BACKGROUND: The ability to achieve a long-term, stricture-free urethral repair is one of the ongoing challenges of reconstructive urologic surgery. A successful initial repair is critical, as repeat procedures are difficult, owing to distortion, scarring, and short urethral stumps. METHODS: We describe a technique in which the gracilis muscle flap is laid on or wrapped around the urethral repair site to provide a well-vascularised soft tissue reinforcement for urethral repair. This technique promotes vascular induction, whereby a new blood supply is introduced to the repair site to improve the outcome of urethral repair or anastomotic urethroplasty. The surface contact between the muscle flap and the repair site is enhanced by the use of fibrin glue to improve adherence and promote inosculation and healing. We employed this technique in 4 patients with different urethral defects. RESULTS: After a follow-up period of 32 to 108 months, all of the urethral repairs were successful without complications. CONCLUSIONS: Our results suggest that the use of a gracilis muscle flap to vascularise urethral repairs can improve the outcome of challenging urethral repairs.
Cicatrix ; Fibrin Tissue Adhesive ; Follow-Up Studies ; Humans ; Muscles ; Reinforcement (Psychology) ; Surgical Flaps ; Urethra

Antimicrobial resistance and emerging infectious diseases, including avian influenza, Ebola virus disease, and Zika virus disease have significantly affected humankind in recent years. In the premodern era, no distinction was made between animal and human medicine. However, as medical science developed, the gap between human and animal science grew deeper. Cooperation among human, animal, and environmental sciences to combat emerging public health threats has become an important issue under the One Health Initiative. Herein, we presented the history of One Health, reviewed current public health threats, and suggested opportunities for the field of public health through better understanding of the One Health paradigm.
Animals ; Communicable Diseases ; Communicable Diseases, Emerging ; Drug Resistance, Microbial ; Ecology ; Hemorrhagic Fever, Ebola ; Humans ; Influenza in Birds ; Korea ; Public Health* ; Zika Virus Infection ; Zoonoses

INTRODUCTIONSeveral randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fibrinolytic therapy in the treatment of patients with ST-segment elevation myocardial infarction (STEMI) and normal renal function. Whether this benefit extends to patients with impaired renal function is uncertain.

MATERIALS AND METHODSWe studied 1672 patients with STEMI within 12 hours of symptom onset who were admitted to 2 major public hospitals in Singapore from 2000 to 2002. All patients received either upfront fibrinolytic or PCI as determined by the attending cardiologist. Serum creatinine was measured on admission and the glomerular filtration rate (GFR) was determined using the Modification of Diet in Renal Disease equation. The impact of reperfusion strategy on 30-ay mortality was then determined for patients with GFR > or =60 mL min-(1) 1.73 m-(2) and GFR <60 mL min-(1) 1.73 m-(2).

RESULTSThe mean age was 56 +/- 12 years (85% male) and mean GFR was 81 +/- 30 mL min-(1) 1.73 m-(2). Unadjusted 30-day mortality rates for fibrinolytic-treated vs primary PCI-treated patients were 29.4% vs 17.9%, P <0.05, in the impaired renal function group and 5.4% vs 3.1%, P <0.05, in the normal renal function group. After adjusting for covariates, primary PCI was associated with a significantly lower mortality in the normal renal function group [odds ratio (OR), 0.41; 95% confidence interval (CI), 0.19-0.89] but not in the impaired renal function group [OR, 0.70; 95% CI, 0.31-1.60].

CONCLUSIONSPrimary PCI was associated with improved 30-day survival among patients with normal renal function but not among those with impaired renal function. Randomised trials are needed to study the relative efficacy of both reperfusion strategies in patients with impaired renal function.

Adult ; Angioplasty, Balloon, Coronary ; Antifibrinolytic Agents ; therapeutic use ; Electrocardiography ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; drug therapy ; surgery ; Registries ; Renal Insufficiency, Chronic ; complications ; Retrospective Studies ; Survival Analysis

BACKGROUNDThe increased incidence of pyogenic liver abscess caused by Klebsiella pneumoniae (K.pneumoniae) was reported in the recent literature. This study was conducted retrospectively to investigate the clinical characteristics and outcomes of these patients.

