Browse publications by year: 1999

  1. Antimicrobial effects of psidium guajava extract as one mechanism of its antidiarrhoeal action
    Lutterodt GD, Ismail A, Basheer RH, Baharudin HM
    Malays J Med Sci, 1999 Jul;6(2):17-20.
    PMID: 22589684
    A morphine-like spasmolytic action (not naloxone reversible; involving the inhibition of acetylcholine release) and also effects on the transmural transport of electrolytes (Na(+) and K(+)) and water have been reported as possible modes of the antidiarrhoeal action of polar fractions of Psidium guajava leaf extractives. The objective for this study was to verify if the reported modes of the antidiarrhoeal action should be broadened to include direct antimicrobial actions on some of the more common bacteria known to cause toxin-induced acute diarrhoea. Serial dilutions of a water-soluble, freeze-dried methanolic extract were tested on 10 such organisms, grown separately on nutrient agar plates, to determine the minimum inhibitory concentration (MIC) for each of these bacteria. These included the causative agents for (i) enteric fever (Salmonella typhi, Salmonella paratyphi A, Salmonella paratyphi B and Salmonella paratyphi C), (ii) food poisoning (Salmonella typhimurium and Staphylococcus aureus), (iii) dysentery (Shigella dysenteriae, Shigella flexneri and Shigella sonnei), and (iv) cholera (Vibrio cholerae). The growth of all these organisms was inhibited at the MIC of 10mg/ml of the extract, which is equivalent to 2.5μg/ml of active extractable flavonoids. The most sensitive organisms (MIC = 1mg/ml) were Staphylococcus aureus, Vibrio cholerae and Shigella flexneri.
  2. Evidence for a general-purpose genotype in Candida albicans, highly prevalent in multiple geographical regions, patient types and types of infection
    Schmid J, Herd S, Hunter PR, Cannon RD, Yasin MSM, Samad S, et al.
    Microbiology (Reading), 1999 Sep;145 ( Pt 9):2405-2413.
    PMID: 10517593 DOI: 10.1099/00221287-145-9-2405
    Epidemiological studies, using the probe Ca3, have shown that in a given patient population a single cluster of genetically related Candida albicans isolates usually predominates. The authors have investigated whether these local clusters are part of a single group, geographically widespread and highly prevalent as an aetiological agent of various types of candidiasis. An unrooted neighbour-joining tree of 266 infection-causing C. albicans isolates (each from a different individual) from 12 geographical regions in 6 countries was created, based on genetic distances generated by Ca3 fingerprinting. Thirty-seven per cent of all isolates formed a single genetically homogeneous cluster (cluster A). The remainder of isolates were genetically diverse. Using the maximum branch length within cluster A as a cut-off, they could be divided into 37 groups, whose prevalence ranged between 0.3% and 9%. Strains from cluster A were highly prevalent in all but one geographical region, with a mean prevalence across all regions of 41%. When isolates were separated into groups based on patient characteristics or type of infection, strains from cluster A had a prevalence exceeding 27% in each group, and their mean prevalence was 43% across all patient characteristics. These data provide evidence that cluster A constitutes a general-purpose genotype, which is geographically widespread and acts as a predominant aetiological agent of all forms of candidiasis in all categories of patients surveyed.
    MeSH terms: Candida albicans/classification*; Candida albicans/genetics*; Candidiasis/microbiology*; Candidiasis/epidemiology*; Candidiasis/pathology; DNA, Fungal/analysis; DNA, Fungal/genetics; Genotype; Humans; Prevalence; DNA Fingerprinting
  3. Use of a New External Fixator for the Correction of Fixed Flexion Deformity of the Fingers
    Siow YS, Ahmad TS, Goh SY
    Hand Surg, 1999 Dec;4(2):167-174.
    PMID: 11089175
    Three patients with severe fixed flexion deformity of the fingers caused by trauma were reported. As an alternative treatment, a new mini external fixator was used to correct the deformities. The use of this device has made treatment of contractures simpler and more predictable. Gradual distraction and straightening was applied to loosen and extend the joints, followed by a period of mobilisation while still on the device. In all the three patients, this experimental device and approach led to improvement of the fixed flexion deformities. With use of this device, surgical release may not be necessary.
