Background: Individuals with AD have an increased susceptibility to colonization with Staphylococcus aureus (S. aureus), contributing to the exacerbation of the disease. Sodium hypochlorite (bleach) has both in vitro and in vivo antimicrobial activity against S.aureus. Objectives: To evaluate the efficacy and safety of diluted sodium hypochlorite (bleach) baths in patients with moderate to severe atopic dermatitis in our Malaysian population. Methods: This was a prospective randomized, investigator-blinded, placebo-controlled study. Patients were randomly assigned through computer generated simple randomized numbers to treatment (bleach baths) or placebo (distilled water baths). Patients were instructed to soak in the baths neck down for 10 minutes, twice a week for 2 months. The efficacy outcome measures were the Eczema Area and Severity Index (EASI) score, percentage body surface area involved, quantitative S. aureus counts and patient’s assessment of overall response (including itch scores). Safety outcomes were also assessed. Results: A total of 36 patients completed the study. EASI scores and body surface area showed significant improvement between treatment and placebo groups at 2 months (p=0.02, p=0.02). At baseline, 88% of patients yielded S. aureus from lesional skin. Although most cultures in the treatment group continued to yield S. aureus, there was a reduction in the density over time, although not statistically significant. Five patients reported burning/stinging and dry skin in the treatment arm which did not differ significantly compared to placebo. Conclusion: Diluted sodium hypochlorite baths as an adjunctive treatment decreased the clinical severity of patients with moderate to severe atopic dermatitis and may reduce S. aureus density. This treatment was well tolerated with minimal adverse effects.

Background & Objective: Symptomatic sarcocystosis has been said to be rare until recent years, when there were reports of outbreaks of febrile myositis for travellers returning from the Malaysian island resorts. In 2012, an outbreak of Sarcocystis nesbitti infection involving 92 college students and staff occurred after returning from Pangkor Island, Malaysia. A few months after recovering from the febrile illness, some patients complained of hair loss. This study aimed to determine the prevalence, clinical features and outcome of this disorder. Methods: All patients who became sick in the outbreak were asked whether they had the hair loss. For those who had, they were interviewed with standard questionnaires, examined and investigated. Patients were followed-up via an online survey 2 years later. Results: Out of 89 patients who were ill, 19 patients (21.4%) complained of alopecia. The mean peak onset was 4 months after the initial illness. Eleven patients (57.9%) reported the hair fall of more than 100 per day. The other symptoms were itch 10 (52.6%), scaling 10 (52.6%), erythema 4 (21.1%), none had scarring. Eleven patients (57.8%) had positive antinuclear factor with high titre (speckled or nucleolar pattern). Two years after the event, 10 had complete or near complete spontaneous recovery, 1 had partial response and 1 had no improvement. Conclusions: A delayed transient diffuse alopecia is seen in close to half of patients with Sarcocystis nesbittiinfection. This high frequency of positive ANF suggested an immune-mediated mechanism.
Sarcocystosis

Syphilis is an ancient sex u a l ly transmitted infection, described since centuries ago, caused by the bacterium Treponema pallidum. Syphilis or luetic disease is known as the great imitator as it can have myriads of clinical presentations, often making it a diagnostic challenge to clinicians. We report a patient with secondary syphilis, wh o presented with scaly plaques on his trunk and face, sparing the palms and soles.

