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Molecular markers associated with resistance to commonly used antimalarial drugs among Plasmodium falciparum isolates from a malaria-endemic area in Taiz governorate-Yemen during the transmission season

Alareqi LMQ, Mahdy MAK, Lau YL, Fong MY, Abdul-Ghani R, Mahmud R

Acta Trop, 2016 Oct;162:174-179.
PMID: 27343362 DOI: 10.1016/j.actatropica.2016.06.016

Since 2005, artesunate (AS) plus sulfadoxine/pyrimethamine (SP) combination has been adopted as the first-line treatment for uncomplicated malaria in Yemen in response to the high level of Plasmodium falciparum resistance to chloroquine (CQ). Therefore, the aim of the present study was to determine the frequency distribution of molecular markers associated with resistance to CQ and AS plus SP combination among P. falciparum isolates from a malaria-endemic area in Taiz governorate, Yemen. Fifty P. falciparum isolates were collected during a cross-sectional study in Mawza district, Taiz, in the period from October 2013 to April 2014. The isolates were investigated for drug resistance-associated molecular markers in five genes, including P. falciparum CQ resistance transporter (pfcrt) 76T and P. falciparum multidrug resistance 1 (pfmdr1) 86Y as markers of resistance to CQ, mutations in the Kelch 13 (K13) propeller domain for resistance to AS, and P. falciparum dihydrofolate reductase (pfdhfr) and P. falciparum dihydropteroate synthase (pfdhps) genes for resistance to SP. Nested polymerase chain reaction was used to amplify target genes in DNA extracts of the isolates followed by restriction fragment length polymorphism for detecting 76T and 86Y mutations in pfcrt and pfmdr1, respectively, and by DNA sequencing for detecting mutations in K13, pfdhfr and pfdhps. All the investigated isolates from Mawza district were harboring the pfcrt 76T mutant and the pfmdr1 N86 wild-type alleles. The pfdhfr 51I/108N double mutant allele was found in 2.2% (1/45) of the isolates; however, no mutations were detected at codons 436, 437, 540, 581 and 613 of pfdhps. All P. falciparum isolates that were successfully sequenced (n=47) showed the K13 Y493, R539, I543 and C580 wild-type alleles. In conclusion, the pfcrt 76T mutant allele is fixed in the study area about six years after the official withdrawal of CQ, possibly indicating its over-the-counter availability and continued use as a self-medication in the study area. However, the almost predominant wild-type alleles of the genes associated with resistance to AS and SP among P. falciparum isolates in the present study indicates the sustained efficacy of the currently adopted first-line treatment of AS plus SP in the study area.
Fulltext Foundation and methodologies in computer-aided diagnosis systems for breast cancer detection

Jalalian A, Mashohor S, Mahmud R, Karasfi B, Saripan MIB, Ramli ARB

EXCLI J, 2017;16:113-137.
PMID: 28435432 DOI: 10.17179/excli2016-701

Breast cancer is the most prevalent cancer that affects women all over the world. Early detection and treatment of breast cancer could decline the mortality rate. Some issues such as technical reasons, which related to imaging quality and human error, increase misdiagnosis of breast cancer by radiologists. Computer-aided detection systems (CADs) are developed to overcome these restrictions and have been studied in many imaging modalities for breast cancer detection in recent years. The CAD systems improve radiologists' performance in finding and discriminating between the normal and abnormal tissues. These procedures are performed only as a double reader but the absolute decisions are still made by the radiologist. In this study, the recent CAD systems for breast cancer detection on different modalities such as mammography, ultrasound, MRI, and biopsy histopathological images are introduced. The foundation of CAD systems generally consist of four stages: Pre-processing, Segmentation, Feature extraction, and Classification. The approaches which applied to design different stages of CAD system are summarised. Advantages and disadvantages of different segmentation, feature extraction and classification techniques are listed. In addition, the impact of imbalanced datasets in classification outcomes and appropriate methods to solve these issues are discussed. As well as, performance evaluation metrics for various stages of breast cancer detection CAD systems are reviewed.
Computer-Assisted Diagnosis System for Breast Cancer in Computed Tomography Laser Mammography (CTLM)