    MeSH terms: Contracture; Fingers; Humans; External Fixators
  4. Cloning, expression, and characterization of recombinant Hev b 3, a Hevea brasiliensis protein associated with latex allergy in patients with spina bifida
    Wagner B, Krebitz M, Buck D, Niggemann B, Yeang HY, Han KH, et al.
    J Allergy Clin Immunol, 1999 Nov;104(5):1084-92.
    PMID: 10550757
    BACKGROUND: Two natural rubber latex proteins, Hev b 1 and Hev b 3, have been described in spina bifida (SB)-associated latex allergy.

    OBJECTIVE: The aim of this study was to clone and express Hev b 3 and to obtain the immunologic active and soluble recombinant allergen for diagnosis of SB-associated latex allergy.

    METHODS: A complementary DNA (cDNA) coding for Hev b 3 was amplified from RNA of fresh latex collected from Malaysian rubber trees (Hevea brasiliensis). PCR primers were designed according to sequences of internal peptide fragments of natural (n) Hev b 3. The 5'-end sequence was obtained by specific amplification of cDNA ends. The recombinant (r) Hev b 3 was produced in Escherichia coli as a 6xHis tagged protein. Immunoblotting and inhibition assays were performed to characterize the recombinant allergen.

    RESULTS: An Hev b 3 cDNA clone of 922 bp encoding a protein of 204 amino acid residues corresponding to a molecular weight of 22.3 kd was obtained. In immunoblots 29/35, latex-allergic patients with SB revealed IgE binding to rHev b 3, as did 4 of 15 of the latex-sensitized group. The presence of all IgE epitopes on rHev b 3 was shown by its ability to abolish all IgE binding to nHev b 3. Hev b 3 is related to Hev b 1 by a sequence identity of 47%. Cross-reactivity between these 2 latex allergens was illustrated by the large extent of inhibition of IgE binding to nHev b 1 by rHev b 3.

    CONCLUSION: rHev b 3 constitutes a suitable in vitro reagent for the diagnosis of latex allergy in patients with SB. The determination of the full sequence of Hev b 3 and the production of the recombinant allergen will allow the epitope mapping and improve diagnostic reagents for latex allergy.

    MeSH terms: Adolescent; Adult; Allergens/genetics; Allergens/immunology*; Allergens/isolation & purification; Amino Acid Sequence; Base Sequence; Child; Cloning, Molecular; Evaluation Studies as Topic; Female; Humans; Immunoglobulin E/immunology; Latex/immunology*; Male; Molecular Sequence Data; Plant Proteins/genetics; Plant Proteins/immunology*; Plant Proteins/isolation & purification; Recombinant Fusion Proteins/genetics; Recombinant Fusion Proteins/immunology*; Recombinant Fusion Proteins/isolation & purification; Immunoblotting; Gene Expression; Spinal Dysraphism/blood; Spinal Dysraphism/complications; Spinal Dysraphism/immunology*; Sequence Homology, Amino Acid; Sequence Analysis, DNA; DNA, Plant; Euphorbiaceae/genetics; Latex Hypersensitivity/blood; Latex Hypersensitivity/complications; Latex Hypersensitivity/immunology*; Antigens, Plant
  5. Monoamine oxidase inhibitory naphthoquinone and/or naphthalene dimers from Lemuni Hitam (Diospyros sp.), a Malaysian herbal medicine
    Okuyama E, Homma M, Satoh Y, Fujimoto H, Ishibashi M, Yamazaki M, et al.
    Chem Pharm Bull (Tokyo), 1999 Oct;47(10):1473-6.
    PMID: 10553643
    From the extract of a Malaysian herbal medicine, Lemuni Hitam (Diospyros sp.), which exhibited monoamine oxidase (MAO) inhibition, three new naphthoquinone and/or naphthalene dimers (lemuninols A-C, 1-3) were isolated together with 4,6-dihydroxy-5-methoxy-2-methyl-naphthalene (8) and six known monomers (4-7, 9 and 10). The structures were determined by spectroscopic methods including 2D-NMR techniques. Among them, lemuninol A showed 45% inhibition of MAO (mouse liver) at 5.0 x 10(-6) g/ml, and lemuninols B and C and a naphthoquinone (9) indicated weak activity. Some related quinones were also tested for their MAO inhibitory activities.
