Browse publications by year: 2006

  1. Nisar A, Choon DS, Varaprasad M, Abbas AA
    Med J Malaysia, 2006 Feb;61 Suppl A:100-2.
    PMID: 17042242
    A variety of reconstructive options exist for revision of both femoral and acetabular components in total hip replacement surgery. The use of impaction bone grafting with morsellised allograft has shown promising results in revision total hip arthroplasty. It works as a biologic reconstitution of bone stock defects and provides a solid construct with stable fixation. We present a case of bilateral revision total hip arthroplasty with poor bone stock where reconstructive surgery was done by using impaction bone grafting, mesh and C-stem implants.
    MeSH terms: Aged; Female; Humans; Transplantation, Homologous; Osteoarthritis, Hip/surgery*; Bone Transplantation/instrumentation; Bone Transplantation/methods*; Arthroplasty, Replacement, Knee/instrumentation; Arthroplasty, Replacement, Knee/methods*
  2. Matsui M
    Zoolog Sci, 2006 Sep;23(9):821-30.
    PMID: 17043405
    Three new megophryid species, Leptolalax melanoleucus, L. fuliginosus, and L. solus, are described from southwestern and southern Thailand on the bases of acoustic and morphological characteristics. Leptolalax melanoleucus and L. fuliginosus are similar to L. pelodytoides from northern Thailand, but differ from it completely in advertisement call characteristics and ventral color. Leptolalax solus is similar to L. heteropus from peninsular Malaysia, but differs from it by advertisement call, as well as by some body proportions. The distributional pattern of Leptolalax within Thailand is discussed.
    MeSH terms: Animals; Anura/anatomy & histology*; Anura/classification*; Anura/physiology; Demography; Female; Male; Species Specificity; Thailand; Vocalization, Animal/classification*; Biodiversity
  3. Yu CP, Whynes DK, Sach TH
    Int J Health Plann Manage, 2006 10 19;21(3):193-210.
    PMID: 17044546
    Throughout the world, policy makers are considering or implementing financing strategies that are likely to have a substantial impact on the equity of health financing. The assessment of the equity implication is clearly important, given the potential impact that alternative finance sources have on households. Households incur out-of-pocket payment directly from their budget, apart from their public or private insurance. Out-of-pocket payment is the primary concern, given their undesirable impact on households. Progressivity measures departures from proportionality in the relationship between out-of-pocket payment and ability to pay. It is the most frequently used yardstick to assess the equity of out-of-pocket payments in empirical studies. This paper provides an evaluation of such progressivity measures, undertaken using four approaches (proportion approach, tabulation approach, concentration curve and Kakwani's index), in order to reveal their usefulness and underlying notion. It is illustrated empirically with data on out-of-pocket payment for health care in Malaysia for 1998/ 1999, based on the nationally representative Household Expenditure Survey. Results indicate that out-of-pocket payments are mildly progressive, whilst the four approaches have their benefits and limitations in assessing equity implications. This analysis is of interest from a policy perspective, given Malaysia's heavy reliance on out-of-pocket payments to finance health care.
    MeSH terms: Health Expenditures/trends; Health Expenditures/statistics & numerical data*; Financing, Personal/trends*; Financing, Personal/statistics & numerical data; Health Policy/trends*; Humans; Malaysia; Social Class; Cost Sharing/trends*; Cost Sharing/statistics & numerical data; Health Care Surveys
  4. Quek SC, Low PS, Saha N, Heng CK
    Ann. Hum. Genet., 2006 Nov;70(Pt 6):951-7.
    PMID: 17044869
    Factor VII (FVII) is an independent risk factor for coronary artery disease. Three polymorphisms of the factor VII gene (F7) were studied in a group of healthy newborns comprising 561 Chinese, 398 Malays and 226 Asian Indians from Singapore. The allele frequencies of 3 polymorphisms (R353Q, Promoter 0/10bp Del/Ins and Intron 7) in the FVII gene were ascertained through genotyping by polymerase chain reaction and restriction digestion of amplified fragments. In Chinese the minor allele frequencies are Q: 0.04, Ins: 0.03, R7: 0.44; Malays, Q: 0.06, Ins: 0.10, R7: 0.41; and Indians, Q: 0.25, Ins: 0.23, R7: 0.43. Strong linkage disequilibrium (Delta > 0.7) is observed between the 0/10 bp and the R353Q sites in all ethnic groups. We conclude that: (i) the prevalence of the minor Q and Ins alleles of the R353Q and 0/10 bp polymorphisms are significantly higher in the Indian newborns than the Chinese and Malays; (ii) the Q allele is significantly associated (p = 0.01) with a lower plasma FVII coagulant level in the Indian and Malay neonates; and this polymorphism explains up to 3.8% of the variance in FVII coagulant levels; (iii) there is no significant difference in allele frequencies of the three polymorphisms between neonates with and without family histories of CAD.
