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DRUG-RESISTANT FALCIPARUM MALARIA FROM CAMBODIA AND MALAYA

CONTACOS PG, LUNN JS, COATNEY GR

Trans R Soc Trop Med Hyg, 1963 Nov;57:417-24.
PMID: 14081296
The dietary pattern of schoolchildren in the Muar District, Malaya

GRANT MW, TAN PHUI YONG, WADSWORTH GR

J Trop Med Hyg, 1959 May;62(5):118-22.
PMID: 13655347
Severe infections in systemic lupus erythematosus: disease pattern and predictors of infection-related mortality

Teh CL, Wan SA, Ling GR

Clin Rheumatol, 2018 Aug;37(8):2081-2086.
PMID: 29667100 DOI: 10.1007/s10067-018-4102-6

Infection is a major cause of morbidity and mortality among patients with systemic lupus erythematosus (SLE). To describe the pattern of serious infections in patients with SLE and to identify the predictors of infection-related mortality among SLE patients with serious infections, we prospectively studied all SLE patients who were hospitalized with infections in Sarawak General Hospital during 2011-2015. Demographic data, clinical features, and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of infection-related mortality. There were a total of 125 patients with 187 episodes of serious infections. Our patients were of multiethnic origins with female predominance (89.6%). Their mean age was 33.4 ± 14.2 years. The patients had a mean disease duration of 66.8 ± 74.0 months. The most common site of infection was pulmonary (37.9%), followed by septicemia (22.5%). Gram-negative organisms (38.2%) were the predominant isolates within the cohort. There were 21 deaths (11.2%) during the study period. Independent predictors of infection-related mortality among our cohort of SLE patients were flare of SLE (HR 3.98, CI 1.30-12.21) and the presence of bacteremia (HR 2.54, CI 0.98-6.59). Hydroxychloroquine was protective of mortality from serious infections (HR 9.26, CI 3.40-25.64). Pneumonia and Gram-negative organisms were the predominant pattern of infection in our SLE cohort. The presence of flare of SLE and bacteremia were independent prognostic predictors of infection-related mortality, whereas hydroxychloroquine was protective of infection-related mortality among SLE patients with serious infections.
Salt: an ineffective vehicle for iodine delivery to young children in rural Sarawak

Foo LC, Zainab T, Nafikudin M, Letchuman GR

Ann Endocrinol (Paris), 1996;57(6):470-5.
PMID: 9084692

The urinary iodine excretions of women (15-40 y) and young children (< or = 6 y) from two longhouse villages in the iodine-deficient district of Lubok Antu, Sarawak, were compared. One longhouse (Mengkak) was provided with freshly produced iodized salt every two months (one kg per family) while the other (Menjiling) was provided with iodized water via fortification of the village piped-water supply. Spot urines were collected for iodine determination at baseline and at 6 and 12 months after the start of the study. Salt and water samples were collected at monthly intervals. Goiter assessment was performed on the women at the start and end of the one-year study. The mean iodine concentrations in the salt samples from Mengkak and Menjiling were, respectively, 47.1 +/- 9.7 mg/kg (n = 60) and 0.8 +/- 3.4 mg/kg (n = 60) while the mean iodine concentration in the water samples from Menjiling was 138.6 +/- 43.2 micrograms/L (n = 24); iodine could not be detected in the water samples from Mengkak. There were significant and sustained increases in median urinary iodine excretions of both women and young children in Menjiling; in Mengkak, however, significant and sustained increases in median urinary iodine excretions were observed only in women while the median urinary iodine excretions of children remained essentially unchanged throughout the study period. Goiter prevalences in the women were reduced in both longhouses. The above observations reveal the inadequacy of iodized salt as a vehicle for iodine delivery to young rural Sarawakian children and indicate the need for other means of delivering supplemental iodine to this age group in areas where salt iodization is the only strategy for IDD control. In contrast, iodization of village water supply by itself is adequate in delivering iodine uniformly to the whole community.
In vitro activities of 28 antimicrobial agents against methicillin-resistant Staphylococcus aureus (MRSA) from a clinical setting in Malaysia

