Genital ulcer disease is a common presentation of sexually transmitted infections (STIs) and can cause significant morbidity in patients. Syphilis (chancre of primary syphilis) and genital herpes are the two most significant ulcerative STIs and are occasionally indistinguishable clinically. Infectious syphilis is on the rise in Singapore particularly in men who have sex with men (MSM); whilst genital herpes although showing a decreasing incidence in recent years still presents with more than 500 notifications a year as first episode genital herpes. Due to the breaks in the mucosa of the skin caused by the ulcers, the risk of acquisition as well as transmission of HIV infection are both increased making timely treatment of genital ulcers of utmost importance. Although uncommon in Singapore, chancroid, LGV and granuloma inguinale remain endemic in some parts of Asia and there should be a high index of suspicion for patients who have returned from these regions presenting with ulcerative lesions. All patients who present with genital ulcers should have their blood tested for syphilis and HIV as well as a swab for culture or PCR testing taken from the ulcer to exclude genital herpes.

Objective: To establish the chemical fingerprint of various secondary metabolites of Zanthoxylum rhetsa (Roxb.) DC, a medicinally important plant. Methods: Preliminary phytochemical screening for various secondary metabolites was carried out. HPTLC profiles of various individual secondary metabolites were done and profiles were developed for authentication. Result: The ethanolic extract of the fruit showed the presence of 8 Glycosides, 10 Flavonoids, 6 Essential Oils, 5 Anthraquinones, 9 bitter principles, 7 Coumarins and 8 Terpenoids. Conclusions: The development of such fingerprint for the fruits of Zanthoxylum rhetsa (Roxb.) DC is useful in differentiating the species from the adulterant and also act as biomarker for this plant in the Pharmaceutical industry.

Aims: Indian folk medicine has been in practice from time immemorial. Traditional medicine interconnects our body with nature for a healthy living. The naturally occurring antimicrobials in food vary in their efficacy and function, toxicology, safety and mechanism of action against microorganisms. Methodology and Results: The study revitalizes the traditional system of medicine in order to achieve self reliance in health care and health for all by analyzing the antimicrobial property of aqueous extracts of aloevera (Aloevera barbedensis), carrot (Daucus carota), Indian gooseberry (Emblica officinalis), honey and pomegranate (Punica granatum), and to assess the reason for inhibition of growth of pathogenic organisms by DNA and protein analysis. Various aqueous extracts showed inhibition to microrganisms like Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi, Shigella flexineri and Staphylococcus aureus. Conclusion significance and impact of study: The study also formulated and standardized a nourishing health drink and salad using the tested foods and estimated their shelf life and nutritive value. The health drink and salad had a low protein, low fat and moderate carbohydrate content. Therapeutically this drink and salad can be used to treat obesity.

Background Autoimmune pemphigus is a potentially life threatening bullous disease. The cornerstone of treatment is systemic corticosteroids. However, adjuvant therapy with immunosuppressant drugs is commonly used to improve disease control and alleviate the high morbidity and mortality associated with the use of corticosteroids. Adjunctive treatment with pulse intravenous cyclophosphamide may be more efficacious and less toxic than other immunosuppressants. Objective To retrospectively review the clinical outcome of 18 patients with recalcitrant pemphigus who were treated with cyclophosphamide over the past 10 years. Methodology A retrospective study was conducted between 1985 and 2009 in thirteen Malaysian dermatology centres. Data collected were analysed for comparison of relapse rates, compliance rates and adverse drug effects between the 2 regimes. Results Eighteen patients were included in this audit of which 12 patients had pemphigus vulgaris and 6 patients had pemphigus foliaceous. Prior to treatment with cyclophosphamide, fourteen patients were on azathioprine, three were given intravenous immunoglobulin, and two were prescribed dapsone; however all these patients were either unresponsive, intolerant or suffered serious side-effects with these drugs. Subsequently, 7 patients (median age: 31 years) received a combination of pulse intravenous cyclophosphamide and either intravenous dexamethasone or methylprednisolone. These seven patients received between 2 to 21 pulses of intravenous cyclophosphamide and steroids at monthly intervals with oral prednisolone and cyclophosphamide (50-100mg) in between pulses. The remaining 11 patients (median age: 46 years) received oral cyclophosphamide and corticosteroids. Of the 18 patients in our cohort, 15 achieved control and consolidation of disease activity at an average of 4 weeks and 10 weeks respectively. The remaining three patients are yet to achieve disease control. The total duration of treatment with cyclophosphamide ranged from 2 to 62 months with a cumulative dose ranging from 2.95g to 93.55g. Four patients achieved partial remission on minimal therapy and 3 achieved complete remission. None of patients experienced serious side effects. Conclusion Cyclophosphamide may be an alternative treatment option in patients in patients with pemphigus who fail to respond to standard therapy. Controlled trials are needed to further evaluate the efficacy and safety of this therapy.

Objective: To determine the chemical composition and antioxidant potential of essential oil isolated from the leaves of Curcuma longa (turmeric). Methods: Chemical composition of the oil was analyzed using GC-MS. Antiperoxidative potential was evaluated using linoliec acid emulsion system. Free radical scavenging activity was evaluated using stable DPPH and ABTS free radicals. Results: GC-MS analyses showed that major compound present in the turmeric leaf oil is b-sesquiphellandrene (22.8%) followed by terpinolene (9.5%). Essential oil also exhibited reductive potential and antioxidant potential in linoleic acid emulsion system along with DPPH and ABTS free radical scavenging potential. Conclusions: The overall result suggests that turmeric leaf oil is capable of retarding oxidation reaction and free radical mediated damage and can be developed as a potent natural antioxidant.

