Occupational exposure and challenges in tackling M. bovis at human-animal interface: a narrative review.

Zoonotic tuberculosis caused by Mycobacterium bovis (M. bovis), a member of Mycobacterium tuberculosis complex (MTBC) has increasingly gathered attention as a public health risk, particularly in developing countries with higher disease prevalence. M. bovis is capable of infecting multiple hosts encompassing a number of domestic animals, in particular cattle as well as a broad range of wildlife reservoirs. Humans are the incidental hosts of M. bovis whereby its transmission to humans is primarily through the consumption of cattle products such as unpasteurized milk or raw meat products that have been contaminated with M. bovis or the transmission could be due to close contact with infected cattle. Also, the transmission could occur through aerosol inhalation of infective droplets or infected body fluids or tissues in the presence of wound from infected animals. The zoonotic risk of M. bovis in humans exemplified by miscellaneous studies across different countries suggested the risk of occupational exposure towards M. bovis infection, especially those animal handlers that have close and unreserved contact with cattle and wildlife populations These animal handlers comprising of livestock farmers, abattoir workers, veterinarians and their assistants, hunters, wildlife workers as well as other animal handlers are at different risk of contracting M. bovis infection, depending on the nature of their jobs and how close is their interaction with infected animals. It is crucial to identify the underlying transmission risk factors and probable transmission pathways involved in the zoonotic transmission of M. bovis from animals to humans for better designation and development of specific preventive measures and guidelines that could reduce the risk of transmission and to protect these different occupational-related/populations at risk. Effective control and disease management of zoonotic tuberculosis caused by M. bovis in humans are also hindered by various challenges and factors involved at animal-human interface. A closer look into factors affecting proper disease control and management of M. bovis are therefore warranted. Hence, in this narrative review, we have gathered a number of different studies to highlight the risk of occupational exposure to M. bovis infection and addressed the limitations and challenges underlying this context. This review also shed lights on various components and approaches in tackling M. bovis infection at animal-human interface.

A case of arrhythmogenic right ventricular cardiomyopathy with right ventricle thrombus: A case report

@#Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited cardiomyopathy characterised by right ventricular dysfunction, ventricular arrhythmias and increased risk of sudden cardiac death. Due to the replacement of myocardium with fibro-fatty and fibrous tissue, patients with ARVC are prone to develop ventricular tachycardia. Histologically, it is often reported as the ‘triangle of dysplasia’ involving the inflow tract, outflow tract and apex of the right ventricle.2 We describe a 20-years-old patient who collapsed during a futsal match and was subsequently diagnosed to have ARVC with a right ventricular thrombus from cardiac magnetic resonance imaging.

Microbe-host interplay in atopic dermatitis and psoriasis.

Despite recent advances in understanding microbial diversity in skin homeostasis, the relevance of microbial dysbiosis in inflammatory disease is poorly understood. Here we perform a comparative analysis of skin microbial communities coupled to global patterns of cutaneous gene expression in patients with atopic dermatitis or psoriasis. The skin microbiota is analysed by 16S amplicon or whole genome sequencing and the skin transcriptome by microarrays, followed by integration of the data layers. We find that atopic dermatitis and psoriasis can be classified by distinct microbes, which differ from healthy volunteers microbiome composition. Atopic dermatitis is dominated by a single microbe (Staphylococcus aureus), and associated with a disease relevant host transcriptomic signature enriched for skin barrier function, tryptophan metabolism and immune activation. In contrast, psoriasis is characterized by co-occurring communities of microbes with weak associations with disease related gene expression. Our work provides a basis for biomarker discovery and targeted therapies in skin dysbiosis.

Diagnostic value of electrocardiogram in cardiac tamponade

@#We aim to study the diagnostic value of electrocardiogram (ECG) in cardiac tamponade.

