Characteristics, symptom management and outcomes in Covid-19 patients referred to palliative care in a tertiary hospital: A retrospective observational study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) variants pose unique challenges with inevitable premature death when cases of severe disease exponentially rise in a healthcare system. It is imperative that palliative care is provided with a proactive approach to symptom recognition, assessment, management and treatment escalation to ensure comfort throughout the course of this illness. OBJECTIVES: To evaluate the characteristics, symptom burden, palliative care management and outcomes of COVID-19 patients referred to a palliative care unit (PCU) in a single tertiary hospital. Clinical outcomes specifically observed the management of agitation in these patients based on their Richmond Agitation and Sedation Scale (RASS) scores. METHODS: A retrospective observational study was conducted in a tertiary hospital by reviewing electronic medical records and extracting data from 1st June 2021to 31st July 2021 of all COVID-19 patients referred to the PCU. RESULTS: A cohort of 154 (75 males, 79 females) COVID-19 patients was referred to the PCU with a mean age of 67 (20- 95) years. The median number of days of COVID-19 illness before referral was 7(4-11), with 79.3% of patients being in categories 4 and 5. The median duration of the PCU involvement was 4(1-24) days; 74% of families were engaged in virtual platform communication. The most prevalent symptoms were dyspnoea (73.4%) and agitation (41.6%). Common medications used were opioids, antipsychotics and benzodiazepines. Among agitated patients, none had RASS scores above +2 in the last encounter. Palliative care doctors in the team reported complete effectiveness in patient's symptom control in 74% of patients. CONCLUSIONS: A hallmark of severe COVID-19 is rapid deterioration, which calls for proactive assessment and urgent palliation. Breathlessness and agitation are priority symptoms to address. Among agitated patients, benzodiazepines and antipsychotics are highly effective in addressing agitation and reducing RASS scores. Communication with families using virtual platforms is effective in providing a supportive presence and closure when face-to-face communication is not possible.

Renal point-of-care ultrasound performed by ED staff with limited training and 30-day outcomes in patients with renal colic.

BACKGROUND AND AIM: Emergency Department (ED) renal point-of-care ultrasound (PoCUS) in renal colic by accredited specialists has good prognostic value. This may not be generalizable to under-resourced EDs. We investigated PoCUS in renal colic in our ED with lesser training. METHODS: We performed a single-centre health records review of adult ED patients with renal colic and PoCUS. Patients were managed by a non-ED specialist/resident doctor with no POCUS accreditation in consultation with an attending. These doctors attended a 3.5-h training session conducted by accredited attendings to examine hydronephrosis. They needed to verify their PoCUS findings with an attending during the first two weeks of their six-month posting before performing it independently. The primary outcome was 30-day urological procedures in hydronephrotic vs. non-hydronephrotic groups. Secondary outcomes were the distribution of primary outcome with grades of hydronephrosis, 30-day ED nephrolithiasis-related reattendances in hydronephrotic vs. non-hydronephrotic groups and its distribution with grades of hydronephrosis. We compared outcomes using Fisher's exact test. We also reported crude odds ratio (COR) and 95% CI of primary outcome between hydronephrotic vs. non-hydronephrotic groups. p values ≤ 0.05 were significant. RESULTS: We recruited 651 patients; 160 (24.6%) without and 491 (75.4%) with hydronephrosis. Rates of grades of hydronephrosis were: mild (76.6%), moderate (13.8%), severe (1.2%) and undifferentiated (8.4%). There was a difference in 30-day urological procedures (rates [95% CI]) in hydronephrotic vs. non-hydronephrotic groups, 11.2 [8.7-14.0]% vs. 2.5 [1.0-6.3]%; p < 0.001; COR (95% CI) 4.9 (1.8-13.8); p = 0.002. Increasing 30-day urological procedural rates were associated with increasing grade of hydronephrosis [no: 2.5%, mild: 7.7%, moderate: 23.5%, severe: 67.0% and undifferentiated: 14.6%; p < 0.001]. No differences occurred in other secondary outcomes. CONCLUSIONS: Renal PoCUS could be performed by non-ED specialist/resident doctors to identify patients without hydronephrosis who rarely required urological intervention. Hydronephrotic patients could benefit from further risk stratification.

