INTRODUCTION: Despite reports suggesting an association between COVID-19 mRNA vaccination and pericarditis and myocarditis, detailed nationwide population-based data are sparsely available. We describe the incidence of pericarditis and myocarditis by age categories and sex after COVID-19 mRNA vaccination from a nationwide mass vaccination programme in Singapore. METHODS: The incidence of adjudicated cases of pericarditis and myocarditis following COVID-19 mRNA vaccination that were reported to the vaccine safety committee between January to July 2021 was compared with the background incidence of myocarditis in Singapore. RESULTS: As of end July 2021, a total of 34 cases were reported (9 pericarditis only, 14 myocarditis only, and 11 concomitant pericarditis and myocarditis) with 7,183,889 doses of COVID-19 mRNA vaccine administered. Of the 9 cases of pericarditis only, all were male except one. The highest incidence of pericarditis was in males aged 12-19 years with an incidence of 1.11 cases per 100,000 doses. Of the 25 cases of myocarditis, 80% (20 cases) were male and the median age was 23 years (range 12-55 years) with 16 cases after the second dose. A higher-than-expected number of cases were seen in males aged 12-19 and 20-29 years, with incidence rates of 3.72 and 0.98 case per 100,000 doses, respectively. CONCLUSION Data from the national registry in Singapore indicate an increased incidence of pericarditis and myocarditis in younger men after COVID-19 mRNA vaccination.
Adolescent ; Adult ; COVID-19/prevention & control* ; COVID-19 Vaccines/adverse effects* ; Child ; Female ; Humans ; Male ; Middle Aged ; Myocarditis/etiology* ; Pericarditis/etiology* ; RNA, Messenger ; SARS-CoV-2 ; Vaccination/adverse effects* ; Vaccines, Synthetic ; Young Adult ; mRNA Vaccines

Introduction: The past few years have shown a marked improvement in acute ischaemic stroke (AIS) thrombolysis therapy in Malaysia. We analysed our data on stroke code activation performed in a non-neurologist hospital. Methods: Data of all stroke code activated patients from September 2019 to September 2020 was collected. Demographic, clinical characteristics and outcomes of these patients were analysed and reviewed with published data in Malaysia. Results: Seventy cases were stroke code activated. Majority of the stroke cases (80%) were ischaemic in nature with the highest subgroups of lacunar infarct at 60.7%. Hypertension is the most prevalent risk factor followed by dyslipidaemia and diabetes. The median time for onset-to-door was 95minutes, door-to-CT was 24minutes, door-to-decision was 46.5 minutes and door-to-needle was 80minutes. There was a sequential reduction in median door-to-CT and door-to-needle time to 16.5 and 65.5minutes respectively. Fifteen patients (21.4%) were given thrombolysis therapy. The median NIHSS score was 7.5 on arrival and 6 upon discharge. They had an improvement of mRS from a median of 4 upon discharge to 1 at six months follow-up. There were no haemorrhage incidences post thrombolysis. The outcome of LACI strokes versus non-LACI strokes was similar at 3 and 6-months follow-up despite non-LACI strokes having a more severe presentation upon admission. Conclusion: With AIS thrombolysis therapy, non-LACI strokes may have similar functional outcomes as LACI strokes. With backup support from hospitals with neurologists and neurosurgeons, physician-led AIS thrombolysis therapy is implementable in a non-neurologist centre. Strong adherence to protocol is pertinent to ensure success.

Vancomycin is used to manage methicillin-resistant Staphylococcus aureus (MRSA) and other bacterial infections that are Gram-positive in nature. Linezolid belongs to the oxazolidinone class of antibiotics, which is primarily used to treat vancomycin-resistant Enterococcus (VRE), MRSA, diabetic foot, soft tissue, and skin infections. Here, we discuss vancomycin and linezolid dosing in obese patients, their mechanism of actions, pharmacokinetics, problems with dosing and evaluation of several dosing protocols in the obese patient population. There is no generally accepted dosing protocol for linezolid and vancomycin. Evidence suggests that using trough concentrations alone is insufficient for estimating vancomycin and linezolid exposure accurately as many researchers have revised protocol guidelines, developed more rigorous dosing and monitoring guidelines, or developed novel dosage strategies to meet the needs of overweight patients. Peaks and troughs measurement should be considered because it improves precision and reduces the area under the curve (AUC) estimate bias. To provide better dosing guidelines in this vulnerable group, obese patients must be included in all phases of drug design.

