The larval growth of Liosarcophaga dux Thompson (Diptera: Sarcophagidae) was studied under varying indoor room temperatures in Malaysia. Five replicates were established. The immature growth of this species from first instar until adult emergence was 307.0+/-3.0 hours. The mean larval length measured for second instar, third instar, post-feeding stage and puparia were 6.5+/-0.5 mm (n=10), 11.8+/-3.7 mm (n=31), 12.7+/-0.8 mm (n=16), and 9.5+/-0.5 mm (n=15), respectively.
Two insular settlements (Kampung Pulau Ketam and Kampung Sungai Lima) were selected to study the population dynamics of Aedes aegypti and Aedes albopictus mosquitoes, vectors of dengue and chikungunya infections. Ovitrap surveillance was conducted between October 2007 and October 2008. There was an inverse negative association between ovitrap index and rainfall at the time of collection, probably because rainfall increased the number of available oviposition sites. Rainfall and ovitrap index were positively associates the 25th day after rainfall occurred. A minor, second peak was observed from the 38th to the 42nd day. The first peak was consistent with the minimum 18-day period between the hatching of eggs to the first oviposition. The second minor peak could be due to the second gonotrophic cycle of the female mosquitoes. Rainfall is an important environmental factor associated with Aedes breeding at the study sites.
Abstract. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a pathogen recognized to be distinct in both phenotype and genotype from hospital-acquired MRSA. We have identified CA-MRSA cases in Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, including their antibiotic susceptibility patterns and genotypic characteristics. Cases were identified during January to December 2009 from routine clinical specimens, where culture and antibiotic susceptibility results yielded pauci-resistant MRSA isolates suspected as being CA-MRSA. The patients' clinical data were collected and their specimens were sent for molecular confirmation and analysis. Five cases of CA-MRSA were identified, which had a multi-sensitive pattern on antibiotic susceptibility tests and were resistant to only penicillin and oxacillin. All cases were skin and soft-tissue infections, including diabetic foot with gangrene, infected scalp hematoma, philtrum abscess in a healthcare worker, thrombophlebitis complicated with abscess and infected bedsore. All five cases were confirmed MRSA by detection of mecA. SCCmec typing (ccr and mec complex) revealed SCCmec type IV for all cases except the infected bedsore case. Panton-Valentine leukocidin gene was positive in all isolates. As clinical features among methicillin-sensitive Staphylococcus aureus, CA-MRSA and "nosocomial CA-MRSA" are indistinct, early recognition is necessary in order to initiate appropriate antibiotics and infection control measures. Continual surveillance of pauci-resistant MRSA and molecular analysis are necessary in order to identify emerging strains as well as their epidemiology and transmission, both in the community and in healthcare setting.
Dengue fever is a major public health problem in Malaysia. This study aimed to assess factors affecting knowledge, attitudes, and practices regarding dengue fever among a selected population in Malaysia. A descriptive, community-based, cross sectional study was conducted with 300 participants from three different geographical settings in urban, semi-urban, and rural areas within the states of Selangor and Kuala Lumpur. The questionnaire included questions on demographic data, knowledge, attitudes, and practices regarding dengue fever. Mean age of respondents was 34.4 (+/- 5.7) years, and the age ranged from 18 to 65 years. The majority of respondents were married (54.7%), Malays (72.7%) and heard about dengue fever (89.7%). Television was the common source of information about dengue fever (97.0%). Participants answered 4 out of 15 items of knowledge incorrectly. There was no significant association between knowledge score and socio-demographic factors. About one-fifth of the respondents (24%) believed that immediate treatment is not necessary for dengue fever, and the majority of them were not afraid of the disease (96.0%). Attitudes toward dengue fever were significantly associated with the level of education and employment status (p < 0.05). Practice was associated significantly with age, marital status, and geographic area (p < 0.05) and knowledge on dengue fever (p = 0.030). There is a need to increase health promotion activities through campaigns and social mobilization to increase knowledge regarding dengue fever. This would help to mold positive attitudes and cultivate better preventive practices among the public to eliminate dengue in the country.