This report describes a case of malignant granular cell tumour arising in the mediastinum, detailing the investigations undertaken to reach this rare diagnosis. A 63-year-old man was referred from the Pacific Islands for investigation of a 8cm mediastinal mass extending into the left pleura and associated with pleural nodules and pleural effusion. Needle aspiration via bronchoscopy yielded insufficient material for cytological interpretation and needle biopsy showed normal respiratory epithelium. CT-guided FNA revealed scattered large polygonal to spindle cells with granular cytoplasm and indistinct borders. The needle core biopsy yielded scanty cells with abundant granular cytoplasm, oval and regular nuclei which were moderately positive for CD68, vimentin and S100 and negative for CKMNF116, CK5/6, CK7, CK20, TTF-1, chromogranin and synaptophysin. In view of the benign morphology, these cells were interpreted to be histiocytes. The incisional biopsy revealed cords and trabeculae of cells identical to the CT samples. These cells were polygonal with abundant granular cytoplasm. Some cells showed large eosinophilic cytoplasmic globules not seen in the FNA sample. The tumour was however, heterogeneous in appearance with some areas exhibiting criteria of malignancy: necrosis, vesicular nuclei with large nucleoli, high nuclear-to-cytoplasmic ratio and nuclei pleomorphism. In addition, p53 expression in 10% of tumour nuclei, a high Ki67 proliferative rate (>10%), the deep seated location and extension of the tumour into adjacent organs favoured a diagnosis of malignancy.

Estrogen is a steroid and the predominant female sex hormone in the body. Ovariectomised (OVX) adult female rats exhibit greater myocardial injury compared to the sham rats following ischemic insult in the presence of beta-adrenoceptor stimulation. Estrogen replacement restores the response of OVX female rats to ischemic/beta-adrenoceptor stimulation to that of normal female rats, providing evidence for a cardioprotective role of estrogen during ischemic insult. The protective effect is due to down-regulation of the beta(1)-adrenoceptor. There is also evidence that estrogen suppresses the expression and activity of protein kinase A (PKA), a second messenger of the G(s) protein/adenylyl cyclase/cAMP/PKA pathway which ultimately influences contractile function. There is also preliminary evidence that estrogen may suppress the activity of Ca(2+)/calmodulin kinase II deltac isoform (CaMKII-deltac), another downstream second messenger of the beta(1)-adrenoceptor pathway, which is involved in PKA-independent cell apoptosis. Acute administration of estrogen at physiological level could inhibit myocardial beta(1)-adrenoceptor and attenuate Ca(2+) influx independent of the estrogen receptor. In addition, brain studies also show estrogen inhibits the activities activated by the beta-adrenoceptor in brain regions responsible for the regulation of arterial blood pressure. Thus, it can be appreciated that the interaction between estrogen and the beta(1)-adrenoceptor and its signaling pathways is a complex one. Estrogen plays an important role not only in reproduction but also in other regulatory functions such as cardioprotection.
Animals ; Cyclic AMP-Dependent Protein Kinases ; Down-Regulation ; Estrogens ; physiology ; Female ; Gonadal Steroid Hormones ; Heart ; physiology ; Heart Diseases ; prevention & control ; Myocardium ; Rats ; Rats, Sprague-Dawley ; Receptors, Adrenergic, beta-1 ; physiology ; Signal Transduction

Aims: Palm oil mill effluent (POME) is a major agricultural waste product of Malaysia. The aim of this study was to identify endophytic fungi capable of producing biofuel feedstock utilizing POME. Methodology and results: Endophytes were isolated from the Nipah palm tree, Nypa fruticans, and exposed to different POME concentrations (25%, 50% and 75%), with and without the addition of nutrients. The utilization of glucose was measured using the Dinitrosalicylic Acid assay whereas the lipid content in the fungal cells was extracted using the Bligh and Dyer method with slight modifications. Three endophytic fungi that displayed the highest growth on POME were identified using ITS 1 and 4 primers and found to be related to Pestalotiopsis sp., Lasiodiplodia theobromae and Rhizoctonia bataticola. Nutrient addition caused an average increase of 8 times in biomass, indicating nitrogen requirement for cell proliferation. The highest POME concentration (75%) resulted in lower biomass yield. Furthermore, all fungal samples in high POME concentration and nutrient conditions showed a decrease in lipids accumulated per milligram of biomass whereby lipid synthesis was enhanced under nitrogen limitation (25% without nutrients). Conclusion, significance and impact of study: In conclusion, all fungal samples can be classified as oleaginous microorganisms with Pestalotipsis sp. being the most efficient (up to 70% of its biomass). This is to our knowledge the first study that shows the potential use of Pestalotiopsis sp., L. theobromae and R. bataticola for the utilisation of POME as biofuel feedstock and could in the future potentially provide an alternative approach to the treatment of POME with value-added effect.