Aims: Linezolid has become a decisive therapy in treating infections with vancomycin-resistant Enterococcus (VRE). Currently, the emergence of linezolid-resistant Enterococcus further complicates the therapeutic options and leads to global health threat not only in hospital setting but in the community. The study aimed at antimicrobial pattern of Enterococcus isolated from 6 poultry farms in Kelantan, Malaysia. Methodology and results: Between February and December 2019, 300 broiler cloacal swab sample (Gallus gallus domesticus) were collected and screened for linezolid-resistant enterococci (LRE) using a standard biochemical and antimicrobial susceptibility tests. Among all the samples, 32.3% (n=97/300) grew Enterococcus, 71.1% (n=69/97) of it were identified Enterococcus casseliflavus by molecular identification, whilst remaining isolates 28.9% (n=28/97) were further identified as Enterococcus gallinarum by 16S rRNA sequencing. None of the isolates were found to exhibit high-level resistance to vancomycin. However, 3/97 (3.1%) were exhibit resistance to high-level gentamicin based on Kirby-Bauer disk diffusion test. Whereas 48/97 (49.5%) of isolates were observed to be resistant to ampicillin, 28/97 (28.9%) were resistant to penicillin. Surprisingly, among the two strains isolated, 18.6% (n=18/97) of it were resistant to linezolid. Isolates showed resistance to linezolid by disk diffusion test were verified by VITEK-2 automated system (bioMérieux, USA) with MIC ≥8 µg/mL. All antimicrobial susceptibility test and minimal inhibitory concentration (MIC) results were interpreted according to Clinical and Laboratory Standard Institute (CLSI). Conclusion, significance and impact of study In conclusion, this study has reported the prevalence of linezolid resistant Enterococcus (LRE) in highly intrinsic antibiotic resistant of E. casseliflavus and E. gallinarum in Malaysia poultry farms, alongside with the truancy of vanA strains. The emergence of LRE strains is an alarming problem to the animal husbandry and healthcare setting worldwide. This could lead to potentially untreatable and life-threatening enterococcal infections. Even more worrying is the spread of LRE to geographical regions where these strains were previously unreported, which may pose a global health threat. Antimicrobial surveillance in poultry husbandry is thus, dimly necessary to prevent wide spread of multidrug-resistant bacteria.
Linezolid ; Enterococcus ; Farms

Aims: New therapeutics are needed to ease the prevailing waterborne disease, and one of the alternatives is by exploring the natural compounds with antimicrobial properties. Duckweed, Lemna sp. is recorded as a medicinal herb that known to have antifungal and antibacterial activities towards several fungi and bacteria. Suitability of duckweed (Lemna minor) as an antibacterial resource against selected waterborne bacteria were evaluated in terms of its antibacterial activity and toxicity. Methodology and results: Antibacterial activity of the duckweed methanolic extract was tested against 11 selected waterborne bacteria using disc diffusion, minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC) assay. Brine shrimp lethality assay was used to determine the toxicity of this extract. The lethal concentrations of plant extract resulting in 50% mortality of the brine shrimp (LC50) were then determined. Conclusion, significance and impact of study Results showed that duckweed extract exhibited bacteriostatic and bactericidal against the selected bacteria activity at the concentration of MIC = 1.8-2.0 mg/mL and MBC ≥ 2.0 mg/mL. This study shows that methanolic extract of L. minor may contain bioactive compounds against bacteria and potential therapeutic effect. The crude extract is slightly toxic and may not safe to be used in high concentration but is valuable in further study as a potential antitumor agent.