Jalalian A, Mashohor S, Mahmud R, Karasfi B, Iqbal Saripan M, Ramli AR

J Digit Imaging, 2017 Dec;30(6):796-811.
PMID: 28429195 DOI: 10.1007/s10278-017-9958-5

Computed tomography laser mammography (Eid et al. Egyp J Radiol Nucl Med, 37(1): p. 633-643, 1) is a non-invasive imaging modality for breast cancer diagnosis, which is time-consuming and challenging for the radiologist to interpret the images. Some issues have increased the missed diagnosis of radiologists in visual manner assessment in CTLM images, such as technical reasons which are related to imaging quality and human error due to the structural complexity in appearance. The purpose of this study is to develop a computer-aided diagnosis framework to enhance the performance of radiologist in the interpretation of CTLM images. The proposed CAD system contains three main stages including segmentation of volume of interest (VOI), feature extraction and classification. A 3D Fuzzy segmentation technique has been implemented to extract the VOI. The shape and texture of angiogenesis in CTLM images are significant characteristics to differentiate malignancy or benign lesions. The 3D compactness features and 3D Grey Level Co-occurrence matrix (GLCM) have been extracted from VOIs. Multilayer perceptron neural network (MLPNN) pattern recognition has developed for classification of the normal and abnormal lesion in CTLM images. The performance of the proposed CAD system has been measured with different metrics including accuracy, sensitivity, and specificity and area under receiver operative characteristics (AROC), which are 95.2, 92.4, 98.1, and 0.98%, respectively.
Fulltext Effect of chemotherapy counseling by pharmacists on quality of life and psychological outcomes of oncology patients in Malaysia: a randomized control trial

Periasamy U, Mohd Sidik S, Rampal L, Fadhilah SI, Akhtari-Zavare M, Mahmud R

Health Qual Life Outcomes, 2017 May 15;15(1):104.
PMID: 28506305 DOI: 10.1186/s12955-017-0680-2

BACKGROUND: Cancer is now becoming a leading cause of death. Chemotherapy is an important treatment for cancer patients. These patients also need consultation during their treatment to improve quality of life and decrease psychological disorders. The objectives of the study were to develop, implement and evaluate the effectiveness of a chemotherapy counseling module by pharmacists among oncology patients on their quality of life and psychological outcomes in Malaysia.
METHOD: A single-blind randomized controlled trial was carried out among 162 oncology patients undergoing chemotherapy from July 2013 to February 2014 in a government hospital with oncology facilities in Malaysia. Participants were randomized to either the intervention group or the control group. Chemotherapy counseling using the module on 'Managing Patients on Chemotherapy' by Pharmacists was delivered to the intervention group. The outcome measures were assessed at baseline, first follow-up and second follow-up and third follow-up post-intervention. Chi-square, independent samples t-test and two-way repeated measures ANOVA were conducted in the course of the data analyses.
RESULTS: In assessing the impact of the chemotherapy counseling module, the study revealed that the module along with repetitive counseling showed significant improvement of quality of life in the intervention group as compared to the control group with a large effect size in physical health (p = 0.001, partial Ƞ2 = 0.66), psychological (p = 0.001, partial Ƞ2 = 0.65), social relationships (p = 0.001, partial Ƞ2 = 0.30), and environment (p = 0.001, partial Ƞ2 = 0.67) and decrease in the anxiety (p = 0.000; partial Ƞ2 = 0.23), depression (p = 0.000; partial Ƞ2 = 0.40).
CONCLUSION: The module on 'Managing Patients on Chemotherapy' along with repetitive counseling by pharmacists has been shown to be effective in improving quality of life and decreasing anxiety and depression among oncology patients undergoing chemotherapy.
TRIAL REGISTRATION NUMBER: National Medical Research Register (NMRR) of Malaysia and given a registration number NMRR-12-1057-12,363 on 21 December 2012.
Fulltext A preliminary study of the influence of HIV infection in the transmission of tuberculosis

