We report a series of dermatitis cases caused by the staphilinid beetles, Paederusfuscipes Curtis, among university students staying in the residential college in Puncak Alam, Selangor, Malaysia from 1 January to 31 December 2010. A total of 360 cases (6.0%) were recorded in the Student Health Center throughout the year; the majority of patients stayed at a hostel near an oil palm plantation. Skin symptoms included erythema, edema, vesicular papules, painful blisters, burning sensation, pruritus, hyper pigmentation and peeling of skin. The commonly involved sites were the face, neck, shoulders and arms. Most students noticed the symptoms upon awakening in the morning. The patients were treated with fusidic acid cream and the symptoms resolved within 5 days. These beetles are nocturnally active and enter the room whenever a light source is available. The unintentional crushing of these beetles during sleep causes the release of its hemolymph (paederin) which is the cause of the dermatitis.
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.
Although the association between non-alcoholic fatty liver disease (NAFLD) and metabolic syndrome has been previously firmly established, the prevalence of NAFLD and its risk factors in rural communities remains incompletely defined. This study aimed to determine the prevalence and factors associated with ultrasound-diagnosed NAFLD amongst a rural community in Sarawak. An indigenous village was randomly selected where all adults aged 21 years and above underwent an abdominal ultrasound, biochemical tests and an anthropometric assessment. Respondents with a score > or =8 on an alcohol-use disorders-identification test (AUDIT) indicating harmful or hazardous drinking were excluded. Seventy-seven respondents (46.8% male, mean age 48.4 SD 16.64), met inclusion criteria. The prevalence of ultrasound diagnosed NAFLD was 44.2% (n=34), among them 52.9% had moderate NAFLD. There were no significant age or gender differences between respondents with and without NAFLD, although those with NAFLD were older. Respondents with NAFLD had a significantly higher BMI t,han those without NAFLD (p<0.001). Both male and female respondents with NAFLD had a significantly higher waist circumference than those without NAFLD (p<0.001). Prevalence of diabetes, hypertension, hyperglycemia and hypertriglyceridemia were significantly higher among those with NAFLD. However, there were no significant differences in terms of percentage of unhealthy body fat and muscle, and serum HDL levels. Risk factors independently associated with NAFLD included male gender (odd ratio 0.06; 95% CI 0.008-0.523) and waist circumference (odd ratio 1.2; 95% CI 1.036-1.421). There was a high prevalence of NAFLD and the presence of more severe stages of disease in this indigenous population. Life-style related diseases, such as fatty liver disease, can occur in rural as well as urban populations.
A twelve-week controlled intervention trial was carried out to evaluate the effects of combined physical activity and dietary intervention on obesity and metabolic risk factors among employees of Universiti Putra Malaysia. Participants consisted of adults aged 25-55 years with no reported chronic diseases but with abdominal obesity. They were assigned to either a combined physical activity and dietary intervention group or a control group. The final sample consisted of 56 participants, with an equal number of 28 for each study group. No significant group effect was observed for any variable except for hip circumference (HC) and fasting plasma glucose (FPG). There was a significant increase in HC (p=0.007) and reduction in FPG (p=0.02) in the intervention group compared to the control group. In the intervention group, HC (p=0.002), triglycerides (TG) (p=0.0001), total cholesterol (TC) (p=0.0001), LDL cholesterol (LDLC) (p=0.0001) and FPG (p=0.005) were significantly reduced, while waist circumference (WC) (p=0.025) and the waist-to-hip ratio (WHR) (p=0.027) were significantly reduced in the control group. No significant change in steps/day or calorie intake'was observed in either group. Taken together, these data indicate that the combined physical activity and dietary intervention was not effective at improving diet or physical activity level. However, the intervention was effective in improving FPG among participants with abdominal obesity. The significant increase in HC in the interventions group warrants further study. These findings will be useful to further improve group-based intervention for the prevention and management of obesity.
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.
We studied asymptomatic primary schoolchildren in northeastern Malaysia with light to moderate trichuriasis to determine the effect of albendazole treatment on growth rates and TNF-alpha levels. Thirty-seven schoolchildren aged 6-7 years with stool samples positive for Trichuris trichiura and negative for other geohelminths and protozoa were randomized to receive albendazole 400 mg or a placebo daily for 2 days. Anthropometric parameters at baseline, 3, 6 and 12 months were compared between the 2 groups. The placebo group had a significantly greater increase in height (p = 0.04) than the albendazole treatment group. There were no significant differences in urinary TNF-alpha levels (p = 0.8) between the 2 groups and no significant changes between baseline and 1 month post-treatment levels. Further studies are needed to determine the etiology of this apparent association between the albendazole treatment group and the delay in growth rate at 6 months post-treatment.
