In Malaysia, maggot debridement therapy (MDT) utilizes maggots of Lucilia
cuprina (Wiedemann) to debride necrotic tissue from wound surface, reduce bacterial infection
and therefore, enhance wound healing process. To evaluate the sterility of the sterile maggots
produced after sterilization process before delivering onto patient wounds. Sterility of sterile
maggots is crucial in ensuring the safe usage of MDT and patient’s health. Eggs of L. cuprina
collected from a laboratory colony were divided into treated group (sterilized) and control
group (non-sterilized). Treated group underwent sterilization while eggs from control group
were allowed to hatch without sterilization. Sodium hypochlorite and formaldehyde were the
main disinfectants used in this sterilization process. Scanning electron microscope (SEM)
was used to examine and ascertain the sterility of sterile maggots. SEM results showed that
all sterilized L. cuprina eggs and maggots achieved sterility and all were cleared from
bacterial contamination. In contrast, all non-sterilized eggs and maggots were found to be
colonized by microorganisms. Sterilization method employed to sterilize eggs and maggots
used in Malaysia MDT was proven successful and MDT is safe to be used as wound management
tools.
This study explored the efficacy of Toxorhynchites splendens, predator of Aedes
albopictus as a biocontrol agent. There was a negative correlation between Ae. albopictus
larval population and Tx. splendens larval population in ovitraps (r= -0.287, R2
=0.0821). The correlation is higher between the mean number of Ae. albopictus larvae per ovitrap and the number of Tx. splendens larvae in an ovitrap (r=-0.987, R2 =0.9737). Larvae of Tx. splendens were observed to co-exist with larvae of Ae. albopictus and Culex fuscocephala in the ovitraps placed in the study area. The existence of Tx. splendens larvae in the study area coincides with their habit, preferring to breed in bamboo stumps. A total of 480 ovitraps were inspected for 30-week study period and 281 ovitraps were positive with Ae. albopictus larvae respectively. There was a significant difference between numbers of ovitrap positive for Ae. albopictus larvae with number of Tx. splendens larvae in the ovitraps (ANOVA, F(4,475)
2.655, p< 0.05). Of 281 ovitraps positive with Ae. albopictus larvae, 255 ovitraps contained only one Tx. splendens larva each. Only one ovitrap contained four, the most number of Tx. splendens larvae (p
Scanning electron microscope (SEM) images of dust mites, Suidasia pontifica, is
presented to provide an improved visualization of the taxonomic characters of these mites.
Suidasia pontifica can easily be identified by its scale-like cuticle, presence of external
vertical setae (ve), longer external scapular setae (sce) compared to internal scapular setae
(sci) and 3 ventral spines on apex of tarsus I. The differences in morphology of male and
female S. pontifica are also discussed.
The objective of our study was to study the effectiveness of CHROMagar CandidaTM
as the primary identification method for various clinical Candida isolates, other than the
three suggested species by the manufacturer. We studied 34 clinical isolates which were
isolated from patients in a local teaching hospital and 7 ATCC strains. These strains were first
cultured in Sabouraud dextrose broth (SDB) for 36 hours at 35ºC, then on CHROMagar plates
at 30ºC, 35ºC and 37ºC. The sensitivity of this agar to identify Candida albicans, Candida
dubliniensis, Candida tropicalis, Candida glabrata, Candida rugosa, Candida krusei and
Candida parapsilosis ranged between 25 and 100% at 30ºC, 14% and 100% at 35ºC, 56% and
100% at 37ºC. The specificity of this agar was 100% at 30ºC, between 97% and 100% at 35ºC,
92% and 100% at 37ºC. The efficiency of this agar ranged between 88 and 100% at 30ºC, 83%
and 100% at 35ºC, 88% and 100% at 37ºC. Each species also gave rise to a variety of colony
colours ranging from pink to green to blue of different colony characteristics. Therefore, the
chromogenic agar was found to be useful in our study for identifying clinical Candida isolates.