Viruses in the family Picornaviridae are classified into nine genera. Within the family Picornaviridae, two species: Encephalomyocarditis virus and Theilovirus, are listed under the genus Cardiovirus. A novel Theilovirus, Saffold virus (SAFV), was first reported in 2007. Since then, numerous SAFV isolates have been detected around the world and genetic recombinations have been reported among them. In 2009, SAFV-Penang was isolated from a febrile child with influenza-like illness in Malaysia. SAFV-Penang is a genotype 3 SAFV. In this study we investigated the genome features of SAFV-Penang to exclude the possibility it is a recombinant variant. SAFV-Penang was found not to be a recombinant variant but to have three unique non-synonymous substitutions, alanine [A689], lysine [K708] and isoleucine [I724] in the VP1 protein.
Aural tick usually menisfests as intolerable otalgia. The severity of pain makes the patient to seek early treatment. Other uncommon symptoms include inner ear dyfunctions such as vertigo and tinnitus. The diagnosis is established by clinical examinaion either by otoscopic evidence of the tick itself, or its fecal remnant. We report a case of patient with acute labyrinthitis features with concurent otoscopic findings of tick fecal material.
This retrospective study was conducted among 59 HIV/AIDS patients with opportunistic infections admitted to the University Malaya Medical Centre between 2000 and 2009. Fifty-five point nine percent of cases were Chinese, 25.4% were Malays, 11.9% were Indians and 6.8% were of unknown ethnic origin. The male:female ratio was 2.9:1 (44 males and 15 females). The highest prevalence (38.9%) occurred in the 30-39 year old age group. Men comprised 47.7% and women 53.3%; the majority of both were married. The majority of cases were Malaysians (89.8%) and the rest (10.2%) were immigrants. Most of the patients (18.6%) were non-laborers, followed by laborers (11.9%), the unemployed (5.1%) and housewives (3.4%). The most common risk factor was unprotected sexual activity (20.3%). The two most common HIV/AIDS related opportunistic infections were Pneumocystis carinii (jirovecii) pneumonia (PCP) (62.7%) and toxoplasmosis (28.8%). Seventy-two point nine percent of patients had a CD4 count <200 cells/microl and 5.1% had a CD4 count >500 cells/microl. Eleven point nine percent of cases died during study period. A low CD4 count had a greater association with opportunistic infections. Most of the patients presented with fever (44.1%), cough (42.4%) and shortness of breath (28.8%). Detection of the etiologic pathogens aids clinicians in choosing appropriate management strategies.
This study was conducted to identify the prevalence of stress, types of stressors, consequences of stress and stress relievers among undergraduate dental students at the University of Malaya during the different years of study. A descriptive cross-sectional quantitative study was conducted using a self-administered questionnaire among Bachelor of Dental Surgery students during Years 2 to 5. A 100% response rate was obtained. The instrument asked questions about the preceding academic year. The results of the questionnaire reveal the prevalence of stress was 100%. The most common cause of stress among preclinical students was academic concerns and among clinical students was patient management and clinical performance. Physical and behavioral problems were reported as consequences of stress. Most students overcame stress by having strong interpersonal relationships.
Several equations have been used to predict lung function standard results for different populations. It is important lung function evaluations use appropriate standards for the study population. The objective of this study was to develop a prediction equation for lung function test results for the Malaysian population. Spirometry was performed among 5,708 subjects and 1,483 healthy, lifetime never smoked subjects (386 males and 1,097 females). Prediction equations were derived for both men and women for FVC and FEV1 results. The equations were validated on new subjects (n = 532, 222 males and 310 females) who met the same inclusion and exclusion criteria as the main cohort. There was a positive correlation between the measured values and the values derived from the new prediction equations (0.62 for FEV1 and between 0.66 and 0.67 for FVC; both p < 0.05) for both men and women with a smaller bias and limit of agreement compared to the published reference equations of ECCS, Knudson, Crapo and NHANES III. The reference equations derived from local spirometry data were more appropriate than generally used equations based on data from previous studies in different population.
Field surveys of ectoparasites on rodents and scandents were conducted in four localities of wildlife reserves in Peninsular Malaysia from October 2008 to November 2009. A total of 16 animals comprising 5 species of hosts were caught and examined for ectoparasites. The hosts examined were Maxomys rajah, Maxomys whiteheadi, Leopoldamys sabanus, Lariscus insignis and Tupaia glis. Of these hosts, 9 genera, consisting of 14 species of ectoparasites were extracted. Three species of ticks (Ixodidae), 7 species of mesostigmatid mites (Laelaptidae), 3 species of chiggers (Trombiculidae) and 1 species of listrophorid mites (Listrophoriidae) were identified. The infestation rate of ectoparasites observed ranged from 12.5% to 62.5%. Among the ectoparasites found, Ixodes granulatus and Leptotrombidium deliense are of known medical importance.
