A cross-sectional study was conducted to identify the factors related to smoking habits of secondary school teachers in Kelantan, Malaysia. A total of 180 male teachers and trainee teachers from four secondary schools in Kelantan and a Teachers' Training College were interviewed by using a structured questionnaire. Cluster sampling was applied. The significant findings found were current smokers were found as high as 40.56%. Mean duration of smoking was 6.8 years and mean initiation age was 16.5 years. Trainee teachers had a significantly higher proportion of current smokers. There was a significant association between smoking status of teachers and their fathers' and perception of the hazards of smoking on health. Peer influence was found to be the major reason for smoking among smokers. Religious belief and care for health attitude prevented non-smokers from smoking. About 3/5 of smokers thought of quitting smoking and of these 1/4 had tried at least once. There was a significant difference of proportion of attempted quitting between regular and occasional smokers. Mass media was the best source of information on knowledge about smoking hazards. Anti-smoking campaigns should start as early as possible in schools. Lectures and talks on smoking should be included in the curriculum of teachers' training courses.
Fermented fish and meat samples were purchased from supermarket and wet market for microbiological analysis of Listeria species and Listeria monocytogenes contamination. Listeria species were isolated from 17 (73.9%) of 23 samples of imported frozen beef, 10 (43.5%) of the 23 samples of local beef and 14 (56%) of the 25 samples of fermented fish from wet market. Listeria monocytogenes occurred in 15 (75%) of the frozen beef samples, 6 (30.4%) of the 23 samples of local meat and 3 (12%) of the 25 samples from fermented fish. Listeria species was not isolated from any of the 23 samples of imported frozen beef from supermarket and from the 5 samples of buffalo meat examined. This highlights the possibility of Listeria spp or L. monocytogenes to persist in meat and fermented fish in wet market and raises the problem of illness due to the handling and consumption of Listeria-contaminated meat or fermented fish are likely as evidence by the high contamination rates of samples sold at the wet market.
Mycoplasma pneumoniae is increasingly recognized as an important cause of community acquired pneumonia (CAP) in children. We determined the importance of M. pneumoniae as a causative agent in 170 children aged 1 month to 15 years who were hospitalized with CAP over a 6-month period. The diagnosis of M. pneumoniae infection was based on serological evidence obtained by a particle agglutination test (SERODIA-MYCO II). A positive serological diagnosis was made if the acute phase serum titer was more than 1:160 or paired samples taken 2-4 weeks apart showed a four-fold or greater rise in the serum titer. M. pneumoniae was identified as the causative agent in 40 (23.5%) children. Children with M. pneumoniae infection were more likely to be older than 3 years (OR 4.0 95%CI 1.8-9.1, p<0.001), Chinese (OR 4.3 95%CI 2.0-8.9, p<0.001), have a duration of illness longer than 7 days prior to admission (OR 6.0 95%CI 2.7-13.5, p<0.001) and have perihilar interstitial changes on chest X-ray (OR 4.6 95%CI 2.2-9.9, p<0.001). A significant number of hospital admissions for CAP in Malaysian children can be attributed to M. pneumoniae. It is important to identify these children so as to administer the most appropriate antibiotic treatment.
Tuberculosis (TB) has made a comeback. It has become a resurgent public health problem in developing countries in the tropics and is the leading cause of death from any single infectious agent. Non-compliance to anti-tuberculosis treatment is the most serious problem in TB control. A cross-sectional study was conducted to investigate the determinants of poor compliance with anti-tuberculosis treatment among tuberculosis patients in Kota Bharu, Kelantan, Malaysia in 1999. A total of 390 patients were included in the study of which 130 were tuberculosis patients who defaulted treatment and 260 were those compliant to treatment. Data collection was done by interviewing the patients and collecting clinical and laboratory data from their medical records. Using multiple logistic regression analysis, patients who were not on direct observed therapy (DOT) lived distant to the health facility, were non-intravenous drug users (IVDU) and were HIV positive had statistically significant higher odds of being non-compliant. Patients should be given treatment under direct supervision with special attention to IVDU and HIV positive groups. Anti-TB treatment should be accessible to patients at the nearest health center from their residence. Interventions with health education programs emphasizing the benefits of treatment compliance should be implemented by further large-scale multicentered studies.
