Browse publications by year: 2024

  1. Mazlan R, Dar HM
    BMC Pediatr, 2024 Nov 15;24(1):740.
    PMID: 39548470 DOI: 10.1186/s12887-024-05230-y
    BACKGROUND: Childhood hearing loss poses a significant public health challenge in Pakistan, with prevalence rates over double the global average. Parental knowledge and attitudes play a crucial role in timely detection and intervention. However, limited research explores this issue within the Pakistani context. This study aimed to examine parental knowledge and attitudes regarding childhood hearing loss in Rawalpindi, Pakistan, and identify key demographic factors influencing parental perspectives.

    METHODS: This cross-sectional survey was conducted in Rawalpindi, Pakistan from March 1 to August 31, 2023. A total of 150 parents (79 fathers and 71 mothers) of children aged 0-12 years were recruited through convenience sampling at public locations such as schools, malls, and hospitals. Data were collected through face-to-face interviews using the validated "Parental Knowledge and Attitudes towards Childhood Hearing Loss Questionnaire," administered by a graduate student to assess parental knowledge and attitudes about childhood hearing loss. Descriptive statistics determined the percentage of correct responses and knowledge/attitudes scores. Chi-square tests explored associations between demographic factors and parental perspectives.

    RESULTS: Overall, 67.3% of parents demonstrated good knowledge of childhood hearing loss. Notably, parents scored high on recognizing congenital causes (79.3%) but displayed low awareness of measles as a risk factor (29.3%). Significant gender disparities emerged in parental knowledge, with mothers exhibiting superior knowledge compared to fathers regarding newborn screening (63.4% vs. 46.8%), treatment availability (81.7% vs. 64.6%), and educational inclusion for children with hearing impairment (57.7% vs. 38.0%). Despite these knowledge gaps, parents generally held positive attitudes towards childhood hearing loss, with an average score of 94.7%. Gender and educational level significantly influence knowledge and attitudes.

    CONCLUSIONS: Although parents in Rawalpindi generally have a good understanding and positive attitudes towards childhood hearing loss, gaps in knowledge about preventable causes and gender disparities need attention. Providing tailored counselling for higher-risk, less educated groups and expanding policies for paediatric audiology services nationwide can help address these issues.

    MeSH terms: Adult; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Health Knowledge, Attitudes, Practice*; Male; Pakistan; Young Adult
  2. Lushchekina S, Weiner L, Ashani Y, Emrizal R, Firdaus-Raih M, Silman I, et al.
    Protein Sci, 2024 Dec;33(12):e5206.
    PMID: 39548604 DOI: 10.1002/pro.5206
    We earlier showed that Torpedo californica acetylcholinesterase (AChE) contains a cluster of four conserved aspartates that can strongly bind divalent cations, which we named the 4D motif. Binding of the divalent metal cations greatly increases its thermal stability. Here we systematically examined all available crystallographic structures of T. californica AChE. Two additional metal-binding sites were identified, both composed of acidic and histidine residues. Relative binding to the 4D and additional sites was studied using metadynamics simulations. It was observed that in crystal structures devoid of metal ions in the 4D site, the conformation of T. californica AChE is almost identical to that in structures in which it is occupied by a divalent metal ion. Closer examination of the 4D motif reveals that three of the four acidic residues form ion pairs with conserved basic residues surrounding them. We named this new motif the 4A/3B motif. Molecular dynamics with quantum potential simulations was used to quantify the 4D motif's binding strength compared with that of the metal-binding site in the protein fXIIIa, which consists of four aspartates, but is devoid of adjacent cationic residues. Whereas fXIIIa's 4D site, in the absence of a metal cation, expanded significantly in the simulation, that of Torpedo AChE displayed only minor periodic changes in size. Furthermore, the energy of metal ion unbinding from the two sites differs by ca. 10 kcal/mol. We identified several other proteins in the PDB that contain the 4A/3B motif, whose conformations are identical in the presence or absence of a metal ion. An animated Interactive 3D Complement (I3DC) is available in Proteopedia at https://proteopedia.org/w/Journal:Protein_Science:4.
    MeSH terms: Animals; Binding Sites; Protein Binding; Protein Conformation; Torpedo; Crystallography, X-Ray; Amino Acid Motifs*; Molecular Dynamics Simulation*
  3. Kamaraj S, Firdaus ML, Norfarahdina R, Muizz AMA, Ranga ARA, Henry TD, et al.
    PMID: 39548661 DOI: 10.1002/ccd.31290
    BACKGROUND: Primary Percutaneous Coronary Intervention (PPCI) is the preferred treatment for ST-Segment Elevation Myocardial Infarction (STEMI) patients in both PCI centers and those transferred from non-PCI centers, provided it can be performed in a timely manner. The challenges in transferring patients from non-PCI centers include not only potential delays beyond 120 min but also the risk of overwhelming the resources at the PPCI hospital. We report a novel strategy implemented within the Serdang STEMI Network involving immediate transfer of patients back to the originating hospitals within 2 h post procedure.