There is a high rate of unintended pregnancies in Malaysia due to low contraceptive use. Only 30% of married women use modern contraceptive methods. Emergency contraception (EC) is used within a few days of unprotected sex to prevent pregnancy. The purpose of this study was to investigate the knowledge, attitudes, and practices regarding EC pill use among Malay women. A cross sectional study was conducted among married female staff using stratified random sampling from 15 faculties in the Universiti Putra Malaysia (UPM). Data about sociodemographic factors, reproductive health, knowledge, attitudes and practices regarding EC use were gathered using validated self-administered questionnaire. The response rate was 87%. Half the 294 subjects who participated had a low knowledge, 33.0% a moderate knowledge and 17.0% a good knowledge about the EC pill. Eighty-eight percent of respondents had a positive attitude and 12.0% a negative attitude toward EC. Eleven percent of respondents had previously used EC. Unplanned and unwanted pregnancies were reported by 35.0% and 14.0% of respondents, respectively. Most respondents lacked knowledge about the indications for using EC, its mechanism of action, when it can be used and its side effects. Our findings show a need to educate women about EC.
Study site: 15 faculties in Universiti Putra Malaysia, Serdang. Selangor, Malaysia
Assessment of schoolchildren's knowledge, attitudes, and practices towards influenza A (H1N1) is crucial as schools play a major role in spreading the infection. The aims of this study were to determine the level of knowledge, attitudes, and practices on influenza A (H1N1) and the factors associated with practices of preventive behavior.A cross sectional study was conducted from July until December 2010. Two public secondary schools for two districts in Kelantan, Malaysia were randomly selected. Data were collected using a self-administered questionnaire. The questionnaire consisted of five constructs: sociodemographic, risk factors of containing influenza A (H1N1) infection, knowledge, attitudes, and practices. The questionnaire had been te,sted for its construct validity and reliability. General linear regression was applied in the data analysis. A sample of 436 secondary school students were recruited in this study involved Malay students aged 16 years old. The total knowledge, attitudes and practices scores for the overall respondents were 69.4, 82.2, and 73.8%, respectively. The significant influencing factors for the practices of preventive behavior were attended talk on H1N1 and attitudes score.This study suggested that health education is important for promoting the health of adolescents and contributing to the overall health of the public so that they will take precautions against the H1N1 infection.
Group B beta-hemolytic streptococcus (GBS) sepsis is a serious bacterial infection in neonates, with significant morbidity and mortality. We report here a neonate with late onset GBS infection manifesting as a urinary tract infection (UTI) in an infant presenting with prolonged neonatal jaundice. The pathogenesis of this late onset is postulated.
Many of the most widely spread vector-borne diseases are water related, in that the mosquito vectors concerned breed or pass part of their lifecycle in or close to water. A major reason for the study of mosquito larval ecology is to gather information on environmental variables that may determine the species of mosquitoes and the distribution of larvae in the breeding habitats. Larval surveillance studies were conducted six times between May 2008 and October 2009 in Pos Lenjang, Kuala Lipis, Pahang. Twelve environmental variables were recorded for each sampling site, and samples of mosquito larvae were collected. Larval survey studies showed that anopheline and culicine larvae were collected from 79 and 67 breeding sites, respectively. All breeding sites were classified into nine habitat groups. Culicine larvae were found in all habitat groups, suggesting that they are very versatile and highly adaptable to different types of environment. Rock pools or water pockets with clear water formed on the bank of rivers and waterfalls were the most common habitats associated with An. maculatus. Environmental variables influence the suitability of aquatic habitats for anopheline and culicine larvae, but not significantly associated with the occurrence of both larvae genera (p>0.05). This study provides information on mosquito ecology in relation to breeding habitats that will be useful in designing and implementing larval control operations.
This study was conducted to determine the inhibitory effects of ribavirin and hydroxyurea on dengue virus replication in Aedes aegypti mosquitoes. Female Ae. aegypti mosquitoes were infected with dengue-2 virus and fed ribavirin at a dose of 0.3 mg/ml and/or hydroxyurea at a dose of 6 mg/ml via artificial membrane feeding technique. The virus in infected mosquitoes was isolated using C6/36 cell culture. Peroxidase-antiperoxidase (PAP) staining was used to detect dengue-infected C6/36 cells and to quantify the level of infection by determining the presence of infected cells. In mosquitoes treated with ribavirin alone, hydroxyurea alone or both drugs in combination had reductions in dengue infection rates of 87.72, 89.47 and 95.61%, respectively. The mortalities of female Ae. aegypti mosquitoes fed with these drugs were significantly higher than the control. Ribavirin also had an inhibitory effect on the fecundity of female Ae. aegypti mosquitoes.