Study site: Chest clinic, Hospital Kota Bharu, Kelantan, Malaysia
Persons infected with human immunodeficiency virus (HIV) have an increased risk of salmonellosis when compared to the general population. We describe seven such patients with Salmonella bacteremia, of whom two had recurrent salmonellosis. In the latter two cases the infection was unusually severe, characterized by widespread infection, bacteremia and relapse, despite standard antimicrobial therapy. HIV-infected individuals will benefit from education on the source of Salmonella, mode of acquisition and prevention through safe food handling and food preparation practices. Because of the difficulty of eradicating Salmonella infection in patients with acquired immunodeficiency syndrome, long-term suppressive treatment with antimicrobials is warranted.
Studies have shown that smokers rationalize smoking by self-exempting beliefs. This study explored lay beliefs about smoking in Kelantan, Malaysia, using focus groups among outpatients, medical students and staff, and a questionnaire survey of 193 male smokers. In focus groups, patients said they could do something to make smoking safe. When asked, 'Do you think there are any safe ways to smoke?' 132/193 (68%) male smokers described at least one way. The commonest were 'drink water' (69/193, 36%), 'use a filter' (60/193, 31%), 'smoke after food' (27/193, 14%), and 'take sour fruit' (21/193, 11%). At three- or six-month follow-up, numbers agreeing with these beliefs were: for 'drink water' 67/115 (58%), for 'take sour fruit' 61/115 (53%), and for 'smoke after food' 38/115 (33%), with 88/115 (77%) supporting at least one. The main explanations for water were that it cleaned or moistened the lungs or throat. Sour fruit was described as cleaning, and sometimes as 'sharp', able to scrape out the essence of cigarettes. The conclusion is that self-exempting false beliefs about smoking are widespread, and here they probably represent an extension of the traditional humoral system. Anti-smoking campaigns and health workers in smoking cessation services should address these beliefs.
Study site: outpatients clinic (Klinik Perubatan Masyarakat, KPM), Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Smoking deception is often ignored, but is important in health care. In this trial it was assessed at both study entry and outcome. At study entry, 1,044 males at a primary care clinic were asked smoking status and tested for breath carbon monoxide (CO). Of self-reported non-smokers, 57/402 (14%) were actually smokers, as were 59/251 (24%) of self-reported ex-smokers. The self-reported smokers (n=387) entered a randomized, controlled trial where the intervention comprised four questions on knowledge and beliefs about smoking, standardized verbal advice against smoking, and a leaflet. At follow-up, subjects were also questioned about beliefs. Follow-up was difficult, but 191/387 (49%) attended at three or six months. Of 27 who claimed to have quit, 6 (22%) were deceivers and 21 were confirmed quitters. Cessation did not differ between intervention and control groups. Overall confirmed cessation at six months was 16/387 (4.1 %). Confirmed quitters were significantly lighter smokers than deceivers and still smokers. There were non-significant trends between the outcome groups whereby deceivers had least knowledge and most lay beliefs, and quitters had most knowledge and fewest lay beliefs. The lay beliefs may prevent some smokers from quitting.
Study site: open-access outpatients
clinic (KPM) attached to the teaching hospital
(HUSM) of Universiti Sains Malaysia
The objective of this study was to determine the sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of Diff-Quik-stained gastric imprint cytology smears in the detection of H. pylori compared with histology. Air-dried imprint smears of gastric biopsies from 150 patients were stained by the Diff-Quik method in the endoscopy suite and examined for H. pylori, providing results within minutes. The presence of inflammation and intestinal metaplasia were documented. The same biopsy was processed and stained with H&E and Warthin-Starry stains, and reviewed by a different pathologist blind to the imprint cytology results. Ninety-four of the 150 patients were male with a mean age of 50 years. Based on histology, the H. pylori prevalence was very low at 8%. The sensitivity and specificity of imprint cytology in the detection of H. pylori were 83.3% and 100%, respectively. The PPV and NPV were 100% and 98.6%, respectively. There were two false negatives and no false positives. A combination of imprint cytology and histology achieved 100% sensitivity. Imprint smears did not provide added value over histology with regards to inflammation and metaplasia. Gastric imprint smears stained with Diff-Quik method is a rapid, cheap, and reliable method for the detection of H. pylori and have their best results when complemented with histology.
