Displaying publications 1 - 20 of 40 in total

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  1. Ab Razak A, Rahman NA, Zulkifly MFM, Sapiai NA, Phoa PKA, Mohamed Mustafar MF, et al.
    Malays J Med Sci, 2023 Oct;30(5):1-6.
    PMID: 37928788 DOI: 10.21315/mjms2023.30.5.1
    Improving healthcare and living conditions has led to an increase in life expectancies and challenges of population aging in Malaysia. The Advanced Memory and Cognitive Service builds on integrated healthcare among multidisciplinary specialists to provide holistic and patient-centred healthcare. The service treats older adults experiencing neurocognitive impairment as well as young individuals with complex neurocognitive disorders and thoroughly screens asymptomatic individuals at high risk of developing neurocognitive disorders. This early intervention strategy is a preventive effort in the hope of reducing disease burden and improving quality of life to prepare Malaysia for the forthcoming population aging.
  2. Ab Wahab SZ, Abdul Kadir A, Nik Hussain NH, Omar J, Yunus R, Baie S, et al.
    PMID: 26101537 DOI: 10.1155/2015/849647
    Channa striatus has been consumed for decades as a remedy to promote wound healing by women during postpartum period. The objectives of this study were to compare postoperative pain, wound healing based on wound evaluation scale (WES), wound cosmetic appearance based on visual analogue scale (VAS) scores and patient satisfaction score (PSS), and safety profiles between C. striatus group and placebo group after six weeks of lower segment caesarean section (LSCS) delivery. A randomised, double-blind, placebo-controlled study was conducted. Subjects were randomised in a ratio of 1 : 1 into either the C. striatus group (500 mg daily) or placebo group (500 mg of maltodextrin daily). 76 subjects were successfully randomised, with 38 in the C. striatus group and 35 in the placebo group. There were no significant differences in postoperative pain (p = 0.814) and WES (p = 0.160) between the C. striatus and placebo groups. However, VAS and PSS in the C. striatus group were significantly better compared with the placebo group (p = 0.014 and p < 0.001, resp.). The safety profiles showed no significant differences between the groups. In conclusion, six-week supplementation of 500 mg of C. striatus extract showed marked differences in wound cosmetic appearance and patient's satisfaction and is safe for human consumption.
  3. Abdul Razak A, Abu-Samah A, Abdul Razak NN, Jamaludin U, Suhaimi F, Ralib A, et al.
    Med Devices (Auckl), 2020;13:139-149.
    PMID: 32607009 DOI: 10.2147/MDER.S231856
    Purpose: This paper presents an assessment of an automated and personalized stochastic targeted (STAR) glycemic control protocol compliance in Malaysian intensive care unit (ICU) patients to ensure an optimized usage.

    Patients and Methods: STAR proposes 1-3 hours treatment based on individual insulin sensitivity variation and history of blood glucose, insulin, and nutrition. A total of 136 patients recorded data from STAR pilot trial in Malaysia (2017-quarter of 2019*) were used in the study to identify the gap between chosen administered insulin and nutrition intervention as recommended by STAR, and the real intervention performed.

    Results: The results show the percentage of insulin compliance increased from 2017 to first quarter of 2019* and fluctuated in feed administrations. Overall compliance amounted to 98.8% and 97.7% for administered insulin and feed, respectively. There was higher average of 17 blood glucose measurements per day than in other centres that have been using STAR, but longer intervals were selected when recommended. Control safety and performance were similar for all periods showing no obvious correlation to compliance.

    Conclusion: The results indicate that STAR, an automated model-based protocol is positively accepted among the Malaysian ICU clinicians to automate glycemic control and the usage can be extended to other hospitals already. Performance could be improved with several propositions.

