Bugs for the next century: the issue of antibiotic resistance.

Objective: To address the issue of emerging antibiotic resistance and examine which organisms will continue to pose problems in the new century.

Methods: Review of articles pertaining to bacteria recognised for increasing resistance.

Results: Changing resistance patterns are correlated with patterns of antibiotic use.

Clinics in diagnostic imaging (57). Melioidotic prostatic abscess.

A 46-year-old previously healthy man presented with urosepsis and lower urinary tract obstruction. Both urine and blood cultures grew Burkholderia pseudomallei. Intravenous Ceftazidime failed to control the infection.

Melioidosis splenic abscess--an unusual presentation as osteomyelitis of rib.

Introduction: We report an unusual case of splenic melioidosis abscess presenting as osteomyelitis.

Clinical Picture: A 74-year-old nondiabetic gentleman presents with a non-healing left chest wall abscess from osteomyelitis.

Treatment: He underwent rib resection and the infection was found to involve the underlying pleura, lung, adjacent stomach, liver and diaphragm with a splenic abscess.

Effects of a herbal ergogenic drink on cycling performance in young cyclists.

It is essential to replace fluids lost so as to remain well hydrated during exercise. The intake of fluids is considered a physiological ergogenic aid to enhance exercise performance. There are currently several products in the market that are believed to have ergogenic properties which act as fluid replacement drinks during exercise.

Herbert Screw Fixation of Scaphoid Fractures.

Forty-four scaphoid fractures treated with open reduction and internal fixation using the Herbert screw were available for evaluation at an average follow-up period of 2.1 years and a range of 1 to 6 years. They were classified according to Herbert into 25 unstable (type B); 8 delayed unions (type C); and 11 nonunions (type D).

Outbreak of suspected trichinosis among travelers returning from a neighboring island.

Background: An outbreak of trichinosis involving a cohort of 33 returning travelers from a resort island in a neighboring country was suspected, beginning with 2 initial cases who were hospitalized with a syndrome of fever, myalgia and eosinophilia.

Method: At the initial visit, a full history was obtained and a physical examination was performed for each individual. Also, blood was drawn for full blood count, blood film for malaria parasites and Trichinella serology.

Nipah viral encephalitis or Japanese encephalitis? MR findings in a new zoonotic disease.

Background And Purpose: An epidemic of suspected Japanese encephalitis occurred in Malaysia in 1998-1999 among pig farmers. In neighboring Singapore, an outbreak occurred among pig slaughterhouse workers. It was subsequently established that the causative agent in the outbreak was not the Japanese encephalitis virus but a previously unknown Hendra-like paramyxovirus named Nipah virus.

Insulin reduces leucine oxidation and improves net leucine retention in parenterally fed humans.

Protein metabolism during parenteral feeding was measured with and without euglycemic hyperinsulinemic clamping in five healthy human subjects using the primed continuous infusion of [(13)C]leucine (LEU) tracer methodology. All subjects underwent two periods of protein measurement. Subjects were randomized to have the clamp first or second.

Outbreak of Nipah-virus infection among abattoir workers in Singapore.

Background: In March 1999, an outbreak of encephalitis and pneumonia occurred in workers at an abattoir in Singapore. We describe the clinical presentation and the results of investigations in these patients.

Methods: Clinical and laboratory data were collected by systemic review of the case records.

Skin stapled bowel anastomosis in a canine model.

Aim Of Study: The aim of this study is to compare the safety and cost effectiveness of the use of staples designed for skin closure in the construction of colonic anastomoses.

Method: Twenty healthy dogs were prospectively randomised to either skin stapled or sutured anastomosis. The ascending colon was transected and reanastomosed.

Prolonged cutaneous sequelae after intra-arterial injection of propofol.

Propofol is a popular drug for the induction of anaesthesia and sedation in the intensive care. Previous cases of inadvertent intra-arterial injection propofol injection have had no more than a few hours of hyperaemia. However in this case, residual cutaneous hyperaemia for 12 days were found after intra-arterial injection.

Clinical characteristics and natural history of human immunodeficiency virus infected patients seen at a general hospital in Singapore.

The number of patients with human immunodeficiency virus (HIV) infection in Singapore has risen over the years. A considerable proportion of them present with acquired immunodeficiency syndrome (AIDS). In this study, we document the clinical characteristics and natural history of a consecutive series of 50 patients who were found to have HIV infection when they were seen at a tertiary care hospital.

