Nutrient availability in the Setiu Wetland Lagoon, Malaysia: trends, possible causes and environmental impacts.

The objective of this study was to identify the spatial and temporal variabilities of selected nutrients in the Setiu Wetlands Lagoon (SWL), Malaysia. Water samples were collected quarterly at ten monitoring sites. This study presents results from a 10-year field investigation (2003 to 2010 and 2014 to 2015) of water quality in the SWL. For the spatial pattern, four clusters were identified with hierarchical cluster analysis. Analysis of the temporal trend shows that the high total suspended solid loading in 2010 was due to large-scale land clearing upstream of the SWL. The enrichment of ammonium after 2010 could plausibly be due to land-based aquaculture diffuse discharges. In 2005-2007, expansion of oil palm plantations within the Setiu catchment had doubled the phosphorus concentration in the SWL. The natural and anthropogenic alterations of the lagoon inlets profoundly influenced the spatial distribution patterns of nutrients in the SWL. These results suggest that intense anthropogenic disturbances close to the SWL accounted for the water quality deterioration.

Determination of trace metals in airborne particulate matter of Kuala Terengganu, Malaysia.

Results from the present study in Kuala Terengganu, Malaysia indicated a significant spatial variation but generally the total suspended particulate concentrations (mean = 17.2-148 microg/m(3)) recorded were below the recommended Malaysia guideline for total suspended particulate (mean of 24-h measurement = 260 microg/m(3)). Some of the elemental composition of particulate aerosol is clearly affected by non crustal sources, e.g. vehicular emission sources. Based on correlation and enrichment analyses, the elements could be grouped into two i.e. Pb, Cd and Zn group with sources from vehicular emission (r > 0.6; enrichment factor > 10) and Al, Fe, Mn and Cr group that appears to be of crustal origin (r > 0.6; enrichment factor < 10). It can also be concluded that the mean levels of Pb (1 ng/m(3)), Cd (0.02 ng/m(3)) and Zn (2 ng/m(3)) in the study area are generally lower than other urban areas in Malaysia (Pb < 181 ng/m(3); Cd < 6 ng/m(3); Zn < 192 ng/m(3)).

Epidemiology of sudden unexpected death syndrome among Thai migrant workers in Singapore.

A total of 235 cases of sudden unexpected death syndrome (SUDS) among apparently healthy male Thai migrant workers in Singapore were reported between 1982 and 1990. Most of the deaths occurred during sleep and 13% were not sleep-related. The median age at the time of death was 33 years and the median interval between arrival and death was 8 months. These deaths occurred singly and sporadically throughout the year. Post-mortem examination revealed few abnormal findings except for haemorrhagic congestion or oedema of the lungs. There were moderate to severe intra-alveolar haemorrhages with some evidence of myocarditis or pneumonitis. Preliminary findings of serial sections of the hearts indicate evidence of anomalies in the cardiac conduction system. Epidemiological investigations showed that a family history of similar deaths and serological evidence of current or recent infection with Pseudomonas pseudomallei were significantly associated with SUDS. Extensive biochemical and toxicological investigations were inconclusive. There was no evidence of chronic deficiency in thiamine or potassium among the healthy Thai workers living and working in the same conditions as the cases, and no significant abnormalities were detected on electrocardiographic examination. As these migrant workers experienced various psychosocial problems which could stem from maladjustment to an urban environment, separation from the family, burden of debts and long hours of work, stress could be a precipitating factor for SUDS.

Cardiac output increases prior to development of pulmonary edema after re-expansion of spontaneous pneumothorax.

Pulmonary edema following reexpansion of spontaneous pneumothorax is an uncommon complication. The underlying mechanism of this condition is unclear. We report the hemodynamic characteristics in a series of 7 male patients with spontaneous large (>50%) pneumothoraces of > or = 24 h and correlate the changes with reexpansion pulmonary edema (REPE). A pulmonary artery floatation catheter was inserted and hemodynamic data were obtained before therapeutic chest tube insertion, 1 h after chest tube insertion and the following day. Four (57%) patients developed REPE. There was a tendency for larger pneumothorax to develop REPE. Capillary wedge pressure did not change significantly 1 h after the insertion of chest tube in all our patients. Cardiac output increased significantly in patients who developed REPE compared to those who did not (+ 1.06 l/min vs -0.27 l/min; P = 0.03) 1 h after insertion of chest tube. One patient did not develop pulmonary edema despite having a large (> 80%) pneumothorax. His cardiac output did not rise 1 h after chest tube insertion. REPE is not an uncommon complication following chest tube drainage in patients with large and long-standing pneumothorax. The increase in cardiac output after chest tube insertion may be associated with subsequent development of REPE.

