A survey was conducted in 4 paediatric wards in Malaysia to determine the distribution of various species of cockroaches and to examine their gut contents for bacteria. Cockroaches were trapped from food dispensing areas (kitchens), store rooms, cupboards and open wards. 104 cockroaches were caught, consisting of Periplaneta americana (67.3%), Blattella germanica (26%), P. brunnea (4.8%), and Supella longipalpa (1.9%). Bacteria were isolated from all cockroaches except 3 P. americana. Many bacterial species were identified, including the pathogenic and potentially pathogenic species Shigella boydii, S. dysenteriae, Salmonella typhimurium, Klebseilla oxytoca, K. ozaena and Serratia marcescens.
The polymorphism of the human leucocyte antigen HLA-DR2 and the heterogeneity of HLA-DR2 class II-related haplotypes (HLA-DRB1-DRB5-DQA1-DQB1) were investigated in four populations of east and south-east Asia (SEA) and five Melanesian populations using TaqI restriction fragment length polymorphism (RFLP) analysis, and the polymerase chain reaction (PCR) amplification-based techniques PCR-RFLP and sequence-specific oligonucleotide (SSO) typing. The haplotype DRB1*1502-DRB5*0101-DQA1*0102-DQB1*0601 was common in Malaysians, Javanese, Thursday Islanders, Madang, Goroka and the Australian Aborigines, while DRB1*16021-DRB5*0101-DQA1*0102-DQB1*0502 was common in the Thai and Thursday Islanders. DRB1*1501-DRB5*0101-DQA1*0102-DQB1*0602 was present at a high frequency in Northern Chinese, Goroka, Watut and Australian Aborigines. The study describes four rare or unusual haplotypes: HLA-DRB1*1501-DRB5*0101-DQA1*0101-DQB1*0601, DRB1*1502-DRB5*0101-DQA1*0101-DQB1*0502, DRB1*1502-DRB5*0102-DQA1* 0102-DQB1*0502 and DRB1*1501-DRB5*0101-DQA1*0101/2-DQB1*0503; the latter two were confirmed by segregation in two Javanese families. A new DR2 allele, initially detected by PCR-RFLP and confirmed by DNA sequencing as DRB1*16022 (previously designated DRB1*16Madang), was seen in a Madang individual. A new HLA-DR2 TaqI RFLP subtype, locally designated as DR15U, is also described. This RFLP subtype segregated in a Javanese family and correlated with a typically SEA haplotype, DRB1*1502-DRB5*0102-DQA1*0101-DQB1*0501. The allele HLA-DR16Thai, determined by TaqI DRB RFLP, was found by PCR-RFLP and SSO typing to correlate with a unique SEA haplotype, HLA-DRB1*16021-DRB5*0101-DQA1*0102-DQB1*0502, and was observed in the Thai, Malaysian, Thursday Islander, Javanese and Northern Chinese populations.
A study was conducted among out-patients attending the Melaka Tengah Health Clinic to determine their compliance status towards antihypertensive, antidiabetic and antiasthmatic drugs. A total of 585 patients were enrolled in this study. Assessment of compliance was carried out using pill-counting and house-to-house interviews 14 days from the date of medication dispensed at the counter. The noncompliance rate among the 464 successfully interviewed patients was 56%. The mean noncompliance percentage was 78.0 +/- 43.1% (range: -10.0-314.3%). Among the four variables of compliance studied, race was not seen as a determinant of compliance. The older age group and those taking two or more drugs were statistically significant to be a noncomplier. Females were highly likely not to comply with drug therapy. Patients who conform to their refill dates were not really drug compliers. Forgetting to take their drugs and inability to read instructions on drug labels were the main reasons given. Underdosing was more common than overdosing, with an estimated cost of RM20,261.00 of unused medications per year.
Study site: Klinik Kesihatan Melaka Tengah, Melaka, Malaysia
Four species of synanthropic flies were trapped in downtown Kuala Lumpur: Chrysomya megacephala, Chrysomya rufifacies, Musca domestica, and Musca sorbens. Burkholderia pseudomallei, the organism causing melioidosis, was the dominant bacteria isolated from Chrysomya megacephala. Klebsiella oxytoca, commonly associated with nosocomial infections, was commonly isolated from Chrysomya megacephala, Musca domestica, and Musca sorbens. Aeromonas hydrophila, the bacteria causing gastroenteritis, was predominantly isolated from Chrysomya megacephala and also from Musca domestica and Musca sorbens. A total of 18 bacterial species was isolated from the synanthropic flies trapped. Burkholderia pseudomallei had been reported for the first time.