BACKGROUND/AIMS: This study compared the clinical benefits of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) with pemetrexed to identify the clinical parameters that correlated with response. METHODS: A retrospective chart review examined patients who were 1) treated with EGFR TKI or pemetrexed, 2) diagnosed with advanced non-squamous non-small-cell lung cancer, and 3) previously treated with platinum-based chemotherapy in Soonchunhyang Bucheon Hospital. RESULTS: Sixty-one patients (18 erlotinib, 18 gefitinib, 25 pemetrexed) were investigated from February 2002 to August 2009. The median follow-up period was 37 months (7~97 months). Overall, their median age was 63 years, 41 patients were non-smokers, 57 patients had adenocarcinoma, and 55 patients were at stage IV. Twenty-one patients received the study drugs as second-line chemotherapy, and others as third-line or more. No significant differences in the overall response rate (erlotinib 33.3% vs. gefitinib 38.9% vs. pemetrexed 20.0%) and progression-free survival (erlotinib 1.9 months vs. gefitinib 3.0 months vs. pemetrexed 2.9 months) were found among the three groups. Female gender was related to a good response to EGFR TKIs (p=0.047). Skin rash in the erlotinib group (p=0.037) and adenocarcinoma in the pemetrexed group (p=0.02) were related to improved progression-free survival. Few side effects were reported. CONCLUSIONS: Both EGFR TKIs and pemetrexed therapy for non-squamous non-small-cell lung cancer were efficient and tolerable after the failure of first-line platinum-based chemotherapy. Further prospective studies are needed to validate the predictive role of the suggested clinical parameters in this study.
Adenocarcinoma ; Disease-Free Survival ; Exanthema ; Female ; Follow-Up Studies ; Glutamates ; Guanine ; Humans ; Lung ; Lung Neoplasms ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Retrospective Studies ; Erlotinib Hydrochloride ; Pemetrexed

Extranodal NK-T cell lymphoma is a subtype of non-Hodgkin's lymphoma (NHL) and this most commonly affects the nasal and paranasal cavities. Primary lymphoma of the gallbladder is extremely rare and solitary relapsed extranodal NK-T cell lymphoma of the gallbladder has not yet been reported in Korea. We experienced a case of a solitary relapsed extranodal NK-T cell lymphoma of the gallbladder. One year earlier, a 55-year-old man was diagnosed with extranodal NK-T cell lymphoma of the anus, and he underwent six cycles of chemotherapy with CHOP (cyclophosphamide, adriamycin, vincristine and prednisone), and he achieved complete remission. The patient was admitted for right upper quadrant pain. Computed tomography (CT) performed on readmission revealed gallbladder wall thickening. Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed hypermetabolic lesions along the gallbladder wall. The specimen obtained at cholecystectomy revealed CD3(+) and CD56(+) lymphoma, which is characteristic of NK-T cell lymphoma.
Anal Canal ; Cholecystectomy ; Doxorubicin ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Korea ; Lymphoma ; Lymphoma, Non-Hodgkin ; Middle Aged ; Vincristine

PURPOSE: High-dose chemotherapy (HDT) and autologous stem cell transplantation (ASCT) have been used for the treatment of clinically aggressive non-Hodgkin's lymphoma (NHL). However, the superiority of specific conditioning regimens has not yet been established. The present study evaluated the efficacy and toxicity of a conditioning regimen involving fractionated total body irradiation (TBI), and the use of Ara-C and melphalan (TAM) for clinically aggressive NHL. MATERIALS AND METHODS: Between March 2002 and December 2004, 31 patients with aggressive NHL received fractionated TBI with a dose of 12 Gy over 3 days, and were administered 9 g/m2 Ara-C and 100 mg/m2 melphalan followed by autologous peripheral blood stem Cell Transplantation at the Catholic Hematopoietic Stem cell transplantation Center Korea. Patients that responded to first line chemotherapy and achieved complete remission (CR), or were in a first sensitive relapse were defined as having less advanced disease, while the other patients were defined as having more advanced disease. RESULTS: Objective responses were obtained in 24 of 31 patients (77.4%), comprising complete remission in 19 patients (61.3%) and partial remission in 5 (16.1%) patients. The median follow-up time was 28 months (range 1~62 months). At 3 years, the overall survival and event-free survival (EFS) rates were 62.3% and 47.3%, respectively. Patients with less advanced disease and more advanced disease showed 3-year EFS rates of 73.3% and 22.5 %, respectively (p=0.006). Early (within the first 100 days) treatment-related mortality occurred in 3 (9.7%) patients. Of the 31 total patients, 15 (48.4%) developed grade 3 mucositis, 22 (70.9%) developed neutropenic fever, and two (6.5%) developed interstitial pneumonia syndrome >grade 3. CONCLUSION: The modified TAM conditioning regimen and ASCT appear to be a feasible treatment regimen for clinically aggressive NHL, particularly for patients with less advanced disease.
Cytarabine ; Disease-Free Survival ; Drug Therapy ; Fever ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation ; Humans ; Korea ; Lung Diseases, Interstitial ; Lymphoma, Non-Hodgkin* ; Melphalan ; Mortality ; Mucositis ; Peripheral Blood Stem Cell Transplantation ; Recurrence ; Stem Cell Transplantation* ; Stem Cells* ; Whole-Body Irradiation