The bioefficacy of Piper aduncum L. essential oil formulated in aerosol cans was
evaluated against Aedes aegypti and Aedes albopictus in a simulated room. The aerosol spray
test was based on the Malaysian test standard for aerosol (MS 1221:1991UDC 632.982.2
modified from WHO 2009 methodology) and examined the knockdown effect within 20
minutes of exposure. Mortality rate after 24 hour of holding period was also determined. A
commercial aerosol spray (0.09% pral lethr in 0.05% d-phenothr in) was al so tes ted as a
comparison. Our results showed that the knockdown effect of the commercial aerosol spray
and P. aduncum essential oil spray (8% and 10% concentrations) was significantly higher in
Ae. albopictus adult females, when compared with that of Ae. aegypti adult females (P
Early detection of a dengue outbreak is an important first step towards implementing
ef fect ive dengue intervent ions resul t ing in reduced mor tal i ty and morbidi ty. A dengue
mathematical model would be useful for the prediction of an outbreak and evaluation of
control measures. However, such a model must be carefully parameterized and validated
with epidemiological, ecological and entomological data. A field study was conducted to
collect and analyse various parameters to model dengue transmission and outbreak. Dengueprone areas in Kuala Lumpur, Pahang, Kedah and Johor were chosen for this study. Ovitraps
were placed outdoor and used to determine the effects of meteorological parameters on
vector breeding. Vector population in each area was monitored weekly for 87 weeks. Weather
stations, consisting of a temperature and relative humidity data logger and an automated rain
gauge, were installed at key locations in each study site. Correlation and Autoregressive
Distributed Lag (ADL) model were used to study the relationship among the variables. Previous
week rainfall plays a significant role in increasing the mosquito population, followed by
maximum humidity and temperature. The secondary data of rainfall, temperature and humidity
provided by the meteorological department showed an insignificant relationship with the
mosquito population compared to the primary data recorded by the researchers. A well fit
model was obtained for each locality to be used as a predictive model to foretell possible
outbreak.
House dust mites and storage mites are well-known causes for allergenic diseases.
The aim of thi s s tudy was to inves t igate the immunogenic s i tes of Blomia t ropi cal i s,
Aleurogyphus ovatus and Glycycometus malaysiensis. The mites were maintained in a
culture medium at 25ºC and 75% relative humidity. Mites were harvested either with heat
escape or floatation method, purified, homogenized, quantified and used for the production of
polyclonal antibody and immunostaining. For each species of mites, five male mice and five
male rats were randomly selected and immunized intraperitoneally with respective crude
mite extract at two-weekly intervals. Blomia tropicalis, A. ovatus or G. malaysiensis whole
mites and paraffin-embedded mite sections were immunostained with the respective polyclonal
antibody. The faecal pellets of mites were intensely stained for all the three species in the
present study. The legs of sectioned A. ovatus were not immunogenic as compared with
those of G. malaysiensis and B. tropicalis. The outer layer (cuticle) of whole mites and the
eggs for these species were very immunogenic. Hence, the polyclonal antibodies obtained in
this study may serve as potential tools in detecting the eggs and immature mites in
environmental samples. Future studies should focus on the antigenic components of eggs
since they were relatively abundant in dust and highly antigenic as seen in the present study.
Transmission of soil-transmitted helminthes infection is by faecal oral route, and is influenced by food preference. Kelantanese love to consume ulam which are raw vegetables and herbs. Some of the herbs grow on grounds with high humidity and are abundant near drainage areas, these are also places with higher likelihood of harbouring viable parasite ova. The aim of this study was to determine the prevalence of soiltransmitted helminthes in vegetables, herbs and fruits found in our local setting. The results by microscopy showed that there was no helminthes ovum or protozoan parasite in the samples. However, Strongyloides stercoralis rhabdatiform larvae were identified in water samples used to wash pegaga, kesum and water spinach, and the number of larvae observed were 152, 9 and 16 respectively. Analysis by real-time PCR confirmed the microscopic observation of this helminth. This study highlighted that vegetables and herbs are likely sources of Strongyloides stercoralis infection in Kota Bharu, Kelantan. Thus vegetable sellers as well as the food handlers are the two important groups who are at high risk of acquiring the infection.