Persistent air-leak in spontaneous pneumothorax--clinical course and outcome.

Persistent air-leak in patients with spontaneous pneumothorax (SP) is not uncommon and may present a management dilemma in those who are unfit or unwilling for surgery. Video-assisted thoracoscopic surgery (VATS) has been advocated in the management of patients with broncho-pleural fistulae (air-leak persisting beyond 7 days): however the optimum time for surgical intervention remains unclear. We reviewed the records of 130 episodes of SP in 115 patients over a 2-year period to determine clinical course and outcome, particularly with respect to duration of air-leak. There were 90 first episodes and 40 recurrent episodes. Eighty-one episodes (62%) occurred in patients with underlying lung disease (secondary pneumothorax). Initial management consisted of chest-tube drainage in 104 episodes (80%) occurring in 90 patients, percutaneous needle aspiration in five patients (4%) and observation in 21 episodes (16%) in 20 patients. In the group treated with chest-tube drainage, there was spontaneous resolution of air leak and lung re-expansion in 90 episodes (87%). The overall incidence of broncho-pleural fistula was 34.6%. In the primary SP group. 75% of air-leaks ceased by 7 days and 100% by 15 days. In the secondary SP group, 61% of air-leaks resolved by 7 days and 79% by 14 days, after which time resolution of air-leak proceeded at a much slower rate. Five patients underwent surgery while nine patients were discharged with residual pneumothoraces. There were no major complications or mortality. Based on our findings, we advocate surgery for patients with air-leak persisting beyond 14 days, while favouring a conservative approach before this time, as the majority of air-leaks (especially in patients with primary pneumothorax) would resolve by 14 days.

Congestive heart failure due to a pancreatic pseudocyst.

BACKGROUND: Mediastinal extension of pancreatic pseudocysts has caused rare cases of cardiac compression, but to our knowledge, congestive heart disease due to cardiac compression by a pancreatic pseudocyst has never been reported. SUMMARY: A 48-year-old man presented with dyspnea, swelling of both lower limbs, left-sided chest pain, and colicky, nonradiating epigastric pain. Computed tomography of the abdomen and lower thorax revealed a huge cystic mass directly behind the heart, extending through the esophageal hiatus into the abdomen. The patient subsequently noted dysphagia and epigastric pain and began vomiting after meals. Radiography of the upper gastrointestinal system with barium contrast confirmed that the lower end of the esophagus and the right and lower portions of the stomach were extrinsically compressed. Complete recovery followed surgical removal and internal drainage of a large pancreatic pseudocyst. CONCLUSIONS: Mediastinal extension of a pancreatic pseudocyst can cause cardiac compression, leading to congestive heart failure.

Lymphangioleiomyomatosis--treatment with progesterone.

Lymphangioleiomyomatosis is a rare devastating disease affecting women mostly of child-bearing age. It presents with spontaneous pneumothorax, chylous effusions, hemoptysis and progressive breathlessness. Most patients die from respiratory failure within 10 years. There are no controlled studies on the efficacy of various treatment regimens. We report our experience with progesterone therapy in three patients. Two failed to respond, one died about 11 years after presentation and another after 5 1/2 years. The third patient has survived 11 years after onset of disease.

Waldenstrom's macroglobulinemia presenting with pleuropulmonary and gastric manifestations.

A case of Waldenstrom's macroglobulinemia is reported in which the main clinical presentation was related to pulmonary infiltrations and pleural effusion. Serum protein studies demonstrated the characteristic monoclonal increase in immunoglobulin M (IgMK). Pleural and percutaneous lung biopsies showed dense lymphocytic infiltration. Gastric biopsy also showed focal atypical lymphoid hyperplasia. There was good clinical and radiological response to treatment with chlorambucil and prednisolone.