METHODSMicrobiological and medical databases of a medical center were searched from January 2000 to June 2003. Eighty-four patients with liver abscess caused by K.pneumoniae were analyzed.

RESULTSIn the 84 patients, 52 men and 32 women aged (58.2 +/- 13.3) years on average, 64.4% had concomitant diabetes mellitus and 23.8% had biliary disease. The most common clinical symptoms were fever (98.8%), chills (69.0%) and abdominal pain (58.3%). 85.7% of the 84 patients received catheter drainage for the abscess. The length of hospital stay was (17.4 +/- 8.7) days. The mortality rate was 7.1%. Older age and presence of biliary disease were associated with mortality.

CONCLUSIONSThe low mortality of our patients was probably related to the high proportion of patients who received catheter drainage. Older age and presence of biliary disease were associated with the mortality.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Klebsiella Infections ; complications ; Klebsiella pneumoniae ; Liver Abscess, Pyogenic ; etiology ; Male ; Middle Aged ; Retrospective Studies

Introduction: The careHPV™ Test is a US FDA approved, CE mark, and WHO prequalified in vitro diagnostic test designed to screen for 14 high-risk human papillomavirus (HRHPV) genotypes. The careHPV™ Test is one of the commercial HPV test validated to be used in low resource settings, boasting the economy of processing a maximum of 90 samples per batch and a near point-of-care turnaround time of 3 hours. According to the manufacturer, cervical swabs stored in careHPV™ Collection Medium are stable for 30 days when stored between 2-8°C. However, we often had difficulty consolidating enough samples for a full batch-test within 30 days, especially when screening women living in the low-density villages in rural Sarawak, Malaysian Borneo. This study aimed to evaluate the stability and repeatability of cervical swabs preserved in careHPV™ Collection Medium stored at 4°C exceeding the recommended 30 days using the careHPV™ Test. Methods: Two groups of confirmed HRHPV-positive and HRHPV-negative cervical swab samples in careHPV™ Collection Medium consisting of 4 samples each were maintained at 4°C and tested using the careHPV™ Test at Day -38, -123, -131, -223, and -395. Results: All cervical swabs in the careHPV™ Collection Medium stored at 4°C remained stable for testing and demonstrated 100% repeatability for at least 395 days from the day of collection. Conclusion: The careHPV™ Test can be successfully performed on cervical swabs preserved in careHPV™ Collection Medium, which were stored at 4°C for at least 395 days.

Cost of Illness ; Financial Stress ; Hepatitis B, Chronic ; Humans ; Perception ; Self Report

Background/Aims: Non-alcoholic fatty liver disease (NAFLD) is associated with the development of cardiovascular disease. While existing studies have examined cardiac remodeling in NAFLD, there has been less emphasis on the development of carotid atherosclerosis and stroke. We sought to conduct a meta-analysis to quantify the prevalence, risk factors, and degree of risk increment of carotid atherosclerosis and stroke in NAFLD. Methods: Embase and Medline were searched for articles relating to NAFLD, carotid atherosclerosis, and stroke. Proportional data was analysed using a generalized linear mixed model. Pairwise meta-analysis was conducted to obtain odds ratio or weighted mean difference for comparison between patients with and without NAFLD. Results: From pooled analysis of 30 studies involving 7,951 patients with NAFLD, 35.02% (95% confidence interval [CI], 27.36–43.53%) had carotid atherosclerosis with an odds ratio of 3.20 (95% CI, 2.37–4.32; P<0.0001). Pooled analysis of 25,839 patients with NAFLD found the prevalence of stroke to be 5.04% (95% CI, 2.74–9.09%) with an odds ratio of 1.88 (95% CI, 1.23–2.88; P=0.02) compared to non-NAFLD. The degree of steatosis assessed by ultrasonography in NAFLD was closely associated with risk of carotid atherosclerosis and stroke. Older age significantly increased the risk of developing carotid atherosclerosis, but not stroke in NAFLD. Conclusions This meta-analysis shows that a stepwise increment of steatosis of NAFLD can significantly increase the risk of carotid atherosclerosis and stroke development in NAFLD. Patients more than a third sufferred from carotid atherosclerosis and routine assessment of carotid atherosclerosis is quintessential in NAFLD.