Mohammad Z, Naing NN, Salleh R, Ahmad N, Hamzah WM, Mahmud R

Southeast Asian J Trop Med Public Health, 2002 Mar;33(1):92-8.
PMID: 12118468

The human immunodeficiency virus (HIV) epidemic has had a profound influence on the epidemiology of tuberculosis (TB). The potential for HIV-associated TB cases to transmit M. tuberculosis and to produce a secondary increase in TB morbidity is unknown. A cross-sectional study was carried out to compare the prevalence of M. tuberculosis infection among the household contacts of HIV-positive and HIV-negative pulmonary tuberculosis (PTB) patients. Records of tuberculin (Mantoux) tests administered during routine contact investigations at the Chest Clinic, Hospital Kota Bharu, from 1999 to 2000 were reviewed. The HIV status of the patients was based on the results of ELISA tests while information on household contacts was gathered during visits to their houses. Ninety-four contacts of 39 HIV-negative patients and 44 contacts of 17 cases of HIV-positive patients were included in this preliminary study. 30% (12/40) of the contacts of HIV-positive PTB had a positive tuberculin compared with 52.8% (47/ 94) of the contacts of HIV-negative patients [OR = 0.41, 95% Confidence interval (CI) 0.17 - 0.97; p = 0.016]. The difference was still significant after performing multivariate logistic regression analysis to adjust for variables associated with infectiousness of TB (adjusted OR = 0.24, 95% CI 0.07 - 0.87; p = 0.03). This study has shown that HIV-infected PTB patients are less infectious to their contacts than HIV-negative patients. The presence of MV in the community may not necessitate a change of the current policy of the management of contacts.
Study site: Chest Clinic, Hospital Kota Bharu, Kelantan, Malaysia
Fulltext The Authentication and Grading of Edible Bird's Nest by Metabolite, Nutritional, and Mineral Profiling

Mohamad Ibrahim R, Mohamad Nasir NN, Abu Bakar MZ, Mahmud R, Ab Razak NA

Foods, 2021 Jul 07;10(7).
PMID: 34359444 DOI: 10.3390/foods10071574

Edible bird's nest (EBN) produced by Aerodramus fuciphagus has a high demand for nutritional and medicinal application throughout the world. The present study was to evaluate the authentication of a man-made house EBN, which are half cup and stripe-shaped by FTIR. Next, both samples were compared according to their metabolite, nutritional, and mineral composition. The results indicated that the FTIR spectra of both EBN samples were identical and similar to the reference, suggesting the authenticity of the EBN used. The metabolites that contribute to the possible medicinal properties of EBN were found by using GC-MS. The results of the proximate analysis, followed by the standard AOAC method, inferred that both EBN shapes to be rich in crude protein and carbohydrate contents. However, the proximate composition between the half cup and stripe-shaped EBN showed significant differences. Major mineral elements detected were calcium and sodium, and magnesium contents were significantly different between both EBN. Additionally, the half cup and stripe-shaped EBN had a low level of heavy metal content than the maximum regulatory limit as set by the Malaysian Food Act 1983. This study concludes that the nutritional composition varied between the samples and thus suggests that nutrient content should be considered as criteria for the grading requirement of commercialized EBN.
Fulltext Cross-Cultural Adaptation of the Functional Assessment of Cancer Therapy-Breast (FACT-B) in Malaysian Breast Cancer Survivors

Md Yusof K, Mahmud R, Abdullah M, Avery-Kiejda KA, Rosli R

Asian Pac J Cancer Prev, 2021 Apr 01;22(4):1055-1061.
PMID: 33906296 DOI: 10.31557/APJCP.2021.22.4.1055