Background：In November 2012, an outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections affecting students at a boarding school in Hong Kong Special Administrative Region (China) was detected.Methods：A case was defined as any student or staff notified with MRSA infection from 25 October 2012 to 5 July 2013 with the clinical isolate being of staphylococcal cassette chromosome mec type IV or V and positive for Panton-Valentine leukocidin gene. We conducted field investigations, advised on control measures and enhanced surveillance for skin and soft tissue infections at the school. Decolonization therapies were offered to all cases and contacts, and carrier screening was conducted.Results：There were five cases; two (40%) were hospitalized and three (60%) required surgical treatments. Initial screening comprised 240 students and 81 staff members. Overall, four cases (80%) plus eight other students (3.3%) were carriers, with eight of 12 (66.7%) from the same dormitory. All staff members screened negative. After intensified control measures, the number of students screened positive for CA-MRSA decreased from nine to one with no more cases identified in the school.Conclusion：Identification of carriers, decolonization therapy, monitoring of cases and contacts and strengthening of environmental and personal hygiene were control measures that helped contain this CA-MRSA outbreak in a boarding school in Hong Kong Special Administrative Region (China).

The International Health Regulations (IHR) (2005) require World Health Organization Member States to notify events fulfilling two of four criteria: (1) serious public health impact; (2) unusual or unexpected event; (3) significant risk of international spread; or (4) significant risk of international travel or trade restrictions. In-flight transmission of infections like severe acute respiratory syndrome is well documented. With the enormous amount of air travel today, the risk of increasing in-flight transmission and subsequent international spread of infections are increasing. Prompt notification and information sharing under the IHR mechanism is critical for effective contact tracing and prompt control measures. We report on a case of in-flight exposure to an infection with significant public health risks that was successfully resolved using IHR (2005) guidelines.

No abstract available.

INTRODUCTIONThe aim of this study was to determine the prevalence of hearing loss amongst the elderly population attending community services in Singapore. The usefulness of the Hearing Handicap Inventory for the Elderly Screening version (HHIE-S) in detecting hearing loss was also investigated.

MATERIALS AND METHODSPure-tone audiometry was carried out on a randomly recruited cohort of people (n = 338) over 60 years old and who were attending rehabilitation and social day care services for senior citizens at St Luke's Elder Care centres located throughout the city. Prior to the hearing test, subjects were administered the HHIE-S questionnaire, which was translated into the language they were most conversant in.

RESULTSThe study cohort showed mean pure-tone average at speech frequencies (0.5, 1, 2 and 4 kHz; 4-frequency average hearing level [4FA HL]) of the subjects' better hearing ear that has worsened with age. The percentage of the elderly with disabling hearing impairment (4FA >40 dB HL) was 9.1% (60 to 69 years old), 22.0% (70 to 79 years old), 35.7% (80 years old and above). Across all age groups, males had significantly poorer thresholds at 4 kHz than females. When adjusted for the demographic profile of the country, the prevalence of hearing loss (4FA >25 dB HL) and disabling hearing impairment (4FA >40 dB HL) amongst the elderly in Singapore was 63.7% and 16.2%, respectively. We estimate that there are currently 422,000 elderly with hearing loss greater than 25dB HL and over 100,000 elderly with disabling hearing loss of over 40 dB HL. Of subjects with a disabling hearing impairment, only 7.5% used hearing aids. The use of self-reporting HHIE-S showed poor sensitivity in detecting hearing loss of various severities amongst the elderly.

CONCLUSIONThese data provide estimates of the prevalence and severity of hearing loss in older persons in Singapore and suggest that more can be done to help the elderly recognise, acknowledge and address hearing loss in the country.