  4. Abdullah Aszrin, Shah M. Azarisman, Rahman A. Jamaluddin, Razak A. Tariq, Noor M. Noriah
    MyJurnal
    Introduction: Prehypertension precedes overt hypertension and has been acknowledged by many guidelines.
    Hypertension is an important risk factor for cardiovascular disease in Malaysia. Hypertension prevalence is
    at 42.6% and population-based control is poor at 26.8%. The objective of the study is to ascertain the
    cardiovascular risk profile of prehypertensive and mildly hypertensive young adults against age-matched
    controls in rural Malaysia. Methods: 484 (four hundred and eighty four) subjects attending primary care
    clinic were screened. 91 (Ninety one) young adults with pre/mild hypertension and normotensive, agematched controls were enrolled. The blood pressure and biochemical profiles for both groups were assessed
    and compared. Results: Fifty-four subjects and 37 controls were enrolled. Amongst subjects, 46.3% had
    prehypertension and 53.7% had mild hypertension. Mean values compared to age-matched controls for MAP
    were 102.68 ± 7.48 vs 83.25 ± 6.08 mmHg (p< 0.001), LDL 3.75 ± 0.95 vs 3.32 ± 0.93 mmol/L (p=0.03), FBG
    4.65 ± 0.54 vs 4.33 ± 0.42 mmol/L (p=0.03), BMI 28.81 ± 5.16 vs 24.12 ± 4.91 (p< 0.001). The mean BP was
    significantly associated with BMI, FBG, triglycerides, HDL and the TC/HDL ratio. Conclusions: Greater BMI,
    FBG, HDL, triglyceride levels and TC/HDL ratio characterised the young adults with pre/mild hypertension.
    The data suggests that hypertension in young adults is secondary to metabolic syndrome.
  5. Abdullah JM, Wan Ismail WFN, Mohamad I, Ab Razak A, Harun A, Musa KI, et al.
    Malays J Med Sci, 2020 Mar;27(2):1-9.
    PMID: 32308536 DOI: 10.21315/mjms2020.27.2.1
    When the first report of COVID-19 appeared in December 2019 from Wuhan, China, the world unknowingly perceived this as another flu-like illness. Many were surprised at the extreme steps that China had subsequently taken to seal Wuhan from the rest of the world. However, by February 2020, the SARS-CoV-2 virus, which causes COVID-19, had spread so quickly across the globe that the World Health Organization officially declared COVID-19 a pandemic. COVID-19 is not the first pandemic the world has seen, so what makes it so unique in Malaysia, is discussed to avoid a future coronacoma.
  6. Abu Bakar MR, Abdul Kadir A, Abdul Wahab SZ, Abdul Karim AH, Nik Hussain NH, Mohd Noor N, et al.
    PLoS One, 2015;10(7):e0133514.
    PMID: 26222158 DOI: 10.1371/journal.pone.0133514
    AIM: To compare the mean of anteroposterior (AP) measurements of the uterus in longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine artery and superficial skin wound artery between patients taking Channa striatus and placebo.

    BACKGROUND: Channa striatus, also known as haruan, is a fresh water snakehead fish consumed in many parts of Southeast Asia. Channa striatus is also normally consumed by women postpartum to promote wound healing as well as to reduce post-operative pain.

    METHODOLOGY: This study is a randomised, double blind, placebo-controlled study conducted in women after Lower Segment Caesarean Section (LSCS). Subjects were randomised to either a Channa striatus or a placebo group and were given a daily dosage of 500 mg of Channa striatus extract or 500 mg maltodextrin, respectively, for six weeks post LSCS. The anteroposterior measurements of the uterus in the longitudinal and oblique transverse planes, and the pulsatility index (PI) and resistive index (RI) of the uterine and superficial skin wound arteries were assessed using pelvic Gray-scale ultrasound and Doppler ultrasound at baseline (Day 3) and at two weeks, four weeks and six weeks post-operatively.

    RESULTS: Sixty-six subjects were randomised into the study with 33 in the Channa striatus group and 33 in the placebo group. No significant differences were detected in terms of the pulsatility index (PI) and the resistive index (RI) of the uterine and superficial skin wound arteries between the Channa striatus and placebo groups. However, in the Channa striatus group, the AP measurements of the uterus on the longitudinal and oblique transverse planes were significantly lower compared to the placebo group (p<0.05 and p<0.001, respectively).

    CONCLUSION: Daily intake of Channa striatus extract results in marked differences compared to placebo in terms of uterine involution and recovery in women post LSCS.

    TRIAL REGISTRATION: www.isrctn.com 11960786.