    MeSH terms: Animals; Male; Phytotherapy; Models, Chemical; Monoamine Oxidase Inhibitors/isolation & purification*; Monoamine Oxidase Inhibitors/pharmacology; Naphthalenes/isolation & purification*; Naphthalenes/pharmacology; Naphthoquinones/isolation & purification*; Naphthoquinones/pharmacology; Plant Extracts/pharmacology*; Plants, Medicinal/chemistry*; Spectrophotometry, Ultraviolet; Spectrometry, Mass, Fast Atom Bombardment; Dimerization; Mice
  6. Fulltext Career choices of physicians in Malaysia
    Ahmad Z, Jaafar R
    JUMMEC, 1999;4(1):47-50.
    A survey of career choices was conducted for two batches of physicians applying for a medical speciality course in Malaysian medical schools. There were a total of 952 applications, with 477 males and 475 females. Surgery ranked highest, followed by obstetrics and gynaecology, fanlily medicine and orthopaedic surgery. The minor specialities of otorhinolaryngology, psychiatry and pathology were the least popular choices. Questionnaires were sent to a random sample of 250 physicians in each batch to note factors affecting their choices of speciality. A total of 359 physicians responded, giving a response rate of 71.8%. Fixed hours of work and the ability to have direct contact with patients were relatively important factors for choice of speciality. Working as a clinical consultant was the nlost popular nature of employment while worliing in the health office, service consultant in a public hospital, a non-clinical lecturer in a university hospital and working in a private clinic were less popular choices for these physicians. KEYWORDS: Career choice; medical speciality; doctors; Malaysia.
    MeSH terms: Career Choice; Cross-Sectional Studies; Employment; Female; Humans; Malaysia; Male; Physicians
  7. Malnutrition and helminth infection among pre-school children in orang asli resettlement villages in Kelantan
    Zulkifli A, Khairul Anuar A, Atiya AS, Yano A
    JUMMEC, 1999;4:99-103.
    A survey of malnutrition and helminth infections among 268 pre-school children living in the Kuala Betis Orang Asli resttlement villages in Kelantan. The prevalence of helminth infections was 47.4% with Ascaris lumbricoides being the most common helminth (43.9%), followed by Trichuris trichiura (29.7%) and hookworm (6.3%). The prevalence of Ascaris lumbricoides and Trichuris trichiura infections increased with age, with the highest prevalence found in the 6-7 years age group. The overall prevalence of stunting, underweight and wasting were 61.7%, 60.4% and 17.5% respectively. Both stunting and underweight were significantly higher among the infected children. Factors associated with helminth infections in the pre-school children were older age group, poor water supply and households with more than 5 members. Rountine regular deworming is recommended based on the World Health Organisation recommendations for school children.
    MeSH terms: Ascaris; Child; Hookworm Infections; Infection; Malaysia; Trichuris; Water; Water Supply; Prevalence; Ascaris lumbricoides; Malnutrition
  8. Investigation of a recurrent case of salmonellosis due to Salmonella bovismorbificans and Salmonella matopeni using pulsed-field gel electrophoresis analysis and antibiograms
    Thong KL, Puthucheary S, Boey CCM, Pang T
    JUMMEC, 1999;4:103-109.
    A restropective study on a case of recurent salmonellosis in a 3 month old child due to Salmonella bovismorbificans and Salmonella matopeni was carried out using pulsed field gel electrophoresis (PFGE) and antibiotic susceptibility analysis. PFGE clearly distinguished the two serovars and that the recurrent infection was shown to associated with variant forms of Salmonella bovismorbificans. The chromosomal changes detected among the seqential isolates of Salmonella bovismorbificans appeared to be associated with varing antibiogram patterns. The study also showed that the recurrent infection in the patient could be related to prolonged antibiotic therapy. KEYWORDS: Recurrent salmonellosis, PFGE typing, Antibiograms, Salmonella bovismorbificans.