    AIMS: This study aims to evaluate the clinical outcomes and practicality of immediately transferring stable STEMI patients back to their originating hospitals within 2 h postprimary PCI, within the Serdang STEMI Network. Specifically, it seeks to assess the in-hospital mortality rate and 30-day major adverse cardiac events (MACE) among these patients to determine the safety and feasibility of this novel early transfer strategy.

    METHODS: This retrospective cohort study involved 1374 STEMI patients participating in the Serdang STEMI network from May 2015 to December 2022, including 570 patients admitted directly to Hospital Sultan Idris Shah, Serdang (HSIS) and 804 transferred from non-PCI centers.

    RESULTS: Of the 804 transferred patients, 415 (52%) were transferred back to referring hospitals within 2 h of PPCI. These patients met specific criteria including hemodynamic stability, absence of procedural complications, and fit for transfer at the discretion of the attending cardiologist. The primary outcomes measured were in-hospital and 30-day mortality rates, as well as major adverse cardiac events (MACE). MACE was defined as a composite of death, myocardial infarction, stroke, or repeat revascularization. In the early return group, there was no in-hospital or 30-day mortality. No patient required repeat revascularization or readmission within 30 days.

    CONCLUSIONS: Our results indicate that carefully selected patients can be safely returned to their originating hospitals very early following successful PPCI. These findings have important implications for large regional STEMI networks worldwide, particularly in areas where PPCI centers may have limited resources to handle high STEMI volumes.

  4. Balinu CP, Diam S, Chua TH
    Trop Biomed, 2024 Sep 01;41(3):230-240.
    PMID: 39548775 DOI: 10.47665/tb.41.3.001
    Numerous human diseases, including those caused by viruses like Nipah virus and SARS-CoV, can be traced back to bats as their origin. Malaysia, notably Sabah and Sarawak in Borneo Island, is home to a rich diversity of bats that serve as hosts for various viruses. This comprehensive review represents the inaugural exploration of viruses found in Malaysian bats, as documented in scientific journals. It also encompasses documented instances of bat virus-related disease outbreaks in Malaysia up to the present day, along with an analysis of the risk factors associated with virus spillover events. Furthermore, this review offers insights into prospective research areas of significance and suggests potential mitigation strategies.
    MeSH terms: Animals; Disease Outbreaks/veterinary; Disease Reservoirs/virology; Humans; Malaysia/epidemiology; Virus Diseases/epidemiology; Virus Diseases/veterinary; Virus Diseases/virology; Viruses/classification; Viruses/isolation & purification
  5. Ang WX, Tan SH, Wong KT, Perera D, Kuppusamy UR, Ong KC
    Trop Biomed, 2024 Sep 01;41(3):241-250.
    PMID: 39548776 DOI: 10.47665/tb.41.3.002
    Hand, Foot and Mouth Disease (HFMD), a highly contagious viral disease common among infants and young children, is primarily caused by Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CVA16). Nonetheless, emerging enteroviruses, such as CV-A10 and CV-A6, have also caused widespread outbreaks globally, in part due to the absence of effective antiviral therapies, and the high personto-person transmission rate. Person-to-person transmission is usually through fecal-oral or oral-oral routes, and sometimes via droplets. As the oral cavity is a primary site for early virus infection and replication, controlling oral viral shedding can mitigate the risk of transmission through this route. Povidone-iodine (PVP-I), a widely used antiseptic, has shown broad-spectrum antimicrobial properties but antiviral studies against HFMD-causing enteroviruses are limited, especially for CV-A10 and CVA6. Our study demonstrated that a 1% PVP-I solution (final concentration of 0.5%) exhibited virucidal activity against EV-A71, CV-A16, CV-A10, and CV-A6. All seven EV-A71 isolates and five CV-A16 isolates showed a significant virus titer reduction after a 1-minute incubation, while five CV-A10 isolates and two CV-A6 isolates required a 5-minute incubation to achieve this. The virucidal activity was confirmed through the EN14476:2013+A2:2019 virucidal quantitative suspension test, wherein all four viruses were completely inactivated after a 30-minute incubation with PVP-I at 37°C under both clean and dirty conditions. Western blot analysis suggested that PVP-I could affect the VP1 structural proteins of EV-A71. Our results suggest that PVP-I could serve as a potential virucidal agent to reduce the risk of person-to-person transmission of HFMD.
