To evaluate the efficacy of polygexamethylene biguanide(PHMB) in Pseudomonas aeruginosa(P. aeruginosa) keratites model, 10microliter of P. aeruginosa bacterial suspension(1x103 colony-forming unit(cfu)/ml) was injected intrastromally into rabbit corneas. Eighteen rabbits(36 eyes) were divided into three treatment groups: balanced salt solution(BSS) group(N=18 eyes). PHMB(0.02%, 200microliter/ml) group(n=9 eyes), tobramycin(14microliter/ml) group(n=9 eyes). Topical antibiotic drops were given hourly from 12 hours after inoculation. A subconjunctival infection was every 24 hours during the first 72 hours. The Severity of keratitis was scored in basked fashion every 8 hours. Corneal buttons were excised and homogenized at the end of the study to determine the viable bacterial counts. In P. aeruginosa keratitis model, tobramycin was statistically more efficacious than PHMB, according the clinical scores at 58 hours(9.9 vs. 15.1, P<0.0001) and log10 cfu(0.54+/-0.21 vs. 4.87+/-1.07. P<0.0001). No differences were found between the PHMB and BSS groups in either clinical scores or bacterial counts. PHMB appears to be ineffective against P. aeruginosa in experimental keratitis model of rabbit.
Bacterial Load ; Cornea ; Keratitis* ; Pseudomonas aeruginosa* ; Pseudomonas* ; Tobramycin

BACKGROUND: It has recently been suggested that diffusion and perfusion MRI can identify subgroups likely to benefit or potentially be harmed by reperfusion therapies. CASE REPORT: We investigated serial MRI data of two patients with occlusion of the proximal middle cerebral artery (MCA). In both cases, acute multiple cortical infarcts evident on diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) showed extensive areas of severe perfusion delays, indicating a malignant MRI profile. However, despite the malignant MRI profiles in these cases, no new ischemic lesions or hemorrhage evolved even in the presence of persistent arterial occlusion, and the patients recovered without sequelae. CONCLUSIONS: These two cases suggest that time-domain PWI findings should be interpreted with caution in certain scenarios of acute ischemic stroke.
Diffusion ; Hemorrhage ; Humans ; Ischemia ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion ; Reperfusion ; Stroke

OBJECTIVES: One of the factors that obstructs active progress of the temperament study in Korea is lack of the standardized assessment tools. Therefore, this study was designed and conducted for the purpose of Korean standardization of "Parental Temperament Questionnaire(PTQ)", which was developed by Thomas and Chess, to assess the temperament of children between the ages of 3 and 7 years through parental questionnaire. METHOD: The samples consisted of 1,175 children who were attending nurseries nationwide. PTQ was translated into Korean language by the authors and distributed to the parents of these children, along with "Toddler Temperament Scale(TTS)" and "Yale Child Inventory(YCI)" which had been previously standardized by different investigators. The reliability and validity of the Korean version of PTQ were tested. RESULTS: Test-retest reliability, item-category correlations and internal consistency of the Korean version of PTQ were generally satisfactory. Correlations between the perceived temperament and the rated temperament were statistically significant in all temperamental categories except distractibility. The correlation between PTQ and TTS was statistically significant in all categories. The 9 categories of PTQ correlated variously with 11 subscales of preschool behavioral assessment of YCI. CONCLUSIONS:The Korean version of PTQ is a standardized tool to assess the temperament of children between ages 3 and 7 years, which will be a useful basic tool for the study of temperament of Korean children.
Child* ; Humans ; Korea ; Nurseries ; Parents* ; Surveys and Questionnaires* ; Reproducibility of Results ; Research Personnel ; Temperament*

Background/Aims: To determine if patients with a positive intraoperative cholangiogram (IOC) who undergo a subsequent endoscopic retrograde cholangiopancreatography (ERCP) have an increased risk of post-ERCP pancreatitis (PEP) compared to those who undergo ERCP directly for suspected common bile duct stones. Methods: A retrospective case-control study was performed from 2010 to 2016. Cases included inpatients with a positive IOC at cholecystectomy who underwent subsequent ERCP. The control group included age-sex matched cohorts who underwent ERCP for choledocholithiasis. Multivariate logistic regression was used to assess the association between PEP and positive IOC, adjusting for matching variables and additional potential confounders. Results: Of the 116 patients that met the inclusion criteria, there were 91 women (78%) in each group. Nine patients (7.8%) developed PEP in the IOC group, compared to 3 patients in the control group (2.6%). The use of pancreatic duct stents and rectal indomethacin was similar in both groups. After adjusting for age, sex, total bilirubin levels, and any stent placement, patients with a positive IOC had a significantly increased risk of PEP (odds ratio, 4.79; 95% confidence interval, 1.05–21.89; p<0.05). Conclusions In this single-center case-control study, there was a five-fold increased risk of PEP following a positive IOC compared to an age-sex matched cohort.

Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.

Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.

INTRODUCTIONSince the fi rst imported case on 26 May 2009, pandemic (H1N1) 2009 has spread from travellers and has resulted in sustained community transmission. Singapore began with a strict containment policy where all suspected and confirmed cases of pandemic (H1N1) 2009 were admitted for testing. We describe here the clinical and laboratory characteristics of the fi rst 50 adult cases with confirmed pandemic (H1N1) 2009.

MATERIALS AND METHODSA review was conducted of medical notes of adult patients with confirmed pandemic (H1N1) 2009 by polymerase chain reaction assay from combined nasal and throat swabs admitted to the Communicable Disease Centre, Tan Tock Seng Hospital.

RESULTSFrom 26 May to 18 June 2009, 50 patients with a median age of 27 years old were admitted at a median of 3 days from illness onset. Half were male and all were travellers arriving in Singapore. Non-Singaporean citizens (38%) and other ethnic groups (40%) were over-represented. History of fever was reported in 90% and respiratory symptoms in 92%. Gastrointestinal symptoms were uncommon, present in 4% only. Temperatures on presentation of >or=38.0 degrees C, >or=37.8 degrees C and >or=37.5 degrees C were present in 48%, 56% and 76%, respectively. Only 46% of patients met the United States Centers for Disease Control and Prevention (US CDC) case definition of influenza-like illness (ILI). Clinical and laboratory findings were unremarkable for the majority. All cases were treated with oseltamivir and had uncomplicated recovery.

CONCLUSIONPandemic (H1N1) 2009 had mild clinical and laboratory findings in immunocompetent patients. Use of the US CDC ILI criteria alone would have detected less than half of confirmed cases.

Adult ; Communicable Diseases, Emerging ; epidemiology ; Disease Outbreaks ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; isolation & purification ; Influenza, Human ; diagnosis ; epidemiology ; Male ; Medical Audit ; Middle Aged ; Polymerase Chain Reaction ; Singapore ; epidemiology ; Young Adult