Design and Development of an Ergonomic Trolley-Lifter for Sheet Metal Handling Task: A Preliminary Study

BACKGROUND: There have been some concerns related to manual handling of large items in industry. Manual handling operations of large sheet metal may expose workers to risks related to efficiency as well as occupational safety and health. Large sheet metals are difficult to move and burdensome to lift/transfer, and handling the sharp sheet edges may result in contact stress and/or cut injuries on the workers. METHODS: Through observation, interview, and immersive simulation activities, a few problems related to current handling of sheet metals were identified. A sheet metal trolley-lifter was then designed and fabricated to address these issues. A pilot study on the use of the developed trolley-lifter for handling sheet metals was conducted to compare between the new and traditional handling methods. RESULTS: The pilot study of the trolley-lifter showed promising results in terms of improving the cycle time, manpower utilization, and working postures compared with the traditional handling method. CONCLUSION: The trolley-lifter offers an alternative solution to automation and a mechanized assistive device by providing a simple mechanism to assist the handling of sheet metals effectively and safely.

Acute myocarditis mimicking ST-elevation myocardial infarction: A diagnostic challenge for frontline clinicians

@#The clinical presentation of acute myocarditis is highly variable ranging from no symptoms to cardiogenic shock. Despite considerable progress, it remains a challenge for frontline physicians to discriminate between acute myocarditis and myocardial infarction, especially in the early phase. Our case serves as a reminder that acute presentation of myocarditis could resemble ST elevation myocardial infarction potentially misdirecting the therapeutic decision. The clinical presentation, electrocardiographic and laboratory findings of the patient are not specific enough to distinguish acute myocarditis from myocardial infarction. The gold standard tests such coronary angiography and cardiovascular magnetic resonance (CMR) can reliably differentiate the two entities.

Secondary polycythaemia in a Malay girl with homozygous Hb Tak

Hb Tak is one of more than 200 high affinity haemoglobin variants reported worldwide. It resultsfrom the insertion of two nucleotides (AC) at the termination codon, between codon 146 and codon147 of the beta-globin gene [Beta 147 (+AC)]. Polycythaemia is the main clinical feature althoughaffected carriers are usually asymptomatic and do not require intervention. Several case studies inthis region have reported the co-inheritance of Hb Tak with Hb E, delta beta and beta thalassaemiawith one case of homozygous Hb Tak in a Thai boy. In this case report, a cluster of haemoglobinTak was found in a family of Malay ethnic origin. Cascade family screening was conducted whileinvestigating a 4-year old girl who presented with symptomatic polycythaemia. She had 2 previousHb analysis done, at 7-month and 2-year-old with the diagnosis of possible Hb Q Thailand andHomozygous Hb D, respectively. Both diagnosis did not fit her clinical presentations. She was plethoric,had reduced exercise tolerance as well as cardiomyopathy. Her parents were consanguineouslymarried and later diagnosed as asymptomatic carriers of Hb Tak. Consequently, re-analysis of thegirl’s blood sample revealed a homozygous state of Hb Tak. In conclusion, high oxygen affinityhaemoglobin like Hb Tak should be considered in the investigation of polycythaemic patients withabnormal Hb analyses. In this case, DNA analysis was crucial in determining the correct diagnosis.

Expression of the ATP-gated P2X7 Receptor on M Cells and Its Modulating Role in the Mucosal Immune Environment

Interactions between microbes and epithelial cells in the gastrointestinal tract are closely associated with regulation of intestinal mucosal immune responses. Recent studies have highlighted the modulation of mucosal immunity by microbe-derived molecules such as ATP and short-chain fatty acids. In this study, we undertook to characterize the expression of the ATP-gated P2X7 receptor (P2X7R) on M cells and its role in gastrointestinal mucosal immune regulation because it was poorly characterized in Peyer's patches, although purinergic signaling via P2X7R and luminal ATP have been considered to play an important role in the gastrointestinal tract. Here, we present the first report on the expression of P2X7R on M cells and characterize the role of P2X7R in immune enhancement by ATP or LL-37.