ABSTRAIT: CONTEXTE ET OBJECTIF: L'échographie rénale au point de soin (PoCUS) dans les coliques rénales par des spécialistes agréés a une bonne valeur pronostique. Cela peut ne pas être généralisable aux SU sous-financés. Nous avons étudié PoCUS dans les coliques rénales dans notre DE avec une formation moindre. MéTHODES: Nous avons effectué un examen des dossiers médicaux d'un seul centre des patients adultes atteints de coliques rénales et de PoCUS. Les patients étaient pris en charge par un médecin résident/spécialiste non-membre de la DG sans accréditation POCUS en consultation avec un médecin traitant. Ces médecins ont assisté à une séance de formation de 3,5 heures menée par des titulaires accrédités pour examiner l'hydronéphrose. Ils devaient vérifier leurs résultats PoCUS auprès d'un assistant pendant les deux premières semaines de leur affectation de six mois avant de l'effectuer de manière indépendante. Le critère de jugement principal était des procédures urologiques de 30 jours dans les groupes hydronéphrotiques vs non-hydronephrotiques. Les critères de jugement secondaires étaient la distribution du critère de jugement primaire avec les grades d'hydronéphrose, les reattendances liées à la néphrose ED de 30 jours dans les groupes hydronéphrotiques vs non hydronéphrotiques et sa distribution avec les grades d'hydronéphrose. Nous avons comparé les résultats en utilisant le test exact de Fisher. Nous avons également signalé un rapport de cotes brut (RC) et un IC à 95 % du critère de jugement principal entre les groupes hydronéphrotiques et non hydronéphrotiques. Les valeurs de P 0,05 étaient significatives. RéSULTATS: Nous avons recruté 651 patients; 160 (24,6%) sans et 491 (75,4%) avec hydronéphrose. Les taux d'hydronéphrose étaient les suivants : légère (76,6 %), modérée (13,8 %), sévère (1,2 %) et indifférenciée (8,4 %). Il y avait une différence dans les interventions urologiques de 30 jours (taux [IC à 95 %]) dans les groupes hydronéphrotiques par rapport aux groupes non-hydronephrotiques, 11,2 [8,7-14,0] % contre 2,5 [1,0-6,3]%; p < 0,001; RCC (IC à 95 %) 4,9 (1,8-13,8); p = 0,002. L'augmentation des taux de procédures urologiques de 30 jours était associée à l'augmentation du grade d'hydronéphrose [non : 2,5%, léger : 7,7%, modéré : 23,5%, sévère : 67,0% et indifférencié : 14,6%; p < 0,001]. Aucune différence n'est survenue dans les autres critères de jugement secondaires. CONCLUSIONS: La PoCUS rénale pourrait être réalisée par des médecins non spécialistes/résidents de la D pour identifier les patients sans hydronéphrose qui ont rarement nécessité une intervention urologique. Les patients hydronéphrotiques pourraient bénéficier d'une meilleure stratification des risques.

Experience of a screening centre for influenza A/H1N1: the first 50 days.

BACKGROUND: The authors' emergency department (ED) served as Singapore's screening centre for influenza H1N1 cases. The aims of the study were to describe their screening experience and to compare clinical and laboratory features of H1N1 versus seasonal flu cases. METHODOLOGY: The authors conducted a prospective observational study on consecutive patients aged 16 years and above presenting to a busy, urban ED for H1N1 screening over 50 days. Clinical, laboratory, radiological and PCR data were collected from the hospital electronic databases. Primary outcomes were proportions of confirmed H1N1 cases and their distribution of clinical, laboratory and radiological features. Secondary outcomes were comparison of clinical and laboratory features of H1N1 versus seasonal flu cases. Data were analysed using descriptive statistics and univariate analysis was used to compare factors between the two groups. A p value <0.05 was considered statistically significant. RESULTS: 1205 patients were screened. 31 (2.6%) and 133 (11%) of them had H1N1 and seasonal flu infections, respectively. The two groups had similar symptoms. There were six clinical and two laboratory features with statistically significant differences between H1N1 and seasonal flu cases. Clinical factors were travel or contact history, median age, respiratory rate, diastolic blood pressure and length of hospital stay. Laboratory factors were median platelet and lymphocyte counts. CONCLUSIONS: The authors report their experience as the nation's H1N1 screening centre. They identified factors that were different between H1N1 and seasonal flu cases. Future research is needed to elucidate if and how this information can be used as a screening tool for H1N1.