Neela V, Sasikumar M, Ghaznavi GR, Zamberi S, Mariana S

Southeast Asian J Trop Med Public Health, 2008 Sep;39(5):885-92.
PMID: 19058585

Methicillin-resistant Staphylococcus aureus (MRSA), an established nosocomial and emerging community pathogen associated with many fatalities due to its hyper-virulence and multiple drug resistant properties, is on the continuous rise. To update the current status on the susceptibility of local MRSA isolates to various classes of antibiotics and to identify the most potent antibiotics, thirty-two clinical isolates comprised of hospital acquired (HA) and community acquired (CA) infections were investigated by disk diffusion test. Of the 32 MRSA isolates, 14 (43.75%) and 18 (56.25%) were community and hospital acquired MRSA, respectively. All isolates were multiple drug resistant to more than 3 classes of antibiotics despite the source or specimen from which it was isolated. The oxacillin MICs for all isolates ranged from 2 to > or = 256 microg/ml. Twenty-five of 26 erythromycin-resistant MRSA isolates exhibited an inducible MLS(B) resistance phenotype while one showed an MS phenotype. More than half the isolates (68.75%) were resistant to at least one of the six aminoglycosides tested, with netilmicin as the most susceptible. The most effective antistaphylococcal agents were linezolid, vancomycin, teicoplanin and quinupristin/dalfopristin exhibited 100% susceptibility. Since MRSA is under continuous pressure of acquiring multiple drug resistance, it is imperative to focus routine surveillance on HA and CA-MRSA strains to monitor and limit the spread of this organism.
Fulltext A community-based study on the prevalence and factors affecting smoking in Terengganu state, Malaysia, 2004

Lekhraj Rampal, G. R., Sanjay, R., Azhar, M. Z., Kamil, M. H.

Malaysian Journal of Medicine and Health Sciences, 2006;2(2):61-69.
MyJurnal

Introduction: It is estimated that 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine, about half of them prematurely. This huge death toll is rising rapidly, especially in low and middle income countries where most of the world’s 1.2 billion tobacco users live.
Objectives: This study aimed to determine (i) the prevalence of smoking among the community aged 18 and above in Terengganu state, and (ii) the relationship between smoking and age, sex, educational level, family and peer influence.
Methods: A cross-sectional study design was used in this study and data was collected using a standardised pre-tested structured questionnaire.
Results: The overall mean age of the respondents was 38.9 (95% CI= 37.7 – 40.2) years. The majority of the respondents were Malays (99.1%). Of the 653 respondents, 32.2% and 23.6% were ever and current smokers respectively. Of this, 211 ever smokers, 199 (94.3%) were males and only 12 (5.7%) were females. The prevalence of ever and current smokers for males was 73.2% and 53.7% respectively compared to the females (3.1% and 2.1% respectively). There was a significant association between smoking status and sex (p<0.001). The prevalence of ever smokers was lowest amongst respondents with college or university educational level. However, for current smokers, those with college or university education had the highest prevalence. The overall mean initiation age of ever smokers was 19.7 years (95% CI = 18.8 – 20.7). The mean initiation age for the males (19. 1 years) was significantly lower compared to 29.8 years for the females (p<0.001). The mean duration of smoking for the current smokers was 21.6 (95% CI= 19.1 – 24) years. There was also no significant difference in the mean duration of current smoking for males compared to the females (p = 0.5). The majority (93.4%) of the ever smokers started either because their friends asked them to try or they were trying for fun. The quit ratio was 27%.
Conclusion : The prevalence of ever and current smokers in males is very high (73.2% and 53.7% respectively) compared with the females (3.1% and 2.1% respectively). The mean initiation age for the males (19.1 years) was significantly lower compared to 29.8 years for the females (p<0.001). Key words: Smoking, prevalence, initiation age, duration, Terengganu state
Tocotrienol preserves ovarian function in cyclophosphamide therapy