Targeted Delivery of VP1 Antigen of Foot-and-mouth Disease Virus to M Cells Enhances the Antigen-specific Systemic and Mucosal Immune Response

Application of vaccine materials through oral mucosal route confers great economical advantage in animal farming industry due to much less vaccination cost compared with that of injection-based vaccination. In particular, oral administration of recombinant protein antigen against foot-and-mouth disease virus (FMDV) is an ideal strategy because it is safe from FMDV transmission during vaccine production and can induce antigen-specific immune response in mucosal compartments, where FMDV infection has been initiated, which is hardly achievable through parenteral immunization. Given that effective delivery of vaccine materials into immune inductive sites is prerequisite for effective oral mucosal vaccination, M cell-targeting strategy is crucial in successful vaccination since M cells are main gateway for luminal antigen influx into mucosal lymphoid tissue. Here, we applied previously identified M cell-targeting ligand Co1 to VP1 of FMDV in order to test the possible oral mucosal vaccination against FMDV infection. M cell-targeting ligand Co1-conjugated VP1 interacted efficiently with M cells of Peyer's patch. In addition, oral administration of ligand-conjugated VP1 enhanced the induction of VP1-specific IgG and IgA responses in systemic and mucosal compartments, respectively, in comparison with those from oral administration of VP1 alone. In addition, the enhanced VP1-specific immune response was found to be due to antigen-specific Th2-type cytokine production. Collectively, it is suggested that the M cell-targeting strategy could be applied to develop efficient oral mucosal vaccine against FMDV infection.

Residual periodontal pockets are a risk indicator for peri-implantitis in patients treated for periodontitis.

OBJECTIVES: The aim of this retrospective study was to compare the clinical outcomes of implant treatment in periodontally compromised and periodontally healthy patients (PHP), with a minimum follow-up period of 5 years. METHODS: Thirty treated periodontally compromised patients (PCP) and 30 PHP, with a total of 117 Straumann implants (PCP = 56, PHP = 61) were matched for age, gender, smoking and implant characteristics. The PCP group was further stratified with patients having at least one periodontal pocket ≥6 mm at follow-up examination allocated to a "residual periodontitis" (RP) group, while the remaining patients were assigned to a "no residual periodontitis" (NRP) group. These groups were compared with respect to probing pocket depth (PPD), bleeding on probing (BOP) and marginal bone loss. RESULTS: The mean follow-up period in the PCP and PHP groups was 7.99 years (range 5.04-14.40) and 8.20 years (range 5.00-13.46) respectively. There was no difference in mean PPD between the PCP and PHP groups, but the prevalence of implants with PPD ≥5 mm + BOP was greater in the PCP group than in the PHP group, at both implant- (27% vs. 13%) and patient- (37% vs. 17%) level analyses. Mean implant PPD was significantly greater in the RP group (3.18 mm) than in both the NRP (2.67 mm) and PHP (2.81 mm) groups. Mean bone loss was also significantly greater in the RP group (0.68 mm) than in the NRP (0.23 mm) and PHP groups (0.26 mm). The prevalence of bone loss and PPD ≥5 mm + BOP at the implant level was significantly greater for the RP group compared with both the NRP and PHP groups. CONCLUSIONS: Implants in PCP with residual pocketing at follow-up had increased PPD and bone loss compared with implants placed in PHP and PCP without residual pocketing. Hence, it is the maintenance of periodontal health rather than a previous history of periodontitis that is the critical determinant of increased risk of peri-implantitis, highlighting the importance of effective periodontal therapy and maintenance in patients with a history of periodontitis.

A report of two families with sarcosinaemia in Hong Kong and revisiting the pathogenetic potential of hypersarcosinaemia

<p><b>INTRODUCTION</b>Sarcosinaemia is a rare metabolic disorder which has not been reported in Asia.</p><p><b>CLINICAL PICTURE</b>The urine samples of 2 patients were screened as a routine metabolic screening offered for patients with mental retardation in our hospital. We used gas chromatography-mass spectrometry (GC-MS) which is capable of detecting abnormal pattern in amino acids and organic acids. Plasma sarcosine level was further quantified by GC-MS. The same methods were used in the investigations of asymptomatic family members. Urine examination by GC-MS revealed excessive amount of sarcosine in urine (normally undetectable) and their plasma sarcosine levels were raised. The 2 differential diagnoses of presence of sarcosine in urine--glutaric aciduria type II and folate deficiency--were ruled out by the absence of abnormal organic acids in the initial urine screen and by normal serum folate level respectively. Screening of the 2 families identified excessive sarcosine in urine in 2 siblings, one from each family. However, these 2 siblings of indexed patients thus identified have no neurological or developmental problem.</p><p><b>CONCLUSION</b>Our finding was consistent with the notion that sarcosinaemia is a benign condition picked up coincidentally during screening for mental retardation.</p>