A study was made of the oviposit behavior of gravid female Aedes mosquitos in man-made habitats under field conditions. The study showed that the gravid female Aedes mosquitos preferred containers with relatively easy access but not too open to external environmental influence. The dark surface of the containers served as the initial and long-range attractant to the breeding sites. Volatile chemicals generated by the decaying vegetation in the container may serve as a close-range attractant. Finally, the water quality and the quantity of 'food' derived from decaying vegetative matter in the water determined the amount of eggs deposited in each container. The study confirmed previous findings that each gravid female Aedes mosquito had the tendency to lay her eggs in more than one container. However, the results of the study suggests that under favorable conditions, each gravid female Aedes mosquito could be encouraged to lay all her eggs in a single breeding site.
Job stress has now become one of the most significant health and safety issues in the workplace and one of the least understood areas of organizational cost. A cross-sectional study to assess job strain and dissatisfaction in lecturers of the School of Medical Sciences, Universiti Sains Malaysia (USM) was undertaken between August 2001 and May 2002. The original English version of the Job Content Questionnaire (JCQ) version 1.7 (revised 1997) by Robert Karasek was self-administered to 73 (response rate 58.4%) lecturers in School of Medical Sciences USM. The prevalence of job strain (defined by low decision latitude and high psychological demands) in USM was 23.3%. The risk factors of job strain in the lecturers were psychological stressors (adjusted OR 1.2, 95% CI 1.0, 1.4), created skill (adjusted OR 0.4, 95% CI 0.2, 0.8) and working in clinical-based departments (adjusted OR 18.7, 95% CI 1.6, 22.7). The prevalence of job dissatisfaction was 42.6%. Associated factors of job dissatisfaction in USM lecturers were decision authority (p < 0.001) and psychological job demand (p < 0.001). We conclude that psychological stressors and created skill were non-protective and protective, respectively, against job strain in USM lecturers. Clinical-based lecturers experienced higher job strain compared to non-clinical-based lecturers. Psychological job demand was strongly associated with job dissatisfaction, and decision authority was protective against job dissatisfaction.
To characterize the demographic profiles, clinical features, radiological patterns and outcomes of treatment of HIV-infected TB patients, a descriptive study was carried out on 149 HIV-infected TB cases diagnosed from 1998 through 2001 at Kota Bharu Hospital, Kelantan, Malaysia. The majority of the patients were males (94.6%), single (45.0%), ethnic Malay (94.0%) with a mean age of 34 years (standard deviation 7.8, range 18-76). The most common HIV transmission category was through injecting drug use (73.8%) and being the inmates or former inhabitants of drug rehabilitation centers and prisons were the commonest high-risk groups. One hundred and seventeen patients were diagnosed as having pulmonary TB, while about 20% were extra-pulmonary in type with 9 cases of milliary TB. The majority (45%) presented with cough symptoms while only 51% had a positive sputum smear. Fifty-five percent were found to have pulmonary lesions on chest x-ray, such as localized, milliary or diffuse pulmonary infiltrates, or opacities. Eight (5.4%) had pleural lesions while another 8 cases had hilar or mediastinal lymph node lesions. Overall, fifty-eight (38.9%) patients had died by the completion of data collection. The median weeks or survival from the time of starting TB treatment was 13.5 (range 1-56) and the majority of them (74%) died without completing the 6-month regime of treatment.
