levels appeared high in the majority of HCWs. However, concerns of HCWs could affect their overall effectiveness in a pandemic and should be addressed by incorporating strategies to manage them in pandemic planning.

Adolescent ; Adult ; Aged ; Animals ; Attitude of Health Personnel ; Birds ; Disaster Planning ; Disease Outbreaks ; Female ; Humans ; Infectious Disease Transmission, Patient-to-Professional ; prevention & control ; Influenza A Virus, H5N1 Subtype ; pathogenicity ; Influenza in Birds ; transmission ; Influenza, Human ; epidemiology ; prevention & control ; transmission ; virology ; Male ; Middle Aged ; Primary Health Care ; Singapore

INTRODUCTIONDuring an avian influenza (AI) pandemic, primary-care physicians (PCPs) are expected to play key roles in the prevention and control of the disease. Different groups of PCPs could have different concerns and preparedness level. We assessed the concerns, perceived impact and preparedness for an outbreak among PCPs in Singapore.

MATERIALS AND METHODSA cross-sectional survey of PCPs working in private practice (n=200) and public clinics (n=205) from March to June 2006 with an anonymous self-administered questionnaire on concerns (12- items), perceived impact (10 items) and preparedness (10 items) for an outbreak.

RESULTSTwo hundred and eighty-five PCPs responded - 149 (response rate: 72.7%) public and 136 (response rate: 67.3%) private. The majority were concerned about risk to their health from their occupation (95.0%) and falling ill with AI (89.7%). Most (82.5%) accepted the risk and only 33 (11.8%) would consider stopping work. For perceived impact, most felt that people would avoid them (69.6%) and their families (54.1%). The majority (81.3%) expected an increased workload and feeling more stressed at work (86.9%). For preparedness, 78.7% felt personally prepared for an outbreak. Public PCPs were more likely to be involved in infection-control activities and felt that their workplaces were prepared.

CONCLUSIONSMost PCPs felt personally prepared for an outbreak but were concerned about their exposure to AI and falling ill. Other concerns included social ostracism for themselves and their families. Public PCPs appeared to have a higher level of preparation. Addressing concerns and improving level of preparedness are crucial to strengthen the primary-care response for any AI outbreak.

Adult ; Animals ; Birds ; Communicable Disease Control ; methods ; Cross-Sectional Studies ; Disease Outbreaks ; prevention & control ; statistics & numerical data ; Female ; Health Care Surveys ; Humans ; Influenza A Virus, H5N1 Subtype ; isolation & purification ; Influenza in Birds ; epidemiology ; Male ; Middle Aged ; Odds Ratio ; Physicians, Family ; statistics & numerical data ; Risk Factors ; Singapore ; epidemiology ; Surveys and Questionnaires

OBJECTIVE: Tocotrienols (T3s) have been hypothesized to have greater antioxidant capacity than tocopherols (Ts) due to differences in biokinetics that affect their absorption and function. The present trial compares the antioxidant effectiveness following postprandial challenge of two different doses of α-T or palm T3-rich fraction (TRF) treatments and evaluates their dose-response effects on antioxidant status. METHODS: Ten healthy volunteers were given four different doses of vitamin E formulations (268 mg α-T, 537 mg α-T, 263 mg TRF or 526 mg TRF) in a cross-over postprandial trial. Blood was sampled at 0, 2, 4, 5, 6 and 8 hours after meal consumption and plasma antioxidant status including total glutathione, superoxide dismutase, malondialdehyde (MDA), ferric reducing antioxidant potential and trolox-equivalent antioxidant capacity, was analyzed. RESULTS: Supplementation with the different doses of either α-T or TRF did not significantly improve overall antioxidant status. There was no significant difference in overall antioxidant status among treatments at the different doses compared. However, a significant dose-response effect was observed for plasma MDA throughout the 8-hour postprandial period. MDA was significantly lower after the 537 mg α-T treatment, compared to the 268 mg α-T treatment; it was also lower after the 526 mg TRF treatment compared to the 263 mg TRF treatment (P < 0.05). CONCLUSION T3 and α-T demonstrated similar antioxidant capacity, despite markedly lower levels of T3 in blood and lipoproteins, compared to α-T.

Introduction: Acne vulgaris is a chronic inflammatory dermatosis caused by Propionibacterium acnes. Clinicians are constantly attempting to discover the best antibiotic regimes in treating acne vulgaris. This study compares two regimens in terms of efficacy, tolerability, compliance and recurrence rate to make recommendation on which is the best regime. Methods: An open-labelled prospective randomized investigator-blinded interventional study was carried on moderate acne vulgaris patients. Patients were assigned to treatment arm at enrolment followed by follow-up and maintenance visits. Demographic data were collected at enrolment and questionnaire enquiring acne condition, general health and quality of life impairment were filled at every visit followed by blinded dermatologist assessment. Antibiotic tablets were provided based on assigned arm until follow-up 3. Results: 26 mild acne vulgaris patients aged 17 to 29 years were recruited. Physician assessment based on GAGS and photo assessment analysis showed an overall significant change (p<0.05) with decreasing trend indicating that the treatment is statistically effective. However, no significant differences (p>0.05) were found between regimens. Similarly, patient self-perceived assessment and CADI assessment also showed overall significant changes (p<0.05) with increasing trend indicating improvement in acne condition but no significant differences (p<0.05) between regimens. Conclusion: Neither regimen were significantly more efficacious than another. In view of cost, oral azithromycin 500mg daily for consecutive 4 days monthly is suggested as a better option.

Aims: This study was designed to examine the enzyme activity of selected virulent isolates of Ganoderma boninense against oil palm. In a separate in vitro assessment, the effect of macronutrients on the mycelial growth of four selected Ganoderma spp. was also tested. Methodology and results: The study involved a comparison of ligninolytic enzymes; lignin peroxidase (LiP), manganese peroxidase (MnP) and laccase (Lac) profiling of eight isolates of G. boninense, categorized into three levels of aggressiveness, with two control isolates (G. boninense PER71 and G. tornatum NPG1) using solid-state fermentation (SSF). The Principal Component Analysis (PCA) revealed that the isolates had a significant production of ligninolytic enzymes on day 80. The most aggressive isolate, ET61 had the highest Lac production. As for the macronutrient test, mycelial growth for all the Ganoderma spp. was highly affected by potassium (K). Conclusion, significance and impact of study The findings of this study elucidated the characteristics of G. boninense in relation to enzyme production for the degradation of oil palm lignin and the identification of essential nutrients involved in the survival and growth of Ganoderma spp. The study provides vital information on the pathogenic characteristics of G. boninense isolates involved in biomass degradation along with the role of nutrient on the growth of Ganoderma spp. that may influence basal stem rot (BSR) management in the field.
Enzymes ; Ganoderma ; Palm Oil