Case series of haemothorax secondary to avulsed bullae vessel.

Haemothorax refer to the bleeding in the pleural space. It is commonly due to iatrogenic, blunt or penetrating chest trauma. Non-traumatic haemothorax is a rare entity that can potentially lead to life threatening complications. The initial management of both traumatic and non-traumatic haemothorax includes resuscitation and stabilisation of the patient. We would like to present two cases of non-traumatic haemothorax secondary to an avulsed bullae vessel.

Endometriosis - A rare cause of primary spontaneous pneumothorax.

Catamenial pneumothorax is a rare condition. We report a case of a 36-year-old female who presented with dyspnoea every time before she had her regular menses. Further investigation confirmed that she had catamenial pneumothorax. With this case we wish to highlight this rare diagnostic entity that every clinician should keep in mind.

Cross-sectional study on knowledge of chronic kidney disease among medical outpatient clinic patients.

BACKGROUND: Chronic kidney disease (CKD) is a major health concern worldwide. There are limited studies which look into the actual knowledge level of CKD among the general population both locally and internationally. This study aims to assess the knowledge level of CKD among patients in a secondary hospital in Malaysia. METHODS: Consecutive sampling of patients attending the Medical Outpatient Clinic was performed in this crosssectional study. Respondents were given self-administered questionnaires which contain questions on demographic characteristics and knowledge on CKD. RESULTS: Out of 300 respondents, 78.6% (n=236) of the respondents completed the questionnaire. Majority of respondents (73.7%, n=174) scored less than 4 out of 7 marks on knowledge on CKD. Respondents who were younger, males, having higher education status, professionals/executives and earned higher monthly income were more likely to have a higher mean knowledge score of CKD. Respondents who have heard of CKD were also significantly associated with higher mean knowledge score of CKD. CONCLUSION: The study findings suggest that our Malaysian population is still inadequately informed on CKD, especially those who are at risk of developing CKD and its complications, and also among those of the lower socioeconomic group. In order for successful primary and secondary prevention of CKD, more importance should be placed on increasing awareness on CKD among these atrisk groups.

The Effect of Pre-operative use of Antiplatelets and Anticoagulants on Time to Surgery in Hip Fracture Patients.

Introduction: Hip fractures are a major health concern resulting in significant morbidity worldwide. They are the leading cause of fall-related injuries amongst the elderly with high risk of death, and numbers are expected to rise with the growing elderly population. Expedited surgical repair has been proven to improve patient outcomes, however there are often multiple barriers to early surgery especially in the elderly. The use of antiplatelets and anticoagulation is a significant contributory factor to surgical delay. Materials and methods: We conducted a retrospective, single centre study on hip fracture patients admitted to an acute care orthogeriatric unit over a 12-month period, aimed at determining the impact of pre-operative use of antiplatelets and anticoagulants on time to surgery (TTS) and its impact on one-year mortality rates. Results: Amongst 404 eligible patients, 102 were on antiplatelets, 23 on anticoagulants and 279 were neither on antiplatelets or anticoagulants. Our study showed that patients taking clopidogrel (p<0.001) and DOACs (p=0.001) were more likely to have delayed surgery compared to those who were not on these agents. In addition, all patients on warfarin experienced surgical delay. Warfarin group also had highest mortality rates compared to other group and 10 times more likely to die within a year (p=0.001). Conclusion: The results from this study are consistent with existing literature, suggesting that the use of clopidogrel and anticoagulants have a negative impact on TTS in hip fracture patients. Strategies should be developed for patients on these medications to enhance their TTS.

Rapid preliminary differentiation of species within the Mycobacterium tuberculosis complex: proposition of a radiometric method.

A radiometric method using the "Bactec 460-TB" apparatus now enables rapid obtaining of drug-susceptibility data and differentiation of clinical mycobacterial specimens into those belonging to the Mycobacterium tuberculosis complex (comprised of M. tuberculosis, M. bovis, M. bovis BCG and M. africanum) and non-tuberculous mycobacteria, using a specific inhibitor (p-nitro-alpha-acetyl-amino-beta-hydroxypropiophenone). In the present work, further differentiation of the M. tuberculosis complex into 4 individual species was achieved using the susceptibility of strains to 1.25 micrograms/ml of thiophene-2-carboxylic acid hydrazide, 40 micrograms/ml of D-cycloserine, and 100 micrograms/ml of pyrazinamide.

Selective inhibition of the Mycobacterium tuberculosis complex by p-nitro-alpha-acetylamino-beta-hydroxypropio phenone (NAP) and p-nitrobenzoic acid (PNB) used in 7H11 agar medium.