Pulsed field gel electrophoresis (PFGE) and antimicrobial susceptibility analysis were undertaken on twenty-three strains of Salmonella enterica serovar Tshiongwe, an unusual serovar, which recently emerged in Malaysia. Antimicrobial susceptibility analysis showed that all the strains were sensitive to ampicilin, chloramphenicol, cotrimoxazole, and kanamycin. Twenty (87%) and 8 (3.5%) strains had resistance to tetracycline and streptomycin respectively. PFGE analysis subtyped 23 strains into 10 profiles (Dice coefficient of similarity, F = 0.7-1.0). The predominant profile, X1 was found in both clinical and environmental isolates and was widely distributed in different parts of Malaysia during the study period. In addition, isolates recovered from food, a hand-towel, apron and the surface of a table-top in one particular location had unique, indistinguishable profiles (X4/4a) and identical antibiograms. Similarly, isolates from cooked meat and a chopping board had PFGE profiles similar to some human isolates. These probably indicated cross-contamination and poor hygiene in food practices, hence contributing to Salmonellosis. Factors causing the emergence of this rare Salmonella serovar being responsible for food poisoning episodes during the study period remained unclear. The study reiterated the usefulness and versatility of PFGE in the molecular subtyping of this rare Salmonella serovar in Malaysia.
The effect of ten microalgal chlorophytes isolated from mosquito breeding containers on the survival, larval development and adult body size of the mosquito Aedes aegypti was investigated. All larvae fed with six of the microalgal isolates died after 7 days. These isolates were found to be resistant to digestion by mosquito larvae. Delayed pupation and body size reduction of the mosquitos fed with Chlorococcum UMACC 218 and Scenedesmus UMACC 220 were observed. In contrast, larvae fed with Ankistrodesmus convolutus UMACC 101 and Chlorococcum UMACC 213 were bigger in size than those fed with normal insectory feed. The present study showed that microalgal chlorophytes have the potential to be used as larvicidal agents for mosquitos.
A pilot study was undertaken to determine the effectiveness of space application of insecticides for the control of malaria in Ranau, a district in Sabah. A village each was treated monthly: with chemical adulticide--alpha cypermethrin (Fendona SC(R)/10SC(R)) at 2 g a.i./10,000 m2 in Pahu; with biological larvicides--Bacillus thuringiensis israelensis (Vectobac 12AS(R)) at 500 ml/10,000 m2 or B. sphaericus (Vectolex WG(R)) at 500 g/10,000 m2 in Pinawantai; and with a mixture of chemical adulticide and biological larvicide in Togop Laut. All sprayings were conducted using a portable mist blower. During the study period all villages, including Tarawas the untreated village, received the conventional malaria control measures. Entomological and epidemiological surveillance was used to measure the effectiveness of the space application. The entomological surveillance indicated that the An. balabacensis population was significantly reduced by alpha cypermethrin in Pahu and Togop Laut and B. sphaericus in Pinawantai; but was not reduced by B.t.i. in Pinawantai. There was a significant reduction in the number of malaria cases and in the slide positivity rate in the treated villages during the study period. The pilot study does indicate that space application of larvicides/adulticides or a mixture of both is able to reduce the malaria vector population and the malaria transmission. A larger scale study needs to be undertaken in a malarious village/province to determine whether space application of insecticides together with other malaria control measures will be able to eradicate malaria.
We reviewed various studies regarding human toxoplasmosis in Malaysia. They showed a varying prevalence of specific Toxoplasma antibodies among the Malaysian population. The Malays have shown the highest seroprevalence of toxoplasmosis, by most studies, when compared to other races. Demographic profiles have shown that Toxoplasma seropositivity is higher in males than females, lower in people with higher incomes, higher in the unemployed and tends to increase with age. In general, the route of transmission, such as contact with a cat, consumption of undercooked meat and blood transfusion were shown to have no significant association with Toxoplasma seropositivity (p > 0.05). The immune status (CD4 cell count < 200 cell/mm3) was strongly associated with toxoplasmic encephalitis (p < 0.05).
A 38-year old female with underlying systemic lupus erythematosus was admitted with tuberculous meningoencephalitis. After an initial good response to anti-tuberculous treatment, she developed cerebral infarction and profound hyponatremia. This was due to cerebral salt wasting syndrome, which has only previously been described in 2 cases. The difficulties in diagnosis and management of this case are discussed.
