No abstract available.
Histocompatibility Antigens* ; Histocompatibility*

Space spraying of chemical insecticides is still an important mean of controlling Aedes mosquitoes and dengue transmission. For this purpose, the bioefficacy of space-sprayed chemical insecticide should be evaluated from time to time. A simulation field trial was conducted outdoor in an open field and indoor in unoccupied flat units in Kuala Lumpur, to evaluate the adulticidal and larvicidal effects of Sumithion L-40, a ULV formulation of fenitrothion. A thermal fogger with a discharge rate of 240ml/min was used to disperse Sumithion L-40 at 3 different dosages (350 ml/ha, 500 ml/ha, 750 ml/ha) against lab-bred larvae and adult female Aedes aegypti and Aedes albopictus. An average of more than 80% adult mortality was achieved for outdoor space spray, and 100% adult mortality for indoor space spray, in all tested dosages. Outdoor larvicidal effect was noted up to 14 days and 7 days at a dosage of 500 and 750 ml/ha for Ae. aegypti and Ae. albopictus, respectively. Indoor larvicidal effect was up to 21 days (500 ml/ha) and 14 days (750 ml/ha), respectively, after spraying with larval mortality > 50% against Ae. aegypti. This study concluded that the effective dosage of Sumithion L-40 thermally applied against adult Ae. aegypti and Ae. albopictus indoor and outdoor is 500 and 750 ml/ha. Based on these dosages, effective indoor spray volume is 0.4 – 0.6 ml/m³. Additional indoor and outdoor larvicidal effect will be observed at these application dosages, in addition to adult mortality. INTRODUCTION Dengue is a serious public health disease in Malaysia since the first nationwide dengue outbreak in 1973; the most prevalent vectors for dengue are Aedes aegypti and Aedes albopictus (Lee et al., 1997). In the continued absence of specific treatment and effective vaccine against dengue virus, dengue control relies on suppressing Aedes populations and subsequent interruption of disease transmission through the use of insecticides, especially during outbreaks (Esu et al., 2010). The organophosphate fenitrothion was applied in space spraying for dengue and malaria control since 1970s (Samutrapongse & Pant, 1973; Pant

More people are traveling to remote places for leisure and business. It is not uncommon for patients to get medication and advice for travel to high altitudes. Although high altitude cerebral and pulmonary oedemas are more frequent at very high and extreme altitudes, they may sometimes occur at lower altitudes and lead to fatalities. Even though acute mountain sickness (AMS) is generally deemed benign, it can easily wreck a holiday. The Lake Louise Score Questionnaire is a useful screening tool for AMS and it can be self-administered during travel. Non-pharmacological means in the prevention and treatment of AMS, especially acclimatisation, are the most important. Pharmacological prevention and treatment strategies should be used as a useful adjunct. This paper provides an approach to the provision of education and advice for high altitude travel in the primary care setting.

This is a case report of subcutaneous mycosis presenting as a non-healing left calf ulcer in an immunocompromised patient. Traumatic inoculation of the causative agent is the most likely route of infection. The diagnosis requires a detailed history and high clinical suspicion, confirmed by histopathological examination. The management requires a multidisciplinary team approach involving surgeon, pathologist, physician sub-specialised in infectious disease, wound care nursing team as well as social support services. The literature review recommended that the treatment of choice for such infection is surgical debridement in addition to optimal antifungal therapy.
Mycoses

OBJECTIVEUnderstand the public's current attitudes and knowledge about suicide and, thus, provide essential information to the development of targeted public education programs-important components of the suicide prevention effort.

METHODSSeventeen mental health professionals who were extensively trained in the methods of conducting focus groups used a pre-tested focus group outline on attitudes and knowledge about suicide to conduct 101 focus groups and 18 individual in-depth interviews with a total of 842 community respondents from 6 regions in northern China. The focus groups and in-depth interviews were audio-taped, transcribed and analyzed using the QSR Nvivo text analysis software.

RESULTSMost respondents believed that suicide was a greater problem in rural areas and among women and identified physical illnesses, economic problems and interpersonal conflicts (particularly family conflicts) as the main causes of suicide. Rural residents and women were believed to exhibit impulsive suicidal behavior because of their personal limitations and over-sensitiveness. Most thought that suicide was understandable and a small proportion felt that it was acceptable behavior in certain circumstances. Almost all felt that suicide resulted in the stigmatization and a loss of 'face' for the family. Most believed that one should show concern for persons who have suicidal behavior and their family members and expressed a willingness to have superficial social relationships with them but were unwilling to establish close personal relations with them. The vast majority believed that suicide was either very difficult or impossible to prevent.

CONCLUSIONSIn China the community is tolerant, sympathetic and, in some cases, accepting of suicide but there remains a substantial underlying stigmatization of suicide. Community members have some misunderstandings about suicide; the most obvious misunderstanding is the underestimation of the importance of mental illness as a cause of suicide. The content of public health messages used in suicide prevention programs should be developed by combining findings from both qualitative and quantitative research.

Retrospective review.

Retrospective review.

Splenic artery embolization plays an important role in the management of various medical and surgical conditions that are non-traumatic in etiology, in addition to its well-established and widely discussed role in managing splenic trauma. In nontraumatic emergencies of catastrophic bleeding originating from the spleen or splenic artery, splenic artery embolization can be effective in achieving hemostasis as a definitive management, temporary stabilizing measure, or preoperative optimization technique. In addition to emergency clinical conditions, splenic artery embolization can be performed electively as an alternative to splenectomy for managing patients with hypersplenism.Herein, we report 6 cases of splenic artery embolization performed at our center to highlight its various indications. This article aims to demonstrate the role of splenic artery embolization in different clinical scenarios and the considerations behind the techniques employed through illustrative cases.

INTRODUCTION: Single-disease clinical practice guidelines (CPGs) are not designed to consider patients with multiple chronic conditions, or multimorbidity. Applying multiple CPGs to a single patient may create an overwhelming treatment burden resulting in poor adherence and clinical outcomes. No studies on the cumulative treatment burden from multiple CPGs have been done in Singapore. We described the treatment burden on a hypothetical patient with six chronic conditions when multiple CPGs were applied, and appraised each CPG with respect to the patient-centred care of older adults with multimorbidity. METHODS: A treatment plan was developed for a hypothetical 72-year-old woman with asthma, depression, diabetes mellitus, dyslipidaemia, hypertension and osteoarthritis according to the latest CPG recommendations. Treatment burden was quantified in terms of time spent, cost, and the number of appointments and medications. Each CPG was appraised with respect to the care of older adults, patients with multimorbidity and patient-centred care. RESULTS: Following the CPGs strictly, an average of about two hours was spent daily taking 14 different medications and following 21 non-pharmacological recommendations. Her out-of-pocket payment was SGD 104.42 monthly despite a near 90% subsidy on healthcare bills. Patient-centred care of older adults with multimorbidity was inadequately addressed in all six CPGs. CONCLUSION When six CPGs were cumulatively followed, the treatment burden was time-consuming, costly and disruptive. Patients' goals and preferences must guide prioritisation of care such that treatment burden remains minimally disruptive to their lives. Developing future CPGs to deliver patient-centred rather than disease-focused care will be crucial to the management of multimorbidity.