INTRODUCTION: The survival rate of female breast cancer survivors has been reported to be higher than other types of cancer in Malaysia. Nonetheless, breast cancer survivors face new challenges from unwanted side effects of treatment or management such as fatigue, psychological disturbance, or arm swelling, which can lead to the decline of quality of life (QOL). This study aims to adapt the Malay version of the Functional Assessment of Cancer Therapy-Breast (FACT-B) to evaluate the QOL and to test its reliability and validity in Malaysian breast cancer survivors.
METHODS: The Malay version of the FACT-B, with Disabilities of Arms, Shoulders and Hands (DASH), and Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) were distributed to female breast cancer survivors which were recruited on a voluntary basis, from cancer support groups based in selected states in Malaysia. Reliability was assessed based on internal consistency (Cronbach's α), whereas concurrent validity was examined by comparing domains in FACT-B with DASH and PHQ-ADS. Finally, total scores of each domain were analysed between lymphedema and without lymphedema groups for known-group validity.
RESULTS: A total of 113 breast cancer survivors agreed to participate (response rate = 100%) in the study. Our results showed that the Cronbach's α value for Malay FACT-B is 0.88, and each domain ranged from 0.62 to 0.88. A strong correlation was found between the physical well-being domain of FACT-B with DASH. Meanwhile, the breast cancer scale (BCS) displayed significant correlation with the instrument, Patient Health Questionnaire- Anxiety Depression Scale (PHQ-ADS), indicating that multiple factors including psychological distress were measured in the BCS domain. Furthermore, the instrument was able to detect differences in physical, functional and QOL between participants from lymphedema and without lymphedema groups.
CONCLUSION: The Malay version of the FACT-B demonstrated reliable properties and is effective in assessing QOL and can be applied in Malaysian breast cancer survivors.
Small-field output ratio determination using 6 mol% Ge-doped silica fibre dosimeters

Lam SE, Noor NM, Bradley DA, Mahmud R, Pawanchek M, Abdul Rashid HA

Biomed Phys Eng Express, 2020 Nov 05;6(6).
PMID: 35042836 DOI: 10.1088/2057-1976/abc2a4

This work investigates the suitability of locally fabricated 6 mol% Ge-doped optical fibres as dosimeters for small-field output ratio measurements. Two fabrications of fibre, cylindrical (CF) and flat (FF) fibres, were used to measure doses in small photon fields, from 4 to 15 mm. The findings were compared to those of commercial Ge-doped fibre (COMM), EBT3 film and an IBA CC01 ionization chamber. Irradiations were carried out using a 6 MV SRS photon beam operating at a dose rate of 1000 cGy min-1, delivering a dose of 16 Gy. To minimise the possibility of the fibres failing to be exposed to the intended dose in small fields, the fibres were accommodated in a custom-made Perspex phantom. For the 4 mm cone the CF and FF measured output ratios were found to be smaller than obtained with EBT3 film by 32% and 13% respectively. Conversely, while for the 6 to 15 mm cone fields the FF output ratios were consistently greater than those obtained using EBT3 film, the CF output ratios differed from those of EBT3 film by at most 3.2%, at 6 mm, otherwise essentially agreeing with EBT3 values at the other field sizes. For the 4 to 7.5 mm cones, all output ratios obtained from Ge-doped optical fibre measurements were greater than those of IBA CC01 ionization chamber. The measured FF and CF output ratios for the 7.5 to 15 mm cones agreed with published MC estimates to within 15% and 13%, respectively. Down to 6 mm cone field, present measurements point to the potential of CF as a small-field dosimeter, its use recommended to be complemented by the use of EBT3 film for small-field dosimetry.
Fulltext Bioassay-guided antidiabetic study of Phaleria macrocarpa fruit extract

Ali RB, Atangwho IJ, Kaur N, Abraika OS, Ahmad M, Mahmud R, et al.

Molecules, 2012 Apr 30;17(5):4986-5002.
PMID: 22547320 DOI: 10.3390/molecules17054986

An earlier anti-hyperglycemic study with serial crude extracts of Phaleria macrocarpa (PM) fruit indicated methanol extract (ME) as the most effective. In the present investigation, the methanol extract was further fractionated to obtain chloroform (CF), ethyl acetate (EAF), n-butanol (NBF) and aqueous (AF) fractions, which were tested for antidiabetic activity. The NBF reduced blood glucose (p < 0.05) 15 min after administration, in an intraperitoneal glucose tolerance test (IPGTT) similar to metformin. Moreover, it lowered blood glucose in diabetic rats by 66.67% (p < 0.05), similar to metformin (51.11%), glibenclamide (66.67%) and insulin (71.43%) after a 12-day treatment, hence considered to be the most active fraction. Further fractionation of NBF yielded sub-fractions I (SFI) and II (SFII), and only SFI lowered blood glucose (p < 0.05), in IPGTT similar to glibenclamide. The ME, NBF, and SFI correspondingly lowered plasma insulin (p < 0.05) and dose-dependently inhibited glucose transport across isolated rat jejunum implying an extra-pancreatic mechanism. Phytochemical screening showed the presence of flavonoids, terpenes and tannins, in ME, NBF and SFI, and LC-MS analyses revealed 9.52%, 33.30% and 22.50% mangiferin respectively. PM fruit possesses anti-hyperglycemic effect, exerted probably through extra-pancreatic action. Magniferin, contained therein may be responsible for this reported activity.
Chemical composition, antioxidant and cytotoxicity activities of the essential oils of Myristica fragrans and Morinda citrifolia