This comparative cross-sectional study was conducted in the pediatric daycare unit, Hospital Universiti Sains Malaysia to determine the prevalence of craniofacial deformities (CFD) and the association between these deformities and different clinical presentations among thalassemia patients. Patients were classified as either craniofacial deformity positive (CFD+) or craniofacial deformity negative (CFD-) by two examiners based on the presence or absence of deformity of the cheeks, frontal and/or maxillary bones. Fifteen clinical parameters were compared between the groups. Nineteen out of 43 patients (44.2%; confidence interval, 30.2-58.2%) had craniofacial deformities (CFD+). Both groups were comparable among the clinical parameters studied. Patients in the CFD+ group did not start their blood transfusions significantly earlier than the CFD- group (p = 0.50) and had a nonsignificantly lower mean pretransfusion hemoglobin level than the CFD- group (p = 0.71). Patients receiving regular monthly blood transfusions had a nonsignificantly smaller percentage of CFD than those transfused less often (p = 0.495). CFD+ patients had a splenectomy at a nonsignificantly younger age than CFD- patients (p = 0.36). HbE/beta thalassemia patients were not significantly less likely to develop CFD than other varieties (p = 0.50) and males had a nonsignificantly higher percentage of CFD than females (p = 0.29). This study shows CFD in thalassemia patients are still prevalent but no significant associated factors were found; however, a nonsignificantly higher prevalence of CFD was observed in patients with signs of severe disease and less efficient treatment.
Maternal nutrition has a programming effect on fetal growth. This cross-sectional study investigated the association between maternal micronutrient, fruit and vegetable intake with birth size. Nutrient and food intake were examined using a validated semi-quantitative food frequency questionnaire. One hundred twenty-one pregnant women at 28 to 38 weeks gestation aged 19-40 years, were recruited from the Universiti Sains Malaysia Hospital, Malaysia. Birth weight, length and head circumference were obtained from the medical records. Data were analyzed using multiple linear regression. Results indicate no significant association between any of the measured micronutrients and birth size. However, 2 of the 6 vegetable subgroups and those consumed fruit during pregnancy had children whose birth size was significantly associated with consumption. An increase of 10 g of leafy vegetables per day was associated with a 1.78 cm increase in head circumference (p = 0.04), and tuber vegetable intake was associated with birth length (beta = 0.21, p = 0.03) and head circumference (beta = 0.21, p = 0.01). Fruit intake was associated with birth weight (beta = 0.19, p = 0.04), birth length (beta = 0.20, p = 0.04) and head circumference (beta = 0.19, p = 0.03). The lack of association between maternal nutrient intake and fetal growth and the significant association between fruit and vegetable intake and birth size suggests the existence of other micronutrients and phytochemicals present in foods that play an important role in birth size. The types of nutrients and their roles in birth size warrant further investigation.
Abstract. Salmonella enterica serovar Paratyphi B is known to cause either paratyphoid fever or gastroenteritis. Differentiation of Salmonella ser. Paratyphi B into biotype Java (d-tartrate fermenting, dT+) and biotype Paratyphi B (d-tartrate non-fermenting, dT) is important for Salmonella epidemiology. This study applied a PCR approach to differentiate the two biotypes to augment the conventional biochemical method and to determine the antibiograms and genomic diversity of Malaysian S. Paratyphi B. Among 100 strains tested (clinical, 86; non-humans, 14), only two clinical strains were confirmed as biotype Paratyphi B as indicated by both lead acetate test and PCR. Antibiotic resistance rates were as follows: streptomycin 18%, sulphonamides 13%, ampicillin 10%, chloramphenicol 4%, tetracycline 3%, cefotaxime 2%, cefpodoxime 2%, ceftazidime 2%, gentamicin 1% and trimethoprim 1%. None showed resistance towards amoxicillin-clavulanic acid, ceftiofur, ciprofloxacin, nalidixic acid and trimethoprim-sulphamethoxazole. Seven strains showed multidrug resistance towards 3 or more classes of antimicrobial agents. REP-PCR and PFGE generated 32 and 76 different profiles, respectively. PFGE (D = 0.99) was more discriminative than REP-PCR (D = 0.93) and antimicrobial susceptibility test (D = 0.48) in subtyping the strains. Strains isolated 18 years apart (1982 - 2008) from different localities in Malaysia were clonally related as demonstrated by REP-PCR and PFGE, indicating that these strains were stable and widely distributed. In some clusters, strains isolated from different sources (clinical, food and animal) were grouped together. Thus, biotype Java was the most common biotype of Salmonella ser. Paratyphi B in Malaysia. The PCR approach is highly recommended due to its simplicity, specificity and ease of operation. The level of antimicrobial resistance among Salmonella ser. Paratyphi B remained relatively low in Malaysia but the emergence of resistance to cephalosporins is a cause for concern.