Saleh HS, Omar E, Froemming GR, Said RM

Hum Exp Toxicol, 2015 Oct;34(10):946-52.
PMID: 25585998 DOI: 10.1177/0960327114564793

Cyclophosphamide (CPA) chemotherapy leads to ovarian failure and infertility. Tocotrienol (T3) is an antioxidant and anti-inflammatory agent. The role of T3 in ovarian protection throughout chemotherapy remains unclear.
Fulltext Concha bullosa in chronic sinusitis

Subramanian S, Lekhraj Rampal GR, Wong EFM, Mastura S, Razi A

Med J Malaysia, 2005 Dec;60(5):535-9.
PMID: 16515102

Sinusitis is an important cause of morbidity and one of the major sources of income loss. Anatomical variations of the nose have been reported to predispose to sinusitis. These variations include concha bullosa, nasal septal deviation and oversized bulla. The aim of this study was to determine the proportion and the distribution of concha bullosa in patients with chronic sinusitis and to determine the relationship between concha bullosa and age, sex, ethnicity. A cross-sectional study was conducted at the Department of Ear, Nose and Throat in Kuala Lumpur Hospital (HKL). Data was collected retrospectively using a pretested proforma. All patients who underwent Sino nasal surgery between January 1999 and December 2000 and whose preoperative CT scans were available were included in the study. The CT scans were reviewed. Analysis was carried out using Statistical Package for Social Sciences. Out of 146 patients who underwent sinonasal surgery between January 1999 and December 2000, 101 (69.2% preoperative CT scans of these patients were available and these were reviewed. The proportion of patients with concha bullosa was 49.5%. The results showed that there was significant relationship between presence of concha bullosa and age and sex. The overall mean age of patient with concha bullosa was 35.7 years (95% CI 12.1-39.3) and ranged from 11-years to 56-years. The mean age of respondents with concha bullosa was significantly lower than patients without concha bullosa 41.98 (95% CI 37.6-46.3; t-test = 2.221; df=99; p < 0.05). Concha bullosa was significantly more in females (66.0%) compared to males (chi2 = 4.465, df=1, p < 0.05). There was no significant relationship between presence of concha bullosa and ethnicity.
Hypersensitivity reactions to high-dose co-trimoxazole in HIV-infected Malaysian and Scottish patients

Pakianathan MR, Kamarulzaman A, Ismail R, McMillan A, Scott GR

AIDS, 1999 Sep 10;13(13):1787-8.
PMID: 10509585
Satay and Salmonella and listeria infection

Arumugaswamy RK, Ali GR, ab Hamid SN

Lancet, 1993 Jul 24;342(8865):247.
PMID: 8100972
Prevalence of Listeria monocytogenes in foods in Malaysia

Arumugaswamy RK, Ali GR, Abd Hamid SN

Int J Food Microbiol, 1994 Sep;23(1):117-21.
PMID: 7811569

A total of 234 samples of food, consisting of 158 of raw and 76 samples of ready-to-eat food were examined for the presence of Listeria monocytogenes. The frequencies of L. monocytogenes contamination in raw foods were: chicken portions (60%), liver (60%) and gizzard (62%), beef (50%), beansprout (85%), prawns (44%), kupang (dried oysters) (33%), bean cake (25%), satay (48%) and leafy vegetables (22%). Of the ready-to-eat foods: satay (26%), prawns, squids, clams and chicken dishes (22%), cucumber (80%) and peanut sauce (20%) were found to yield L. monocytogenes.
Structural analysis of a missense mutation (Val414Phe) in the catalytic core domain of the factor XIII(A) subunit