    MeSH terms: Animals; Cercopithecus aethiops; Hand, Foot and Mouth Disease/prevention & control; Hand, Foot and Mouth Disease/virology; Humans; Vero Cells; Enterovirus A, Human/drug effects
  6. Izwan-Anas N, Ya'cob Z, Low VL, Lourdes EY, Teoh BT, Mansor MS, et al.
    Trop Biomed, 2024 Sep 01;41(3):251-256.
    PMID: 39548777 DOI: 10.47665/tb.41.3.003
    Simulium asakoae Takaoka and Davies has been confirmed to bite humans and has been incriminated as a vector of blood protozoan parasites of the genera Leucocytozoon and Trypanosoma, as well as an unknown filarial parasite in Thailand. However, its attraction to humans has remained uninvestigated in Malaysia. Recently, 27 black flies were collected in Pahang, Malaysia, of which 25 were captured in CO2-baited Malaise traps and two were collected from humans during trapping activity. All specimens were morphologically identified as S. asakoae. Cytochrome c oxidase I sequences of the two specimens caught on humans showed 100% similarity with those of S. asakoae in the NCBI GenBank, confirming their morphological identity. Blood-meal analysis using a HAL·HARTM kit did not show the presence of domestic or wild animal DNA. However, human DNA was amplified from one engorged fly in the cytochrome b gene amplification assay, providing the first evidence of blood-feeding by S. asakoae in Malaysia.
    MeSH terms: Animals; Electron Transport Complex IV/genetics; Feeding Behavior; Female; Humans; Malaysia; Male; Cytochromes b/genetics
  7. Sayuti NASA, Ibrahim FW, Jufri NF, Masre SF, Abdullah AHA, Raub SHA, et al.
    Trop Biomed, 2024 Sep 01;41(3):257-263.
    PMID: 39548778 DOI: 10.47665/tb.41.3.004
    Tuberculosis (TB) is a critical disease that predominantly affects the lungs. This disease remains a global health threat. Currently, the incidence of TB is estimated to be 92 cases in every 100 000 population. However, latent TB infection (LTBI) cases among Malaysians are another great health concern that requires immediate steps to be taken to detect, diagnose, and treat LTBI as one of the key strategies to end TB. Although individuals with LTBI are unlikely to infect others, the threat of infection is still imminent as these individuals can potentially develop into active TB cases. As such, this study aims to identify the prevalence of LTBI among asymptomatic individuals that underwent QuantiFERON®-TB Gold Plus test from a private laboratory in Malaysia to determine the association between the risk factors and the detected LTBI cases. A retrospective study was conducted by analyzing the archive records of 3 877 samples from January 2021 to March 2022. The cases underwent QuantiFERON®-TB Gold Plus tests for LTBI at Premier Integrated Labs. This study underlines that those who were LTBI positive had a prevalence of 638/3 877 (16.46%) with males contributing to 343/638 cases (53.76%). Furthermore, the majority of the positive cases were between the age of 30-43 years old with 197/638 (30.88%), and Chinese ethnicity with 225/638 (35.27%). The risk factors significantly associated with LTBI cases were age (p = 0.001) and ethnicity (p = 0.001). The prevalence of LTBI determined through this study is considered remarkably low for an intermediate TB burden country. Although LTBI is not contagious, specific clinical and preventative considerations are needed for the diagnosis, treatment, and implementation of appropriate safety measures to curb the spread of TB in Malaysia.
    MeSH terms: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Malaysia/epidemiology; Male; Middle Aged; Retrospective Studies; Risk Factors; Prevalence; Young Adult; Interferon-gamma Release Tests
  8. Boonsuya A, Arunsan P, Pechdee P, La N, Thanchonnang C, Rattanapitoon NK, et al.
    Trop Biomed, 2024 Sep 01;41(3):264-270.