    MeSH terms: Anti-Bacterial Agents; Child; Electrophoresis; Infection; Malaysia; Salmonella
  9. Fulltext Angioedema secondary to angiotensin converting enzyme inhibitors
    Thiruventhiran T, Ho BK
    JUMMEC, 1999;4(2):113-114.
    Angioedema due to whatever cause is potelltially life threatening, especially if it involves the head and neck region. Patients at risk need to be identified and precautionary measures are necessary. The use of Angiotensin Converting Enzyme Inhibitors (ACEIs) has been associated with angioedenia of the face and tongue. Its widespread use has resulted in an increased awareness of this rare but important camplication. We report liere a case of angioedenla secondary to ACEls developing a few months after initiation of therapy and discuss its clinical importance. KEYWORDS: Angioedema, Angiotensin Converting Enzyme Inhibitor.
    MeSH terms: Aged; Angioedema*; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Enzyme Inhibitors; Humans; Malaysia; Male; Drug-Related Side Effects and Adverse Reactions
  10. Intramuscular versus oral iron supplementation in patients on renal replacement therapy receiving erythropoietin
    Thiruventhiran T, Ang BB, Tan SY
    JUMMEC, 1999;4:110-112.
    Anaemia in patients on renal replacement therapy is a cornmon problem and response to treatment with erythropoietin may be limited by functiollal iron deficiency. We recently studied prospectively for 22 weeks the effect of iron supplemetltation via intramuscular and oral vs intramuscular vs oral routes in 16 patients on chronic haemodialysis with renal anaenlia treated with erythropoietin injections. The rise in haemoglobin was significant in all patients except those on intramuscular iron only. This study supports unconfirmed observations that oral iron supplementation may be effective in patients with renal anaemia associated with functional iron deficiency. KEYWORDS: Renal, Anaemia, Erythropoietin, Iron deficiency, Oral, Parenteral.
    MeSH terms: Anemia; Erythropoietin; Injections; Iron; Renal Replacement Therapy; Observation
  11. ß-blockers in congestive heart failure
    Teh BT, Wan Azman WA, Thuraisingham S, Choy AM, Tan KH, Jesudason P, et al.
    JUMMEC, 1999;4:26-33.
    Activation of the synlpathetic nervous system (SNS) and renin-angiotensin system (RAS) plays a pivotal role in the pathophysiology and progression of the disease in chronic heart failure (CHF). Blocking the activation of the RAS with angiotensin converting enzyme inhibitors not only improves sylnptonls but also prolongs life in symptomatic CHF. Does a similar analogy hold true for the use of ß-blockers in CHF? Evidence from a number of small trials and several recent large prospective trials show that b-blockers may improve ventricular function and symptoms in CHF. In a combination of trials investigating the use of carvedilol (an α, and ß-blocker) in congestive heart failure a mortality benefit appears to be evident. There are still a number of key questions that relnaill unanswered regarding the tolerability, patient type and stage of CHF in which ß-blockers should be advocated. Several large scale trials are in progress to answer some of these questions and also to add further information regarding its efficacy and impact on survival. KEYWORDS: Beta-adrenoreceptor antagonist, congestive heart failure.
    MeSH terms: Enzyme Inhibitors; Heart; Heart Failure; Malaysia; Mortality; Nervous System; Renin-Angiotensin System; Survival
  12. Recent advances in geriatric medicine - a review
    Srinivas P
    JUMMEC, 1999;4:67-73.
    The rapid aging of populations worldwide demands major changes across all aspects of health care for older persons. Geriatric medicine which is that branch of of medicine which is concerned with the clinical, preventive and rehabilitative aspects of care of older persons, has much to offer in relieving the suffering and increasing the disability free years they can enjoy. Recent advances in Geriatric Medicine based on well designed randomised trials and meta-analysis that are clinically significant to the practicing physician are reviewed in this article. KEYWORDS: Recent advances, Geriatric Medicine, Older persons.
    MeSH terms: Aged; Aging; Geriatrics; Malaysia; Review
  13. The role of nutritional support in acute pancreatitis: a review and proposal of a clinical pathway for management
    Ramanujam TM
    JUMMEC, 1999;4:81-87.