  7. Abu Kasim NH, Abu Kassim NL, Razak AA, Abdullah H, Bindal P, Che' Abdul Aziz ZA, et al.
    Eur J Dent Educ, 2014 Feb;18(1):51-7.
    PMID: 24423176 DOI: 10.1111/eje.12058
    Training dentists today is challenging as they are expected to provide a wide range of dental care. In the provision of good dental care, soft skills are equally important as clinical skills. Therefore in dental education the development of soft skills are of prime concern. This study sought to identify the development of soft skills when dental students are paired in their clinical training. In this perception study, four open-ended items were used to elicit students' feedback on the appropriateness of using clinical pairing as an instructional strategy to promote soft skills. The most frequently cited soft skills were teamwork (70%) and communication (25%) skills. However, both negative and positive behaviours were reported. As for critical thinking and problem solving skills, more positive behaviours were reported for abilities such as to explain, analyze, find ideas and alternative solutions, and make decisions. Leadership among peers was not evident as leading without legitimate authority could be a hindrance to its development. If clinical pairing is to be used as an effective instructional strategy to promote soft skills amongst students, clear guidelines need to be developed to prepare students to work in a dental team and the use of appropriate assessment tools can facilitate the development of these soft skills.
  8. Agha R, Abdall-Razak A, Crossley E, Dowlut N, Iosifidis C, Mathew G, et al.
    Int J Surg, 2019 Nov 06;72:156-165.
    PMID: 31704426 DOI: 10.1016/j.ijsu.2019.11.002
    INTRODUCTION: The STROCSS guideline was developed in 2017 to improve the reporting quality of observational studies in surgery. Building on its impact and usefulness, we sought to update the guidelines two years after its publication.

    METHODS: A steering group was formed to review the existing guideline and propose amendments to the 17-item checklist. A Delphi consensus exercise was utilised to determine agreement across a list of proposed modifications to the STROCSS 2017 guideline. An expert panel of 46 surgeons were invited to assess the proposed updates via Google Forms.

    RESULTS: The response rate was 91% (n = 42/46). High agreement was reached across all the items and the guideline was finalised in the first round. The checklist maintained 17-items, with modifications primarily considered to improve content and readability.

    CONCLUSIONS: The STROCSS 2019 guideline is hereby presented as a considered update to improve reporting of cohort, cross-sectional and case-control studies in surgery.

  9. Al-Makramani BMA, Razak AAA, Abu-Hassan MI
    J Prosthodont, 2008 Feb;17(2):120-124.
    PMID: 18047490 DOI: 10.1111/j.1532-849X.2007.00270.x
    PURPOSE: The current study investigated the effect of different luting agents on the fracture resistance of Procera AllCeram copings.

    METHODS: Six master dies were duplicated from the prepared maxillary first premolar tooth using nonprecious metal alloy (Wiron 99). Thirty copings (Procera AllCeram) of 0.6-mm thickness were manufactured. Three types of luting media were used: zinc phosphate cement (Elite), glass ionomer cement (Fuji I), and dual-cured composite resin cement (Panavia F). Ten copings were cemented with each type. Two master dies were used for each group, and each of them was used to lute five copings. All groups were cemented according to manufacturer's instructions and received a static load of 5 kg during cementation. After 24 hours of distilled water storage at 37 degrees C, the copings were vertically compressed using a universal testing machine at a crosshead speed of 1 mm/min.

    RESULTS: ANOVA revealed significant differences in the load at fracture among the three groups (p < 0.001). The fracture strength results showed that the mean fracture strength of zinc phosphate cement (Elite), glass ionomer cement (Fuji I), and resin luting cement (Panavia F) were 1091.9 N, 784.8 N, and 1953.5 N, respectively.

    CONCLUSION: Different luting agents have an influence on the fracture resistance of Procera AllCeram copings.