    MeSH terms: Antigens/blood*; China/ethnology; Coronary Artery Disease/genetics; Demography; Factor VII/genetics*; Factor VII/metabolism; Gene Frequency; Humans; India/ethnology; Infant, Newborn; Malaysia/ethnology; Polymorphism, Genetic*; Singapore/ethnology; Singapore/epidemiology; Linkage Disequilibrium; Asian Continental Ancestry Group/genetics*
  5. Hung LC, Wong SL, Chan LG, Rosli R, Ng AN, Bresee JS
    Int J Infect Dis, 2006 Nov;10(6):470-4.
    PMID: 17046306
    The objectives of the study were to describe the epidemiology and strain characterization of rotavirus (RV), to determine the proportion of hospitalizations for diarrhea attributable to RV among children under 5 years of age, and to estimate the disease burden of RV diarrhea in Malaysia.
    MeSH terms: Age Factors; Child, Preschool; Diarrhea/microbiology; Diarrhea/epidemiology*; Female; Hospitalization/statistics & numerical data; Hospitals, Urban; Humans; Infant; Infant, Newborn; Malaysia/epidemiology; Male; Prospective Studies; Rotavirus Infections/epidemiology*; Rotavirus/classification*; Seasons; Incidence
  6. Gaber NN, Darwis Y, Peh KK, Tan YT
    J Nanosci Nanotechnol, 2006 10 20;6(9-10):3095-101.
    PMID: 17048523
    The potential of using poly-(ethylene oxide)-block-distearoyl phosphatidyl-ethanolamine (mPEG-DSPE) polymer to prepare BDP-loaded micelles with high entrapment efficiency and mass median aerodynamic diameter of less than 5 microm demonstrating sustained release properties was evaluated. The result showed that lyophilized BDP-loaded polymeric micelles with entrapment efficiency of more than 96% could be achieved. Entrapment efficiency was affected by both the drug to polymer molar ratio and the amount of drug used. Investigation using FTIR and DSC confirmed that there was no chemical or physical interaction and the drug was molecularly dispersed within the micelles. TEM images showed that the drug-loaded polymeric micelles were spherical in shape with multivesicular morphology. Further analysis by photon correlation spectroscopy indicated that the particle size of the BDP-loaded micelles was about 22 nm in size. In vitro drug release showed a promising sustained release profile over six days following the Higuchi model. The mass median aerodynamic diameter and fine particle fraction were suitable for pulmonary delivery. Moreover, the small amount of deposited drug in the induction port (throat deposition) suggested possible reduction in incidence of oropharyngeal candidiasis, a side effect normally associated with inhaled corticosteroids therapy. The high encapsulation efficiency, comparable inhalation properties, sustained release behavior together with biocompatibility nature of the polymer support the potential of BDP-loaded polymeric micelles as a versatile delivery system to be used in the treatment of asthma and chronic obstructive pulmonary disease.
    MeSH terms: Administration, Inhalation; Aerosols/chemistry; Animals; Beclomethasone/administration & dosage*; Beclomethasone/pharmacokinetics; Beclomethasone/chemistry*; Colloids/chemistry*; Diffusion; Drug Carriers/chemistry*; Humans; Lung/metabolism; Materials Testing; Micelles; Particle Size; Nanostructures/chemistry*
  7. Seidler TG, Plotkin JB
    PLoS Biol, 2006 Oct;4(11):e344.
    PMID: 17048988
    Theories of tropical tree diversity emphasize dispersal limitation as a potential mechanism for separating species in space and reducing competitive exclusion. We compared the dispersal morphologies, fruit sizes, and spatial distributions of 561 tree species within a fully mapped, 50-hectare plot of primary tropical forest in peninsular Malaysia. We demonstrate here that the extent and scale of conspecific spatial aggregation is correlated with the mode of seed dispersal. This relationship holds for saplings as well as for mature trees. Phylogenetically independent contrasts confirm that the relationship between dispersal and spatial pattern is significant even after controlling for common ancestry among species. We found the same qualitative results for a 50-hectare tropical forest plot in Panama. Our results provide broad empirical evidence for the importance of dispersal mode in establishing the long-term community structure of tropical forests.