Isolation, cDNA cloning, and overexpression of a 33-kD cell surface glycoprotein that binds to the globular "heads" of C1q.

This work describes the functional characterization, cDNA cloning, and expression of a novel cell surface protein. This protein designated gC1q-R, was first isolated from Raji cells and was found to bind to the globular "heads" of C1q molecules, at physiological ionic strength, and also to inhibit complement-mediated lysis of sheep erythrocytes by human serum. The NH2-terminal amino acid sequence of the first 24 residues of the C1q-binding protein was determined and this information allowed the synthesis of two degenerate polymerase chain reaction primers for use in the preparation of a probe in the screening of a B cell cDNA library. The cDNA isolated, using this probe, was found to encode a pre-pro protein of 282 residues. The NH2 terminus of the protein isolated from Raji cells started at residue 74 of the predicted pre-pro sequence. The cDNA sequence shows that the purified protein has three potential N-glycosylation residues and is a highly charged, acidic molecule. Hence, its binding to C1q may be primarily but not exclusively due to ionic interactions. The "mature" protein, corresponding to amino acid residues 74-282 of the predicted pre-pro sequence, was overexpressed in Escherichia coli and was purified to homogeneity. This recombinant protein was also able to inhibit the complement-mediated lysis of sheep erythrocytes by human serum and was shown to be a tetramer by gel filtration in nondissociating conditions. Northern blot and RT-PCR studies showed that the C1q-binding protein is expressed at high levels in Raji and Daudi cell lines, at moderate levels in U937, Molt-4, and HepG2 cell lines, and at a very low level in the HL60 cell line. However, it is not expressed in the K562 cell line. Comparison of gC1q-R NH2-terminal sequence with that of the receptor for the collagen-like domain of C1q (cC1q-R) showed no similarity. Furthermore, antibodies to gC1q-R or an 18-amino acid residue-long NH2-terminal synthetic gC1q-R peptide did not cross-react with antibodies to cC1q-R. Anti-gC1q-R immunoblotted a 33-kD Raji cell membrane protein, whereas anti cC1q-R recognized a molecule of approximately 60 kD. The NH2-terminal sequence of gC1g-R appears to be displayed extracellularly since anti-gC1g-R peptide reacted with surface molecules on lymphocytes, polymorphonuclear leukocytes, and platelets, as assessed by flow cytometric and confocal laser scanning microscopic analyses.(ABSTRACT TRUNCATED AT 400 WORDS)

Angiostrongylus cantonensis: proof of direct transmission with its epidemiological implications.

Infective larvae of the rat lungworm Angiostrongylus cantonensis, presumed cause of human eosinophilic meningoencephalitis, are shed in mucus exuded by naturally infected Malayan slugs (Microparmarion malayanus). Larvae passed by slug hosts were recovered from lettuce and produced normal infection in white rats. Lettuce sold in the local public market also yielded small numbers of infective larvae. Experimental evidence from rats suggests that the local human population, exposed to repeated low-level infections, may become immunized against the rare massive exposure and against clinical disease that might otherwise result after ingestion of heavily infected raw mollusks.

Role of Coronary Angiography in Pre-Liver Transplantation Cardiac Evaluation: Experience From an Asian Transplant Institution.