    PMID: 39548779 DOI: 10.47665/tb.41.3.005
    Liver fluke infection, particularly Opisthorchis viverrini, poses a significant public health risk in Thailand, where it is closely associated with cholangiocarcinoma and contributes to substantial mortality in the northeastern region. Diagnosis of this condition employs various parasitological approaches. This research aims to compare the diagnostic accuracy of three parasitological techniques: the Kato Katz technique (KKT), the formalin-ethyl acetate concentration technique (FECT), and the Fully Automatic Feces Analyzer (FAFA) for O. viverrini identification. A total of 455 fecal specimens were collected from rural areas across five provinces in northeastern Thailand. The specimens were processed according to each method and examined through microscopy for KKT and FECT, and by utilizing an artificial intelligence-based machine for FAFA. Data analysis was conducted to assess parasitic infection rates and observe diagnostic accuracy. The results revealed a parasitic infection rate of 19.34%, with the majority of infections attributed to O. viverrini (18.02%), followed by Strongyloides stercoralis (0.88%). FECT exhibited the highest positive detection of O. viverrini eggs (16.48%), followed by FAFA (10.55%), and KKT (8.57%), respectively. Statistical analysis indicated sensitivity and specificity values for O. viverrini detection by KKT (100% and 89.21%), FECT (98.67% and 97.63%), and FAFA (97.92% and 91.15%). The positive predictive value, negative predictive value, and kappa were reported for FECT (89.16%, 99.73%, 0.92), FAFA (56.63%, 99.73%, 0.67), and KKT (45.78%, 100%, 0.58). Additionally, the preparation time for KKT, FECT, and FAFA was 30, 15, and 10 min, respectively. In conclusion, this study highlights FECT, KKT, and FAFA as comparably sensitive in diagnosing O. viverrini. The FAFA machine emerges as a potentially valuable tool for detecting O. viverrini and other parasitic infections, showcasing promise for clinical use. The findings provide valuable insights into the diagnostic landscape and underscore the potential of FAFA in enhancing efficiency and accuracy in parasitological assessments.
    MeSH terms: Adolescent; Adult; Aged; Animals; Child; Female; Humans; Male; Middle Aged; Parasite Egg Count/methods; Sensitivity and Specificity*; Thailand; Young Adult
  9. Muslim A, Mohd Rustam FR, Mohd Khalid MS, Sahlan N
    Trop Biomed, 2024 Sep 01;41(3):271-275.
    PMID: 39548780 DOI: 10.47665/tb.41.3.006
    Toxoplasmosis is an infectious disease caused by the intracellular protozoan parasite, Toxoplasma gondii. While the infection is typically asymptomatic in healthy individuals, it can progress to cerebral toxoplasmosis, especially in those with human immunodeficiency virus (HIV) or weakened immune systems. In this communication, we present a case of a newly diagnosed HIV infection patient who presented with neurological symptoms. The patient was later diagnosed with probable cerebral toxoplasmosis. The case depicts the severe consequences of toxoplasmosis in immunocompromised patients, highlighting the urgent need to identify those at high risk of contracting the disease and the importance of prophylactic treatment. This requires the necessity for early HIV diagnosis and close monitoring of HIV-positive patients.
    MeSH terms: Humans; Malaysia; Immunocompromised Host
  10. Lee HY, Khoo HY, Yap PC, Mansor SM, Abdul Majid MA
    Trop Biomed, 2024 Sep 01;41(3):276-282.
    PMID: 39548781 DOI: 10.47665/tb.41.3.007
    The indigenous community in Malaysia also known as Orang Asli have preserved their unique cultural identity in the face of rapid national development and modernization efforts. Over the years, poverty alleviation has become a central pillar of Malaysia development. In this review, seroprevalence report from the Orang Asli and their health status about neglected tropical diseases were collated and analyzed. The review will show the potential areas of research for future development. Specifically, the review will cover a 12-year period preceding the onset of COVID-19 pandemic, offering critical insights into the community health landscape. In depth discussion on the unique impact of the pandemic covering healthcare access, socioeconomic dynamics and community resilience. Analysis revealed the burden of parasitism is high in the community and the sustainability of certain basic access such as clean water and education remains a challenge. Different approaches to improve future intervention strategies were also discussed. The review can contribute to essential knowledge for policymakers, researchers, healthcare providers interested in enhancing the well-being of the Orang Asli community.
    MeSH terms: Humans; Malaysia/epidemiology; Seroepidemiologic Studies
  11. Sabri N, Kamaldin J, Sivanathan M, Rasli R
    Trop Biomed, 2024 Sep 01;41(3):283-289.