A virus, named Oya virus, was isolated in Vero cell cultures from the lungs of a pig suspected of Nipah virus infection. The virus was revealed as a spherical enveloped RNA virus with a diameter of 79 nm. For identification of Oya virus, RT-PCR was performed. A common primer set for S-RNA of the Simbu serogroup of the genus Bunyavirus was able to amplify a cDNA from Oya virus RNA. The sequence data of the product revealed that the partial gene of Oya virus S-RNA segment had 65-70% homology with published cDNA sequences of Simbu serogroup viruses. The phylogenetic analysis of the data showed that the Oya virus is grouped in Simbu serogroup, but is genetically distinct from the serogroup viruses that have been analyzed molecularly. Serological surveys revealed that the virus distributed widely and densely in Malaysia.
BACKGROUND: The purposes of this study are to determine the viewing distance with minimum heterophoria and its relationship with refractive error and the resting position of accommodation. METHODS: The heterophoria and the accommodation responses of 36 optometry students (25 emmetropes and 11 myopes) were tested. Heterophoria was measured with the Free-Space Heterophoria Card at five different viewing distances (25 cm, 33 cm, 50 cm, 100 cm and 300 cm). The dioptric viewing distance with minimum heterophoria for each individual was estimated from the graph, where heterophoria in prism dioptres was plotted against viewing distance in centimetres. The Canon R-1 autore-fractor was used to determine the accommodation response at six different viewing distances (25 cm, 33 cm, 50 cm, 100 cm, 300 cm and 600 cm). The resting position of accommodation for each individual was estimated from the graph where the accommodative stimulus in dioptres was plotted against the accommodative response in dioptres. RESULTS: The dioptric viewing distance with minimum heterophoria ranges from 0.003 D to 0.65 D in emmetropes and ranges from 0.03 D to 2.36 D in myopes. There is no difference in the dioptric viewing distance with minimum heterophoria between myopes and emmetropes. Our results show a possible but not significant correlation between the dioptric viewing distance with minimum heterophoria and the resting position of accommodation. CONCLUSIONS: The viewing distance with minimum heterophoria is not affected by refractive error (stable early-onset myopia) and is poorly correlated with the resting position of accommodation.
The purpose of this study was to investigate the relationship between heterophoria and refractive error. Thirty-six subjects (11 myopes, 25 emmetropes) participated in this study. Heterophoria was measured with the Free-Space Phoria Card at five different viewing distances (25cm, 33cm, 50cm, 100cm and 300cm). Regardless of the types of heterophoria, the amount of heterophoria reduced towards orthophoric position with increasing viewing distance. Emmetropes and myopes did not show any significant difference in the degree of heterophoria at different viewing distances (F = 0.30, p>0.05) or in the type of heterophoria (χ(2) = 2, p>0.05).
How people perceive risk influences their behaviour towards these risks. We do not know how workers perceive risk of dying from diseases or accidents. This study was conducted among 198 workers of a security company in Malaysia. The workers were asked to score on a Likert scale of 1 to 5 the perceived risk of death of Malaysians from selected causes of death. The highest perceived risks of death were, in order of ranking, motor vehicle accidents, cancer and diabetes mellitus whereas according to the certified causes of death in Malaysia the highest risks of death among the selected items were cardiovascular disease, cancer and stroke. The difference in perception and mortality data needs be addressed.
In the peace-loving, moderate and progressive country of Muslim-dominated Malaysia, violence generally is alien to the culture. Terrorism initially took shape during the post-independence, communist era by jungle recalcitrant actions. In recent years, this has been superceded by a more internationally related trend of violence. Only very few incidents were based locally, while the majority were linked to international groups or organizations abroad, including the Kumpulan Mujahidin Malaysia (KMM), Jemaah Islamiyah (JI), and the Abu Sayyaf Group (ASG). Kidnapping with ransom seemed to have been the most commone modus operandi, while killing and robbery accounted for very few of these incidents. The number of victims in each event so far has been small, and smaller for those physically harmed or killed. This pattern of terrorist attacks suggests that the current level of provision of emergency medical services is sufficient to handle such incidents. Recent advances in local emergency medicine also have witnessed the establishment of various teaching and training modules, a pivotal role played by university hospitals and supported by the Ministry of Health. However, the spate of ongoing events of mass destruction such as the conflict in Israel/Palestine, wars in Afghanistan and Iraq, the World Trade Center and Pentagon tragedies of 11 September 2001, and the Bali bombing in Indonesia, remain as great concerns to Malaysians. Both the government and the people of Malaysia abhor such unjustified uses of terror, and take every measure to curtail them. The National Security Council policies of Arahan No. 18 and Arahan No. 20 detail specific roles and responsibilities of various agencies in managing terrorism and disasters respectively, while the use of the stern Internal Security Act that allows indefinite detention without trial, evidently has been an efficient intelligence and security apparatus. With more recent developments of terrorist events regionally and globally, Malaysia continues to face an ongoing threat from such activities. Various measures have been and will be actively undertaken both by government and non-governmental agencies in facing these challenges.