    MeSH terms: Animals; Birds/physiology; Fruit/physiology; Gravitation; Panama; Phylogeny; Seeds/growth & development; Seeds/physiology*; Trees/physiology*; Tropical Climate*; Wind; Ecosystem; Plant Physiological Phenomena; Forensic Ballistics
  8. Low WY, Ng CJ, Choo WY, Tan HM
    Aging Male, 2006 Sep;9(3):175-80.
    PMID: 17050117 DOI: 10.1080/13685530600914601
    INTRODUCTION: Erectile dysfunction (ED) is a common medical disorder affecting the aging male. A man's perception of a disease affects his health seeking behaviour. This study aimed to explore perceptions of ED among men with ED and how these perceptions came about.
    METHODS: This qualitative study utilized in-depth interviews involving 17 urban men aged between 40 and 75 years old.
    RESULTS: Misconceptions existed regarding the definitions of ED. Most men perceived impotence to be more serious than ED. Although most were aware of the medical causes of ED, 'overuse of penis' and black magic were mentioned as culturally-related causes. ED was perceived as a serious problem associated with loss of manhood and it had a significant impact on relationships with their partners. However, some adopted an 'accepting' view and attributed it to aging and fate. Most men were only familiar with PDE-5 inhibitors and traditional therapies. PDE-5 inhibitors were perceived to be effective but they were concerned about side effects and costs.
    CONCLUSIONS: Identifying men's perceptions of ED and its treatment would help doctors in their consultation, and inform health policy makers in planning appropriate public education and services.
    MeSH terms: Adult; Age Factors; Aged; Attitude to Health*; Humans; Erectile Dysfunction/drug therapy*; Erectile Dysfunction/psychology*; Male; Middle Aged; Phosphodiesterase Inhibitors/therapeutic use*; Surveys and Questionnaires; Sexual Behavior/drug effects; Sexual Behavior/psychology; 3',5'-Cyclic-GMP Phosphodiesterases/antagonists & inhibitors*; Treatment Outcome; Cyclic Nucleotide Phosphodiesterases, Type 5
  9. Sim SM, Azila NM, Lian LH, Tan CP, Tan NH
    Ann Acad Med Singap, 2006 Sep;35(9):634-41.
    PMID: 17051280
    INTRODUCTION: A process-oriented instrument was developed for the summative assessment of student performance during problem-based learning (PBL) tutorials. This study evaluated (1) the acceptability of the instrument by tutors and (2) the consistency of assessment scores by different raters.

    MATERIALS AND METHODS: A survey of the tutors who had used the instrument was conducted to determine whether the assessment instrument or form was user-friendly. The 4 competencies assessed, using a 5-point rating scale, were (1) participation and communication skills, (2) cooperation or team-building skills, (3) comprehension or reasoning skills and (4) knowledge or information-gathering skills. Tutors were given a set of criteria guidelines for scoring the students' performance in these 4 competencies. Tutors were not attached to a particular PBL group, but took turns to facilitate different groups on different case or problem discussions. Assessment scores for one cohort of undergraduate medical students in their respective PBL groups in Year I (2003/2004) and Year II (2004/2005) were analysed. The consistency of scores was analysed using intraclass correlation.

    RESULTS: The majority of the tutors surveyed expressed no difficulty in using the instrument and agreed that it helped them assess the students fairly. Analysis of the scores obtained for the above cohort indicated that the different raters were relatively consistent in their assessment of student performance, despite a small number consistently showing either "strict" or "indiscriminate" rating practice.

    CONCLUSION: The instrument designed for the assessment of student performance in the PBL tutorial classroom setting is user-friendly and is reliable when used judiciously with the criteria guidelines provided.

    MeSH terms: Education, Medical/methods*; Education, Medical/standards; Educational Measurement/methods*; Humans; Surveys and Questionnaires/standards*; Retrospective Studies; Students, Medical*; Problem-Based Learning/standards*
  10. Azila NM, Rogayah J, Zabidi-Hussin ZA
    Ann Acad Med Singap, 2006 Sep;35(9):647-54.