Piaru SP, Mahmud R, Abdul Majid AM, Ismail S, Man CN

J Sci Food Agric, 2012 Feb;92(3):593-7.
PMID: 25520982

In this study the chemical composition, antioxidant activities and cytotoxic effect of the essential oils of Myristica fragrans (nutmeg) and Morinda citrifolia (mengkudu) were determined.
Fulltext Antioxidant and antiangiogenic activities of the essential oils of Myristica fragrans and Morinda citrifolia

Piaru SP, Mahmud R, Abdul Majid AM, Mahmoud Nassar ZD

Asian Pac J Trop Med, 2012 Apr;5(4):294-8.
PMID: 22449521 DOI: 10.1016/S1995-7645(12)60042-X

OBJECTIVE: Toinvestigate the anti-angiogenic activity and antioxidant properties of Myristica fragrans (M. fragrans) (nutmeg) and Morinda citrifolia (M. citrifolia)(mengkudu) oils.
METHODS: The nutmeg and megkudu essential oils were obtained by steam distillation. The antioxidant activities of both essential oils were determined by beta-carotene/linoleic acid bleaching assay and reducing power while the anti-angiogenic activity was investigated using rat aortic ring assay using various concentrations.
RESULTS: The results showed that nutmeg oil has higher antioxidant activity than mengkudu oil. The nutmeg oil effectively inhibited the oxidation of linoleic acid with (88.68±0.1)% while the inhibition percentage of oxidation of linoleic acid of the mengkudu oil is (69.44±0.4)%. The nutmeg oil and mengkudu oil showed reducing power with an EC(50) value of 181.4 μg/mL and 3 043.0 μg/mL, respectively. The antiangiogenic activity of nutmeg oil showed significant antiangiogenic activity with IC(50) of 77.64 μg/mL comparing to mengkudu oil which exhibits IC(50) of 109.30 μg/mL.
CONCLUSIONS: Bioactive compound(s) will be isolated from the nutmeg essential oil to be developed as antiangiogenic drugs.
Differentiating Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii using nested polymerase chain reaction (PCR) in rural communities in Malaysia

Ngui R, Angal L, Fakhrurrazi SA, Lian YL, Ling LY, Ibrahim J, et al.

Parasit Vectors, 2012;5:187.
PMID: 22947430

In this study, a total of 426 human faecal samples were examined for the presence of Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii infection via a combination of microscopic examination and nested polymerase chain reaction (PCR) targeting 16S ribosomal RNA of Entamoeba species.
Fulltext Hexaplex PCR detection system for identification of five human Plasmodium species with an internal control

Chew CH, Lim YA, Lee PC, Mahmud R, Chua KH

J Clin Microbiol, 2012 Dec;50(12):4012-9.
PMID: 23035191 DOI: 10.1128/JCM.06454-11

Malaria remains one of the major killers of humankind and persists to threaten the lives of more than one-third of the world's population. Given that human malaria can now be caused by five species of Plasmodium, i.e., Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and the recently included Plasmodium knowlesi, there is a critical need not only to augment global health efforts in malaria control but also, more importantly, to develop a rapid, accurate, species-sensitive/species-specific, and economically effective diagnostic method for malaria caused by these five species. Therefore, in the present study, a straightforward single-step hexaplex PCR system targeting five human Plasmodium 18S small-subunit rRNAs (ssu rRNAs) was designed, and the system successfully detected all five human malaria parasites. In addition, this system enables the differentiation of single infection as well as mixed infections up to the two-species level. This assay was validated with 50 randomly blinded test and 184 clinical samples suspected to indicate malaria. This hexaplex PCR system is not only an ideal alternative for routine malaria diagnosis in laboratories with conventional PCR machines but also adds value to diagnoses when there is a lack of an experienced microscopist or/and when the parasite morphology is confusing. Indeed, this system will definitely enhance the accuracy and accelerate the speed in the diagnosis of malaria, as well as improve the efficacy of malaria treatment and control, in addition to providing reliable data from epidemiological surveillance studies.
Morphological characteristics of developmental stages of Acanthamoeba and Naegleria species before and after staining by various techniques