Anti-Bacterial Agents ; therapeutic use ; Drug Resistance, Microbial ; drug effects ; Education, Medical, Continuing ; standards ; Health Knowledge, Attitudes, Practice ; Humans ; Practice Guidelines as Topic ; Singapore

Aims: The oral cavity has the most complex microbiota after the stomach. A disturbed oral equilibrium can lead to the onset and development of periodontal disease. The known causative agents are the red complex bacteria (Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola). This study was carried out to provide insights on the prevalence of periodontal pathogens in Sarawakian oral cavity since the data at present is still lacking. Methodology and results: A total of two millilitres (2 mL) of saliva samples were collected from twenty-seven (n=27) individuals (21 gingivitis, 6 healthy) between aged 18 until 30 years old, from Sarawak General Hospital. DNA extraction for the saliva samples was done by using phenol-chloroform method. Then, 16S rRNA PCR was performed followed by species-specific PCR for red complex bacteria detection. Statistical data was analysed using GraphPad Prism 8.4.1 software. As a result, 14% of gingivitis-affected female subjects were found with all the member of red complex species. Co-occurrence of red complex species was observed but no significant difference was found. An alarming presence of red complex bacteria particularly T. forsythia was detected in 57% of gingivitis subject as compared to the other red complex species. Conclusion, significance and impact of study The risk of acquiring periodontal disease increases by having at least one of the red complex species in the oral environment. Therefore, the rapid molecular detection of red complex bacteria in this study is useful for risk assessment of periodontal disease and proper species-targeted treatment to patients especially Sarawakian in general as the result has shed lights to the fairly poor oral status of volunteers.
Periodontal Diseases ; Saliva ; Mouth

Introductions: The emergence of multidrug-resistant bacteria such as Methicillin-Resistant Staphylococcus aureus (MRSA) complicates the treatment of the simplest infection. Although glycopeptides such as vancomycin still proves to be effective in treating MRSA infections, the emergence of vancomycin-resistant strains limits the long term use of this antibiotic. Bacteriophages are ubiquitous bacterial viruses which is capable of infecting and killing bacteria including its antibiotic-resistant strains. Bactericidal bacteriophages use mechanisms that is distinct from antibiotics and is not affected by the antibioticresistant phenotypes. Objectives: The study was undertaken to evaluate the possibility to isolate bacteriolytic bacteriophages against S.aureus from raw sewage water and examine their efficacy as antimicrobial agents in vitro. Methods: Bacteriophages were isolated from the raw sewage using the agar overlay method. Isolated bacteriophages were plaque purified to obtain homogenous bacteriophage isolates. The host range of the bacteriophages was determined using the spot test assay against the 25 MRSA and 36 MSSA isolates obtained from the Sarawak General Hospital. Staphylococcus saprophyticus, Staphylococcus sciuri and Staphylococcus xylosus were included as non-SA controls. The identity of the bacteriophages was identified via Transmission Electron Microscopy and genomic size analysis. Their stability at different pH and temperature were elucidated. Results: A total of 10 lytic bacteriophages infecting S.aureus were isolated and two of them namely ΦNUSA-1 and ΦNUSA-10 from the family of Myoviridae and Siphoviridae respectively exhibited exceptionally broad host range against >80% of MRSA and MSSA tested. Both bacteriophages were specific to S.aureus and stable at both physiologic pH and temperature. Conclusion: This study demonstrated the abundance of S.aureus specific bacteriophages in raw sewage. Their high virulence against both MSSA and MRSA is an excellent antimicrobial characteristic which can be exploited for bacteriophage therapy against MRSA.