Mycotic aneurysm of a coronary artery in SLE--a rare complication of salmonella infection.

We describe a 27y old female systemic lupus erythematosus (SLE) patient with salmonella bacteraemia who presented with fever, back pain and an enlarging heart size. A two dimensional echocardiogram (2D Echo) showed a mass in the right atrium. Subsequent computer tomographic (CT) and magnetic resonance imaging (MRI) studies showed that this had become a ring shaped lesion at the posterior end of the interventricular septum with an area communicating with the right atrial cavity.

Bronchoscopy in immunocompromised host with pulmonary infiltrates.

Pulmonary complications related to immunosuppression may be secondary to infection, neoplasia, toxic effects of chemotherapy and radiotherapy or the primary disease itself. The diagnostic yield from bronchoscopic studies on immunocompromised hosts (ICH) with pulmonary infiltrates varies widely and the indication and timing for bronchoscopic procedures remain uncertain. We prospectively studied 60 consecutive ICH with pulmonary lesions over a 12-month period.

Validity of Bayesian forecasting programme in therapeutic drug monitoring of vancomycin in a surgical intensive care unit: a prospective evaluation.

The objectives of this study were: (a) to assess the predictive performance of a 2-compartment Bayesian vancomycin forecasting programme in critically ill patients in the surgical intensive care unit, and (b) to show the applicability of the programme, which is based on parameters derived from Western population, in our local Asian population. Twenty critically ill patients were enrolled into the study programme. All patients received multiple-dose vancomycin for infections due to methicillin-resistant staphylococcus aureus (MRSA).

Bed rest decreases whole-body protein turnover in post-absorptive man.

1. Whole-body protein turnover was measured using the [15N]glycine tracer technique in 10 post-absorptive healthy volunteers during normal daily activities and a period of bed rest. 2.

Urinary tract infections.

Urinary tract infections are common clinical problems which result in significant morbidity and even mortality. UTI's can range from minimal disease to life-threatening sepsis and it is important to differentiate between the former which usually involves the lower urinary tract and the latter which invariably involves the upper urinary tract. Diagnosis depends on an abnormal urine microscopy and demonstration of bacteria in the urine.

Whole-body protein turnover in response to hyperinsulinemia in humans postabsorptively with [15N]glycine as tracer.

Studies using stable isotopes to determine the effect of insulin on whole-body protein turnover have given conflicting results. The precursor approach to studying healthy subjects in a postabsorptive state shows reductions in breakdown and oxidation; with end product methods in parenterally fed patients no such changes are seen. To explain these discrepancies, we measured protein turnover with and without euglycemic hyperinsulinemic clamping postabsorptively in nine healthy subjects by using single-dose [15N]glycine with calculations based on ammonia and urea end product excretion.

Lipid fuel metabolism after abdominal surgery.

The work investigated fuel interrelationships in surgical patients infused with saline (Group I) or glucose (Group II) (13 patients in each group) on the day of surgery and subsequently maintained solely on saline until the fifth postoperative day. Blood concentrations of non-esterified fatty acids (NEFA) and ketone bodies were markedly increased in response to surgical stress on the day of surgery only in patients who were not administered carbohydrate. Increased concentrations of lactate and glucose were observed on the day of surgery in patients infused with either saline or glucose.

Candidemia from a urinary tract source: microbiological aspects and clinical significance.

Twenty-six cases of candidemia associated with a well-defined urinary tract source were retrospectively identified and reviewed. Urinary tract abnormalities were present in 23 of 26 patients (88%), 19 (73%) of whom had urinary tract obstruction. Nineteen patients had undergone urinary tract procedures before the onset of candidemia.

Perfluorocarbon liquids (perfluorodecalin) in vitreoretinal surgery--a local experience.

A low viscosity perfluorocarbon liquid (perfluorodecalin) known commercially as DKLine was used intraoperatively as a temporary vitreous substitute in 20 patients undergoing vitrectomy surgery for a variety of complicated vitreoretinal conditions. The indications for its use included giant retinal tears (9), proliferative vitreoretinopathies (2), dislocated lenses (2), dislocated posterior chamber implant (1), endophthalmitis with retinal detachment (2), traction retinal detachment (1), pseudophakic retinal detachment (2) and exudative retinal detachment (1). In all cases with retinal detachment, perfluorodecalin was successful in flattening the retina intraoperatively.