Globally, HIV/AIDS-related stigma and discriminatory attitudes deter the effectiveness of HIV prevention and care programs. This study investigated the general public's perceptions about HIV/AIDS-related stigma and discrimination towards people living with or affected by HIV/AIDS in order to understand the root of HIV/AIDS-related stigma and discriminatory attitudes. Study was carried out using qualitative focus group discussions (FGD). An interview guide with semi-structured questions was used. Participants were members of the public in Malaysia. Purposive sampling was adopted for recruitment of participants. A total 14 focus group discussions (n = 74) was carried out between March and July 2008. HIV/AIDS-related stigma and discrimination towards people living with HIV/AIDS (PLWHA) was profound. Key factors affecting discriminatory attitudes included high-risk taking behavior, individuals related to stigmatized identities, sources of HIV infection, stage of the disease, and relationship with an infected person. Other factors that influence attitudes toward PLWHA include ethnicity and urban-rural locality. Malay participants were less likely than other ethnic groups to perceive no stigmatization if their spouses were HIV positive. HIV/AIDS-related stigma and discrimination were stronger among participants in rural settings. The differences indicate attitudes toward PLWHA are influenced by cultural differences.
We studied the use of exhaled carbon monoxide (CO) to identify nicotine dependence among adult Malaysian male smokers. We conducted a cross-sectional study among 107 male smoking staff at a university hospital. We measured their exhaled CO using a piCO+ Smokerlyzer and diagnosed nicotine dependence using a Mini-International Neuropsychiatric Interview (MINI). The optimal cut-off value for exhaled CO was determined. The correlation between exhaled CO level and the Fagerstrom Test for Nicotine Dependence (FTND) was also assessed. The mean exhaled CO level among subjects with nicotine dependence (15.78 ppm) was significantly higher than subjects without nicotine dependence (9.62 ppm). The cut-off value used to identify smokers with nicotine dependence was set at 10 ppm (specificity = 0.721, sensitivity = 0.731, positive predictive value = 0.817 and negative predictive value = 0.617). Psychometric properties were stable with various durations of smoking. Exhaled CO correlated positively with FTND scores (Pearson's rho = 0.398, p = 0.01). Our findings show exhaled CO can be used to identify nicotine dependence among adult Malaysian male smokers.
A higher occurrence of iron deficiency anemia is present in rural Malaysia than urban Malaysia due to a lower socio-economic status of rural residents. This study was conducted in Tanah Merah, a rural district of Kelantan, Malaysia. Our objective was to investigate the impact of nutrition education alone, daily iron, folate and vitamin C supplementation or both on knowledge, attitudes and hemoglobin status of adolescent students. Two hundred eighty fourth year secondary students were each assigned by school to 1 of 4 different treatment groups. Each intervention was carried out for 3 months followed by 3 months without treatment. A validated self-reported knowledge and attitude questionnaire was administered; hemoglobin levels were measured before and after intervention. At baseline, no significant difference in hemoglobin was noted among the 4 groups (p = 0.06). The changes in hemoglobin levels at 3 months were 11, 4.6, 3.9 and -3.7% for the supplementation, nutrition education, combination and control groups, respectively. The changes at 6 months were 1.0, 6.8, 3.7 and -14.8%, respectively. Significant improvements in knowledge and attitude were evidenced in both the nutritional education and combination groups. The supplementation and control groups had no improvement in knowledge or attitudes. This study suggests nutritional education increases knowledge, attitudes and hemoglobin levels among Malaysian secondary school adolescents.