BACKGROUND: Liver transplant (LT) patients with significant coronary artery disease (CAD) have poorer outcomes. Pre-LT coronary angiography (CA) is associated with significant complications in cirrhotic patients. METHODS: This study aimed to identify predictors of abnormal CA in pre-LT cardiac assessment and to develop a predictive model to reduce unnecessary CA. From January 2006 to June 2013, 122 patients underwent CA based on the current institutional protocol. RESULTS: Forty-one (33.6%) patients had abnormal CA. Univariate analysis showed age ≥65 years (P = .001), cryptogenic cirrhosis (P = .046), cardiac comorbidities (P = .027), ischemic heart disease (IHD; P = .002), left ventricular hypertrophy (LVH; P = .004), hypertension (P = .002), diabetes mellitus (P = .017), dyslipidemia (P < .001), metabolic syndrome (P = .003), ≥2 CAD risk factors (P = .001), and high Framingham risk score (hard CAD risk, P = .018; cardiovascular disease: lipids, P = .002; body mass index, P < .001) to be significant predictors of abnormal CA. A predictive model was developed with the use of multivariable logistic regression and included diabetes, dyslipidemia, IHD, age ≥65 years, and LVH, achieving a specificity of 55.1% and sensitivity of 90.0%. This would reduce unnecessary CA by up to one-half in our study population (from 81 to 35) while maintaining a false negative rate of only 8.5%. CONCLUSIONS: Diabetes, dyslipidemia, IHD, age ≥65 years, and LVH appear to be predictors of abnormal CA in pre-LT patients. Our predictive model may help to better select patients for CA, although further validation is required.

Characterization of the murine gene of gC1qBP, a novel cell protein that binds the globular heads of C1q, vitronectin, high molecular weight kininogen and factor XII.

gC1qBP is a novel cell protein which was found to interact with the globular heads of C1q, high mol. wt kininogen, factor XII and the heparin-binding, multimeric form of vitronectin. The protein sequence shows no homology to any protein family. This paper describes the genomic organization of mouse gC1qBP and the characterization of its 5' flanking region. The mouse gene consists of six exons separated by five introns, and its total length is approximately 6kb. Exon 1 encodes the putative signal peptide, a long stretch of 70 amino acid residues, and the first four amino acid residues found in the mature gC1qBP. Exons 2-5 encode four very hydrophilic domains, whereas exon 6 encodes a neutral domain. The amino acid sequence responsible for binding to the heparin-binding, multimeric form of vitronectin is located in exon 2. A 1kb DNA fragment upstream of the first initiation codon was sequenced, which contained four potential TATA boxes, seven CAAT boxes, six SP1 sites and various putative transcription factor-binding elements, indicating that the promoter region is in close proximity to the first exon. The mouseC1qbp gene was mapped to chromosome 11, closely linked to D11Mit4 using genomic DNAs from a (C57BL/6J x Mus spretus)F1 x Mus spretus backcross.

Scrub typhus infection in rats in four habitats in Peninsular Malaysia.

Rickettsia tsutsugamushi isolations were attempted from blood samples obtained from rats captured in four adjacent habitats near Kuala Lumpur, Malaysia. Antibody surveys were also made. Rickettsial infections were most frequent in rats captured in the forest and in lalang grass (Imperata cylindrica) and least frequent in the most extensively disturbed habitat, an Orang Asli (aborigine) village. Forest rats such as Rattus sabanus (31%), as well as rats in the subgenus R. (Rattus), i.e. R. tiomanicus (26%) and R. argentiventer (35%) had frequent active infections. The house rat R. exulans had less frequent infections (15%). Frequency of antibody occurrence followed a similar pattern. No marked seasonal differences in the frequency of infections could be detected during the 18-month study.

In situ localization of infectious bursal disease virus-binding cells by a biotin-streptavidin system.