The molecular basis of variable phenotypes in P-thalassaemia patients with identical genotypes has been associated with co-inheritance of alpha-thalassaemia and persistence of HbF production in adult life. The Xmn I restriction site at -158 position of the Ggamma-gene is associated with increased expression of the Ggamma-globin gene and higher production of HbF This study aims to determine the frequency of the digammaferent genotypes of the Ggamma Xmn I polymorphism in P-thalassaemia patients in two ethnic groups in Malaysia. Molecular characterisation and frequency of the Ggamma Xmn I polymorphism were studied in fifty-eight Chinese and forty-nine beta-thalassaemia Malay patients by Xmn I digestion after DNA amplification of a 650 bp sequence. The in-house developed technique did not require further purification or concentration of amplified DNA before restriction enzyme digestion. The cheaper Seakem LE agarose was used instead of Nusieve agarose and distinct well separated bands were observed. Genotyping showed that the most frequent genotype observed in the Malaysian Chinese was homozygosity for the absence of the Xmn I site (-/-) (89.7%). In the Malays, heterozygosity of the Xmn I site (+/-) was most common (63.3%). Homozygosity for the Xmn I site (+/+) was absent in the Chinese, but was confirmed in 8.2% of the Malays. The ratio of the (+) allele (presence of the Xmn I site) to the (-) allele (absence of the Xmn I site)) was higher in the Malays (0.66) compared to the Chinese (0.05). The (+/-) and (+/+) genotypes are more commonly observed in the Malays than the Chinese in Malaysia.
Chinese People ; Thalassemia ; With frequency ; Malaysia ; seconds

Background and objectives The recent joint ACCF/AHA clinical competence statement on cardiac imaging with multi-detector computed tomography recommended a minimum of 6 months training and 300 contrast examinations, of which the candidate must be directly involved in at least 100 studies. Whether this is adequate to become proficient in interpretation of coronary computed tomogsignificant coronary stenosis in a center with 1 year's experience using a 64-row scanner. Methods A total of 778 patients underwent contrast-enhanced CTA between January and December 2005. Out of these patients, 301 patients also underwent contrast-enhanced conventional coronary angiography (CCA). These patients were divided into 4 groups according to the time the examination was underwent. Group Q1: first quarter of the year (n=20), Group Q2: second quarter (n=128), Group Q3: third quarter (n=134), and Group Results The sensitivity, specificity, positive, and negative predictive values were Q1 - 64%, 89%, 49% and 94%, respectively; Q2 -79%, 96%, 74% and 97%, respectively; Q3 - 78%, 96%, 74%, 97%, respectively, and Q4 - 100% for all. Conclusions In a center with formal training and high caseload, our accuracy in CTA analysis reached a plateau after 6 months experience. Test-bolus protocols produce better image quality and can improve accuracy. New centers embarking on CTA will need to overcome an initial 6-month learning curve depending upon the caseload during which time they should consider correlation with CCA.