    PMID: 17051282
    INTRODUCTION: Various curricular innovations were adopted by medical schools worldwide in an attempt to produce medical graduates that could meet future healthcare needs of society locally and globally. This paper presents findings on curricular approaches implemented in Malaysian medical schools, in trying to meet those needs.

    METHODS: Information was obtained from published records, responses from various questionnaires, personal communication and involvement with curricular development.

    RESULTS: Curricular innovations tended to be implemented in new medical schools upon their establishment. Established medical schools seemed to implement these innovations much later. Curricular trends appear to move towards integration, student-centred and problem-based learning as well as community-oriented medical education, with the Student-centred learning, Problem-based learning, Integrated teaching, Community-based education, Electives and Systematic programme (SPICES) model used as a reference. The focus is based on the premise that although the short-term aim of undergraduate medical education in Malaysia is to prepare graduates for the pre-registration house officer year, they must be able to practise and make decisions independently and be sensitive to the needs of the country's multiracial, multi-religious, and often remote communities.

    CONCLUSION: In most cases, curricular planning starts with a prescriptive model where planners focus on several intended outcomes. However, as the plan is implemented and evaluated it becomes descriptive as the planners reassess the internal and external factors that affect outcomes. A common trend in community-oriented educational activities is evident, with the introduction of interesting variations, to ensure that the curriculum can be implemented, sustained and the intended outcomes achieved.

    MeSH terms: Curriculum/trends*; Education, Medical/methods*; Humans; Malaysia; Schools, Medical*
  11. Shetty S, Udupa S, Udupa L, Somayaji N
    Indian J. Physiol. Pharmacol., 2006 Apr-Jun;50(2):163-8.
    PMID: 17051736
    The present study was performed to evaluate the wound healing and antioxidant effect of aqueous extract of Ocimum sanctum Linn. (O. sanctum) in rats. Albino rats of either sex were divided into 2 groups. Group I: Wounded control rats; Group II: Wounded rats administered O. sanctum aqueous extract. Wound breaking strength in incision wound model, epithelization period and percent wound contraction in excision wound model were studied. Using dead space wound model, granulation tissue breaking strength, granulation tissue dry weight, hydoxyproline level in dry granulation tissue, superoxide dismutase (SOD) and catalase levels in wet granulation tissue were estimated in both the groups. Increased wound breaking strength, decreased epithelization period, increased percent wound contraction, increased granulation tissue weight and hydroxyproline concentrations were observed. The increased activity of antioxidant enzymes such as SOD, catalase level in extract treated group compared to controls. Granulation tissue was subjected to histopathological examination to determine the pattern of lay-down for collagen using Haematoxylin and Eosin stains which confirm the results. Owing to wound healing and antioxidant activities, O. sanctum may be useful in the management of abnormal healing such as keloids and hypertrophic scars.
    MeSH terms: Animals; Antioxidants/pharmacology*; Catalase/physiology*; Collagen/metabolism; Female; Male; Plant Extracts/pharmacology*; Superoxide Dismutase/physiology*; Wound Healing/drug effects*; Oxidative Stress; Ocimum*; Rats
  12. Dahlan I, Lee KT, Kamaruddin AH, Mohamed AR
    Environ Sci Technol, 2006 Oct 01;40(19):6032-7.
    PMID: 17051796
    Siliceous materials such as rice husk ash (RHA) have potential to be utilized as high performance sorbents for the flue gas desulfurization process in small-scale industrial boilers. This study presents findings on identifying the key factorfor high desulfurization activity in sorbents prepared from RHA. Initially, a systematic approach using central composite rotatable design was used to develop a mathematical model that correlates the sorbent preparation variables to the desulfurization activity of the sorbent. The sorbent preparation variables studied are hydration period, x1 (6-16 h), amount of RHA, x2 (5-15 g), amount of CaO, x3 (2-6 g), amount of water, x4 (90-110 mL), and hydration temperature, x5 (150-250 degrees C). The mathematical model developed was subjected to statistical tests and the model is adequate for predicting the SO2 desulfurization activity of the sorbent within the range of the sorbent preparation variables studied. Based on the model, the amount of RHA, amount of CaO, and hydration period used in the preparation step significantly influenced the desulfurization activity of the sorbent. The ratio of RHA and CaO used in the preparation mixture was also a significant factor that influenced the desulfurization activity of the sorbent. A RHA to CaO ratio of 2.5 leads to the formation of specific reactive species in the sorbent that are believed to be the key factor responsible for high desulfurization activity in the sorbent. Other physical properties of the sorbent such as pore size distribution and surface morphology were found to have insignificant influence on the desulfurization activity of the sorbent.