    PMID: 39548782 DOI: 10.47665/tb.41.3.008
    The study has generated visible aerosols with the diameter of 11 to 35 µm from the kenaf cellulose nanofiber (KCNF) impregnated with the temephos (KCNF+T) in water suspension. The study aimed to determine whether the KCNF+T aerosols are capable to elicit neurotoxicity in the adult mosquitoes via the respiratory exposure route by observing their behavioural response and measuring its body acetylcholine esterase (AChE) activity. Adult Aedes aegypti mosquitoes were assigned to one negative control group and three treatment groups namely, distilled water (vehicle control), KCNF and KCNF+T. The study adopted the MS1911 whereby the aerosols generated are released into the insecticide bioassay glass chamber (IBGC) separately to achieve four different aerosols concentrations of 6.4 ml/m3, 12.8 ml/m3, 19.2 ml/m3, and 25.6 ml/m3. Then the 20 sugar-fed mosquitoes were released free-flying into each IBGC to observe its behavioural response (knockdown) at 30, 60, 120, 180, 240, 300 minutes intervals and 24th hour mortality. Results showed that only mosquitoes exposed to KCNF+T aerosols exhibited persistent knockdown. There was significant difference (p< 0.05) between observation intervals with the cumulative knockdown of 84.8%, 92.8%, 99.0%, 100.0%, 100.0%, 100.0% compared with the KCNF aerosols. Further, it was distinctive that only KCNF+T is capable to cause the female mosquitoes moribund/mortality at the 24th hour with 90% at the lowest aerosol concentration of 6.4 ml/m3. The neuroenzyme assay on the mosquito that died from the KCNF+T exposure verified to have reduced AChE enzyme activity. The behavioural response and reduction of the AChE activity strongly suggests the temephos from the KCNF+T aerosols has been released into the mosquito body causing the neurotoxicity but KCNF alone is not neurotoxic.
    MeSH terms: Temefos*; Acetylcholinesterase/metabolism; Aerosols*; Animals; Female; Insecticides*; Mosquito Control/methods
  12. Li N, Tian W, Sun L, Yan H, Hasi S
    Trop Biomed, 2024 Sep 01;41(3):290-297.
    PMID: 39548783 DOI: 10.47665/tb.41.3.009
    This study explored the transcriptome differences in Fasciola hepatica at different developmental stages and identified functional genes related to growth and development during juvenile stages. DNBSEQ eukaryotic strand-specific transcriptome resequencing technology was used to sequence the transcriptomes of Fasciola hepatica eggs, juveniles, and adults. Additionally, the genes that were highly expressed during the juvenile stage were validated using qRT-PCR. The Q20 values of all three phases of sequencing were above 98%, and the Q30 values were above 94%. The differentially expressed genes (DEGs) in pairwise comparisons were analyzed by GO functional classification and the KEGG pathway database. Many immune-, growth-, and development-related pathways were found, which might be related to cell proliferation, development, and host immune evasion by Fasciola hepatica. In addition, five DEGs with high expression levels during the juvenile stage were identified: Cathepsin B, Glutathione S-transferase mu, heat shock protein 67B2, Kunitz-CH, and Legumain. Validation analyses revealed that these genes play key roles in maintaining normal growth, development, and immunological processes in liver Fasciola hepatica. RNA-seq was used to analyze the biological characteristics of the DEGs at different developmental stages concerning GO functional classification and KEGG metabolic pathways. Five DEGs with high expression during the juvenile stage were identified. These genes are related to the growth, development, and immune function of Fasciola hepatica, which provides a theoretical basis for subsequent research on the proteomics of Fasciola hepatica and the screening of candidate genes for early diagnosis.
    MeSH terms: Animals; Gene Expression Profiling; Transcriptome*
  13. Woh PY, Ng C
    Trop Biomed, 2024 Sep 01;41(3):298-309.
    PMID: 39548784 DOI: 10.47665/tb.41.3.010
    Rice is often associated with Bacillus cereus (B. cereus) food poisoning. This review aims to explore the food poisoning activity, antimicrobial resistance, and control measures of B. cereus in rice from 1974 to October 2023. We searched for eligible studies from the PubMed database based on explicit criteria following the PRISMA checklist. A total of 117 articles were collected, and the final analysis included 29 studies. Quality appraisal was performed using AMSTAR 2, SANRA 2, and Critical Appraisal Tool standards. B. cereus can grow and multiply in food to cause emetic vomiting or diarrheal syndrome. The primary etiology of B. cereus contamination is improper food handling and storage temperature during the cooking, cooling, and reheating stages of rice. The alarming rise of antimicrobial resistance in B. cereus to beta-lactam antibiotics necessitates alternatives from natural antimicrobial preservatives such as carvacrol, chitosan, or trans-cinnamaldehyde to prevent microbial infestation and toxin production. Implementing food safety strategies tailored to specific food settings, such as restaurants and factorymanufactured ready-to-eat rice, is critical for preventing food contamination by B. cereus. Given the heat-resistant spores and intoxication properties of B. cereus, it is important to develop effective interventions and hygienic protocols from farm to fork.