This study describes the killer phenotypes of tropical environmental yeasts and the inhibition effects of the culture filtrates on the biofilm of Candida albicans. A total of 26 (10.5%) of 258 yeast isolates obtained from an environmental sampling study demonstrated killer activity to Candida species. The killer yeasts were identified as species belonging to the genus Aureobasidium, Pseudozyma, Ustilago and Candida based on sequence analysis of the ITS1-5.8S-ITS2 region of the yeasts. Pseudozyma showed the broadest killing effects against sensitive strains of Candida. New species of Ustilago and Pseudozyma demonstrating killer phenotypes were identified in this study. Interestingly, more than 50% reduction in the metabolic activity of Candida albicans biofilm was noted after exposure to the culture filtrates of the nine killer yeasts. Purification and characterization of toxin and metabolites are essential for understanding the yeast killing effects.
Toxinotype of Clostridium perfringens (CP) isolates collected from the Bernam River, Selangor River and Tengi Canal between April 2007 and January 2008 were determined by Polymerase Chain Reaction (PCR) using published primers. All the 147 isolates were toxinotype Type A, harbouring the alpha toxin gene. In addition, 5 of the isolates also had the enterotoxin (CPE) gene.
MeSH terms: Clostridium perfringens; Enterotoxins; Type C Phospholipases; Polymerase Chain Reaction; DNA Primers; Rivers
Infections and malignancies are common causes of pleural effusion. Among infectious causes, hyperinfection syndrome of Strongyloides stercoralis may occur in immunosuppressive patient. A 62-year-old man, known case of Non-Hodgkin lymphoma (NHL) was presented with recurrent NHL stage IV and had undergone salvage chemotherapy. Patient subsequently developed pneumonia with bilateral pleural effusion and ascites. We reported rhabditiform larvae of S. stercoralis in pleural fluid of both lungs without infiltration by lymphoma cells. Stool for microscopic examination also revealed rhabditiform larvae of S. stercoralis. This patient was a known case of NHL receiving chemotherapy resulting in immunosuppression state. Although S. stercoralis infection is not very common compared to other parasitic infections, it is common in immunosuppressive patients and may present with hyperinfection. Therefore, awareness of this parasite should be kept in mind in immunosuppressive patients.
One hundred and fourteen strains of Pasteurella multocida were isolated from different domestic animals species (cattle, buffalo, sheep, goat, pig, rabbit, dog, cat), avian species (chicken, duck, turkey) and wild animals (deer, tiger, orang utan, marmoset). The serogroups of P. multocida were determined by both conventional capsular serotyping and a multiplex PCR assay targeting specific capsular genes. Based on the conventional serotyping method, the 114 strains of P. multocida were subtyped into 55 species-specific (untypeable strains) P. multocida, 15 serogroup A, 23 serogroup B and 21 serogroup D. Based on the multiplex PCR assay on the specific capsular genes associated with each serogroup, the 114 strains were further divided to 22 species-specific P. multocida (KMT1 – 460 bp), 53 serogroup A (A – 1,044 bp), 33 serogroup B (B – 760 bp) and 6 serogroup D (D – 657 bp). No serogroup E (511 bp) or F (851 bp) was detected among the Malaysian P. multocida. PCR-based typing was more discriminative and could further subtype the previously untypeable strains. Overall, there was a significant and positive correlation between both methods in serogrouping P. multocida (r = 0.7935; p < 0.4893). Various serogroups of P. multocida were present among the livestock with 75% of the strains belonging to serogroups A or B. PCR serotyping was therefore a highly species-specific, sensitive and robust method for detection and differentiation of P. multocida serogroups compared to conventional serotyping. To the best of our knowledge, this is the first report from Malaysia of the application of a PCR to rapidly define the species-specific P. multocida and its serogroups as an important zoonotic pathogen in Malaysia.