    MeSH terms: Adsorption; Air Pollutants/isolation & purification*; Air Pollutants/chemistry; Air Pollution/prevention & control*; Oxides/chemistry*; Oryza*; Sulfur Dioxide/isolation & purification*; Sulfur Dioxide/chemistry; Calcium Compounds/chemistry*
  13. Liam CK, Pang YK, Poosparajah S
    Respirology, 2006 Nov;11(6):786-92.
    PMID: 17052309
    The aims of this study were to investigate the frequency of Mycobacterium tuberculosis as a cause of community-acquired pneumonia (CAP) requiring hospitalization in Malaysia, and to define the clinical features of pulmonary tuberculosis (PTB) that distinguish it from non-TB CAP.
    MeSH terms: Adult; Aged; Diagnosis, Differential; Female; Hospitalization/statistics & numerical data; Humans; Leukocyte Count; Lung/pathology; Lung/physiopathology; Lung/radiography; Lymphopenia/etiology; Lymphopenia/physiopathology; Malaysia/epidemiology; Male; Middle Aged; Mycobacterium tuberculosis/pathogenicity*; Prospective Studies; Sweat/physiology; Radiography, Thoracic; Tuberculosis, Pulmonary/complications*; Tuberculosis, Pulmonary/diagnosis*; Tuberculosis, Pulmonary/epidemiology; Community-Acquired Infections/diagnosis; Community-Acquired Infections/epidemiology; Community-Acquired Infections/radiography; Pneumonia, Bacterial/diagnosis*; Pneumonia, Bacterial/microbiology*; Pneumonia, Bacterial/epidemiology
  14. Yoneda M, Guillaume V, Ikeda F, Sakuma Y, Sato H, Wild TF, et al.
    Proc Natl Acad Sci U S A, 2006 Oct 31;103(44):16508-13.
    PMID: 17053073
    Nipah virus (NiV), a paramyxovirus, was first discovered in Malaysia in 1998 in an outbreak of infection in pigs and humans and incurred a high fatality rate in humans. Fruit bats, living in vast areas extending from India to the western Pacific, were identified as the natural reservoir of the virus. However, the mechanisms that resulted in severe pathogenicity in humans (up to 70% mortality) and that enabled crossing the species barrier were not known. In this study, we established a system that enabled the rescue of replicating NiVs from a cloned DNA by cotransfection of a constructed full-length cDNA clone and supporting plasmids coding virus nucleoprotein, phosphoprotein, and polymerase with the infection of the recombinant vaccinia virus, MVAGKT7, expressing T7 RNA polymerase. The rescued NiV (rNiV), by using the newly developed reverse genetics system, showed properties in vitro that were similar to the parent virus and retained the severe pathogenicity in a previously established animal model by experimental infection. A recombinant NiV was also developed, expressing enhanced green fluorescent protein (rNiV-EGFP). Using the virus, permissibility of NiV was compared with the presence of a known cellular receptor, ephrin B2, in a number of cell lines of different origins. Interestingly, two cell lines expressing ephrin B2 were not susceptible for rNiV-EGFP, indicating that additional factors are clearly required for full NiV replication. The reverse genetics for NiV will provide a powerful tool for the analysis of the molecular mechanisms of pathogenicity and cross-species infection.
    MeSH terms: Animals; Cell Line; Cercopithecus aethiops; Cricetinae; Humans; Plasmids/genetics; Recombinant Proteins/genetics; Recombinant Proteins/metabolism; Virus Replication; Survival Rate; Ephrin-B2/genetics; Ephrin-B2/metabolism; Nipah Virus/pathogenicity; Nipah Virus/physiology*; Henipavirus Infections/genetics; Henipavirus Infections/metabolism; Henipavirus Infections/pathology*; Henipavirus Infections/virology*; Rats
  15. Azila NM, Tan NH, Tan CP
    Med Educ, 2006 Nov;40(11):1125.
