ATORVASTATIN UNVEILING PRIMARY BILIARY CHOLANGITIS AND AUTOIMMUNE HEPATITIS OVERLAP SYNDROME IN AN OLDER ADULT: A CASE REPORT Although statins are generally well-tolerated, recent reports have linked their use to autoimmune liver disease. We present the case of a 70-year-old woman who developed hepatocellular injury 4 months after switching from simvastatin to high-intensity atorvastatin. Discontinuation of atorvastatin led to a gradual improvement in liver function over 3 months; however, her rising LDL(low-density lipoprotein) levels prompted a rechallenge with simvastatin, resulting in recurrent liver function derangement. Despite cessation, the liver enzyme levels continued to rise. Positive autoantibodies, including antinuclear antibodies, anti-mitochondrial M2 and immunoglobulins (i.e. IgA and IgG), along with a liver biopsy, confirmed an overlapping syndrome of primary biliary cholangitis and autoimmune hepatitis. Treatment with prednisolone led to normalisation of liver function, and the patient remained stable on azathioprine and ursodeoxycholic acid. This case underscores the importance of vigilant liver function monitoring, caution when rechallenging statins and the potential for statin therapy to unmask underlying autoimmune liver disease.

Aims: The contact lens (CL) has become one of the most convenience refractive devices used in vision correction, occupational and in cosmetics purposes. Despite the convenience of CL usage, poor hygiene might cause eye infections due to microbial contamination. In this work, a random collection of used CL cases among Universiti Malaysia Terengganu (UMT) students had shown the emergence of antibiotic-resistant bacteria towards commonly used antibiotics to treat eye infections. Methodology and results: The study was carried out from 28 CL cases samples with the duration of one to three months of use. Bacteria that were successfully isolated from the CL cases were then exposed to the commonly prescribed antibiotics followed by identification through the partial 16S rDNA sequencing. Our finding exhibited that the rate of contamination is over 50% where 32 bacteria were isolated, with 20 (62.5%) of the isolates were Gram-positive bacteria. Approximately 31% of the isolated bacteria are resistant and intermediate resistant to the commonly used antibiotics to treat eye infection, especially erythromycin and chloramphenicol. The isolated bacteria were genotypic identified as Bacillus cereus, B. anthracis, Acinetobacter variabilis, Klebsiella pneumoniae, and Serratia marcescens. These bacteria are known as a common cause for microbial keratitis, except for A. variabilis, where the association of this bacteria in causing microbial keratitis is relatively rare. Conclusion, significance and impact of study This study highlights the emergence of antibiotic-resistant bacteria that can cause severe eye infections among CL wearer. The high percentage of contamination (>50%) found from the isolates reflected on the lack of hygiene practice on the CL handling. Thus, it is crucial to perceive this study as microbial contamination will lead to more serious eye infection disease such as conjunctivitis and keratitis.
Drug Resistance, Bacterial ; Contact Lenses

Objective: To study the occurrence of insects fauna obtained in a semi forested area in Malaysia using the carcass of the monkey Macaca fascicularis, Raffles, and to compared the wave of insect succession collected from the carcass placed outdoor and indoor. Methods:The outdoor and indoor studies were conducted at a location of 3o17’57.86”N, 101o47’00.78”E. The euthanized monkeys were placed indoor and outdor. The insect seccession visited the carcass, the envirenmental temperature and relative humidity were recorded. Results:The main insects attracted to specific stages of decomposition were mainly members of Diptera and Coleoptera. There was a delay of fly arrival by two days in indoor carcass. Nocturnal oviposition behaviour was not observed in this study. The flies left the carcass during the twilight zone as noted during a 3 days observation period in outdoor study. The dipteran species found outdoor and indoor were similar but more diverse coleopteran species was found indoor. Conclusions:Information and evidence from this study can be used to improve the estimation of the post mortem interval in forensic cases.