  10. Ali S, Osman NA, Razak A, Hussain S, Wan Abas WA
    Eur J Phys Rehabil Med, 2015 Feb;51(1):31-7.
    PMID: 24963603
    Lower limb amputee's are greatly affected in dealing with the environmental barriers such as ramps and stairs and reported high interface pressure between the residual limb and socket/liner. Interface pressure between the residual limb and socket/liner can affect the satisfaction and use of the prosthesis. Until now, little attention has been paid to interface pressure between socket and stump during ramp negotiation and its effect on amputee's satisfaction.
  11. Ali, N.M., Abd Razak, A., Mohamad, M.F., Bahsan, R.
    MyJurnal
    Ventilation is the process of exchanging air in a closed space to provide good indoor air quality. Computational Fluid Dynamics (CFD) has become one of the most important and reliable tools to assess natural ventilation. This paper presents the effect of wind direction on temperature and velocity inside a building with outlet windows at leeward wall and side wall. The CFD simulation was performed using Reynolds-Average Navier-Stoke (RANS) approach with k-ε model. The selection of standard k-ε model is due to suitability of this model to perform the wind speed profile and temperature profile inside the building. Validation of cross-ventilation is performed based on earlier Particular Image Velocimetry (PIV) measurements and shows very minimal discrepancy between CFD and PIV result. The result of velocity and temperature shows that the wind speed and temperature inside a building strongly depends on the incident winds angle and outlet opening of the building.
  12. Amelia-Yap ZH, Sofian-Azirun M, Chen CD, Lau KW, Suana IW, Syahputra E, et al.
    J Med Entomol, 2019 06 27;56(4):953-958.
    PMID: 30942885 DOI: 10.1093/jme/tjz035
    Resistance to pyrethroid insecticides is widespread in Indonesian Aedes aegypti (Linnaeus), the primary vector of dengue viruses. This study aims to investigate the mutations in the voltage-gated sodium channel (Vgsc) conferring pyrethroid resistance against Ae. aegypti populations from Indonesia. Molecular genotyping of mutations using polymerase chain reaction assay and direct DNA sequencing were performed at positions 989 and 1,016 in IIS6 region, and 1,534 in IIIS6 region of the voltage-gated sodium channel (Vgsc) in nine populations of Indonesian Ae. aegypti. The V1016G and S989P genotyping identified the RR genotype to be predominant in six out of nine populations of Ae. aegypti, whereas the SS genotype occurred only in minority. Interestingly, co-occurrence of the V1016G and S989P mutations was detected in the aforementioned six populations with high frequency. Genotyping of F1534C showed all nine populations exhibited the SS genotype, with merely two individuals from a population were heterozygous (RS). Significant correlations were demonstrated between the allele frequencies of the V1016G mutation and the survivability rates as well as resistance ratios in pyrethroid adult bioassays. This signifies the V1016G can contribute more to the insensitivity of Vgsc than the F1534C. Homozygous 1016G mosquitoes were likelier to survive pyrethroid exposure. Identification of underlying mechanisms resulting in insecticide resistance is advantageous in developing effective mosquito control programs in Indonesia.
  13. Amelia-Yap ZH, Chen CD, Sofian-Azirun M, Lau KW, Suana IW, Harmonis, et al.
    J Econ Entomol, 2018 12 14;111(6):2854-2860.
    PMID: 30265353 DOI: 10.1093/jee/toy296
    Aedes aegypti (L.) (Diptera: Culicidae) is the primary vector of several arthropod-borne viral infectious diseases globally. Relentless vector control efforts are performed to curtail disease transmissions, insecticides remain as the first line of defense in Indonesia. With a dearth of publication on the efficacy of mosquito coil in Indonesia, this is the first report related to mosquito coil despite its common use in households. Ae. aegypti mosquitoes were sampled from nine regencies in Indonesia and tested using the glass-chamber method against three commercially available local pyrethroid-based mosquito coils containing d-allethrin, transfluthrin, and metofluthrin. The 50% knockdown time of female Ae. aegypti tested with d-allethrin, transfluthrin, and metofluthrin containing coils ranged from 0.65 to 14.32; 0.8 to 16.4; and 0.78 to 20.57 min, respectively. Mortality rates in accordance with WHO resistance indicators showed that strains from Denpasar, Mataram, Kuningan, Padang, Samarinda, and Sumba Timur were resistant (<80% mortality rate), whereas strains from Manggarai Barat, Dompu, and Pontianak were susceptible (>98% mortality rate) to the active ingredients assayed. Moreover, the knockdown rates between d-allethrin and transfluthrin, d-allethrin and metofluthrin, as well as transfluthrin and metofluthrin displayed significant associations, portraying the presence of cross-resistance within pyrethroid insecticides. The minimal insecticidal effect of mosquito coils against some Indonesian Ae. aegypti also pointed out the development of pyrethroid resistance, prompting a revamping of the vector control system.
  14. Chokhani R, Razak A, Waked M, Naing W, Bakhatar A, Khorani U, et al.
    J Asthma, 2021 07;58(7):979-989.
    PMID: 32174204 DOI: 10.1080/02770903.2020.1742351
    OBJECTIVE: This survey aimed to understand the physicians' practice pattern and challenges faced while treating their patients with asthma in five countries-Malaysia, Nepal, Myanmar, Morocco and Lebanon.