The potential of p-nitrobenzoic acid (PNB) and p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) for discriminating the Mycobacterium tuberculosis (M.tb) complex from other mycobacteria was evaluated in cases of clinical isolates. For this purpose, 500 micrograms/ml of PNB and 5 or 10 micrograms/ml of NAP were incorporated in 7H11 agar medium, and appropriate dilutions corresponding to about 10(6) viable units were then plated on PNB- or NAP-containing media. Results were reported as growth or no growth as compared to a parallel control. Our data reconfirmed the potential of PNB to discriminate M.tb complex bacteria. This study also showed for the first time that the NAP test (used until now in 7H12a broth only) can also be successfully applied using 7H11 agar. Also, preliminary data with 5 micrograms/ml of NAP on a limited number of strains suggested that it may discriminate the M.tb complex bacilli from M. xenopi and M. gastri better than PNB in 7H11 agar.

Drug susceptibility testing in tuberculosis: a comparison of the proportion methods using Lowenstein-Jensen, Middlebrook 7H10 and 7H11 agar media and a radiometric method.

In the present investigation, the conventional drug susceptibility testing procedures using the 1% proportion method on Löwenstein-Jensen (LJ) and Middlebrook 7H10/7H11 agar media were compared with a recent radiometric method. The latter using "Bactec 460-TB" apparatus and a special broth medium (Becton and Dickinson Diagnostic Instrument Systems, Towson, MD, USA) gave drug susceptibility results within a week as compared to 4-5 weeks with the LJ method, and 3-4 weeks using 7H10/7H11 agar media. This report describes the critical concentrations retained for each of the methods and the methodology used. Also, the compatibility of the results obtained with the radiometric method with those obtained with conventional 7H11 agar method was perfect. In this report, we justify the choice of the 7H11 agar method instead of the LJ method as our conventional drug susceptibility procedure, and suggest also that radiometric drug susceptibility determination by Bactec 460-TB apparatus may be the method of choice for routine, rapid drug susceptibility determinations.

Isolation and characterization of serologically reactive lipooligosaccharides from Mycobacterium tuberculosis.

Two major highly polar antigenic glycolipids were isolated from recent isolates of Mycobacterium tuberculosis from a wide range of geographical origins. The occurrence of these polar glycolipids was demonstrated by isolation, purification and chromatographic characterization and/or serological procedures in 12 strains. Based on their chromatographic properties, these polar glycolipids belong to the lipooligosaccharide family. Preliminary data on the use of these newly described antigens in the serodiagnosis of tuberculosis is presented.

Prevention of prosthetic valve endocarditis by impregnation of gentamicin into surgical pledgets.

A novel drug delivery system was developed for the treatment of prosthetic valve endocarditis (PVE). The antibiotic, gentamicin, was impregnated into surgical pledgets using non-solvent coacervation of polylactic acid (PLA) as a binding/encapsulating agent. The in vitro dissolution profiles show controlled release of gentamicin for up to 36 h when PLA of molecular weight 2000 is used and up to 7 d for PLA with a molecular weight of 50,000. The results indicate potential for the localized treatment of PVE, which is cost-effective, easy to manufacture and permits dosage variability.

Trivalent metal ions in the prevention of calcification in glutaraldehyde treated biological tissues. Is there a chemical correlation?

The influence of chemical factors on trivalent metal ions in the prevention of calcification of glutaraldehyde treated biological tissue has been explored. The results indicate that the chemical link lies in the hard character of the trivalent metal ions. Metal ions with the hardest character appear to have the best chance of reacting with oxygen atoms of the phosphate groups at nucleation sites of hydroxyapatite. This disrupts the nucleation and thus prevents calcification in glutaraldehyde treated biological tissue.

Stazyme, a mycobacteriolytic preparation from a Staphylococcus strain, is able to break the permeability barrier in multiple drug resistant Mycobacterium avium.

As a strategy to augment the potential of existing drugs against Mycobacterium avium we investigated a mycobacteriolytic preparation (stazyme) from the Staphylococcus strain Clavelis, which results in significant mycobacterial growth inhibition. A total of 10 specific protein bands were characterized in the stazyme preparation: three bands within a major 40-60 kDa fraction, five bands within the range of 30-90 kDa, and two bands of about 12 and 14 kDa respectively. Tested at concentrations of 50 and 200 microg ml(-1) of total protein, stazyme was highly bactericidal against M. smegmatis, and bacteriostatic against M. tuberculosis and M. avium. Stazyme was able to break the permeability barrier of M. avium isolates, significantly enhancing the activity of other antituberculous drugs (ethambutol, rifampicin, and amikacin), used at sub-MIC level. Stazyme essentially possessed a lytic activity as evidenced by its ability to lyse purified M. smegmatis cell walls. This lytic activity was also confirmed on intact M. smegmatis and M. avium bacilli by transmission electron microscopy. Precise identification of this mycobacteriolytic determinant(s) in stazyme may be helpful to define novel drug targets in mycobacteria.