Aslam S, Yee VC, Narayanan S, Duraisamy G, Standen GR

Br J Haematol, 1997 Aug;98(2):346-52.
PMID: 9266932

Molecular analysis has been performed on a Malaysian patient with a severe bleeding disorder due to factor XIII(A) subunit deficiency. Total mRNA was isolated from the patient's leucocytes and four overlapping segments corresponding to the entire coding region of the A subunit cDNA were amplified by RT-PCR. The cDNA segments amplified efficiently and were of expected size. Direct sequencing of the complete reading frame revealed a single homozygous base change (nt 1327G-T) in exon 10 corresponding to a missense mutation, Val414Phe, in the catalytic core domain of the A subunit monomer. The mutation eliminates a BsaJ1 restriction site and family screening showed that both parents were heterozygous for the defect. The base substitution was absent in 55 normal individuals. Val414 is a highly conserved residue in the calcium-dependent transglutaminase enzyme family. Computer modelling based on 3D crystallographic data predicts that the bulky aromatic side chain of the substituted phenylalanine residue distorts protein folding and destabilizes the molecule. In addition, conformation changes in the adjacent catalytic and calcium binding regions of the A subunit are likely to impair the enzymatic activity of any protein synthesized.
Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia

Teh CL, Wan SA, Cheong YK, Ling GR

Lupus, 2017 Feb;26(2):218-223.
PMID: 27522092 DOI: 10.1177/0961203316664996

We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a 10-year period (2006-2015) to describe the clinical features, maternal and foetal outcomes in our centre. There were 115 pregnancies in 86 women with SLE. Our patients had a mean age of 29.1 years (SD 5.80) and a mean disease duration of 44.63 months (SD 41.17). Fifteen patients had antiphospholipid syndrome (APS). Our patients had complicated pregnancies: 26.1% had SLE flares, 13.9% had pre-eclampsia and 45.1% needed caesarean sections. There were 23.3% foetal losses and 25% preterm deliveries in our patients. There was a higher rate of unplanned pregnancies and lupus flare among pregnancies with active SLE at conception. Pregnancies in lupus nephritis have higher incidence of lupus flares during pregnancy but similar maternal and foetal outcomes compared to those without nephritis. The prognostic indicators for adverse foetal outcome in our patients were flare of SLE (HR 4.08 [CI 95% 1.65-10.13, p
A naturally acquited quotidian-type malaria in man transferable to monkeys

CHIN W, CONTACOS PG, COATNEY GR, KIMBALL HR

Science, 1965 Aug 20;149(3686):865.
PMID: 14332847 DOI: 10.1126/science.149.3686.865

A quotidian-type parasite, Plasmodium knowlesi, has been found as a natural infection in man. The infection was acquired by a white male during a short visit to peninsular Malaysia. This occurrence constitutes the first proof that simian malaria is a true zoonosis.
Attitudes, barriers and facilitators to the conduct of research in government hospitals: a cross-sectional study among specialists in government hospitals, northern states of Malaysia

Teh LC, Prema M, Choy MP, Letchuman GR

Med J Malaysia, 2017 02;72(1):26-31.
PMID: 28255136 MyJurnal

INTRODUCTION: Specialists constitute a major 'driving force' and catalyst for growth of research in their speciality. A clearer understanding is required as to what motivates their participation in research as well as the barriers they faced. This research aims to study the attitudes, barriers and facilitators faced by specialists and to identify strategies to promote and sustain research activities in their hospitals.
METHODOLOGY: A cross-sectional survey using selfadministered questionnaires was conducted among all specialists working in government specialist hospitals in the northern states of Malaysia.
RESULTS: Out of 733 questionnaires distributed, 467 were returned giving a response rate of 63.7%. Ninety-nine percent of the respondents believed that research benefits patients while 93.3% think research helps in their professional development. However, 34.8% think that under their present working conditions, it is unlikely they will participate in research. The major barriers identified were lack of funds for research (81%); lack access to expertise, software or statistical analysis (78.4%); interference with daily work schedule (75.1%) and inconsistent manpower in their department (74.2%). There are three barriers with statistically significant difference between hospitals with CRC compared to hospitals without CRC; lack of funds, mentors and access to expertise, software or statistical analysis. The demographic factors, attitudes and barriers contributing to involvement in research also investigated. The main facilitators for the conduct of research are potential to benefit patients and potential for professional development.
CONCLUSION: Taking note of the findings, the Ministry of Health can implement appropriate strategies to improve specialist participation in research.
An evaluation of beta-hydroxybutyrate in milk and blood for prediction of subclinical ketosis in dairy cows