    MeSH terms: Anti-Bacterial Agents/pharmacology; Food Handling; Food Microbiology; Humans; Drug Resistance, Bacterial
  14. Liew CSL, Guad RM, Taylor-Robinson AW, Teck KS, Mandrinos S, Duin EV, et al.
    Trop Biomed, 2024 Sep 01;41(3):310-315.
    PMID: 39548785 DOI: 10.47665/tb.41.3.011
    To investigate co-infection of bacterial isolates associated with respiratory syncytial virus (RSV) in children aged less than two years who were admitted to hospital with confirmed lower respiratory tract infection (LRTI) in Kelantan, Malaysia. The demographic data, clinical history, case management, haematological as well as infectious parameters (white blood cell differential and count, plus C-reactive protein, CRP) of the patients were systematically recorded. Less than one-third of cases were RSV-positive (21.03% and 26.23% were diagnosed as acute bronchiolitis or pneumonia, respectively). Blood cultures from approximately 10% of patients demonstrated growth of Haemophilus influenzae, Staphylococcus aureus, coagulase-negative Staphylococcus, Pseudomonas stutzeri, haemolytic Streptococcus group A, and Bacillus subtilis. Further analysis indicated that children with positive bacterial growth had an insignificant predictive value of CRP (2.32-7.16 mg/dl). The total white cell counts were 2.97-7.33 x 109sup>/L despite increased lymphocyte values in the bacteria-positive blood culture. Platelet counts were also within normal limits except for a single case of H. influenzae infection (685.50 x 109sup>/L). Interestingly, 95.01% of patients were treated with antibiotics; 66.23% of RSV infection cases were administered with a combination of antibiotics and 33.77% with only a single antibiotic. The data indicate that the use of antibiotics, either singly or in combination, is not always effective in treating LRTI in infants. Alternative therapeutic regimens should be considered, especially in Asian countries that may have limited resources.
    MeSH terms: Bacteria/drug effects; Bacteria/isolation & purification; Bacterial Infections/drug therapy; Bacterial Infections/microbiology; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Respiratory Tract Infections/drug therapy; Respiratory Tract Infections/microbiology; Respiratory Syncytial Virus, Human
  15. Irekeola AA, Ahmed N, Abdul Hadi MI, Yung TC, Mohd Shukri MF, Mafauzy MM, et al.
    Trop Biomed, 2024 Sep 01;41(3):316-318.
    PMID: 39548786 DOI: 10.47665/tb.41.3.012
    Dengue fever is one of the most common diagnoses in patients presenting with acute febrile illness in tropical countries. Borrelia, on the other hand, is the cause of vector-borne infections of relapsing fever and Lyme disease. While co-infections of dengue with chikungunya, Zika, malaria, influenza and typhoid have been reported, clinical cases of Borrelia infections have never been reported in Malaysia. Based on available evidence, this is the first case series to report dengue fever and Borrelia spp. co-infection. All three patients in this report were admitted to medical wards on day 3 to day 8 of illness for dengue fever as evidenced by a positive dengue NS1 antigen test. The clinical manifestations were typical of dengue fever, with all patients having high grade fever, myalgia, and arthralgia. All patients also had thrombocytopenia. Features of severe dengue, such as shock, hemorrhage and impaired consciousness were absent. Borrelia DNA were detected in the blood samples of the patients. However, all the patients denied having skin lesions and a history of insect bites. All the patients were given intravenous fluid therapy and were discharged after 3 to 5 days of hospitalization.
    MeSH terms: Borrelia Infections/complications; Humans; Malaysia/epidemiology
  16. Haldar T, Sardar SK, Ghosal A, Das K, Saito-Nakano Y, Dutta S, et al.
    Trop Biomed, 2024 Sep 01;41(3):319-327.
    PMID: 39548787 DOI: 10.47665/tb.41.3.013
    Giardiasis, caused by the parasite Giardia lamblia, is a prevalent and serious public health concern, particularly affecting children worldwide. The primary mode of transmission for the parasite is through contaminated food and water sources and often leads to the onset of diarrhoea in infected individuals. However, the present medications for Giardiasis treatment often come with numerous side effects, while the growing problem of drug resistance adds a significant complication. Therefore, there is an urgent need for alternative treatments. In this study, we explored the in-vitro potential of Andrographis paniculata leaf extract as a possible alternative treatment for Giardiasis. Our investigation involved assessing the impact of the ethanolic extract on Giardia trophozoites through the analysis of parameters such as cell death, morphological alterations, adherence, ROS generation, and cell cycle dynamics. A. paniculata leaf extracts demonstrated significant inhibitory activity against the growth of Giardia trophozoites. After being incubated for 24 hours, the test results revealed an IC50 value of 51.26µg/ml (95% CI 37.17- 65.35) for inducing cell death in Giardia trophozoites. We observed a substantial degradation of DNA, alteration in morphology, inhibition in adherence, ROS generation and inhibition of the cell cycle in Giardia trophozoites. The findings indicate that A. paniculata extract has the potential to be used as a therapeutic treatment for giardiasis. This approach aims to offer a natural therapeutic solution for giardiasis, minimizing side effects and reducing the risk of drug resistance.