Occupational stress exists in all professions, but the nursing profession appears to experience more stress at work compared to other health care workers. Stressful conditions at the workplace may cause the high turnover and burnout among nurses. This study objective was to determine the level of stress and its associated factors among in-patient ward nurses. A cross sectional study using the stratified random sampling method was carried out among 114 staff nurses from 5 different departments in a public hospital in Kuala Lumpur. Respondents were requested to complete a single set of validated and self-administered questionnaire, the Depression, Anxiety, Stress Scale (DASS) . Data was analysed using SPSS 17. In general, the prevalence of stress at the department of Medicine was found to be higher compared to other departments studied. There was also a statistical significant relationship between the prevalence of stress and types of department (p 0.05). In conclusion, stress had no significant association with sociodemographic factors (age, marital status and financial status) and working environment except for type of department nurses work in. There might be some other possible confounders that have a bigger potential in becoming stressors compared to those independent variables in this study.
MeSH terms: Anxiety; Anxiety Disorders; Cross-Sectional Studies; Depression; Hospitals, Public; Humans; Nurses; Surveys and Questionnaires; Prevalence; Workplace; Marital Status
The quality of the health care services has been always a big responsibility and sensitive issue. Health care delivery is complex and critical for many reasons related to management and organizational planning and development. Health system reorganization is one of the approaches that health care managers adopt to overcome dysfunction. Clinical Microsystems (CM) is believed to be a one of vital steps in providing a high quality of patient care through system reorganization. CM has the potential to drive the health care to greater success through proper understanding, process and resource planning and health outcomes continuous assessment and improvements. CM integrate patients, providers and family needs and roles to form a vision of community system that cooperate for better outcomes .The components of an effective CM are produce quality, patient safety, and cost outcomes at the front line of care. This article aims to explore the concept, characteristics models and components of these Clinical Microsystems. It also highlights the steps to initiate, plan and sustain this innovation in hospitals in a systematic manner.
MeSH terms: Delivery of Health Care; Patient Care; Health Services; Health Services Administration; Humans; Patient Safety
Comparison of rates of smoking across countries revealed that students are more likely to begin smoking in medical school than to give it up and increase their cigarette consumption rather than decrease it. A cross-sectional survey of all consenting medical students in a private medical university in north Malaysia was conducted in 2008 to determine the prevalence and smoking habits among them. A self administered questionnaire which was returned to the investigators in a sealed envelope was used. Results were tabulated and analysed with SPSS version 13.0 software. The response rate was 83.3% (508/610). The prevalence rate for current smokers was 5.3% (27/508) and for ever smokers 9.3% (47/508). Factors significantly associated with smoking were gender (p<0.001), age group (p<0.001) and family income (p=0.003). The odds of being a smoker was 14 folds high when a family member smoked and the odds of being an ever smoker was almost 6 folds more when a family member smoked. Friends were the most common influence to start smoking and the most common reason to stop smoking among ever smokers. The reasons for not smoking among the never smokers were health concerns and the distasteful smell of cigarettes. A module on how to help medical students to stop smoking should be included in the curriculum of every medical school. This will not only help them become good educators but will prevent them from picking up the habit. Educational intervention should also include family members who smoke.