We report a case of Cryptococcus humicolus meningitis complicated by communicating hydrocephalus in an apparently immunocompetent 49-year-old psychiatric patient from a nursing home. He presented with a history of poor oral intake, weight loss, headache, vomiting, blurred vision, frequent falls and unsteady gait for the previous three months. He had a history of chronic cough, productive of whitish sputum for the previous month but no hemoptysis. Cerebrospinal fluid culture was positive for Cryptococcus humicolus. He was treated with intravenous amphotericin B and oral fluconazole and had clinical and microbiological improvement after three weeks of treatment. Unfortunately, the patient acquired nosocomial methicillin-resistant Staphylococcus aureus infection and died due to overwhelming sepsis.
We carried out a cross sectional study to detect emotional and behavioral problems among adolescents who smoke and their help-seeking behavior. This study was conducted in Sarawak, East Malaysia, between July and September 2006. Emotional and behavioral problems were measured using the Youth Self-Report (YSR/11-18) questionnaire; help seeking behavior was assessed using a help-seeking questionnaire. Three hundred ninety-nine students participated in the study; the smoking prevalence was 32.8%. The mean scores for emotional and behavioral problems were higher among smokers than non-smokers in all domains (internalizing, p = 0.028; externalizing, p = 0.001; other behavior, p = 0.001). The majority of students who smoked (94.7%) did not seek help from a primary health care provider for their emotional or behavioral problems. Common barriers to help-seeking were: the perception their problems were trivial (60.3%) and the preference to solve problems on their own (45.8%). Our findings suggest adolescent smokers in Sarawak, East Malaysia were more likely to break rules, exhibit aggressive behavior and have somatic complaints than non-smoking adolescents. Adolescent smokers preferred to seek help for their problems from informal sources. Physicians treating adolescents should inquire about smoking habits, emotional and behavioral problems and offer counseling if required.
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.
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.
The World Health Organization (WHO) estimates that injury will be the second leading cause of morbidity of disease burden worldwide by the year 2020. We conducted a community-based survey to determine the prevalence of recent illness and injury, in Malaysia. The survey was a cross sectional population-based household survey conducted using face to face interviews. The information was on self-reported recent illness and injury (SRRII) over the previous 2 weeks. This study was conducted during April - August 2006 and as a part of the third National Health and Morbidity Survey of Malaysia. A total of 56,710 respondents were interviewed with a response rate of 98.2% (55,660/56,710). The overall prevalence of combined SRRII was 23.6%; for injuries the prevalence was 3.1%. The groups with the highest SRRII were children 0-5 years old (31.2%), males (24.3%), Indians (26.9%), those with secondary education level (22.9%), those earning RM 1,000/ month (25.0%) and rural dwellers (25.5%). Age, sex, ethnicity, and locality were significantly associated with SRRII while monthly household income and educational level were marginally associated. On multivariate analysis, age, gender, race, ethnicity, education, income and locality were significantly associated with SRRII. The most common reported recent illness was related to the respiratory system (42.0%). The information obtained from this survey is useful to policy makers in the Ministry of Health to review and strengthen existing health programs.
Study name: National Health and Morbidity Survey (NHMS-2006)
The aim of this study was to determine the prevalence of HCV infection and the signal/cutoff (S/CO) value for false reactive, false positive, indeterminate and true positive HCV infection among apparently healthy blood donors in our area. This retrospective study was conducted at the Transfusion Medicine Unit, Hospital Universiti Sains Malaysia from June 2008 to June 2009. Blood samples were screened for anti-HCV using enzyme immunoassay (EIA). Reactive cases were confirmed by recombinant immunoblot assay (RIBA). Sixty-one blood donors were found to be reactive after the first screening test. Twenty-nine blood donors had reactive repeat screening, with only 9 samples being true positives. The S/ CO for false reactive, false positive, indeterminate and true positive anti-HCV samples were 1.02 to 1.45, 1.01 to 2.09, 1.07 to 2.43 and 35.95 to 119.89, respectively. The analysis showed the low incidence of HCV infections among blood donors in our area, however, thorough donor screening and stringent selection criteria are still recommended to eliminate high risk donors to improve our blood transfusion service.