Ithoi I, Ahmad AF, Mak JW, Nissapatorn V, Lau YL, Mahmud R

Southeast Asian J Trop Med Public Health, 2011 Nov;42(6):1327-38.
PMID: 22299400

Seven stains were studied to determine the best color and contrast for staining the developmental stages of free living pathogenic Acanthamoeba and Naegleria species. The acid-fast bacilli stain (AFB) produced a blue color without contrast; trichrome-eosin and modified Field's showed various color contrasts; Giemsa, iron-hematoxylin, modified AFB and Gram produced only one color which distinguished the nucleus, nucleolus, cytoplasm, food- and water-vacuoles. The motile organs (acanthopodia, pseudopodia, lobopodia and flagella) were also clearly differentiated but produced a similar color as the cytoplasm. These motile organelles were first induced by incubating at 37 degrees C for at least 15 minutes and then fixing with methanol in order to preserve the protruding morphology prior to staining. The trichrome-eosin and iron-hematoxylin stains showed good color contrast for detecting all three stages, the trophozoite, cyst and flagellate; Giemsa and Gram stained the trophozoite and flagellate stages; the modified Field's and modified AFB stains stained only the trophozoite stage. Depending on the purpose, all these stains (except the AFB stain) can be used to identify the developmental stages of Acanthamoeba and Naegleria for clinical, epidemiological or public health use.
Fulltext Seroprevalence and sources of toxoplasmosis among Orang Asli (indigenous) communities in Peninsular Malaysia

Ngui R, Lim YA, Amir NF, Nissapatorn V, Mahmud R

Am J Trop Med Hyg, 2011 Oct;85(4):660-6.
PMID: 21976569 DOI: 10.4269/ajtmh.2011.11-0058

This study aims to evaluate the current seroprevalence of toxoplasmosis among indigenous communities in Peninsular Malaysia and relate its association with epidemiological data. Overall seroprevalence of Toxoplasma gondii was 37.0% with 31.0% immunoglobulin (Ig) G, 1.8% IgM, and 4.2% seropositivity for both anti-Toxoplasma antibodies. Multivariate analysis showed that age above 12 years (odds ratio [OR] = 2.70, 95% confidence interval [CI] = 1.75-4.04, P < 0.001), using untreated river and mountain water supplies (OR = 1.50, 95% CI = 1.01-2.40, P = 0.050), and close proximity with cats (OR = 1.40, 95% CI = 1.10-1.76, P = 0.010) were factors associated with toxoplasmosis. Given the high seroprevalence of toxoplasmosis among these communities who live in poor socioeconomic conditions, a comprehensive health surveillance program and screening should be initiated among women of childbearing age and pregnant women during the antenatal period for early diagnosis and treatment. The role of domestic cats and environmental contamination with oocyst in soil and water has to be highlighted and addressed in future prevention strategies for these communities.
Fulltext Zoonotic Ancylostoma ceylanicum infection detected by endoscopy

Ngui R, Lim YA, Ismail WH, Lim KN, Mahmud R

Am J Trop Med Hyg, 2014 Jul;91(1):86-8.
PMID: 24891471 DOI: 10.4269/ajtmh.13-0756

We report a case of Ancylostoma ceylanicum infection detected by endoscopy. It was diagnosed and confirmed using polymerase chain reaction (PCR) and DNA sequencing. The patient is a 58-year-old Malaysian woman who lives in a rural area, where uncontrolled populations of stray and semidomesticated dogs live in close proximity with humans.
Fulltext Spatial distribution of malaria in Peninsular Malaysia from 2000 to 2009

Alias H, Surin J, Mahmud R, Shafie A, Mohd Zin J, Mohamad Nor M, et al.

