Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Dental prosthesis ingestion in adults is uncommon, and delayed presentation may complicate diagnosis and management. We report a 39 -year-old woman with epilepsy who accidentally ingested a broken dental prosthesis during sleep. She initially presented with a foreign body sensation and underwent laryngoscopy and oesophagogastroduodenoscopy 24 hours after ingestion and these were unremarkable with no foreign body identified. Four days later, she developed dyspnoea, chest pain, and sepsis. Clinical and radiological assessments revealed a massive left pleural effusion, pneumomediastinum, and contrast leakage from the distal oesophagus, consistent with an oesophageal perforation. The patient was referred urgently for surgical intervention and was successfully treated. This case illustrates the diagnostic challenges of radiolucent dental prostheses and the potential for mucosal injury that may not be immediately evident, which can lead to delayed diagnosis or misdiagnosis resulting in severe complications. Awareness and early recognition, appropriate imaging with computed tomography or contrast studies, and high clinical suspicion are critical, particularly in neurologically compromised patients. Prompt diagnosis and intervention are essential to prevent serious complications such as mediastinitis, sepsis, and respiratory failure

Hepatic hydrothorax is a pleural effusion (typically ≥500 mL) that develops in patients with cirrhosis and/or portal hypertension in the absence of other causes. In most cases, hepatic hydrothorax is seen in patients with ascites. However, ascites is not always found at diagnosis and is not clinically detected in 20% of patients with hepatic hydrothorax. Some patients have no symptoms and incidental findings on radiologic examination lead to the diagnosis of the condition. In the majority of cases, the patients present with symptoms such as dyspnea at rest, cough, nausea, and pleuritic chest pain. The diagnosis of hepatic hydrothorax is based on clinical manifestations, radiological features, and thoracocentesis to exclude other etiologies such as infection (parapneumonic effusion, tuberculosis), malignancy (lymphoma, adenocarcinoma) and chylothorax. The management strategy involves a stepwise approach of one or more of the following: Reducing ascitic fluid production, preventing fluid transfer to the pleural space, fluid drainage from the pleural cavity, pleurodesis (obliteration of the pleural cavity), and liver transplantation. The complications of hepatic hydrothorax are associated with significant morbidity and mortality. The complication that causes the highest morbidity and mortality is spontaneous bacterial empyema (also called spontaneous bacterial pleuritis).

Introduction: Smoking is associated with a higher risk of mortality, especially in smokers with cardiovascular and respiratory diseases. Smoking cessation remains the most effective approach in reducing smoking-related illness risks at all ages. For elderly smokers, smoking cessation has been proved to prolong life expectancy and reduce the risk of stroke and ischemic heart disease. However, a wide selection of smoking cessation medications makes prescribing challenging, especially among elderly smokers. Inability to recommend the best treatment may reduce the smoking cessation success rate in the elderly. Therefore, this study compares the effectiveness of pharmacotherapy available and correlate the effect of ageing on the effectiveness, leading to the recommendation of the best medication for elderly smokers. Method: A systematic searching strategy was performed in three different databases by using predetermined search strings. Results: Overall, this systematic review revealed that varenicline showed the greatest smoking cessation rate among the elderly, followed by bupropion and NRT. Conclusion: It is suggested that varenicline offered the best medical aid for smoking cessation in the elderly.

Uterine leiomyosarcoma is a malignant smooth muscle tumour of the uterus. It is rare and accounting for less than 2% of cases in malignant gynaepathology. To date, only a few reported cases of leiomyosarcoma arising from leiomyoma documented in the literature. We shared an uncommon occurrence of leiomyosarcoma arising from leiomyoma. Presented herein is a case of a ‘rare epithelioid subtype’ of leiomyosarcoma arising from a leiomyoma in a postmenopausal woman. We highlighted the importance of recognizing the possibilities of this event to allow for a timely diagnosis of leiomyosarcoma and to provide insights on management of patients presented with clinically presumed fibroid.

Aims: Maternal vaginal Group B Streptococcus (GBS) colonization is considered a risk factor for preterm delivery and, consequently, neonatal infections. Previous studies have portrayed the important roles of these virulence factors, including hemolytic pigment, hyaluronidase (HylB), serine-rich protein (Srr) and bacterial surface adhesion of GBS (BsaB) in mediating GBS colonization and intrauterine ascending infection, causing preterm delivery. This study aimed to investigate the association between mRNA expression of virulence genes in GBS isolates obtained from symptomatic pregnant women and preterm delivery. Methodology and results: GBS isolates were obtained from high vaginal swabs of 40 symptomatic pregnant women of gestational age of less than 37 weeks. RNA was extracted from these GBS isolates and RT-qPCR was performed to determine the relative mRNA expression of GBS virulence genes, including CylE (encode enzyme required for the biosynthesis of the hemolytic pigment), HylB, Srr-1 and BsaB. Socio-demographic details and obstetric history were not found to be associated with the delivery outcomes of these women. The GBS isolates from symptomatic pregnant women who delivered prematurely showed a higher expression of CylE gene and a trend towards an elevated expression of HylB gene compared to women with term delivery. Meanwhile the expression of both Srr-1 and BsaB genes was similar between symptomatic pregnant women who had term or preterm delivery. Conclusion, significance and impact of study The results suggest that following vaginal colonization, both CylE and HylB genes are likely to contribute to intrauterine ascending infection and inflammation, leading to preterm delivery in humans. These virulence factors may be targeted for the pre-clinical stages of vaccine development or therapeutic intervention.
Streptococcus agalactiae--isolation & ; purification ; Pregnant Women

Introduction: Imatinib mesylate has been widely used as a standard treatment for chronic myeloid leukemia (CML). It acts as a selective competitive inhibitor of the BCR-ABL tyrosine kinase. Despite the excellent efficacy on CML treatment, some patients developed resistance to the treatment. Mutation in the PDGFRA may be one of the factors involved in the mechanism of resistance that affects the response to imatinib. The mutational status of PDGFRA is highly relevant for prognosis and treatment prediction in CML patients. Thus, this study is intended to establish and validate a High Resolution Melting (HRM) analysis for PDGFRA exon 10 c.1432 T>C polymorphism in CML patients. Methods: High resolution melting (HRM) analysis was used to identify the c.1432 T > C polymorphism in PDGFRA exon 10 (n =86; response = 43; resistance = 43). The results from HRM analysis were compared and validated with Sanger sequencing. The association between the polymorphism and treatment response was assessed by statistical analysis using binomial logistic regression analysis. Results: HRM analyses showed two different melt curves. One curve followed the shape of the reference, homozygous wild type (TT) and the other curve showed a different melting profile than the reference with the TC genotype (heterozygous variant). The results revealed that heterozygous variant (TC) genotype showed a high risk of acquiring resistance with an OR of 3.795; 95% CI: 1.502-9.591, with a statistically significant association, p = 0.005. HRM analysis also showed 100% sensitivity and specificity in the detection of PDGFRA exon 10. Conclusion: The HRM analysis of PDGFRA exon 10 c.1432 T>C was successfully established. The exon 10 c.1432 T>C polymorphism shows a higher risk for the development of resistance toward imatinib treatment.

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