IgE-mediated allergic reaction to squid is one of the most frequent molluscan shellfish allergies. Previously, we have detected a 36 kDa protein as the major allergen of Loligo edulis (white squid) by immunoblotting using sera from patients with squid allergy. The aim of this present study was to further identify this major allergen using a proteomics approach. The major allergen was identified by a combination of two-dimensional electrophoresis (2-DE), immunoblotting, mass spectrometry and bioinformatics tools. The 2-DE gel fractionated the cooked white squid proteins to more than 50 different protein spots between 10 to 38 kDa and isoelectric point (pI) from 3.0 to 10.0. A highly reactive protein spot of a molecular mass of 36 kDa and pI of 4.55 was observed in all of the patients' serum samples tested. Mass spectrometry analysis led to identification of this allergen as tropomyosin. This finding can contribute to advancement in component-based diagnosis, management of squid allergic patients, to the development of immunotherapy and to the standardization of allergenic test products as tools in molecular allergology.
Clostridium perfringens (CP) and sulphite reducing clostridia (SRC) densities in the Selangor River, Bernam River and Tengi River Canal were examined between April 2007 and January 2008. Water samples were taken from two or three locations along each river, using either depth-integration or grab sampling methods. The downstream sampling site of the Selangor River, Rantau Panjang, reported the highest arithmetic mean of CP and SRC densities (583.45 and 8,120.08 cfu/100 ml, respectively). Both CP and SRC densities in the Selangor River increased further downstream, but the reverse was true in the Bernam River. The SRC densities in these rivers were significantly different from each other (p < 0.05) when comparing upstream and downstream results, but CP densities were not significantly different (p > 0.05). SRC densities were significantly correlated (p < 0.05) in different locations along the Selangor River and the Bernam River. The CP densities did not show such pattern (p > 0.05). River discharge had no significant correlation with SRC or CP densities by study site (p > 0.05). Since the Selangor River has a denser human population along its banks, this study confirms CP as a suitable indicator of human fecal contamination. However, tracing CP distribution along the river is more difficult than SRC. To our knowledge, this is the first study of CP and SRC densities from Malaysian rivers. CP densities found in this study were within the range of general water bodies reported from other countries.
This study was conducted to determine the antibiotic susceptibility pattern and distribution of exoU and exoS among 44 clinical isolates of P. aeruginosa collected from different patients over a 3-month period in 2010 at a major Malaysian hospital. Susceptibility data by disk diffusion method for cefepime (30 microg), ceftazidime (30 microg), gentamicin (10 microg), piperacillin-tazobactam (100/10 microg) and ciprofloxacin (5 microg) were available for 38 isolates. Resistance to ceftazidime and piperacillin-tazobactam was the most common (74%) with five isolates not susceptible to three or more different antibiotics. PCR detection of exoU and exoS of all 44 isolates showed the former gene to be present in 18 and exoS in 41. In analyzing the two genes together, 17 isolates were detected for exoU and exoS with only two being negative for both genes. Only one isolate was detected for exoU alone whereas 24 for exoS alone. Distribution of the genes in relation to antibiotic susceptibility was inapplicable due to the majority of the isolates having similar susceptibility patterns, but the tendency of exoU-carrying isolates to be present in male patients (83%) and respiratory sites (61%) was observed (p < 0.050). The finding warrants further investigation in a larger sample of isolates.\
This study was conducted to determine the Campylobacter contamination rate of chicken carcasses and the processing lines of modern processing plants in Malaysia. Three hundred sixty samples were collected from 24 flocks of broiler chickens at 12 modern poultry processing plants in 6 states of Malaysia. Fresh fecal droppings were collected from crates in the arrival area. Neck skin samples were taken from processed chicken carcasses at 3 different processing stages: before inside-outside washing, after inside-outside washing and post chilling. Swab samples from the scalding tank, chilling tank and conveyer belt before chilling were also collected to determine contamination with Campylobacter in the slaughter house environment prior to slaughter. Isolation for Campylobacter was performed following ISO 10272-1:2006(E). The overall of contamination rate with Campylobacter at the 12 plants was 61.0% (220/360). Eighty point six percent of the samples from before the inside-outside wishing step were contaminated with Campylobacter, as were 62.5% of the samples after the inside washing and 38.9% after the post-chilling step. This study shows extensive contamination of chicken carcasses and slaughtering houses in Malaysia with Campylobacter.