    MeSH terms: Antiprotozoal Agents/pharmacology; Cell Cycle/drug effects; Humans; Reactive Oxygen Species/metabolism; Inhibitory Concentration 50; Trophozoites/drug effects
  17. Seyer-Cagatan A, Ruh E, Taylan-Ozkan A
    Trop Biomed, 2024 Sep 01;41(3):328-344.
    PMID: 39548788 DOI: 10.47665/tb.41.3.014
    Vector-borne diseases have been a growing health concern in recent decades due to the global warming, globalization, and increased international travel. With the typical Mediterranean climate and geographical features, Cyprus provides favorable conditions for the growth and survival of arthropod species. For the purpose of this review article, the terms "Cyprus", "vectors" and "vectorborne diseases" were searched in the National Library of Medicine ('PubMed') and the Google Scholar databases. Published articles in the literature have documented mosquito (including Anopheles, Aedes, Culex, and Culiseta), sandfly (Phlebotomus, Sergentomyia), flea (including Ctenocephalides, Xenopsylla, Leptopsylla), and tick (including Rhipicephalus, Ixodes, Hyalomma, Haemaphysalis) species in the island. The presence of these arthropods poses a risk to public health as they can transmit a variety of diseases to both humans and animals. Research studies in Cyprus have identified infectious agents such as West Nile virus, Leishmania spp., sandfly viruses, Rickettsia spp., Coxiella burnetii, and Bartonella spp. in the local arthropods. More importantly, West Nile virus infection and imported malaria cases (mosquitoborne diseases); leishmaniasis and sandfly fever (sandfly-borne diseases); rickettsiosis, tularemia, Q fever, anaplasmosis, tick-borne relapsing fever, and Lyme disease (tick-borne diseases); and flea-borne rickettsiosis were reported in Cyprus. Taken together with the presence of arthropod vectors, published evidence in the literature suggests that Cyprus is an important region for VBDs. In addition to its climatic and geographical conditions, international travels particularly from endemic countries pose a risk for the circulation of VBDs on the island. Therefore, vector control programs should be continuously implemented, and public awareness must be raised in the region. This review, which to the best of our knowledge is the first comprehensive report on VBDs from Cyprus, will provide insight into future islandwide studies and also will be an important contribution to the elimination of VBDs in the region.
    MeSH terms: Animals; Arthropod Vectors; Cyprus/epidemiology; Humans; Ticks/microbiology; Ticks/virology
  18. Mohd Johari SN, Tan PY, Loganathan R, Lim YAL, Teng KT, Lee SC, et al.
    Trop Biomed, 2024 Sep 01;41(3):345-355.
    PMID: 39548789 DOI: 10.47665/tb.41.3.015
    Soil-transmitted helminths (STHs) are known as one of the neglected parasitic diseases, leading to significant health issues and associated complications. This study aims to assess the current prevalence of STH infections and the associated risk factors among rural primary schoolchildren in Malaysia. A cross-sectional study was conducted among 638 schoolchildren (7-11 years old) from 10 rural primary schools in five regions of Malaysia. The overall prevalence of STH infections among schoolchildren was 54.5%, with T. trichiura being the predominant STH species (50.9%), followed by A. lumbricoides (19.6%) and hookworms (7.4%). The highest prevalence of STH infections was recorded in the schools in Perak (96.6%), followed by Pahang (85.4%), Johor (42.1%) and Sabah (6.2%). At the same time, none of the schoolchildren in Sarawak were infected with STHs. The findings also highlighted that the older age group (10-11 years old) exhibited a higher prevalence of STH infection and T. trichiura compared to those aged 7-9 years old (P = 0.01) among the schools with a high prevalence of STH infections (>= 70%). Several variables, such as being female (1.9 [1.2, 3.0]) (Adjusted odd ratio [95% confidence interval]), low household income (30.9 [7.0, 136.5]), using untreated water supply (1.9 [1.1, 3.2]), indiscriminate defaecation (1.9 [1.1, 3.1]), indiscriminate garbage disposal (2.8 [1.3, 6.0]), eating with hands (5.9 [3.4, 10.4]) and experiencing pallor signs (2.3 [1.1, 5.0]), emerged as significant predictors of STH infections in this study population. The present study underscores that in specific rural community areas of Malaysia, STH infections continue to pose health concerns among primary schoolchildren. Hence, to ensure the sustained effectiveness of the measures taken to control STH infections, a collaborative and ongoing effort between various stakeholders is imperative to provide targeted support to rural communities, especially those in areas lacking essential amenities and healthcare services.