Key words: smoking, medical students, university, Malaysia
MeSH terms: Adult; Cross-Sectional Studies; Humans; Malaysia; Surveys and Questionnaires; Schools, Medical; Smoking; Students, Medical; Tobacco Use Disorder; Universities; Prevalence; Young Adult
Satu kajian keratan rentas telah dijalankan untuk melihat kesan pendedahan haba ke atas perubahan fisiologi di kalangan pekerja lelaki sebuah kilang pembuatan komponen otomotif di Shah Alam, Selangor. Seramai 46 orang yang berkerja di bahagian foundri telah dipilih sebagai responden kajian. Pemboleh ubah yang dikaji adalah WBGT Dalaman, kadar haba metabolik, suhu teras badan, tekanan darah, denyutan nadi dan kadar denyutan nadi. Hasil kajian mendapati nilai min WBGT Dalaman di bahagian operasi foundri adalah sebanyak 28.96 0C. Pekerja foundri terdedah kepada haba semasa
proses peleburan besi, proses memasukkan silika dah debu besi ke dalam acuan pembentukan, dan pembentukan teras. Purata masa pengukuran yang paling singkat adalah selama 2 jam dan 8 jam untuk keseluruhan tempoh pendedahan. Ujian Bonferroni menunjukkan terdapat perbezaan yang signifikan di antara suhu teras badan sebelum syif bermula dengan 2 jam selepas syif bermula (p = 0.05) dan di antara sebelum syif bermula dengan selepas tamat syif 8 jam bekerja (p < 0.001). Terdapat perkaitan yang lemah di antara suhu teras badan dengan kadar denyutan nadi sebelum syif bermula (r = 0.293, p = 0.048) dan di antara suhu teras badan dengan tekanan darah sistolik selepas tamat syif 8 jam bekerja (r = 0.309, p =0.036). Kadar denyutan nadi responden adalah berada di antara julat 51 hingga 98 denyutan perminit, menunjukkan tidak terdapat tuntutan aktiviti kerja yang berlebihan ke atas fisiologi. Min suhu teras badan (36.37 ± 0.53 0C) dan kadar denyutan nadi (74.50 ± 10.10 per minit) selepas tamat syif 8 jam menunjukkan pekerja mempunyai kawalan
tubuh badan yang baik terhadap pendedahan haba. Tiga daripada empat seksyen kerja yang dikaji mempunyai bacaan WBGT Dalaman melebihi 28 0C (ACGIH TLV). Pekerja terdedah kepada tegasan haba yang sederhana sepanjang kajian ini berlangsung, walaubagaimanapun, suhu teras badan, kadar denyutan nadi dan tekanan darah masih tidak mencapai tahap tegangan kepada fisiologi.
Treating tuberculosis (TB) remains a public health challenge in many developing countries. Treatment success rate in Malaysia is on declining pattern from 78% in 2000 to 48% in 2006. This study will determine factors associated with unsuccessful treatment among pulmonary TB patients. A retrospective cohort study was conducted on notified and treated pulmonary TB cases in Kota Bharu district Kelantan between January 2006 and December 2007. To identify the associated factors, univariate comparison and multiple logistic regressions were performed. Among the 765 patients identified, 472 (61.7%) cases fulfilled the criteria and were analyzed. There were 316 males and 156 females and their mean (SD) age was 45 (17.9) years. In univariable analysis, age, gender, educational level, employment status, family incomes as well as coexistence of extra-pulmonary TB, smoking, co-morbid disease (diabetes mellitus), HIV status, sputum cultures, chest X-ray findings and duration of delay for diagnosis were all found to have significant relationship with unsuccessful pulmonary TB treatment outcome. After adjusted for the confounders, the significant predictors for unsuccessful tuberculosis treatment were age (Adj. OR 1.09; 95% CI: 1.03-1.15), HIV positive (Adj. OR 23.04; 95% CI: 3.01-176.22) and advanced chest X-ray findings (Adj. OR 6.51; 95% CI: 1.50-28.23). A large proportion of unsuccessfully treated cases could be identified at entry
by screening for age, chest X-rays and HIV status and specially targeted measures could be taken. The use of directly observed treatment short-course (DOTS) should be given more focus and priority among this high risk group of patients.
