Adult ; Female ; Forced Expiratory Volume ; Humans ; Lung ; physiology ; Malaysia ; Male ; Occupations ; Respiration ; Singapore ; United Kingdom ; Vital Capacity

Aged ; Aged, 80 and over ; Deglutition Disorders ; therapy ; Diagnosis, Differential ; Electrocardiography ; Fatal Outcome ; Humans ; Intubation, Gastrointestinal ; adverse effects ; instrumentation ; Male ; Myocardial Infarction ; diagnosis ; etiology ; Stress, Physiological

Background Sexually transmitted infections (STIs), and HIV especially, are a major health problem in Malaysia. The emergence of HIV infection has increased the importance of early and effective treatment of STIs as any delay may lead to enhance transmission or acquisition of HIV infection. A proper understanding of the patterns of STIs is necessary for effective planning and control strategies. The present study is designed to determine the changing pattern of STIs in the Genito-urinary Medicine Clinic (GUM), Hospital Kuala Lumpur (HKL). Objective To study the sociodemographic characteristics of patients with STIs attending the GUM Clinic in HKL and to analyze any changes in the pattern of STIs seen between the 2 study periods of 1995-1999 and 2001-2005. Method A retrospective review of case notes of new patients with STIs attending the GUM clinic, HKL was done during two study periods of 1995-1999 (Poster presentation on “Pattern of STDs” at 14th RCD, Asia-Australasia, 26-30 July 2000, KL, Malaysia by HB Gangaram et al) and 2001-2005. Results In 1995-1999, a total of 3150 STI patients were studied. Among them, 2016 (64%) were males and 1134 (36%) were females. In 2001-2005, a total of 2909 STI patients were examined, of which 1862 (64%) were males and 1047 (36%) were female. There was a decrease of 8.3% in the total number of cases seen in 2001-2005 as compared to 1995-1999. The decline was more evident with bacterial STIs which included syphilis, gonorrhoea, NGU and chancroid. Viral STIs which consisted of herpes genitalis, genital warts and HIV showed an increasing trend. A younger age group (20-39 years old) appeared to be infected with STIs in 2001-2005. Males outnumbered females in the ratio of 1.8:1, which remained unchanged in both the study periods. Based on ethnicity, there was an increase in the percentage of Malays being infected in STIs in the later study period. Syphilis was the commonest STI seen in both the study periods. The second commonest STI seen in 1995-1999 was gonorrhoea and non-gonococcal urethritis (NGU). In 2005, there were 184 patients with syphilis; 64% were heterosexuals; 39.6% homosexuals and 1.6% bisexuals. Majority (82%) were asymptomatic (latent syphilis with positive syphilis serology at presentation. Symptomatic patients with early infectious syphilis constituted 15% (Primary 8%; Secondary 7%). Screening for HIV was positive in 31 (16.8%) patients. HIV infection was noted to be the commonest STI associated with syphilis. Conclusion was an overall decline in the number of patients with STIs attending the GUM clinic, HKL. The decline was more evident with bacterial STIs; viral STIs however showed an increasing trend. Syphilis was still the commonest STI seen in the two study periods although the percentage has declined. Non specific urethritis has superseded gonorrhoea as the second commonest STI. HIV was found to be the commonest STI seen in association with syphilis.

Bile ; analysis ; Calcium Carbonate ; metabolism ; Gallbladder Diseases ; diagnosis ; metabolism ; Humans ; Hydrogen-Ion Concentration ; Male ; Middle Aged

Pattern

A 68-year-old Chinese man presented with an eight-month history of pyrexia of unknown origin and chronic sinusitis despite multiple courses of antibiotics. He underwent extensive investigations, including workups for infections, chronic granulomatous diseases and malignancy. Nasal biopsies were performed twice under local anaesthesia, but did not show any evidence of malignancy. Eventually, the patient was diagnosed with natural killer (NK)/T-cell lymphoma, nasal variant, based on histopathological findings from harvested deep tissue obtained via functional endoscopic sinus surgery. This study highlights that, for patients presenting with pyrexia of unknown origin and nasal symptoms, NK/T-cell lymphoma must be considered as a differential diagnosis. Generous amounts of tissue should be harvested under general anaesthesia rather than limited tissue under local anaesthesia, in order to facilitate and ensure a definitive diagnosis.
Aged ; Anti-Bacterial Agents ; chemistry ; Biopsy ; China ; Humans ; Lymphoma, Extranodal NK-T-Cell ; diagnosis ; diagnostic imaging ; pathology ; Male ; Nasal Cavity ; pathology ; Nose Neoplasms ; complications ; diagnosis ; radiotherapy ; Prognosis ; Radiography ; Radiotherapy ; Sinusitis ; complications ; diagnosis ; Treatment Outcome

Cerebrovascular Disorders ; diagnostic imaging ; Clinical Medicine ; Humans ; Neuroradiography ; methods ; trends ; utilization ; Stroke ; diagnostic imaging

Adult ; Groin ; injuries ; Humans ; Intercellular Signaling Peptides and Proteins ; blood ; therapeutic use ; Male ; Tendon Injuries ; drug therapy ; therapy ; Weight Lifting ; injuries

Assessment: Cognition ; Chronic cough

INTRODUCTIONStenotrophomonas maltophilia is an emerging pathogen in nosocomial infections that may result in high mortality. S. maltophilia often present as part of a polymicrobial culture and it is not well established when treatment is indicated. We aimed to identify predictors of mortality in patients with positive cultures of S. maltophilia.

MATERIALS AND METHODSA retrospective cohort study in a tertiary care medical centre was performed in 150 adult patients with positive cultures of S. maltophilia. Patients' demographics, underlying diseases, severity of illness, length of hospitalisation, prior antibiotic exposure, number/types of indwelling catheters, culture sites, and appropriateness of empiric therapy were collected. Logistic regression was used to determine the independent risk factor(s) for infection-attributed mortality.

RESULTSNinety-nine males and 51 females were studied. The mean (SD) age and APACHE II score of the patients were 61.9 (16.0) and 14.0 (6.1), respectively. The respiratory tract was the most frequent site (55.3%) where S. maltophilia was isolated. Infection-attributed mortality was observed in 22 of the 150 patients (14.7 %). Admission to ICU [Odds ratio (OR), 3.767; 95% confidence interval (CI), 1.277-11.116, P = 0.016], and delayed effective treatment (OR, 18.684; 95% CI, 4.050-86.188; P <0.001) were identified as independent risk factors for mortality.

CONCLUSIONSPredictors of mortality in patients with positive cultures of S. maltophilia were identified, which may guide clinicians in patient assessment and devising therapeutic decisions. Further studies are needed to validate our results.

APACHE ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Infective Agents ; therapeutic use ; Cohort Studies ; Confidence Intervals ; Cross Infection ; drug therapy ; mortality ; Female ; Gram-Negative Bacterial Infections ; drug therapy ; mortality ; Humans ; Intensive Care Units ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Respiratory System ; microbiology ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Stenotrophomonas maltophilia ; drug effects ; isolation & purification ; Treatment Outcome ; Trimethoprim, Sulfamethoxazole Drug Combination ; therapeutic use