The breathing patterns in Chinese and Indian adult males in the supine posture.

The breathing patterns in the supine posture during inspiration from functional residual capacity (simulating the "liver palpation" manoeuvre) were studied in two groups of young adult male Chinese and Indians with each group comprising 30 subjects. Both groups were matched for age, height and weight. Although the findings did not reach a statistically significant level, Indian subjects were found to breathe more with their abdomen compared to the Chinese during the manoeuvre. The two groups behaved similarly when they breathed with increasing amplitude from their resting tidal volume to full inspiratory capacity. There was also no difference between the two groups when they performed the total lung capacity manoeuvre.

Diffuse panbronchiolitis--a case report.

Diffuse panbronchiolitis (DPB) is a chronic progressive obstructive disease of the airways. Of unknown aetiology, it is responsive to macrolide therapy. Although not uncommon among the Japanese, it is rare in other parts of the world. We report a case of DPB in a Chinese patient in Singapore.

Department audit of inpatient management of asthma.

Rising asthma morbidity and mortality worldwide has prompted the recommendation of guidelines for its management. There has also been recent interest in the role of medical audit in assessing the effectiveness of guidelines, and in identifying deficiencies in clinical practice. We disseminated guidelines for the inpatient management of asthma to our department in March 1994, and subsequently performed a criterion-based audit in which we measured our performance in fulfilling various criteria deemed essential for good asthma management. Three periods in time were audited: a five-week period in March/April 1993 before the existence of guidelines (n = 22), the same period in March/April 1994 (n = 27), and the month of August 1994 (n = 17). The introduction of guidelines resulted in definite improvement in history-taking, physical examination, management, review, monitoring and patient fulfillment of pre-discharge criteria. Specific deficiencies identified were underuse of peak flow measurements, which improved after guidelines; and under prescription of oxygen, which persisted despite the guidelines. No difference was noted in terms of the quality outcome indicators of length of hospital stay, complications of procedures, hospital incidents, morbidity, mortality or visits to the A & E. There was, however, an encouraging drop (although not statistically significant) in the one-month readmission rate from 13.6% in 1993, to 7.4% and 5.9% in 1994, after the introduction of guidelines.

Mild haemolysis associated with flu-syndrome during daily rifampicin treatment--a case report.

We describe a woman with the 'flu' like syndrome and haemolysis whilst on a supervised daily rifampicin regimen for the treatment of pulmonary tuberculosis. Although these are known complications of rifampicin therapy, they often occur when therapy is intermittent or interrupted. Hence the case we describe is unique and is the first of its kind to be reported in Singapore.

Aeromonas endocarditis in a patient with chronic hepatitis-B infection.

Aeromonas, a genus of gram-negative bacteria normally found in water and soil, is well established as a pathogen in the animal kingdom. Often considered as a pathogen of low virulence, its role in human infections has recently been recognised. Aeromonas infections in humans range from cellulitis to septicaemia. Endocarditis is rare. We describe here a patient with a chronic liver disease with aeromonas bacteremia and endocarditis.

Group G streptococcal endocarditis and bacteraemia--a report of 3 cases.

Three patients with Group G Streptococcal infection presenting with endocarditis and septicaemia are reported. All had underlying cardiac disease, and one had diabetes mellitus and a colonic carcinoma. Our three patients responded to intravenous crystalline penicillin.

Sleep apnoea syndrome--a report of 14 cases.

Patients with sleep apnoea syndrome suffer considerable morbidity and an increased mortality. We reviewed the characteristics of 14 patients with sleep apnoea syndrome (11 males and 3 females) who were studied since 1986. All were less than or equal to 60 years of age with the majority in their 4th and 5th decade. Obesity was present in 8 patients (57%) and hypertension in 6 (43%). Overnight sleep studies showed that 11 patients had obstructive sleep apnoea, 2 had central and one had predominantly mixed sleep apnoea. Ten patients (71%) had some form of nose and/or throat pathology. Tonsillectomy seemed an effective therapeutic procedure in those with upper airway obstruction due to enlarged tonsils. Four out of 5 patients had significant symptomatic improvement post-tonsillectomy. Nasal continuous positive airway pressure was also effective in alleviating apnoeas and relieving symptoms in 4 other patients who had no obvious upper airway obstruction. A high proportion of our patients had obstructive sleep apnoea due to enlarged tonsils. Tonsillectomy offered a simple and effective therapy for such patients. Nasal continuous positive airway pressure was also effective in the treatment of obstructive sleep apnoea.