Follow up of Mycobacterium tuberculosis transmission in the French West Indies by IS6110-DNA fingerprinting and DR-based spoligotyping.

A total of 115 Mycobacterium tuberculosis isolates from 80 patients were typed using IS6110-DNA fingerprinting and DR-based spoligotyping to describe the active transmission of tuberculosis in a Caribbean setting over a 2-year period. A total of 61 different pattern types were observed by IS6110-RFLP and 10 clusters containing between two and 15 patients could be defined. By spoligotyping, 45 different pattern types were observed with 12 clusters containing two to 11 patients. Thirty-two patients could be included in eight spoligotype-defined clusters and in nine RFLP-defined clusters when strictly concordant matching results were put together. In conclusion, about 40% of the patient isolates were clustered by DNA fingerprinting suggesting recent transmission of tuberculosis in our region. This study confirmed the increased accuracy and discriminatory power of the association of IS6110-RFLP and spoligotyping for studies on the molecular epidemiology of M. tuberculosis, and suggests that despite good implementation of tuberculosis control programs in Guadeloupe, active transmission of tuberculosis may be far more important than suspected.

Synergistic activities of antituberculous drugs with cerulenin and trans-cinnamic acid against Mycobacterium tuberculosis.

The recent upsurge in the incidence of tuberculosis with significant emergence of multidrug-resistant cases has focused on the priority of discovering effective new drugs and on the strategies to augment the potential of existing drugs against Mycobacterium tuberculosis. In the present study, we investigated cerulenin and trans-cinnamic acid, which have recently been shown to augment the activity of various antibiotics against Mycobacterium avium [Antimicrob. Agents Chemother. 38 (1994) 2287-2295], to enhance the activity of isoniazid, rifampin, ofloxacin, amikacin and clofazimine against M. tuberculosis. The synergy observed was compared with identical combinations using ethambutol, a cell wall-inhibiting drug used in standard antituberculous chemotherapy. The results showed that ethambutol resulted in synergistic activity in 12/30 drug combinations, as compared to 15/36 for cerulenin and 101/18 for trans-cinnamic acid. This increase in drug activity was even observed with drug-resistant isolates. Use of novel antimicrobials and understanding of their mechanisms of action may be an effective strategy to determine previously undescribed targets for future drug development.

Antimycobacterial activity of chemically defined natural substances from the Caribbean flora in Guadeloupe.

Eight chemically defined, naturally occurring compounds were extracted from the tropical flora of the Caribbean island of Guadeloupe: pilocarpine, an alkaloid from Pilocarpus racemosus; heraclenol and isomeranzin, coumarins from Triphasia trifolia; lochnerin, an indole alkaloid from Rauwolfia biauriculata; ibogaine and voacangine, indole alkaloids from Tabernaemontana citrifolia; texalin, an oxazole from Amyris elemifera; and canellal, a sesquiterpene dialdehyde from Canella winterana. An essential oil fraction from Canella winterana was also tested. The antimycobacterial activity of these substances was tested against Mycobacterium tuberculosis, M. avium and M. kansasii using the Middlebrook 7H11 agar medium, the Bactec 460-TB radiometric methodology, and determination of bacterial viable counts. Three compounds, namely ibogaine, voacangine and texalin, showed antimycobacterial activity. Investigations on the structure-modification and structure-activity relationships of these compounds may help determine new targets for future drug development.

Evaluation and validation of a commercial ELISA for diazinon in surface waters.

The performance of a commercially available microtiter plate ELISA kit for the determination of diazinon was evaluated for sensitivity, selectivity, intra-assay repeatability, accuracy, and matrix effects in fortified distilled water and filtered and unfiltered environmental surface water samples. Repeatability and reproducibility studies show that the kit satisfies current EPA criteria for the assessment of analytical methods. Mean recoveries from spiked samples averaged 80.3, 95.5, and 103.5% from distilled, unfiltered surface, and filtered surface waters, respectively. The experimentally determined method detection limit (MDL) for the commercial diazinon microtiter plate format (0.0159 microg L(-)(1)) was comparable to the least detectable dose (LDD) established by the manufacturer (0.022 microg L(-)(1)). Specificity studies indicate that the diazinon polyclonal antibody can readily distinguish the target compound from other structurally similar organophosphorus analogues, with the exception of diazoxon. Cross-reactivity with the oxon was approximately 29%, while reactivity with pirimiphos-methyl, pirimiphos-ethyl, and chlorpyrifos-ethyl was negligible. A slight matrix effect was discovered to be present in both filtered and unfiltered environmental water matrixes, but its effect on the immunoassays is insignificant within experimental error. For validation of the microtiter plate ELISA format, environmental surface and storm runoff water samples were collected, split, and analyzed directly by ELISA and by liquid-liquid extraction followed by GC (California State Department of Food and Agriculture method EM 46.0). Results of the two analytical methods were then compared statistically. A close correlation was found between methods for unspiked and untreated river water samples (r = 0.969) while a much less robust correlation was obtained for runoff waters (r = 0.728). Results from runoff waters exhibit a particularly high positive bias for the ELISA method relative to the GC method. Cross-reactivity of diazoxon and probably other unidentified cross-reacting components may be responsible for the exaggerated account of the target analyte in surface and runoff waters. While excellent for screening purposes, further study is required to elucidate and quantify the factors responsible for the consistent overestimation of ELISA results before the kit can be employed routinely for regulatory compliance monitoring.