    The aim of this review is to critically analyse the available literature and to propose a rational, safe and cost-effective clinical pathway to provide nutritional support in acute pancreatitis. This pathway is proposed based on assessment of peer reviewed literature and existing generally accepted knowledge. Acute pancreatitis is a heterogeneous disease and the outcome is variable. The role of nutritional support is controversial. Acute mild pancreatitis (80%) usually does not require nutritional support unless the pre-existing nutritional is poor or complications occur. Contrary to this acute severe pancreatitis is associated with severe catabolism and a high complication rate. Nutritional depletion rapidly occurs. It is logical to support the nutrition once the patient is haemodynamically stable. Although enteral nutrition should be administered whenever feasible, it is not always possible or advisable. Aggressive, hypercaloric parenteral nutrition administered via central venous line is not recommended. A combination of initial peripheral parenteral nutrition with fat in appropriate amount, and gradually switching over to enteral feedings is safer and cost-effective. It also avoids central line associated sepsis. The roles of newer specific therapeutic diets to enhance the immune status in patients with acute pancreatitis are not well established. KEYWORDS: Acute pancreatitis, Enteral nutrition, Parenteral nutrition, Immunonutrition.
    MeSH terms: Diet; Enteral Nutrition; Malaysia; Pancreatitis; Parenteral Nutrition; Review; Nutritional Support; Sepsis; Knowledge
  14. Why are nasopharyngeal carcinoma patients diagnosed at late stage ?
    Prasad U, Pua KC
    JUMMEC, 1999;4:39-42.
    100 consecutivnee wly diagnosed patients with nasopharyngeal carcinoma (NPC) since January 1994 were the subjects for studying various factors related to the delay in the confirmation of the diagnosis. 79 of them were ttlales and the peak age of incidence was the 5th decade. 92% of them were Chinese, 7% Malay and 1% Indian. 76% were agriculture worker or labourers with 66% having either no formal education (16%) or only primary level education (50%). For 50% of patients neck swelling was the first symptom, 26% had nasal symptoms, 12% ear symptoms and 11% hads symptoms due to intracranial extension of tumour. As many as 80% were at UICC Stage IV at the time of diagnosis. While the median delay, on the part of patients, in consulting a doctor was 2.5 days, the median delay on the part of the doctors to confirm the diagnosis of NPC was as long as 127 days, which was particularly worse when the patients presented with ear symptoms (266 days) followed by those with neck swelling (94 days). For those patients who were required to undergo more than one nasopharyngoscopy and biopsy the median doctor's delay was 144 days. Since 82% of patients had consulted general practitioners who remained the first-line health-service provider, it is suggested that their level of awareness with regards to NPC be significantly raised so that the delay on their part be greatly minimized. KEYWORDS: Nasopharyngeal carciuotna, delay in diagnosis, patient's delay, doctor's delay.
    MeSH terms: Biopsy; Diagnosis; Malaysia; Nasopharyngeal Neoplasms; Physicians; Signs and Symptoms; Incidence; General Practitioners
  15. Medico-legal responsibilities of the Malaysian medical graduate and theteaching of undergraduate forensic medicine
    Paul G, Murty OP
    JUMMEC, 1999;4:88-93.
    The requirement of the medical graduate, tabled in the objectives of undergraduate medical education, as envisaged by the Malaysian Medical Council, call for the all round basic doctor to be able to handle any medical emergency, as well as meet the requirements of law in examining, documenting and reporting on the common offences of the Penal Code, where medical documentation is required of law for the purposes of dispensing justice. However, in tabling the amended requirements of the undergraduate syllabus on the lines of those followed in sollie of the more developed nations, we seem to have lost this perspective. The authors discuss, based on his previous experience from another former colonial country viz. India, where the objectives of the undergraduate training is the same, and the influences 011 the legal profession bear a common origin and governance, the relevance of some of these topics, coming under the antbit of Forensic Medicine and Toxicology as an undergraduate subject, in the day-to-day practise of medicine in and out of government service. While this issue has been the frequent topic of discussion in international confereilces and symposia, where the decline in the standards of medico-legal work in the coulltries attending have been blanled on the fall in the standard of undergraduate teaching, due recognition of the pitfalls of the deletion or whittling down of the course content, independent of the overall overhauling of the syllabi of medical schools, to keep up to the trends of overseas universities, has not been accorded in the planing of the coursc revisions, resulting in a deletion of a vital aspect of daily practise of medicine. KEYWORDS: Medico-legal; Undergraduates
    MeSH terms: Documentation; Emergencies; Forensic Medicine; India; Indium; Malaysia; Teaching; Work
  16. Inadvertent expression of dengue 2 virus NS3-EGFP fusion protein in Escherlchla coll using the pEGFP-N 1 mammalian expression vector
    Norazizah S, AbuBakar S
    JUMMEC, 1999;4:41-46.