Parasit Vectors, 2014;7:186.
PMID: 24735583 DOI: 10.1186/1756-3305-7-186

Malaria is still an endemic disease of public health importance in Malaysia. Populations at risk of contracting malaria includes indigenous people, traditional villagers, mobile ethnic groups and land scheme settlers, immigrants from malaria endemic countries as well as jungle workers and loggers. The predominant species are Plasmodium falciparum and P. vivax. An increasing number of P. knowlesi infections have also been encountered. The principal vectors in Peninsular Malaysia are Anopheles maculatus and An. cracens. This study aims to determine the changes in spatial distribution of malaria in Peninsular Malaysia from year 2000-2009.
Fulltext In vitro and in vivo effects of standardized extract and fractions of Phaleria macrocarpa fruits pericarp on lead carbohydrate digesting enzymes

Ali RB, Atangwho IJ, Kuar N, Ahmad M, Mahmud R, Asmawi MZ

BMC Complement Altern Med, 2013;13:39.
PMID: 23425283 DOI: 10.1186/1472-6882-13-39

One vital therapeutic approach for the treatment of type 2 diabetes mellitus is the use of agents that can decrease postprandial hyperglycaemia by inhibiting carbohydrate digesting enzymes. The present study investigated the effects of bioassay-guided extract and fractions of the dried fruit pericarp of Phaleria macrocarpa, a traditional anti-diabetic plant, on α-glucosidase and α-amylase, in a bid to understand their anti-diabetic mechanism, as well as their possible attenuation action on postprandial glucose increase.
Molecular characterization of Giardia duodenalis in Yemen

Alyousefi NA, Mahdy MA, Xiao L, Mahmud R, Lim YA

Exp Parasitol, 2013 Jun;134(2):141-7.
PMID: 23523861 DOI: 10.1016/j.exppara.2013.03.001

Giardia duodenalis is an important intestinal protozoan in Yemen with infection rates ranging from 18% to 27%. To date, there has been no genotyping study to provide a better understanding of the transmission dynamic. This study was conducted to genotype and subtype G. duodenalis in Yemen. Stool samples were collected from 503 Yemeni outpatients between 1 and 80 years old, including 219 males and 284 females. Giardia cysts were detected via microscopy after the formal-ether concentration. Genotyping of Giardia was carried out using PCR and sequence analysis of the 16s rRNA and b-giardin genes. Of the 89 microscopy-positive Giardia samples, 65 were successfully sequenced, of which 66% (43 of 65) were identified as G. duodenalis assemblage A and 34% (22 of 65) as assemblage B. Further subtyping analysis based on b-giardin gene identified the presence of subtypes A2 and A3, which belong to the anthroponotic sub-assemblage AII. Data of the study suggest that anthroponotic transmission played a potential role in the transmission of giardiasis in the community. However, further genotyping and subtyping studies of specimens from humans and animals living in the same households are needed for a more definitive understanding of giardiasis transmission in Yemen.
Fulltext Plasmodium ovale infection in Malaysia: first imported case

Lim YA, Mahmud R, Chew CH, T T, Chua KH

Malar J, 2010;9:272.
PMID: 20929588 DOI: 10.1186/1475-2875-9-272

BACKGROUND:
Plasmodium ovale infection is rarely reported in Malaysia. This is the first imported case of P. ovale infection in Malaysia which was initially misdiagnosed as Plasmodium vivax.

METHODS:
Peripheral blood sample was first examined by Giemsa-stained microscopy examination and further confirmed using a patented in-house multiplex PCR followed by sequencing.

RESULTS AND DISCUSSION:
Initial results from peripheral blood smear examination diagnosed P. vivax infection. However further analysis using a patented in-house multiplex PCR followed by sequencing confirmed the presence of P. ovale. Given that Anopheles maculatus and Anopheles dirus, vectors of P. ovale are found in Malaysia, this finding has significant implication on Malaysia's public health sector.

CONCLUSIONS:
The current finding should serve as an alert to epidemiologists, clinicians and laboratory technicians in the possibility of finding P. ovale in Malaysia. P. ovale should be considered in the differential diagnosis of imported malaria cases in Malaysia due to the exponential increase in the number of visitors from P. ovale endemic regions and the long latent period of P. ovale. It is also timely that conventional diagnosis of malaria via microscopy should be coupled with more advanced molecular tools for effective diagnosis.

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