Rare Cause of Facial Palsy: Case Report of Tick Paralysis by Ixodes Holocyclus Imported by a Patient Travelling into Singapore from Australia.

BACKGROUND: Ticks are blood-sucking arachnids that feed on all classes of vertebrates, including humans. Ixodes holocyclus, also known as the Australian Paralysis Tick, is capable of causing a myriad of clinical issues in humans and companion animals, including the transmission of infectious agents, toxin-mediated paralysis, allergic and inflammatory reactions, and mammalian meat allergies in humans. The Australian Paralysis Tick is endemic to Australia, and only two other exported cases have been reported in the literature. CASE REPORT: We report the third exported case of tick paralysis caused by I. holocyclus, which was imported on a patient into Singapore. We also discuss the clinical course of the patient, the salient points of management, and the proper removal of this tick species. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: With increasing air travel, emergency physicians need to be aware of and to identify imported cases of tick paralysis to institute proper management and advice to the patient. We also describe the tick identification features and proper method of removal of this tick species.

Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis.

Sudden sensorineural hearing loss is typically treated with systemic steroids. The aim of this meta-analysis was to evaluate the efficacy of salvage intratympanic steroid treatment in patients who have initial treatment failure with systemic steroids. A MEDLINE literature search was performed, supported by searches of Web of Science, Biosis, and Science Direct. Articles of all languages were included. Selection of relevant publications was conducted independently by three authors. Only randomized controlled trials were considered. In one arm of the studies, the patients received salvage intratympanic steroids. In the other arm, patients did not receive further treatment. The standard difference in mean (SDM) amount of improvement in hearing threshold between patients who did and did not receive salvage intratympanic steroids was calculated. From an initial 184 studies found via the search strategy, 5 studies met inclusion criteria and were included. There was a statistically significant greater reduction in hearing threshold on pure-tone audiometry in patients who received salvage intratympanic steroids than in those who did not (SDM = -0.401, p = 0.005). Subgroup analysis showed that administration by intratympanic injection (SDM = -0.375, p = 0.013) rather than a round window catheter (SDM = -0.629, p = 0.160) yielded significant improvement in outcome. The usage of dexamethasone yielded better outcomes (SDM = -0.379, p = 0.039) than the use of methylprednisolone (SDM = -0.459, p = 0.187). No serious side effect of treatment was reported. In patients who have failed initial treatment with systemic steroids, additional treatment with salvage intratympanic dexamethasone injections demonstrate a statistically significant reduction in the hearing thresholds as compared to controls.

Low local recurrence rates in young Asian patients with phyllodes tumours: less is more.

BACKGROUND: Phyllodes tumours are increasingly being discovered incidentally in young patients after excision of a seemingly innocuous breast lump. The clinical course of this group of patients has not been well-described, especially in the Asian population. METHODS: A retrospective review of 44 consecutive patients below 25 years of age undergoing surgery for phyllodes tumours at our institution from 1992 to 2010 was conducted. Clinico-pathological data, local recurrence rates and margin involvement were recorded. RESULTS: The majority of the patients had benign lesions treated with simple enucleation, and there were no local recurrences documented after a mean and median length of follow-up of 47.6 and 29.5 months, respectively. CONCLUSION: We conclude that in young Asian patients who present with benign phyllodes tumours, simple excision, followed by close follow-up is sufficient, regardless of surgical margin status.

Clinical audit of the microbiology of otorrhoea referred to a tertiary hospital in Singapore.

INTRODUCTION: Otorrhoea is a common complaint in Ear, Nose and Throat clinics. This study aimed to establish the pathogens involved in cases of otorrhoea in Singapore, their sensitivity patterns and the effectiveness of empirical management. METHODS: A retrospective chart review was conducted on 91 patients with otorrhoea who had undergone swab cultures between July 2010 and February 2011. RESULTS: Of the 91 cases, 53% were diagnosed empirically as bacterial otitis externa and 25% as otomycosis. Aerobic bacteria accounted for 35.8% of the microorganisms cultured, while 34.7% were fungi and 29.5% were anaerobic bacteria. Pseudomonas (P.) aeruginosa and Staphylococcus (S.) aureus made up 31.6% and 21.0% of the microorganisms, respectively. 20% of S. aureus grown was methicillin-resistant. Aspergillus was the most common fungus and 19% of cultures were polymicrobial. 38% of patients had their treatment changed on the basis of culture results, as no improvement was observed on follow-up. P. aeruginosa was sensitive to ciprofloxacin and gentamicin in 81.8% and 76.0% of patients, respectively, while S. aureus was sensitive to cloxacillin in 93.8% and clindamycin in 87.5% of patients. CONCLUSION: The common microorganisms involved in otorrhoea in Singapore are P. aeruginosa, Aspergillus and S. aureus. Resistant strains of Pseudomonas spp. are now present. Methicillin-resistant S. aureus is increasingly prevalent and highly sensitive to vancomycin. Aminoglycoside and fluoroquinolone-containing eardrops are suitable first-line topical antimicrobials. Cloxacillin may be started should a concomitant oral antimicrobial be warranted empirically or for S. aureus infections. Otomycosis should be considered in patients who show no improvement with antibiotics.