    Dengue 2 New Guinea C (NGC) virus NS3 protein, a potentially important virulence factor was cloned to the N-terminus of the Aeqirorea victoria enhanced green fluorescent protein (EGFP) using the pEGFP-N1 mammalian expression vector. During amplification of the recombinant plasmid in E. coli, transformants expressing the EGFP were detected in vivo when viewed using fluorescence microscopy. This inadvertent expression of the recombinant fusion protein was confirmed further by detection of the T7.Tag peptide cloned to the aluino terminal of the fusion protein using T 7.Tag specific monoclonal antibody. These findings represent perhaps the first reported expression of the T7.Tag-NS3-EGFP fusion protein using the pEGFP-N1 mammalian expression vector in E. coli. KEYWORDS: Dengue, NS3, pEGFP-N1, fusion protein.
    MeSH terms: Antibodies; Dengue; Fluorescence; Malaysia; Microscopy; New Guinea; Plasmids; Victoria; Virulence; Green Fluorescent Proteins
  17. Legal implications in routine clinical practice
    Nadesan K, Nambiar P, Swaminathan D
    JUMMEC, 1999;4:119-123.
    MeSH terms: Malaysia
  18. Postgraduate Education In Malaysia
    Mohd Ismail M
    JUMMEC, 1999;4:3-6.
    MeSH terms: Malaysia
  19. Cannabis-induced mania
    Mohd Hussain H
    JUMMEC, 1999;4:62-63.
    Hypomanic episodes have been reported in two patients who were known to have abused cannabis. The nature of its presentation, possible association and treatment modalities are discussed herewith. A greater awareness of such a condition can put clinicians in a better position to give appropriate treatment imediately, and thus prevent any kind of re-occurrence of such a condition especially in vulnerable patients. KEYWORDS: Cannabis, hypomania.
    MeSH terms: Cannabis; Malaysia
  20. Antigen specific lymphocyte proliferative response of patients with acute and chronic toxoplasmosis
    Khairul Anuar A, Rahmah N, Dighe VC, Zurainee MN, Suresh K, Yano A
    JUMMEC, 1999;4:34-38.
    In vitro lymphocyte proliferative response of peripheral blood leucocytes (PBL) to purified Toxoplasma gondii antigen were evaluated by 3[H] methyl thymidine incorporation in patients acutely and chronically infected with Toxoplama gondii. PBL from three patients with acute sylnptonlatic toxoplaslnosis showed no response to T. gondii antigen during the emergence of anti-Toxoplasma 1gM antibodies and the response returned as the infection became chronic. Lymphocytes of twelve chronically-infected patients responded positively to the antigen. In all patients the lymphocyte proliferative response to the mitogen, Concanavalill A (Con A) was normal. Analysis of Toxoplasma proliferative response of PBL from a patient with acute toxoplasrnosis showed that CD8+ cells were responsible for induction of suppression while the response during the chronic infection was lnediated by CD4+ cells. In human toxoplasmosis there was antigen-specific lymphocyte unresponsiveness during the acute phase of the infection and it appears that the initnunesuppression was mediated by CD8+ cells. KEYWORDS: Toxoplasmosis-lymphocyte blastogenesis-antigen specific-CD4+, CD8+
    MeSH terms: Antibodies; Cells; Infection; Japan; Lymphocytes; Malaysia; Thymidine; Toxoplasma; Toxoplasmosis
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