Objective: To explore the biotechnological potential of Ophiorrhiza mungos for micropropagation and camptothecin (CPT) production from in vitro grown plants.Methods: Surface sterilized explants of O. mungos were transferred aseptically in MS media containing various combinations of phytohormones for callus initiation and multiple shoot proliferation. The content of CPT was quantified in the methanolic extract of O. mungos plants and in in vitro grown plants by using high performance liquid chromatography (HPLC). Results: Maximum fresh weight and dry weight biomass of O. mungos callus was obtained from MS medium supplemented with IAA (2 ppm)+ BAP (2 ppm) + GA (1 ppm). The maximum shoot proliferation (25) and elongation (6.5 cm) was found in MS medium supplemented with Picloram + Thidiazuron + Gibberellic Acid in 1:2:1 ratio after four weeks of incubation. The maximum content of CPT (0.0768 % w/w) was found in wholein vitro plants whereas the minimum CPT was observed in adventitious buds (0.0026 % w/w) as compared to the naturally grown O. mungos plants (0.0030% w/w).Conclusions: Present findings indicate that O. mungos plants respond favourably for in vitro propagation and also produce higher amount of CPT as compared to naturally grown plants.

In recent years HIV infections have declined in many parts of the world, however, there are still 35 million persons living with HIV infection and 2.1 million new infections occurred in 2011 worldwide. In many areas HIV continues to affect certain at risk communities viz. men who have sex with men, sex workers, clients of sex workers and injecting drug users. In Singapore the number of newly diagnosed HIV infections appears to have stabilised, however the current trend is that infected individuals are presenting at a late stage of infection and more HIV infections are being diagnosed among MSM and fewer in heterosexuals. The trend for other sexually-transmitted infections is generally stable, with gonorrhea, Chlamydia trachomatis infection and anogenital herpes showing decreases, whilst the incidence of syphilis showed an increase in 2012. Interviews with patients attending the DSC Clinic indicate that most STIs are contracted locally from casual partners. Unregulated sex workers are more frequently cited as primary contacts than are local regulated sex workers, who continue to have very low levels of STIs, underlining the benefits of the programme of routine screening, treatment and condom negotiation skills training provided by the Department of STI Control (DSC) Clinic in Singapore.

Introduction: Stevens Johnson syndrome (SJS), Stevens Johnson Syndrome - toxic epidermal necrolysis overlap syndrome (SJS-TEN overlap), toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome (DHS) are well known severe adverse cutaneous drug reactions (SACDRs). All clinicians are responsible for the diagnosis and management of SACDR. Objective: To retrospectively review the clinical patterns, management strategies and outcome of 134 patients with severe adverse cutaneous drug reactions managed at the Department of Dermatology, Kuala Lumpur Hospital between 2006 and 2010. Results: The mean age of presentation was 44.8 years (13-83). The male: female ratio was 1:1. There were 68 cases (50.7%) of SJS, 10 cases (7.5%) SJS-TEN overlap, 32 cases (23.9%) TEN and 24 cases (17.9%) DHS. The five commonest drugs associated with SACDRs were allopurinol (26.9%), carbamazepine (13.4%), phenytoin (9.7%), non-steroidal anti-inflammatory drugs (11.2%) and co-trimoxazole (7.5%). The mean duration of drug exposure before the onset of reaction was 2.8 weeks. A hundred and thirty patients (97%) were managed as in-patient. The mean duration of in-patient stay was 12.4 days. All identified culprit drugs were withheld. Systemic corticosteroids was given to 96% cases of DHS with mean duration of 9.7 weeks; 52.9% of SJS with mean duration of 2.8 weeks; 60% of SJS-TEN overlap with mean duration of 2.3 weeks; and 62.5% of TEN with mean duration of 3.3 weeks. Thirteen patients (42%) with TEN were treated with intravenous immunoglobulin. Eight patients (6%) died, of which 7 were TEN and one DHS. Conclusion: SACDRs are life-threatening emergencies which not only results in significant morbidity and mortality; but also potentially increases the health care cost and burden. Clinicians should recognize high risk medications and prescribe them with great caution.

Health care systems play a vital role in providing health services and in optimising the population’s health of each nation. The Malaysian health care system primarily consists of the public and private health services. One of the prominent private health care services offered in the General Practitioner’s (GP) Clinic. Despite the prominent role GPs play in the health care system in this country, little is known about their practices, the issues and challenges faced by GPs in this country. The objective of this study was to describe the current GP practice operations in Malaysia in terms of its general operations, financial expenditure and revenue, market competitiveness and laboratory services offered by the clinics. A cross-sectional survey design was used in this study. The study sample comprised of 1800 GPs throughout the West of Malaysia selected using convenient sampling technique. This study provides the general description of the GP operations in terms of the nature of business, operations hours, and number of patients, the third party administrator and managed care organisation linkages, financial expenditure, market competitiveness and laboratory services. The findings of the study reveal that the expenditure of managing GP services has increased over the years due to the changes in policies as well as the involvement of third party administrators in the healthcare system despite it playing an instrumental role in complimenting the healthcare services for the public at large.

Branches of the posterior division of the mandibular nerve show various anomalous communications in the infratemporal region. Understanding such communication has relevance in the management of neuropathies and surgical procedures in this region. This study was conducted to explore such communicating branches, anticipating that they might provide information of clinical significance. A total of 15 human cadavers (30 infratemporal regions) were studied to explore such communicating branches in infratemporal region. The branches of the posterior division of the mandibular nerve were carefully dissected, and these branches were studied and analysed for any abnormal course. In one case, a rare type of bilateral communication between the auriculotemporal nerve and the inferior alveolar nerve, forming a loop with no association with any structure, was observed. It is possible that such communicating branches may be associated with delayed regression of the first arch vessels. The clinical implications of these anomalous communications require further detailed study for improved management of neuropathies and surgical procedures.