A case of primary diffuse tracheobronchial amyloidosis treated by laser therapy.

We report a case of primary diffuse tracheobronchial amyloidosis in a 72-year-old lady who presented with a long history of recurrent cough, dyspnoea, wheezing, haemoptysis and chest infection. She was treated successfully with three sessions of laser therapy. There were improvements in both clinical symptoms and measurements of airway obstruction. Bronchodilators and oral prednisolone were not required after treatment.

Evaluation of the efficacy of sequential intravenous-oral administration of pefloxacin in community-acquired lower respiratory tract infections in patients with underlying conditions.

We studied the efficacy of sequential intravenous-oral pefloxacin therapy in community-acquired lower respiratory tract infection in 24 patients with one or more underlying conditions. Twenty-eight patients were enrolled into the study but only 24 patients were evaluated. There were 16 males and 8 females with a mean age of 66.9 +/- 11.2 years (mean +/- SD, range 46 to 87 years). The underlying conditions present were bronchiectasis, chronic obstructive lung disease and diabetes mellitus. Patients who were older than 70 years but without any underlying condition were also enrolled. All received 4 days of intravenous pefloxacin 400 mg twice a day followed by oral pefloxacin 400 mg twice a day for another 10 days. Assessment of success was based on clinical, microbiological and radiological improvement. Pefloxacin produced 79.2% clinical cure rate. Another 8.3% showed improvement. Pefloxacin was well tolerated. There were few adverse effects and none of the patients required a change of antibiotic. Pefloxacin was an effective and well tolerated treatment for respiratory tract infection and had the advantage of broad in-vitro antibacterial activity, twice daily dosing and sequential availability in an intravenous and oral formulation.

The effect of fresh orange juice on bronchial hyperreactivity in asthmatic subjects.

We studied 16 mild stable asthmatic subjects to determine if orange juice increases nonspecific bronchial hyperreactivity (NSBH). In 9 subjects, bronchial responsiveness to histamine was assessed before and after water ingestion on the control day, and orange ingestion on a consecutive day. The mean (+/- SD) ratio of log10 PD20 FEV1 after water: log10 PD20 FEV1 before water (1.00 +/- 0.13) was not significantly different from the mean (+/- SD) ratio of log10 PD20 FEV1 after orange: log10 PD20 FEV1 before orange (0.97 +/- 0.12). To avoid the possibility of histamine tachyphylaxis, 7 subjects participated in a second protocol in which histamine PD20 FEV1 was determined on a control day (geometric mean 0.11 mg.) and again two days later, thirty minutes after ingestion of orange juice (geometric mean 0.06 mg). There was no significant difference in the PD20 FEV1 (p = 0.344). Our data show that ingestion of fresh orange juice per se did not heighten NSBH in our subjects. (PD20 FEV1 is the dose of histamine required to produce a twenty percent fall in forced expiratory volume in one second [FEV1]).

Occupational asthma due to isocyanates in Singapore.

Nine cases of occupational asthma due to isocyanates are described. The isocyanates involved included toluene diisocyanate (TDI), diphenyl-methane diisocyanate (MDI) and polyisocyanates. The importance of asking the occupational history in a patient with asthma is illustrated. The importance of early diagnosis and removal from further exposure is also discussed.

Carcinoma of the lung with metastases to skeletal muscles.

A prominent feature of the natural history of carcinoma of the lung is that it invariably metastasizes to other organs. The well-known sites include lymph nodes, liver, adrenals, bones and brain. Spread is mainly by lymphatic and haematogenous routes, or by direct extension. However, like many other primary malignancies, the spread of carcinoma of the lung to skeletal muscles is rare. This is despite its bulk and abundant blood supply. Why this is so is unknown. A search of the literature revealed only 3 published case reports of carcinoma of the lung spreading to skeletal muscles. In this paper, we report a case of squamous cell carcinoma of the lung with multiple metastases to skeletal muscles.