    METHODS: Questionnaire-based data was gathered from internal medicine doctors (209), general practitioners (206), chest physicians (152) and pediatricians (58) from 232 locations from across the five countries.

    RESULTS: Of the 816 physicians, 374 physicians encountered at least 5 asthma patients daily. Approximately, 38% physicians always used spirometry for diagnosis and only 12% physicians always recommended Peak flow meter (PFM) for home-monitoring. Salmeterol/fluticasone (71%) followed by formoterol/budesonide (38%) were the most preferred ICS/long-acting beta2-agonists (LABA); Salbutamol (78%) was the most preferred reliever medication. 60% physicians said >40% of their patients were apprehensive to use inhalers. 72% physicians preferred a pressurized metered-dose inhaler (pMDI) to a dry powder inhaler (DPI) with only a third of them using a spacer with the pMDI. 71% physicians believed that using similar device for controller and reliever can be beneficial to patients. Skipping medicines in absence of symptoms (64%), incorrect inhaler technique (48%) and high cost of medication (49%) were considered as major reasons for non-adherence by most physicians. Incorrect inhaler technique (66%) and nonadherence (59%) were considered the most common causes of poor asthma control.

    CONCLUSIONS: There are opportunities to improve the use of diagnostic and monitoring tools for asthma. Non-adherence, incorrect inhaler technique and cost remain a challenge to achieve good asthma control. Asthma education, including correct demonstration of inhaler, can potentially help to improve inhaler adherence.

  15. Davina ST, Linda L, Abdul Razak A, Vijayaprakas Rao R, Norkamaruzaman E
    Med J Malaysia, 2015 Apr;70(2):112-3.
    PMID: 26162392 MyJurnal
    Primary sinonasal clear cell carcinoma is a rare neoplasm classified under malignant epithelial tumours of salivary gland - type carcinomas under World Health Organization (WHO) classification. We report a case which occurred on a 69 year old gentleman presented with epistaxis and nasal endoscopy examination showed tumour arising from the right ethmoid cells. Endoscopic excision of the tumour was done and histopathological examination revealed clear cell carcinoma. In addition, other secondary or primary sites of the lesion were excluded by clinical, immunohistochemical and radiological examinations. 10 months into the postoperative period, patient remains well without recurrence of the tumour.