In vitro strain measurement of a mechanical heart valve in a pulse simulator.

To ascertain the stress magnitude at the stress concentration areas, in vitro strain measurements on a St. Vincent's mechanical heart valve were carried out in a pulse simulator. Results were combined with a finite element (FEM) stress analysis of the titanium valve housing. The maximum stress at the site of stress concentration of the titanium valve housing was 51 MPa. This is well below the fatigue endurance limit of titanium. The imposed stress on the occluder by the upper strut was less than 2 MPa. This is below the lower stress limit of Delrin and may explain why no fracture of the Delrin disk occluder has been reported. The combined use of microstrain analysis and FEM proved to be essential in the determination of dynamic stresses during the opening and closing of the mechanical heart valve.

P53 expression in colorectal carcinoma: the University of Malaya Medical Centre's experience.

Loss of P53 function is regarded as one of the critical steps in colorectal carcinogenesis. This study determines the P53 expression pattern of colorectal carcinoma in a cohort of 116 local patients. There was no significant relationship between overexpression of P53 with tumour stage (p=-0.209, chi square test) and grade (p=0.877, chi square test). Survival analysis using Kaplan-Meier procedure did not show significant relationship between P53 positivity with overall recurrence-free and survival outcome (p=0.3322 and 0.921 respectively; log rank test). Long-term follow-up may give a better evaluation on the prognostic value of P53 overexpression in colorectal carcinoma.

In vitro activity of the new difluorinated quinolone sparfloxacin (AT-4140) against Mycobacterium tuberculosis compared with activities of ofloxacin and ciprofloxacin.

MICs of the new fluoroquinolone drugs ofloxacin, ciprofloxacin, and sparfloxacin (AT-4140) for 10 strains of Mycobacterium tuberculosis were determined by using both a BACTEC radiometric method and testing on solid 7H11 agar medium. Radiometric MICs by 7H12 broth testing ranged from 0.5 to 1.0, 0.25 to 0.5, and 0.1 to 0.2 microgram/ml for ofloxacin, ciprofloxacin, and sparfloxacin respectively, whereas MICs in solid medium ranged from 0.5 to 1.0, 0.5 to 1.0, and 0.2 to 0.5 microgram/ml, respectively. The bactericidal action of the quinolones compared with their reported peak concentrations in human serum showed that sparfloxacin is the most bactericidal, followed by ciprofloxacin and ofloxacin. Our results suggest the potential of the new difluorinated quinolone sparfloxacin for use against the tubercle bacillus and indicate that further determination of its antimycobacterial spectrum and intracellular efficacy may be fruitful.

Action of 1-isonicotinyl-2-palmitoyl hydrazine against the Mycobacterium avium complex and enhancement of its activity by m-fluorophenylalanine.

In the present work, we investigated whether resistance to isoniazid (INH) of organisms belonging to the Mycobacterium avium complex was caused by the bacterial cell envelope, with the cell wall and the outer layer acting as an exclusion barrier. We observed that this exclusion barrier was most efficient in excluding the hydrophilic drug INH, as this drug could not penetrate a wall matrix formed of various polymethylated lipidic or amphipathic substances. Two main strategies were proposed for circumventing this drug resistance: (i) synthesis of amphipathic derivatives of otherwise highly hydrophilic drugs and (ii) inhibition of synthesis of the bacterial outer layer. The purpose of this work was to demonstrate that attaching a palmitic acid side chain to INH rendered it growth inhibitory against M. avium complex bacteria and that the concomitant use of this amphipathic INH derivative with m-fluorophenylalanine (an inhibitor of mycoside C biosynthesis which causes the disruption of the bacterial outer layer) resulted in further enhancement of its activity, leading to a bactericidal effect.