A biotin-streptavidin system was established to directly visualize infectious bursal disease virus (IBDV)-binding cells in cell culture or in fresh tissues. The cells or tissue sections were first incubated with a biotinylated, purified IBDV strain GZ911 and then with a streptavidin-beta-galactosidase conjugate. In the presence of the enzyme substrate X-gal, IBDV-binding cells were labeled in blue color. By applying this method to frozen tissue sections, virus-binding sites were localized in situ in the bursa, spleen, and kidney tissue sections, whereas no positive cells were detected in the thymus tissue sections. Chicken embryo fibroblasts, Vero cells, MOP-8 cells, 293-EBNA cells, PANC-1 cells, and HuTu 80 cells were found to bind to the virus. However, the binding of the virus to MDA-MB-231 cells and SVG p12 cells was undetectable. This method can be employed for the expressional cloning of IBDV receptor and can be applied to studies on other avian viruses.

The in vivo and in vitro effects of chicken interferon alpha on infectious bursal disease virus and Newcastle disease virus infection.

The in vitro and in vivo effects of chicken interferon alpha on infectious bursal disease virus (IBDV) infection were investigated in this study. A cDNA of interferon alpha was first cloned from a Chinese strain chicken Shiqi by reverse transcription-polymerase chain reaction. The deduced amino acid sequence has one amino acid substitution with chicken interferon alpha 1 at residue 65 (N to S) and two amino acid substitutions with chicken interferon alpha 2 at residues 50 (N to S) and 58 (P to L), respectively. A prokaryotic expression system was employed to produce a large quantity of recombinant protein. Recombinant interferon was purified in a one-step process, and an optimal refolding process was devised. About 51% recombinant protein from inclusion bodies was refolded, and the final yield of the recombinant interferon reached 24.66 mg/liter culture. The recombinant interferon suppressed IBDV plaque formation in a dose-dependent manner and ameliorated IBDV and Newcastle disease virus infection in both specific-pathogen-free (SPF) and commercial chickens. The antiviral effect of interferon alpha is more significant in commercial chickens than in SPF chickens, and the route of administration affects the efficacy of interferon therapy. This is the first reported study of the effects of interferon alpha on IBDV infection.

Molecular characterization of seven Chinese isolates of infectious bursal disease virus: classical, very virulent, and variant strains.

Seven infectious bursal disease virus (IBDV) strains isolated from China have been characterized in this study, including a classical strain CJ801, an attenuated strain GZ911, a variant strain GZ902, and four very virulent strains G9201, G9302, F9502, and HK46. With the use of reverse transcription-polymerase chain reaction, the full-length VP2 genes were amplified and the hypervariable regions were sequenced. Protein sequences of the hypervariable region (a.a. 143-382) of the field isolates confirmed their identities. CJ801 has the highest identity to the classical strains STC and 52/70. GZ902 has the highest identity to the American variant strains A, E, and GLS, and they share unique amino acid residue at positions 249K and 254S, which are not present in standard serotype 1 strains. Attenuated strain GZ911, like other cell culture-adapted strains, has substitutions at positions 279(D to N) and 284 (A to T) as well as in the serine-rich heptapeptide region. Hence, these substitutions may take an important role in the reduced virulence of these strains. The four very virulent strains have the highest identity to the European very virulent strain UK661 and Japanese strain OKYM. These strains share unique amino acid residues at positions 222A, 256I, and 294I, which are not present in other less virulent strains. The very virulent strains isolated in Guangdong (G9201, G9303) and Fujian (F9502) Provinces have one to five amino acid substitutions at the two hydrophilic domains of VP2 comparing with UK661 and OKYM, indicating that new very virulent strains are evolving. Phylogenetic analysis suggests that Chinese very virulent IBDVs and European very virulent strains are derived from similar origin.

Identification of functional domains on gC1Q-R, a cell surface protein that binds to the globular "heads" of C1Q, using monoclonal antibodies and synthetic peptides.