    IN CONCLUSION: We report a rare case of primary sinonasal clear cell carcinoma in addition to the limited literature available and emphasize the differentials with other probable tumour through meticulous microscopic examination and use of special immunostains.
    Keywords: Melaka
  16. Haziqah-Rashid A, Chen CD, Lau KW, Low VL, Sofian-Azirun M, Suana IW, et al.
    J Med Entomol, 2019 02 25;56(2):514-518.
    PMID: 30462258 DOI: 10.1093/jme/tjy208
    This study was conducted to monitor the susceptibility status of Aedes aegypti (Linnaeus) larvae in the Sunda Islands of Indonesia against various organophosphates and organochlorines. Larval bioassay was performed in accordance with the World Health Organization standard protocol. Field-collected and reference strains of Ae. aegypti larvae were tested against diagnostic doses of eight larvicides belonging to organophosphates and organochlorines, namely bromophos (0.050 mg/liter), chlopyrifos (0.002 mg/liter), fenitrothion (0.020 mg/liter), fenthion (0.025 mg/liter), malathion (0.125 mg/liter), temephos (0.012 mg/liter), DDT (0.012 mg/liter), and dieldrin (0.025 mg/liter). Mortality rates of larvae were recorded at 24-h posttreatment. This study showed that Ae. aegypti larvae from Padang, Samarinda, Manggarai Barat, and South Central Timor were susceptible to both fenitrothion and dieldrin (mortality rates ≥ 98%). About 6 out of 10 field strains of Ae. aegypti larvae were resistant (<80% mortality rates) against fenthion, whereas Ae. aegypti larvae from Kuningan, Samarinda, Sumba, and South Central Timor exhibited some degrees of resistance (mortality rates 80-98%). All field-collected Ae. aegypti larvae were resistant against diagnostic doses of chlorpyrifos, malathion, temephos, and DDT with mortality rates ranging from 0 to 74.67%. Continued insecticide susceptibility studies are essential to identify the efficacy of insecticides for an improved dengue vector control and to delay the development of insecticide resistance.
  17. Ismail A, Ab Razak A, Sayuti KA, Phoa PKA
    Cureus, 2023 Oct;15(10):e46670.
    PMID: 37942372 DOI: 10.7759/cureus.46670
    This article discusses the case of an adult woman with comorbid major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Due to her poor response to initial treatment regimens, a brain computed tomography (CT) was performed, revealing mega cisterna magna (MCM). Subsequently, she responded well to the addition of lorazepam, a benzodiazepine, along with fluvoxamine and quetiapine XR. The clinical significance of MCM and MDD-OCD remains partially understood. Thus, this case report aims to contribute to the literature and review the treatment of benzodiazepines in relation to MCM, MDD, and OCD comorbidities.
  18. Jayaram G, Razak A
    Malays J Pathol, 2003 Dec;25(2):139-43.
    PMID: 16196371
    The diagnosis of villoglandular adenocarcinoma of cervix on cytological smears is often missed due to the relatively bland cytological features of this tumour. A 45-year-old female with an exophytic cervical growth had three cervical smears reported as unsatisfactory. A cervical biopsy followed by Wertheim's hysterectomy showed a villoglandular adenocarcinoma (VGA) of cervix. Vaginal recurrence of VGA was again missed on the first post-operative vault smear. The second and third vault smears showed characteristic features of VGA that enabled correct identification. Review of some of the smears previously reported as unsatisfactory showed architectural features of VGA in the three dimensional (3-D) fragments that were previously considered to be benign.
  19. Jayaram G, Razak A, Gan SK, Alhady SF
    Malays J Pathol, 1999 Jun;21(1):17-27.
    PMID: 10879275
    1853 thyroid lesions subjected to cytological sampling (either by the fine needle aspiration or fine needle capillary sampling technique) from January 1992 to December 1997 at the University Hospital, Kuala Lumpur, were reviewed. Nodular goitre was the most common thyroid lesion needled (67.35%). Among the neoplastic lesions, follicular neoplasms predominated (64%), followed by papillary carcinoma (29.4%). In 325 cases, partial or total thyroidectomy had been done, providing material for histological review and cyto-histological correlation. Cytological diagnosis was found to have high sensitivity and specificity rates of over 75%. Besides, most non-neoplastic thyroid lesions could be diagnosed on cytology. The scope of cytology in the diagnosis of lymphomas, anaplastic and metastatic tumours rendered diagnostic biopsies (or thyroidectomy) unnecessary in these cases. Being a cost-effective technique and having the capacity to provide exact morphological diagnosis in a large variety of thyroid lesions, cytology is obviously the method of choice in the assessment of thyroid nodules.
  20. Jeffery J, Sulaiman S, Oothuman P, Vellayan S, Zainol-Ariffin P, Paramaswaran S, et al.
    Trop Biomed, 2012 Mar;29(1):180-6.
    PMID: 22543619 MyJurnal
    The following domiciliary cockroaches were collected from restaurants in five zones of Kuala Lumpur Federal Territory, Malaysia using 1L glass beaker traps baited with ground mouse-pellets: Periplaneta americana (Linnaeus) (n = 820), Periplaneta brunnea Burmeister (n = 46), Blattella germanica (Linnaeus) (n = 12504), Supella longipalpa (Fabricius) (n = 321), Symploce pallens Stephens (n = 29) and Neostylopyga rhombifolia (Stoll) (n = 5). The following bacteria were isolated from 10 cockroach specimens: Enterobacter cloacae, Klebsiella pneumoniae ssp. pneumoniae, Klebsiella pneumoniae ssp. rhinoscleromatis and Serratia liquefaciens from 5 B. germanica; Acinetobacter calcoaceticus var. anitratus, Citrobacter diversus/amalonaticus, Escherichia vulneris and K.p. pneumoniae from 3 P. brunnea; and Citrobacter freundii, Enterobacter agglomerans 4, Escherichia adecarboxylate, E. vulneris, K. p. pneumonia, K. p. rhinoscleromatis and Proteus vulgeris from 2 P. americana.
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