Typhoid is an acute febrile illness primarily caused by Salmonella enterica serotype typhi (S. Typhi) which could be challenging to diagnose in children, owing to its non-specific clinical signs and symptoms which may resemble other febrile illnesses. Here, we present a case of typhoid which was atypically presented as fever of unknown origin (FUO) in a two-year-old boy with underlying glucose-6-phosphate dehydrogenase (G6PD) deficiency. This child was initially diagnosed and managed as acute tonsillopharyngitis, however remained febrile despite medications. A series of investigations were performed and S. Typhi was isolated from the bone marrow culture after almost a month of admission. The antibiotic was started based on antibiotic susceptibility testing and he recovered well. Our case underscores the challenges of diagnosis establishment and clinical management of typhoid in paediatric patients who has underlying disease and emphasizes the importance of having high index of clinical suspicion to ascertain timely and proper diagnosis.

Objective: To explore the protective effect of Polygonum minus ethanolic extract on cisplatin-induced neurotoxicity. Methods: In vitro test, total phenolic content assay and DPPH assay were performed to determine the antioxidant activity of Polygonum minus. For in vivo test, 30 male Sprague-Dawley rats were randomly divided into 5 groups: the control group, cisplatin 10 mg/kg, Polygonum minus 100 mg/kg, Polygonum minus 200 mg/kg and Polygonum minus 400 mg/kg. The control group and the cisplatin group were given distilled water whereas Polygonum minus groups received the respective dose of Polygonum minus extract orally for 14 d. On day 15, a single intraperitoneal administration of normal saline was given to the control group; while 10 mg/kg of cisplatin was given to the cisplatin group and Polygonum minus groups. Body weight, signs of illness, daily activity and mortality were observed at least once daily throughout the experimental period. On day 18, the anterior part of the brain was collected and processed for histological and ultrastructural analyses (right hemisphere). The remaining part (left hemisphere) of the brain was assayed to determine malondialdehyde and catalase levels for oxidative stress analyses. Results: Polygonum minus ethanolic extract possessed high phenolic content (977.6 mg GAE/g) and 95.9％ DPPH radical scavenging activities. No mortality was observed in all groups. Rats in the cisplatin group were weak and less active compared to Polygonum minus treated rats. In the cisplatin group, disorganised cellular layers of the cerebral cortex were observed whereas rats treated with low and mid doses of Polygonum minus extract had normal cerebral cortex as in the control group. Mild ultrastructural changes were observed in rats treated with low and mid doses of Polygonum minus extract. Meanwhile, low and mid doses of Polygonum minus extract significantly reduced malondialdehyde level whereas low and mid doses of Polygonum minus extracts groups significantly increased catalase activity compared to the cisplatin group. Conclusions: Polygonum minus ethanolic extract at 100 and 200 mg/kg attenuates cisplatin-induced oxidative stress in the cerebral cortex via its antioxidant activity.

INTRODUCTIONThe present study aimed to obtain preliminary tympanometric data of young Malay adults and to compare the results between genders.

METHODS96 undergraduate students (49 males and 47 females), aged 19-25 (mean and standard deviation 21.14 +/- 1.31) years, participated in this study. Otoscopic examination, pure tone audiometry, qualitative tympanogram and ipsilateral acoustic reflex were measured to ensure a clear ear canal, normal hearing and normal middle ear function, prior to tympanometric measurement. As a result, a total of 154 ears (80 ears from males and 74 ears from females) were selected for further statistical analyses. The tympanometric parameters measured were peak compensated static acoustic admittance (Peak Y(tm)), tympanometric width (TW) and equivalent ear canal volume (V(ea)).

RESULTSThe results showed that the mean Peak Y(tm), V(ea) and TW for males were 0.81 mmhos, 1.48 cubic cm and 113.67 daPa, respectively. The mean Peak Y(tm), V(ea) and TW for females were 0.63 mmhos, 1.12 cubic cm and 98.04 daPa, respectively. Males were found to have significantly higher mean V(ea) and mean Peak Y(tm) than females. However no significant gender difference was observed in the mean TW.

CONCLUSIONThe current study suggests that young Malay adults may require gender-specific Peak Y(tm) and V(ea) values when implementing a quantitative approach in tympanogram interpretation.

Acoustic Impedance Tests ; methods ; Acoustics ; Audiometry ; methods ; Audiometry, Pure-Tone ; Ear Canal ; pathology ; Ethnic Groups ; Female ; Humans ; Malaysia ; Male ; Otoscopy ; methods ; Reference Values ; Sex Factors ; Young Adult

Medullary carcinoma is a rare breast carcinoma with a syncytial growth pattern and high-grade cytology. It can be difficult to diagnose and may be missed on conventional imaging as the findings may overlap with benign lesions i.e. fibroadenomas. The authors report a case of a 25-year-old female who presented with multifocal breast lumps diagnosed with medullary carcinoma and fibroadenomas. Imaging and pathological correlation with contrast-enhanced MRI are presented in the diagnosis of these lesions.

INTRODUCTIONThe aim of this study is to investigate the amount of water loss and percentage dehydration experienced during 1 hour of paddling on the kayak ergometer so as to help coaches and athletes tailor a suitable and adequate rehydration regime. Also, rehydration efficacy between water and a well established, commercially available sports drink (Gatorade, Quaker Oats company, USA) was investigated in this cross-over study.

MATERIALS AND METHODSTen national flatwater kayakers were monitored in a controlled setting while paddling the kayak ergometer for 1 hour at an intensity sustainable for long distance marathon. They rehydrated themselves ad libitum with provided beverage. Post-void towel-dried body mass was measured before and after the exercise with percentage dehydration calculated. Body core temperature (tympanic temperatures), ratings of perceived exertion and thirst index were monitored every 15 minutes. The amount of fluid consumed, urine output and urine specific gravity were obtained after exercise.

RESULTSThe results [mean +/- standard deviation (SD)] showed that kayakers underwent 1.10 +/- 0.52% dehydration while rehydrating with water as compared to 0.72 +/- 0.38% while rehydrating with Gatorade. Also, athletes on water rehydration had higher rating of perceived exertion (RPE) at the 30th and 60th minute mark of the exercise. Overall, athletes undergoing water rehydration lost significantly more body mass (0.70 +/- 0.39 kg) as compared to rehydrating with Gatorade (0.46 +/- 0.27).

CONCLUSIONAlthough the hydration efficacy of Gatorade proved superior to that of water, the athletes' hydration habits with either fluids did not provide adequate hydration. It is recommended that specific strategies be developed to address dehydration and rehydration issues of kayakers in Singapore.

Adult ; Beverages ; Competitive Behavior ; Cross-Over Studies ; Dehydration ; metabolism ; physiopathology ; Drinking ; Exercise ; physiology ; Female ; Fluid Therapy ; methods ; Humans ; Male ; Monitoring, Physiologic ; Physical Exertion ; physiology ; Ships ; Sports ; Water-Electrolyte Balance ; physiology