A membrane protein (33 kDa) that binds to the globular "heads" of C1q (gC1q-R) has been recently described. The full length cDNA encoding gC1q-R has been cloned, expressed in E. coli and using the purified recombinant protein (rgC1q-R) as an immunogen, a panel of IgG monoclonal antibodies (MAb) has been produced by fusion of spleen cells from hyperimmunized BALB/c mice with NSO mouse myeloma partners. From this fusion, 60 anti-gC1q-R hybridomas were selected and evaluated for their ability to (1) discriminate between the mature form (MF) of gC1q-R (residues 74-282) and a truncated form (TF) lacking residues 74-95, which contains a major C1q binding site, (2) recognize two functionally defined synthetic peptides derived from the NH2-(XN18) and COOH-(XC15) terminus of gC1q-R, and (3) bind to microtiter well fixed intact Raji cells. Several clones were identified: MAbs 46.23 and 60.11 (IgG1 kappa), reacted strongly with ELISA plate-fixed intact Raji and K562 cells, MF, and the XN18 peptide, but had poor or no reactivity with TF; MAbs 74.5.2 > 25.15 (IgG1 kappa) recognized both MF and TF and are directed against epitopes in the XC15 peptide that contains a binding site for high-molecular-weight kininogen and Factor XII.

Airway management--when and how?

Keeping the airway patent and protected is the crucial first step in resuscitation of collapsed patients. The patency of the airway can be maintained by head tilt, chin lift and jaw thrust, with or without the assistance of airway adjunct, for example oropharyngeal or nasopharyngeal airways. Before securing definitive airway by endotracheal intubation, the degree of difficulty for intubation can be predicted using Mallampati, Cormack and Lehane classification. Laryngeal mask airway may have a role in resuscitation. A comprehensive training program must be in place to improve the success rate of the laryngeal mask airway insertion and reduce the complication rate associated with the placement of this device. In order to ensure survival of collapsed patients, all medical and nursing staff must know when and how to manage the airways. "Do Not Resuscitate" orders should be written for terminally ill patients to reduce futile resuscitation.

Nausea and vomiting after termination of pregnancy as day surgery cases: comparison of 3 different doses of droperidol and metoclopramide as anti-emetic prophylaxis.

Frequency of nausea and vomiting following day case termination of pregnancy was found to be rather high (42%) without anti-emetic prophylaxis. Droperidol in doses of 2.5 mg, 1.25 mg and 0.25 mg were found to be equally effective as prophylactic anti-emetic, but not metoclopramide 10 mg. This study confirms that low dose droperidol 0.25 mg is effective as a prophylactic anti-emetic, without any delay in immediate recovery and hence suitable for day surgery cases.

PIP: 325 outpatients at Alexandra Hospital in Singapore received intravenously either 2.5 mg droperidol, 1.25 mg droperidol, 0.25 mg droperidol, 10 mg metoclopramide, or a placebo before undergoing surgical abortion. Nursing staff assessed their condition 4-6 hours postoperatively. 42.3% of the women in the untreated group experienced nausea and vomiting after the operation compared to 25.6% for women who received 0.25 mg droperidol (p.05), 23.7% for those who received 1.25 mg droperidol (p.05), and 15.6% for those who received 2.5 mg (p.01). Yet women who received 2.5 mg droperidol were more likely to require sedation 2 hours postoperatively than the other groups and the untreated group (p.05). Even though the percentage of women who experienced nausea and vomiting and received 10 mg metoclopramide was less (37.9%) than those who received the placebo, the difference was not significant. In another study, 1 mg of droperidol slowed perceptual speed and ambulatory recovery. Since 0.25 mg of droperidol resulted in faster recovery in this study and other studies, it was the most effective prophylactic antiemetic.

The first authentic record of Angiostrongylus cantonensis Chen, 1935 Peninsular Malaysia.

Angiostrongylus cantonensis Chen, was recovered from a field rat, Rattus tiomanicus from the East Coast of Peninsular Malaysia. The parasite constitutes the first reported record occurring in this country. Morphological character of the parasite are compared with the original description of A. cantonensis by Chen (1935), A. cantonensis from Formosa and A. malaysiensis from Malaysia.

Digenetic trematodes from rats, squirrels and tree shrews in Malaysia.

