Scimitar syndrome is a rare congenital heart defect occurring in 1 to 3 per 100,000 live births. This is a case of a 26 years old lady presenting with episodic fainting spells since the age of 18 years old. She was initially diagnosed with epilepsy until a referral to our centre found a soft splitting of the second heart sound and multiple premature ventricular complexes on ECG. The computed tomography of the pulmonary artery confirmed the diagnosis if Scimitar syndrome in the presence of anomalous single right pulmonary vein draining into infra-diaphragmatic systemic venous circulation. A corrective open-heart surgery to re-implant the pulmonary vein was performed with excellent clinical outcomes. Therefore, it is crucial for clinicians to embody high index of suspicion of congenital anomaly even in adults presenting with indefinite clinical symptoms. This report also represents the first published case of adult Scimitar syndrome from Malaysia.

This study describes the prevalence of Clostridium difficile toxin (CDT) in loose stool samples from inpatients aged more than two years of a tertiary hospital. A total of 175 samples that had been examined were from stool samples that were sent to the Medical Microbiology & Parasitology Laboratory for various clinical indications. The toxin was detected by a commercial immunochromatograhic test, and the patients’ demography, clinical features, treatment and outcomes were analyzed from their medical records. Clostridium difficile toxin was positive in 24 (13.7%) of the stool samples. Male and female were 11 (45.8 %) and 13 (54.2 %) respectively, with the majority of them aged more than 50 years. Most were from medical wards (n=21, 87.5%), with the rest from surgical wards (n=2, 8.3%) and intensive care units (n=1, 3.4%). All the CDT positive patients had history of prior antibiotic usage within 6 weeks before the detection of the toxin. The mean duration of antibiotics usage was 17.75 (±13.75) days, while the mean duration of diarrhea was 5.21((± 5.85) days. Eighteen patients had underlying medical illnesses that were diabetes mellitus, chronic renal disease, hypertension, ischaemic heart disease, cerebrovascular disease and malignancy; with seven of them being CDT positive while on chemotherapy. Stool occult blood test was positive in 15 patients whereas presence of pus cells in the CD positive stool samples were detected in 21 patients. The duration of hospitalization among the patients was 27.96 (± 23.22) days.

OBJECTIVETo evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit (ICU) of a tertiary care of Fatmawati Hospital Jakarta Indonesia.

METHODSA cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods, and their antibiotic susceptibility testing was performed using disk diffusion method.

RESULTSSpecimens were collected from 385 patients who were given antimicrobial treatment, of which 249 (64.68%) were cultured positive and 136 (35.32%) were negative. The most predominant isolate was Pseudomonas aeruginosa (P. aeruginosa) (26.5%) followed by Klebsiella pneumoniae (K. pneumoniae) (15.3%) and Staphylococcus epidermidis (14.9%). P. aeruginosa isolates showed high rate of resistance to cephalexin (95.3%), cefotaxime (64.1%), and ceftriaxone (60.9%). Amikacin was the most effective (84.4%) antibiotic against P. aeruginosa followed by imipenem (81.2%), and meropenem (75.0%). K. pneumoniae showed resistance to cephalexin (86.5%), ceftriaxone (75.7%), ceftazidime (73.0%), cefpirome (73.0%) and cefotaxime (67.9%), respectively.

CONCLUSIONSMost bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins, and quinolone antibiotics. Regular surveillance of antibiotic susceptibility patterns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

Anti-Bacterial Agents ; pharmacology ; Bacteria ; drug effects ; Bacterial Infections ; epidemiology ; microbiology ; Cross Infection ; epidemiology ; microbiology ; Cross-Sectional Studies ; Drug Resistance, Bacterial ; Humans ; Indonesia ; epidemiology ; Intensive Care Units ; Microbial Sensitivity Tests

Ranking as the most communicable disease killer worldwide, tuberculosis, has accounted with a total of 9.6 million new tuberculosis cases with 1.5 million tuberculosis-related deaths reported globally in 2014. Tuberculosis has remain as an occupational hazard for healthcare workers since 1920s and due to several tuberculosis outbreaks in healthcare settings in the early 1990s, the concern about the transmission to both patients and healthcare workers has been raised. Healthcare workers have two to three folds greater the risk of active tuberculosis than the general population. Several studies on knowledge, attitude and practices on tuberculosis among healthcare workers worldwide have revealed that majority of the participated healthcare workers had good knowledge on tuberculosis. Most of the healthcare workers from South India and South Africa also reported to have positive attitude whereas a study in Thailand reported that most of the healthcare providers have negative attitude towards tuberculosis patients. Nevertheless, majority of the healthcare workers have low level of practice on tuberculosis prevention. An improved communication between healthcare workers and the patients as well as their families is the key to better therapeutic outcomes with good knowledge, attitude and preventive practice towards tuberculosis.

Aims: Wax apple is an important fruit crop in Malaysia and other tropical countries. However, the black spot disease caused by Lasiodoplodia theobromae can damage the wax apple plants, reducing fruit production and quality. Chemical fungicides are commonly used to overcome this disease. However, their overuse might increase fungal resistance to chemicals. Therefore, this study was aimed to evaluate the in vitro antifungal properties of an Aloe vera film incorporated with cinnamon oil on L. theobromae in wax apples. Methodology and results: In vitro antifungal tests were conducted using the poisoned food. This present study found that the inhibition of L. theobromae mycelia when treated with A. vera film with different percentages of cinnamon oil was significantly different compared to the control film at (P<0.05). Results suggest that A. vera film without cinnamon oil showed the highest percentage of inhibition (37.31%) than other films with cinnamon oil due to the antagonistic and less synergistic effect. However, A. vera film with 0.07% of cinnamon oil showed the highest percentage of mycelia inhibition (36.15%) compared to the film with 0.06%, 0.05% and 0.04% cinnamon oil, with mycelia inhibition of 30.55%, 24.25% and 18.82%, respectively, while the mancozeb (positive control) showed 100% inhibition. Conclusion, significance and impact of study In conclusion, A. vera film alone had 37.31% inhibition compared to 36.15% inhibition in A. vera film with 0.7% cinnamon oil. As a result, a tiny amount of cinnamon oil added to the mixture might aid in controlling the black spot disease in wax fruits.
Antifungal Agents ; Aloe ; Oils, Volatile ; Plant Extracts