Enteropathogenic Escherichia coli (EPEC) is a leading cause of diarrhea among infants in developing countries. A total of 38 EPEC isolates, obtained from diarrhea patients of Hospital Miri, Sarawak, were investigated through plasmid profile, antibiotic resistance and randomly amplified polymorphic DNA (RAPD) analysis. From the 8 types of antibiotics used, all isolates were 100% resistant to furoxime, cephalothin and sulphamethoxazole and showed high multiple antibiotic resistant (MAR) indexes, ranging from 0.5 to 1.0. In plasmid profiling, 22 isolates (58%) showed the presence of one or more plasmids in the range 1.0 to 30.9 mDa. The dendrogram obtained from the results of the RAPD-PCR discriminated the isolates into 30 single isolates and 3 clusters at the level of 40% similarity. The EPEC isolates were highly diverse, as shown by their differing plasmid profiles, antibiotic resistance patterns and RAPD profiles.
The intercountry border areas of Thailand have high malaria receptivity and vulnerability that present numerous problems in the control of malaria transmission. This study focused on the 30 provinces of Thailand situated next to neighboring countries, which can be divided into 4 groups: the Thai-Myanmar border (10 provinces), the Thai-Cambodia border (6 provinces), the Thai-Lao border (10 provinces) and the Thai-Malaysia border (4 provinces). The purpose of the present study was to describe the pattern and trend of malaria incidence in the highly endemic provinces along the Thai borders for the 11 years from 1991 to 2001. Analysis of trends showed the distribution of malaria parasites to have shifted from a preponderance of Plasmodium falciparum to Plasmodium vivax along the western border with Myanmar, the northern border with Lao PDR and along the eastern border with Cambodia whereas the southern border with Malaysia the pattern changed from a preponderance of P. vivax to P. falciparum, since 1997. There was a significant difference in annual parasite incidence between borders and non-border districts, especially along the Thai-Myanmar and Thai-Cambodia borders. It is thus evident that all border districts should pay more attention to control of malaria transmission and the activities of the malaria surveillance system, and that monitoring and evaluation of the Thai Malaria Control Program needs to be performed consistently, including some areas where a few malaria cases were found as well as in malaria free areas.
Telomerase, the enzyme that stabilizes telomere length is reactivated with almost all cancer types, and may be a useful diagnostic marker for malignancy. Telomerase activity has been detected in germ line cells and most cancer cells, whereas most normal somatic cells have no clearly detectable telomerase activity. In our study, we aim to detect telomerase activity in 20 human central nervous system tumors from Malaysian patients. Telomerase activity was detected based on a highly sensitive procedure consisting of a CHAPS detergent-based extraction from frozen tissues and a PCR-based telomeric repeat amplification protocol (TRAP) using a TRAPEZE Telomerase Detection Kit (Intergen, Co). Telomerase activity was considered positive when a ladder of products was observed starting at 50bp, with 6bp increments. The activity was detected in 30% of the samples analysed, included glioblastoma multiforme, meduloblastoma, paraganglioma and oligodendroglioma. The result of Fisher's exact test indicated that there was a significant association between telomerase activity status with tumor grade (p=0.003). These results suggest that telomerase activity may be an important marker for tumor malignancy.
Brugia malayi infection is endemic in several Asian countries. Filaria-specific IgG4 antibody detection based on BmR1 recombinant antigen has been shown to be sensitive and specific for the diagnosis of brugian filariasis. Two formats of the test has been reported ie indirect ELISA (BE) and rapid dipstick test (BR). Since different test formats use different amounts of sample and reagents which may affect its sensitivity and specificity, this study was performed to compare these two test formats in the detection of B. malayi. A total of 264 blinded serum samples from India and Malaysia were employed. Group 1 comprised 164 samples from actively infected individuals and group 2 comprised 100 samples from filaria non-endemic areas. Sensitivity was 96.3% (158/164) and 90.8% (149/164) for rapid test and ELISA respectively; chi-square p=0.00. Both test formats demonstrated 100% specificity. Therefore the rapid test format was equally specific but more sensitive than the ELISA format. The ELISA format would be able to demonstrate decline in IgG4 titer post-treatment while the rapid test would be very useful for screening and diagnosis in the field.