Neodiplostomum (Conodiplostomum) Brachylaima, Ectosiphonus and Euparadistomum are reported for the first time from small mammals in Malaysia. New host and locality records are given for Echinostoma, Achillurbainia, Beaveria, Odeningotrema, Leipertrema, Athesmia, Skrjabinus and Zonorchis. Possible-life-cycles of the parasites are discussed in relation to the ecology and feeding habits of the hosts.

The freshwater snail lymnaea rubiginosa as an experimental host of Angiostrongylus malaysiensis: a preliminary report.

Preliminary studies have shown that Lymnaea rubiginosa, a common fresh-water snail in Peninsular Malaysia, which is easily colonized and reared in the laboratory, is a capable experimental intermediate host for Angiostrongylus malaysiensis. Overall 73% of the snails tested became infected following 6 hours exposure to infective rat faeces. Higher infection rates, up to 100%, and heavier worm loads, occurred among the larger sized snails. Snail attrition was low except when very heavy worm loads were acquired.

Rodent and scrub typhus survey in a ricefield at Kramat Tunngak area, Tanjung Priok, Jakarta, Indonesia.

Trapping of small mammals in a ricefield at Kramat Tunggak around Tanjung Priok in Jakarta city, was carried out from July 1977 through June 1978. Of three species of rodents, R.argentiventer was found to be the predominant species in the ricefield. R.r.diardii was an intermittent resident, and the presence of R.norvegicus was interesting observation. S.murinus, a house shrew, was also present. R.argentiventer was the dominant species during the periods when the rice grains were available as a source of food. Infestation with Gamasid mites and non-vector chiggers was found common in all rodent species examined. R. argentiventer was the only species found infested with the classical scrub typhus vector (L. (L.) deliense). The density and mean chigger-load of the scrub typhus vector chiggers were found to be high in stages 4 and 5 of the ricefields when the micro-habitats were favourable. The oriental rat flea (X. cheopis) was found infesting all species of rodents.

Vectors of scrub typhus and their hosts on a mature oil palm estate.

L. (L.) deliense was the predominant vector of scrub typhus in a mature oil palm estate, but a small number of L. (L.) fletcheri (0.1% from rodents) and L. (L.) vivericola (0.02% from rodents and 8.0% from black plates) was also collected. Although good correlation between L. (L.) deliense collected from rodents and from black plates was not established, either method may serve as a general indicator of population fluctuations over a period of time. For the most part, the vectors of scrub typhus were limited to litter piles, and thus, the possibility of contracting scrub typhus within this type of habitat was minimal.

Studies on Malayan filariasis in Bengkulu (Sumatera), Indonesia with special reference to vector confirmation.

In an endemic focus of Brugia malayi in Bengkulu, Indonesia the microfilariae rate was 25%. The microfilariae showed nocturnal periodicity. Domestic cats in the same area were found to harbour B. pahangi, with a microfilariae rate of 23%. In the study area, the most prevalent man-biting Mansonia mosquitoes were Mn.bonneae (41%), followed by Mn.annulata (27%), Mn.uniformis (25%) and Mn.dives (7%). More Mansonia mosquitoes were collected outdoors than indoors between 1800-2200 hours. Natural infections with infective larvae of Brugia spp. were found in Mn.bonneae, Mn.dives, Mn.uniformis, Mn.annulata, and An.nigerrimus. Experimental infection studies revealed that Mn.annulata, Mn.bonneae, Mn.uniformis, An.nigerrimus and An.peditaeniatus permit the development of infective larvae. Under experimental condition, the vectorial competence is high in Mn.bonneae, intermediate in Mn.uniformis and low in An.hyrcanus group. It is concluded that the principal vectors of periodic B.malayi in the study area in Bengkulu are four Mansonia species (Mn.annulata, Mn.bonneae, Mn.uniformis and Mn.dives), and that the potential vectors include two Anopheles species (An.nigerrimus and An.peditaeniatus). This is the first record of Mn.bonneae being a vector of periodic B.malayi in Indonesia.