Samiei A, Liang JB, Ghorbani GR, Hirooka H, Yaakub H, Tabatabaei M

Pol J Vet Sci, 2010;13(2):349-56.
PMID: 20731192

The first objective of this study was to investigate the relationship between concentrations of beta-hydroxybutyrate (BHBA) in milk and blood to assess the reliability of the BHBA concentrations in milk measured by a semi quantitative keto-test paper to detect subclinical ketosis (SCK) in 50 fresh high-producing Iranian Holstein cows in Golestan Province, Iran. The second objective was the effects of SCK on milk yield and components. Concentrations of nonesterified fatty acids (NEFA) and BHBA were analyzed quantitatively in blood plasma and commercial keto-test paper was used for semi quantitative determination of BHBA concentration in milk. Milk yield was measured until 60 d after calving but milk compositions were measured until 30 d after calving. The mean plasma BHBA, milk BHBA, plasma NEFA, milk yield, milk fat percentage and milk fat: protein ratio were 1,234 micromol/L, 145 micromol/L, 0.482 mEq/L, 29.5 kg, 3.9% and 1.4, respectively. Fifty eight percent of the cows had SCK during the first month of lactation. High correlation coefficients were observed between blood BHBA and blood NEFA, and between blood and milk BHBA. The milk yield of cattle with SCK decreased (P < 0.01) but the fat percentage and milk fat: protein ratio increased (P < 0.01). The commercial keto-test paper used had a low false positive result at a cut-off point of 200 fmol of BHBA/L of milk. The results showed that the best time to assess SCK using the commercial keto-test paper was d 10, 14 and 17 after calving.
Treat-to-target (T2T) of serum urate (SUA) in gout: a clinical audit in real-world gout patients

Teh CL, Cheong YK, Wan SA, Ling GR

Reumatismo, 2019 Oct 24;71(3):154-159.
PMID: 31649384 DOI: 10.4081/reumatismo.2019.1225

Treat-to-target (T2T) for gout has been established recently to improve its management, which has been reported to be sub-optimal with significant gaps between the goals of treatment and day-to-day clinical practice. T2T recommended a goal of serum urate (SUA) target of <360 μmoI/L in all patients with gout and <300 μmoI/L in patients with tophaceous or severe gout. T2T strategy was applied in the management of gout patients in two Rheumatology clinics from 1 January 2016 onwards. We performed a clinical audit to assess T2T of SUA in gout patients and to identify causes for failure to achieve target SUA among them. There were a total of 304 patients for our analysis. They were of multi-ethnic origin with male predominance (88.8%). They had a mean age of 57.7+13.7 years and mean disease duration of 10.1+8.7 years. The most common comorbidities were hypertension (76.2%), dyslipidemia (52.5%) and diabetes mellitus (DM) (27.4%). Our patients' body mass indexes showed that 47.7% were obese while 34.2% were overweight. Up to 62.4% of our patients had tophi and 42.6% had joint deformities. Only 34.9% of patients achieved target SUA. Nonadherence (52.3%) was the main reason identified for failure to achieve target SUA. The independent predictors for failure to achieve target SUA were nonadherence (HR=7.84, p=0.000) and presence of tophi (HR=1.95, p=0.001).
Fulltext The effects of Cicletanine, a new antihypertensive agent on insulin release in rat isolated pancreas by the perfusion technique