    MeSH terms: Animals; Child; Cross-Sectional Studies; Female; Helminths/classification; Helminths/isolation & purification; Humans; Malaysia/epidemiology; Male; Risk Factors; Rural Population*; Schools*; Prevalence
  19. Wan Nazri WSM, Lau YL, Cheong FW
    Trop Biomed, 2024 Sep 01;41(3):356-362.
    PMID: 39548790 DOI: 10.47665/tb.41.3.016
    Plasmodium knowlesi, primarily a zoonotic malaria species is the most common malaria pathogen in the Southeast Asia especially in Malaysian Borneo, Malaysia. Due to morphological resemblance of P. knowlesi to other human Plasmodium, the sensitivity for microscopic detection of P. knowlesi, which is the gold standard, is compromised. Thus, efforts have been made in finding alternatives for the disease diagnosis. This study described the potential use of anti-PkTRAMP polyclonal antibodies in sandwich ELISA for P. knowlesi detection. Anti-PkTRAMP polyclonal antibodies raised from mice and rabbit were first evaluated for their binding capability towards native proteins in P. knowlesi lysates using Western blot. These mice and rabbit polyclonal antibodies were then used in the sandwich ELISA as capture and detection antibodies, respectively. P. knowlesi A1H1 culture was utilised to determine the limit of detection (LOD) of this assay. Its clinical performance was determined by testing with archived human malaria and uninfected samples. Western blot analysis affirmed the polyclonal antibodies reactivity to P. knowlesi. The LOD obtained from three replicated assays was at 0.015% parasitaemia. The assay has 76% sensitivity and 75% specificity for P. knowlesi. Its positive and negative predictive values were 76% and 75%, respectively. No cross reactivity with P. falciparum and healthy samples was observed, except for P. vivax where 10 out of 12 samples were detected. In conclusion, anti-PkTRAMP polyclonal antibodies can be useful in detecting P. knowlesi. Regardless, the full potential of anti-PkTRAMP antibodies for diagnostic purposes need to be explored further.
    MeSH terms: Animals; Antigens, Protozoan/immunology; Humans; Malaysia; Rabbits; Sensitivity and Specificity; Blotting, Western/methods; Mice; Limit of Detection
  20. Muhammad Hafiz S, Attah AO, Mohd Salleh S, Rusli MU, Farah Haziqah MT
    Trop Biomed, 2024 Sep 01;41(3):363-369.
    PMID: 39548791 DOI: 10.47665/tb.41.3.017
    Blastocystis a single-celled eukaryotic protist, is known to inhabit the intestines of various hosts, including humans, and has been implicated in a wide spectrum of symptoms, ranging from gastrointestinal issues to skin disorders, thereby establishing its status as an emerging infectious agent. In this study, the prevalence of Blastocystis infection was investigated in insects, including cockroaches, houseflies, and crickets, as well as sea turtles. Additionally, the genotypic characteristics of the isolated Blastocystis strains were examined, and the evolutionary relationships between Blastocystis species found in sea turtles, and animals/humans were determined. Microscopic techniques and molecular methods were utilized in this study. The results showed that four out of 90 insects (4.44%) and one out of 13 sea turtles (7.7%) were infected by Blastocystis. Furthermore, detailed observations revealed the presence of characteristic morphological features, such as vacuolar forms in the cockroach, cricket and sea turtle samples and binary fission from cockroach samples, indicative of Blastocystis' mode of reproduction. While the ST8 of Blastocystis in sea turtles were successfully identified, no subtyping was achieved for the infected insects. This study not only establishes the occurrence of Blastocystis infection in sea turtles but also uncovers its ability to infect insects, suggesting a potential reservoir role for these organisms. Overall, this research emphasizes the significance of comprehending the prevalence, genotypic diversity, and evolutionary relationships of Blastocystis across various hosts. Such insights are instrumental in developing effective control measures and public health interventions to mitigate the associated symptoms and prevent future outbreaks.
    MeSH terms: Animals; Genotype; Houseflies/parasitology; Malaysia/epidemiology; Phylogeny; Turtles/parasitology; Prevalence; Blastocystis Infections/epidemiology; Blastocystis Infections/parasitology; Blastocystis Infections/veterinary
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