    PMID: 17054624
    MeSH terms: Curriculum*; Internship and Residency*; Malaysia; Schools, Medical/organization & administration*; Program Evaluation
  16. Loh KY, Kwa SK, Nurjahan MI
    Med Educ, 2006 Nov;40(11):1131-2.
    PMID: 17054631
    MeSH terms: Education, Medical, Undergraduate/organization & administration*; Malaysia; Palliative Care*
  17. Azlan CA, Ng KH, Anandan S, Nizam MS
    Australas Phys Eng Sci Med, 2006 Sep;29(3):278-80.
    PMID: 17058591
    Illuminance level in the softcopy image viewing room is a very important factor to optimize productivity in radiological diagnosis. In today's radiological environment, the illuminance measurements are normally done during the quality control procedure and performed annually. Although the room is equipped with dimmer switches, radiologists are not able to decide the level of illuminance according to the standards. The aim of this study is to develop a simple real-time illuminance detector system to assist the radiologists in deciding an adequate illuminance level during radiological image viewing. The system indicates illuminance in a very simple visual form by using light emitting diodes. By employing the device in the viewing room, illuminance level can be monitored and adjusted effectively.
    MeSH terms: Environmental Monitoring/instrumentation*; Environmental Monitoring/methods; Equipment Design; Lighting/instrumentation*; Photometry/instrumentation*; Photometry/methods; Radiology/instrumentation*; Radiology/methods; Transducers*; Equipment Failure Analysis
  18. Yip CH, Taib NA, Mohamed I
    Asian Pac J Cancer Prev, 2006;7(3):369-74.
    PMID: 17059323
    Data from the National Cancer Registry of Malaysia for 2004 provide an age-standardised incidence rate (ASR) of 46.2 per 100,000 women. This means that approximately 1 in 20 women in the country develop breast cancer in their lifetime. However, the rate differs between the three main races, the Malays, Chinese and Indians. The age standardized incidence in Chinese is the highest, with 59.7 per 100,000, followed by the Indians at 55.8 per 100,000. The Malays have the lowest incidence of 33.9 per 100,000. This translates into 1 in 16 Chinese, 1 in 16 Indian and 1 in 28 Malay women developing breast cancer at some stage in their lives. The commonest age at presentation is between 40-49 years, with just over 50% of the cases under the age of 50 years, 16.8% below 40, and 2% under 30. Some 55.7% of all cases were found to be ER positive. The commonest presenting symptom was a lump in the breast in over 90% of cases, generally felt by the woman herself. The mean size of the lump was 4.2 cm, and on average, the women waited 3 months before seeking medical attention. Over the 12-year period from 1993 to 2004, about 60-70% of women presented with early stage (Stages 1-2) while 30-40% presented with late breast cancer (Stages 3-4). Especially Malays present at later stages and with larger tumours. Consequently their survival is worse than with Chinese and Indian women. The challenge in Malaysia is to be able to provide a comprehensive service in the diagnosis and treatment of breast cancer, and this requires training of a team of health professionals dedicated to breast health, such as breast surgeons, radiologists specializing in breast imaging, breast pathologists, plastic surgeons specializing in breast reconstruction, medical and radiation oncologists, psycho-oncologists, counselors, and breast nurses. Advocacy can play a role here in galvanizing the political will to meet this challenge.
    MeSH terms: Breast Neoplasms/diagnosis; Breast Neoplasms/epidemiology*; Female; Humans; Malaysia/epidemiology; Incidence
  19. Sam IC, Ngeow YF
    Int J STD AIDS, 2006 Oct;17(10):710-1.
    PMID: 17059643
    MeSH terms: Costs and Cost Analysis; Gonorrhea/diagnosis*; Gonorrhea/economics; Humans; Male; Microscopy; Neisseria gonorrhoeae/isolation & purification*; Rectal Diseases/diagnosis*; Rectal Diseases/economics; Rectum/microbiology; Time Factors
  20. Waters L, Worthen E, O'mahony C
    Int J STD AIDS, 2006 Oct;17(10):710.
    PMID: 17059644
    MeSH terms: Academic Medical Centers; Anti-Infective Agents/pharmacology*; Anti-Bacterial Agents/pharmacology*; Ciprofloxacin/pharmacology*; Gonorrhea/microbiology; Humans; Malaysia; Neisseria gonorrhoeae/drug effects*; Penicillins/pharmacology*; Drug Resistance, Multiple, Bacterial
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