Objective: To evaluate the antimicrobial properties of Kappaphycus alvarezii (K. alvarezii) and Andrographis paniculata (A. paniculata) and to compare the microbial inhibition activities between these two crude extracts. Methods: Both K. alvarezii and A. paniculata were extracted with methanol before the commencement of antimicrobial properties studies. There were a total of eight species of bacteria, including Gram-positive bacteria Bacillus cereus, Bacillus subtilis, Staphylo-coccus aureus and Staphylococcus epidermidis and Gram-negative bacteria, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Salmonella enterica. The antimicrobial activity was tested by disk diffusion method. Results: Crude extract of K. alvarezii was found not effective against both Gram-positive and Gram-negative bacteria. In contrast, A. paniculata showed higher inhibi-tion towards the growth of Gram-positive bacteria compared to Gram-negative bacteria. Results revealed that Bacillus subtilis was susceptible at lower concentration of A. paniculata crude extract however Staphylococcus epidermidis was the most suscep-tible towards A. paniculata at higher concentration. Although the inhibition zones pro-duced by the crude extract were smaller than that of the positive control, streptomycin disc, A. paniculata crude extract still can be considered as potential antimicrobial agents either because it is a natural product or the active compound which is yet identified from its crude extract. Conclusions: Crude extract of K. alvarezii has zero inhibition in bacteria growth whereas A. paniculata exerted higher inhibition towards Gram-positive bacteria. The bioactive compounds contained by A. paniculata can be evaluated in order to yield a better vision towards the mode of action.

P wave abnormalities are commonly found on ECG. However, they are seldom discussed and may also be neglected during ECG interpretion. In this article, we discuss two common types of P wave abnormalities, 'P mitrale' and 'P pulmonale'. The former was found in a patient with mitral valve stenosis, while the latter was from a patient with pulmonary hypertension. Echocardiography is important in evaluating the causes of P wave abnormalities.
Adult ; Anticoagulants ; therapeutic use ; Atrial Fibrillation ; diagnosis ; Cardiology ; methods ; Electrocardiography ; methods ; Exercise Tolerance ; Female ; Heart Atria ; abnormalities ; Humans ; Hypertension, Pulmonary ; diagnosis ; Male ; Middle Aged

Objective To evaluate the antimicrobial properties of Kappaphycus alvarezii (K. alvarezii) and Andrographis paniculata (A. paniculata) and to compare the microbial inhibition activities between these two crude extracts. Methods Both K. alvarezii and A. paniculata were extracted with methanol before the commencement of antimicrobial properties studies. There were a total of eight species of bacteria, including Gram-positive bacteria Bacillus cereus, Bacillus subtilis, Staphylococcus aureus and Staphylococcus epidermidis and Gram-negative bacteria, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Salmonella enterica. The antimicrobial activity was tested by disk diffusion method. Results Crude extract of K. alvarezii was found not effective against both Gram-positive and Gram-negative bacteria. In contrast, A. paniculata showed higher inhibition towards the growth of Gram-positive bacteria compared to Gram-negative bacteria. Results revealed that Bacillus subtilis was susceptible at lower concentration of A. paniculata crude extract however Staphylococcus epidermidis was the most susceptible towards A. paniculata at higher concentration. Although the inhibition zones produced by the crude extract were smaller than that of the positive control, streptomycin disc, A. paniculata crude extract still can be considered as potential antimicrobial agents either because it is a natural product or the active compound which is yet identified from its crude extract. Conclusions Crude extract of K. alvarezii has zero inhibition in bacteria growth whereas A. paniculata exerted higher inhibition towards Gram-positive bacteria. The bioactive compounds contained by A. paniculata can be evaluated in order to yield a better vision towards the mode of action.

Aged ; Cardiac Catheters ; Combined Modality Therapy ; Coronary Restenosis ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paclitaxel ; administration & dosage ; therapeutic use ; Percutaneous Coronary Intervention ; instrumentation ; Stents ; Treatment Outcome ; Tubulin Modulators ; administration & dosage ; therapeutic use

The causes of abnormal T waves on electrocardiography are multiple and varied. Careful clinical history taking and physical examination are necessary for accurate identification of the cause of such abnormalities. Subsequent targeted specialised cardiac investigations, such as echocardiography or coronary angiography, may be of importance in the diagnosis of the underlying cardiac pathology. We present two cases of T wave inversions with markedly different aetiologies.
Aged, 80 and over ; Angioplasty, Balloon, Coronary ; methods ; Aortic Valve Insufficiency ; diagnosis ; diagnostic imaging ; surgery ; Cardiomyopathy, Hypertrophic ; diagnosis ; Coronary Angiography ; methods ; Echocardiography, Doppler ; methods ; Electrocardiography ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; therapy ; Sampling Studies ; Severity of Illness Index ; Treatment Outcome