Formalin-fixed, paraffin wax-embedded tissues of three Malaysian farm pigs naturally infected with Nipah virus were used to investigate the value of anti-Nipah virus mouse monoclonal antibodies (Mabs) and rabbit polyclonal antibody for immunohistochemical diagnosis. Mabs 11F6 and 12A5 gave intense immunolabelling in lung tissue that had been fixed in 10% neutral buffered formalin for about 4 years, whereas the reactivity of Mabs 13A5 and 18C4 and polyclonal antibody was reduced significantly by long-term formalin fixation. Immunohistochemical examination of Malaysian farm pig samples with Mab 11F6 confirmed the affinity of Nipah virus for respiratory epithelium, renal glomerular and tubular epithelium, meningeal arachnoidal cells, and systemic vascular endothelium and smooth muscle. In addition, Nipah virus antigens were identified in laryngeal epithelial cells, Schwann cells of peripheral nerve fascicles in the spleen, and endothelial cells in the atrioventricular valve. The study demonstrated the value of Mabs 11F6 and 12A5 for the immunohistochemical diagnosis of Nipah virus infection in pigs.
This clinical case report details the clinical sequence of a 78-year-old male receiving prosthetic rehabilitation using an implant-supported screwretained fixed partial denture. Despite the limitations imposed, the aesthetic and functional demands of the patient were fulfilled by this prosthetic rehabilitation. The importance of detailed prosthetic planning and evaluation prior to implant surgery is essential, therefore ideally, it should be done by the same operator or a team of operators working together. Problems can arise when the construction of the prosthesis is performed by other people who are not involved in the planning stage.
The National Mental Health Registry (NMHR) collects information about patients with mental disorder in Malaysia. This information allows us to estimate the incidence of selected mental disorders, and to evaluate risk factors and treatment in the country. The National Mental Health Registry (NMHR) presented its first report in 2004, a year after its establishment. The report focused on schizophrenia as a pioneer project for the National Mental Health Registry. The development of the registry has progressed with data collected from government-based facilities, the academia and the private sector. The 2003-2005 report was recently published and distributed. Since then the registry has progressed to include suicides and other mental illnesses such as depression. The NMHR Report 2003-2005 provides detailed information about the profile of persons with Schizophrenia who presented for the first time to various psychiatry and mental health providers throughout Malaysia. More detailed description regarding pharmacotherapy is reported and few cross tabulations done in an effort to provide better understanding and more clinically meaningful reports.
Methicillin-resistant Staphylococcus aureus (MRSA) infection is important among vas-cular surgical patients. Its effect can be devastating resulting in limb amputation and mortality. We performed a retrospective patients record analysis to determine the pat-tern of MRSA infection among vascular surgical patients in Hospital Kuala Lumpur from January 2005 to December 2007. We also attempted to identify the factors asso-ciated with poor clinical outcome after such infection. There were 999 patients who underwent vascular surgeries in HKL within the analysis period. Of these 24 patients (2.4%) were detected to have MRSA surgical site infection. The infection was commoner among cigarette smokers, patients with diabetes melitus and those who had previous vascular surgery. Most infections occurred in the emergency surgery category and manifested as wound breakdown. Fifty-four percent of the infected pa-tients ended with graft removal, amputations or death. MRSA infection complicating vascular surgery resulted in poor clinical outcome. This serious threat requires intensi-fied preventive measures.
When performing a radiological assessment for a trauma case with associated head injury, a fragment of dense tissue detected near the craniovertebral junction would rapidly be assessed as a fractured bone fragment. However, if further imaging and evaluation of the cervical spine with computerised tomography (CT) did not demonstrate an obvious fracture, then the possibility of ligament calcification would be considered. We present a case involving a previously healthy 44-yearold man who was admitted following a severe head injury from a road traffic accident. CT scans of the head showed multiple intracranial haemorrhages, while scans of the cervical spine revealed a small, well-defined, ovoid calcification in the right alar ligament. This was initially thought to be a fracture fragment. Although such calcification is uncommon, accident and emergency physicians and radiologists may find this useful as a differential diagnosis in patients presenting with neck pain or traumatic head injury.