Mashori GR, Tariq AR, Shahimi MM, Suhaimi H

Singapore Med J, 1996 Jun;37(3):278-81.
PMID: 8942229

Treatment of hypertension has reduced the incidence of stroke, heart failure and renal failure. However, the incidence of coronary heart disease is not reduced to the same degree. Many of the drugs advocated as first-line drugs in the step-wise therapy have been shown to cause carbohydrate intolerance and it is an independent risk factor in the development of coronary heart disease. It is thus important to identify the antihypertensive drugs that may cause deterioration in glucose tolerance. Cicletanine, the first derivative of the furopyridines, is a new class of antihypertensive agents. It acts directly on vascular endothelium cells by increasing prostacyclin synthesis. It also decreases intracytosolic calcium levels in smooth muscles. The purpose of this study is to evaluate the effects of Cicletanine on insulin release in rat isolated pancreas by the perfusion technique adapted from Loubatieres and co-workers (1972). Doses used were based on therapeutic peak plasma concentration. Diazoxide was used as a positive control ie a known insulin suppressant. Cicletanine at 1/10 and equivalent therapeutic concentrations (0.5 microgram/mL and 5.0 micrograms/mL) did not suppress insulin release. However, at concentration exceeding 10X its therapeutic levels (50 micrograms/mL) it begins to suppress insulin release. In conclusion, Cicletanine did not inhibit insulin release at concentrations within the therapeutic range.
PE-Ynet: a novel attention-based multi-task model for pulmonary embolism detection using CT pulmonary angiography (CTPA) scan images

Hemalakshmi GR, Murugappan M, Sikkandar MY, Santhi D, Prakash NB, Mohanarathinam A

Phys Eng Sci Med, 2024 Mar 28.
PMID: 38546819 DOI: 10.1007/s13246-024-01410-3

Pulmonary Embolism (PE) has diverse manifestations with different etiologies such as venous thromboembolism, septic embolism, and paradoxical embolism. In this study, a novel attention-based multi-task model is proposed for PE segmentation and detection from Computed Tomography Pulmonary Angiography (CTPA) images. A Y-Net architecture is used to implement this model, which facilitates segmentation and classification jointly, improving performance and efficiency. It is leveraged with Multi Head Attention (MHA), which allows the model to focus on important regions of the image while suppressing irrelevant information, improving the accuracy of the segmentation and detection tasks. The proposed PE-YNet model is tested with two public datasets, achieving a maximum mean detection and segmentation accuracy of 99.89% and 99.83%, respectively, on the CAD-PE challenge dataset. Similarly, it also achieves a detection accuracy of 99.75% and a segmentation accuracy of 99.81% on the FUMPE dataset. Additionally, sensitivity analysis also shows a high sensitivity of 0.9885 for the localization error ɛ = 0 for the CAD-PE dataset, demonstrating the model's robustness against false predictions compared to state-of-the-art models. Further, this model also exhibits lower inference time, size, and memory usage compared to representative models. An automated PE-YNet tool can assist physicians with PE diagnosis, treatment, and prognosis monitoring in the clinical management of CoVID-19.
Fulltext Investigating Feature Ranking Methods for Sub-Band and Relative Power Features in Motor Imagery Task Classification

Mohdiwale S, Sahu M, Sinha GR, Nisar H

J Healthc Eng, 2021;2021:3928470.
PMID: 34616530 DOI: 10.1155/2021/3928470

Interpreting the brain commands is now easier using brain-computer interface (BCI) technologies. Motor imagery (MI) signal detection is one of the BCI applications, where the movements of the hand and feet can be recognized via brain commands that can be further used to handle emergency situations. Design of BCI techniques encountered challenges of BCI illiteracy, poor signal to noise ratio, intersubject variability, complexity, and performance. The automated models designed for emergency should have lesser complexity and higher performance. To deal with the challenges related to the complexity performance tradeoff, the frequency features of brain signal are utilized in this study. Feature matrix is created from the power of brain frequencies, and newly proposed relative power features are used. Analysis of the relative power of alpha sub-band to beta, gamma, and theta sub-band has been done. These proposed relative features are evaluated with the help of different classifiers. For motor imagery classification, the proposed approach resulted in a maximum accuracy of 93.51% compared to other existing approaches. To check the significance of newly added features, feature ranking approaches, namely, mutual information, chi-square, and correlation, are used. The ranking of features shows that the relative power features are significant for MI task classification. The chi-square provides the best tradeoff between accuracy and feature space. We found that the addition of relative power features improves the overall performance. The proposed models could also provide quick response having reduced complexity.

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