Patient waiting time was introduced to orthodontic clinics in 2009 as a Key Performance Indicator (KPI) in the Ministry of Health Malaysia (MOH) as a measure of client satisfaction. A cross-sectional pilot study was carried out in 2009 in all four main government orthodontic clinics in Selangor. The objectives were to measure patient actual waiting time and evaluate conformance to this KPI. The sample comprised of 5,286 patients; 9.2% from Tanjung Karang, 37.1% Kajang, 29.3% Klang and 24.4% Shah Alam. There were 33.8% punctual, 44.2% early and 21.9% late patients. The mean actual waiting time (AWT) in Selangor was 30 min (SD 24.7); shortest in Tanjung Karang (16.5min, SD 15.3) and longest in Shah Alam (47.9min, SD29.6). AWT was 21.9 min (SD 17.4) for patients punctual for appointments, 40.3 min (SD 40.3) for early patients and 21.9min (SD19.8) for late patients respectively. Although the mean AWT was long for early patients, 20% of them were seen earlier than their appointment time. All four clinics complied with the MOH KPI performance target (>50%) with a mean compliance of 87.5% for Selangor. There is statistically significant difference in punctuality of patients in different clinics (p
MeSH terms: Appointments and Schedules; Cross-Sectional Studies; Government; Humans; Malaysia; Patient Compliance; Personal Satisfaction; Pilot Projects; Patient Satisfaction
Adolescents are known to obtain information regarding sexual and reproductive health from a variety of sources and not just during formal lessons in schools. This cross-sectional descriptive study was carried out to determine the source of information on sexual and reproductive health among Form four secondary schools girls in the Klang Valley as well as parents’ relationship profile. A total of 520 secondary school girls were recruited for the study. In this study, the source of information on puberty and sexual topics were categorized as follows: first level of importance - mothers, second level of importance - siblings, third level of importance - fathers, fourth level of importance - friends, fifth level of importance - teachers and sixth level of importance - books/internet. A majority of respondents agreed that their mothers were the first level of importance they sought for information on puberty (74.8%) and sexual topics (53.8%). Thirty nine point three percent (39.3%) of respondents reported it was very easy to have a dialogue with their mothers while only 10.0% of the respondents said it was very easy to have a dialogue with their fathers. While this was the case, only 6.3% of the respondents reported discussing sex-related matter with their mothers.
MeSH terms: Adolescent; Books; Cross-Sectional Studies; Fathers; Female; Humans; Mothers; Puberty; Surveys and Questionnaires; Reproduction; Schools; Sexual Behavior; Sexual Maturation; Internet; Friends; Siblings; Information Seeking Behavior; Reproductive Health
Top-down costing and activity based costing are the most frequent costing methodologies used for analyzing cost. Top-down costing is accomplished by assigning total expenditure of hospital to patient by apportioning the expenditure of cost centers (unit of service) in hospital to give the cost per patient per visit, per day or per admission. Conversely, activity based costing is accomplished by tracking every resource used by patient individually. Since this study started in 2009, Top-down costing calculation was based on financial year in 2009 with adjusted up to 12.6% from 2008 data. This percentage was taken based on the trend of hospital expenditure during 2005 till 2008. An assumption was made that non-financial data (performance and administrative data) for 2009 was similar to 2008. Top-down costing was calculated using Clinical Cost Modeling Software developed by Unit Case-mix of UKMMC to obtain cost of elective lower segment caesarean section (LSCS) per day at ward which was RM922. Whereas activity based costing was calculated using clinical pathway of elective LSCS. Given the average length of stay in 2009 was 4 days, the cost of elective LSCS according to top-down costing was RM3, 688 and activity based costing was RM1774. As a result, cost of elective LSCS is 108% higher using top-down costing.
MeSH terms: Cesarean Section; Costs and Cost Analysis; Diagnosis-Related Groups; Health Expenditures; Health Resources; Hospitals; Humans; Length of Stay; Pregnancy; Software; Critical Pathways