ST segment elevation is one of the most important electrocardiographic features that need to be recognised. Although ST segment elevation myocardial infarction is one of the main causes of this abnormality, there are other non-ischaemic causes that are also important. We discuss reversible apical ballooning syndrome or Takotsubo cardiomyopathy, pericarditis and a case of ST segment elevation due to 'early repolarisation pattern'.
Cardiology ; methods ; Coronary Angiography ; methods ; Dyslipidemias ; complications ; Electrocardiography ; methods ; Female ; Humans ; Leukemia, Myeloid, Acute ; complications ; Male ; Middle Aged ; Myelodysplastic Syndromes ; complications ; Myocardial Infarction ; complications ; diagnosis ; Myocardial Ischemia ; pathology ; Prostatic Neoplasms ; complications ; Respiratory Tract Infections ; complications

The causes of low voltage complexes on the electrocardiogram (ECG) are variable; however, they are not commonly discussed. An ECG with small QRS amplitudes may initially look unremarkable to the unwary, but some of the underlying conditions may be critical. Although imperfect, the ECG is still a useful, noninvasive and readily available tool for the screening of these underlying conditions. We present two cases with low voltage complexes in the ECG. The first case highlights how the findings on ECG and subsequent echocardiogram led to the diagnosis of a rare case of cardiac amyloidosis. In the second case, a screening electrocardiogram alerted the physicians to a life-threatening condition, that of a large pericardial effusion with cardiac tamponade.
Aged ; Cardiac Tamponade ; diagnosis ; etiology ; physiopathology ; Diagnosis, Differential ; Electrocardiography ; Female ; Heart Conduction System ; physiopathology ; Humans ; Male ; Middle Aged ; Pericardial Effusion ; diagnosis ; physiopathology

Attitude ; Education, Medical, Undergraduate ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Radiology ; Students, Medical ; Surveys and Questionnaires

Diabetes mellitus is responsible for diverse cardiovascular complications such as accelerated atherosclerosis, increased plaque burden and diffuse coronary lesions. It is also a major risk factor for myocardial infarction, stroke and peripheral vascular disease. Here, we present two cases. The first patient had subtle changes in the ECGs, with severe coronary artery disease requiring coronary artery bypass grafting, while the second had deep T wave inversion in the ECG and was found to have normal coronary arteries and nonischaemic cardiomyopathy. Although ECG failed to show the severity of the disease, it is invaluable as a simple, noninvasive test to aid in diagnosis. Our two cases stress the importance of a high index of suspicion and the low threshold for investigations in the diabetic population.
Aged ; Biomarkers ; analysis ; Combined Modality Therapy ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Stenosis ; diagnosis ; therapy ; Diabetes Complications ; diagnosis ; drug therapy ; surgery ; Diagnosis, Differential ; Electrocardiography ; Humans ; Male ; Middle Aged ; Pulmonary Edema ; diagnosis ; therapy ; Radiography, Thoracic

INTRODUCTIONSeveral randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fibrinolytic therapy in the treatment of patients with ST-segment elevation myocardial infarction (STEMI) and normal renal function. Whether this benefit extends to patients with impaired renal function is uncertain.

MATERIALS AND METHODSWe studied 1672 patients with STEMI within 12 hours of symptom onset who were admitted to 2 major public hospitals in Singapore from 2000 to 2002. All patients received either upfront fibrinolytic or PCI as determined by the attending cardiologist. Serum creatinine was measured on admission and the glomerular filtration rate (GFR) was determined using the Modification of Diet in Renal Disease equation. The impact of reperfusion strategy on 30-ay mortality was then determined for patients with GFR > or =60 mL min-(1) 1.73 m-(2) and GFR <60 mL min-(1) 1.73 m-(2).

RESULTSThe mean age was 56 +/- 12 years (85% male) and mean GFR was 81 +/- 30 mL min-(1) 1.73 m-(2). Unadjusted 30-day mortality rates for fibrinolytic-treated vs primary PCI-treated patients were 29.4% vs 17.9%, P <0.05, in the impaired renal function group and 5.4% vs 3.1%, P <0.05, in the normal renal function group. After adjusting for covariates, primary PCI was associated with a significantly lower mortality in the normal renal function group [odds ratio (OR), 0.41; 95% confidence interval (CI), 0.19-0.89] but not in the impaired renal function group [OR, 0.70; 95% CI, 0.31-1.60].

CONCLUSIONSPrimary PCI was associated with improved 30-day survival among patients with normal renal function but not among those with impaired renal function. Randomised trials are needed to study the relative efficacy of both reperfusion strategies in patients with impaired renal function.

Adult ; Angioplasty, Balloon, Coronary ; Antifibrinolytic Agents ; therapeutic use ; Electrocardiography ; Female ; Glomerular Filtration Rate ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; drug therapy ; surgery ; Registries ; Renal Insufficiency, Chronic ; complications ; Retrospective Studies ; Survival Analysis