Klebsiella ozaenae is a Gram negative bacillus. It has been described as a colonizer of oral and nasopharyngeal mucosa and is a cause of atrophic rhinitis. Klebsiella ozaenae has seldom been isolated from serious infections. However, several reports have stated that Klebsiella ozaenae may cause invasive infections and even mortality. We report a 55-year-old man with Klebsiella ozaenae infection causing abscesses involving the right eye and left kidney and possibly also in the brain, lungs and prostate. The isolates were sensitive to ceftazidime, ciprofloxacin, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim but resistant to ampicillin. He responded well to 4 weeks of i.v. ceftazidime and i.v. amoxycillin-clavulanic acid. To our knowledge, such a multiorgan infection has not been reported previously for this organism.
Population growth, trophic level, and some aspects of reproductive biology of two congeneric archer fish species, Toxotes chatareus and Toxotes jaculatrix, collected from Johor coastal waters, Malaysia, were studied. Growth pattern by length-weight relationship (W=aL(b)) for the sexes differed, and exhibited positive allometric growth (male, female and combined sexes of T. chatareus; female and combined sexes of T. jaculatrix) and isometric growth (male samples of T. jaculatrix only). Trophic levels of both species were analyzed based on 128 specimens. The results show that, in both species, crustaceans and insects were the most abundant prey items, and among crustaceans the red clawed crab Sesarma bidens and Formicidae family insects were the most represented taxa. The estimated mean trophic levels for T. chatareus and T. jaculatrix were 3.422+/-0.009 and 3.420+/-0.020, respectively, indicating that they are largely carnivores. Fecundity of T. chatareus ranged from 38 354 to 147 185 eggs for females with total length ranging from 14.5 to 22.5 cm and total body weight from 48.7 to 270.2 g, and T. jaculatrix 25 251 to 150 456 eggs for females with total length ranging from 12.2 to 23.0 cm and total body weight from 25.7 to 275.0 g. Differences in values of gonadosomatic and hepatosomatic indexes calculated for both species in this study may have resulted from uneven sample size ranges.
Plants that contain high amounts of polyphenolic compounds are potential candidates for natural antioxidant sources. Studies are on going in the search for new sources of antioxidants. Not much data are available on the antioxidant capacity of tropical herbs. With this in mind, 19 commonly consumed Malaysian herbs were analyzed for their polyphenolic content and antioxidant activities. A majority of these plants have never been studied before with regards to their polyphenolic content and antioxidant activities. The shoots of Anacardium occidentale, the shoots and fruits of Barringtonia racemosa, Pithecellobium jiringa and Parkia speciosa had high polyphenolic contents (> 150 microg gallic acid equivalents/mg dried plant) and antioxidant activities when measured using the ferric reducing antioxidant power (FRAP) (>1.2 mM) and Trolox equivalent antioxidant capacity (TEAC) assays (>2.4 mM). A strong correlation was observed between the two antioxidant assays (FRAP vs TEAC) implying that the plants could both scavenge free radicals and reduce oxidants. There was also a strong correlation between the antioxidant activities and polyphenolic content suggesting the observed antioxidant activities were contributed mainly by the polyphenolics in the plants.
Blunt abdominal trauma can cause multiple internal injuries. However, these injuries are often difficult to accurately evaluate, particularly in the presence of more obvious external injuries. Computed tomography (CT) imaging is currently used to assess clinically stable patients with blunt abdominal trauma. CT can provide a rapid and accurate appraisal of the abdominal viscera, retroperitoneum and abdominal wall, as well as a limited assessment of the lower thoracic region and bony pelvis. This paper presents examples of various injuries in trauma patients depicted in abdominal CT images. We hope these images provide a resource for radiologists, surgeons and medical officers, as well as a learning tool for medical students.
Extra-osseous uptake of bone-seeking radiopharmaceuticals has been reported at various sites and it is known to be induced by various causes. Diffuse pulmonary infection, such as tuberculosis, can be a cause of lung uptake of bone-scan agent. Here we report on a patient with non-tuberculosis mycobacterial infection (NTM) who demonstrated diffuse pulmonary uptake on Tc-99m MDP bone scan. After medical treatment for NTM, the patient's lung lesions improved. Extraskeletal lung Tc-99m MDP uptake on bone scan may suggest lung parenchymal damage associated with disease activity.