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Johor strait as a hotspot for trace elements contamination in peninsular Malaysia

Zulkifli SZ, Ismail A, Mohamat-Yusuff F, Arai T, Miyazaki N

Bull Environ Contam Toxicol, 2010 May;84(5):568-73.
PMID: 20411236 DOI: 10.1007/s00128-010-9998-8

Present study was conducted to evaluate current status of trace elements contamination in the surface sediments of the Johor Strait. Iron (2.54 +/- 1.24%) was found as the highest occurring element, followed by those of zinc (210.45 +/- 115.4 microg/g), copper (57.84 +/- 45.54 microg/g), chromium (55.50 +/- 31.24 microg/g), lead (52.52 +/- 28.41 microg/g), vanadium (47.76 +/- 25.76 microg/g), arsenic (27.30 +/- 17.11 microg/g), nickel (18.31 +/- 11.77 microg/g), cobalt (5.13 +/- 3.12 microg/g), uranium (4.72 +/- 2.52 microg/g), and cadmium (0.30 +/- 0.30 microg/g), respectively. Bioavailability of cobalt, nickel, copper, zinc, arsenic and cadmium were higher than 50% of total concentration. Vanadium, copper, zinc, arsenic and cadmium were found significantly different between the eastern and western part of the strait (p < 0.05). Combining with other factors, Johor Strait is suitable as a hotspot for trace elements contamination related studies.
Scoparia dulcis (SDF7) endowed with glucose uptake properties on L6 myotubes compared insulin

Beh JE, Latip J, Abdullah MP, Ismail A, Hamid M

J Ethnopharmacol, 2010 May 4;129(1):23-33.
PMID: 20193753 DOI: 10.1016/j.jep.2010.02.009

Insulin stimulates glucose uptake and promotes the translocation of glucose transporter 4 (Glut 4) to the plasma membrane on L6 myotubes. The aim of this study is to investigate affect of Scoparia dulcis Linn water extracts on glucose uptake activity and the Glut 4 translocation components (i.e., IRS-1, PI 3-kinase, PKB/Akt2, PKC and TC 10) in L6 myotubes compared to insulin.
An assessment of selected trace elements in intertidal surface sediments collected from the Peninsular Malaysia

Zulkifli SZ, Mohamat-Yusuff F, Arai T, Ismail A, Miyazaki N

Environ Monit Assess, 2010 Oct;169(1-4):457-72.
PMID: 19856123 DOI: 10.1007/s10661-009-1189-x

Concentrations of 11 trace elements (V, Cr, Co, Ni, Cu, Zn, As, Ag, Cd, Pb, and U) were determined in the intertidal surface sediments of Peninsular Malaysia. The average trace element concentrations are ranked as follows: Zn>V>As>Cr>Pb>Cu>Ni>Co>U>g>Cd. Interim Sediment Quality Guidelines (ISQGs) employed in present study are the Australia and New Zealand joint guideline (ANZECC/ARMCANZ), and the Hong Kong authorities. From the pooled data, none of these trace elements have the average concentration above the ISQG-high values. However, As and Ag average concentrations were over the ISQG-low values. Some elements were found to have the average concentration above the ISQG-high and/or ISQG-low in certain locations, including Kampung Pasir Putih (JPP), Lumut Port (ALP), Kuala Perai (PKP), Port Dickson (NPD), and others. The lowest and highest concentrations in a specific sampling location and maritime area varied among the elements, variations that were greatly affected by natural and anthropogenic activities in a given area. For each trace element, there were various levels of concentration among the sampling locations and maritime areas. These patterns indicated pollutant sources of an element for each area perhaps derived from nearby areas and did not widely distributed to other locations. It is necessary for Malaysia to develop an ISQG for effective quick screening and evaluation of the coastal environment of Peninsular Malaysia.
Carotenoid content of underutilized tropical fruits

Khoo HE, Ismail A, Mohd-Esa N, Idris S

Plant Foods Hum Nutr, 2008 Dec;63(4):170-5.
PMID: 18810641 DOI: 10.1007/s11130-008-0090-z

This study was conducted to evaluate the total carotene content (TCC) and beta carotene (BC) in the selected underutilized tropical fruits. TCC of underutilized fruits estimated by spectrophotometric method was in the range of 1.4-19.8 mg/100 g edible portion. The TCC of these fruits decreased in the order: Jentik-jentik > Durian Nyekak 2 > Durian Nyekak 1 > Cerapu 2 > Cerapu 1 > Tampoi Kuning > Bacang 1 > Kuini > Jambu Mawar > Bacang 2 > Durian Daun > Bacang 3 > Tampoi Putih > Jambu Susu. BC contents estimated by HPLC method were highest in Jentik-jentik, followed by Cerapu 2, Durian Nyekak 2, Tampoi Kuning, Durian Nyekak 1, and Cerapu 1, which had a range of 68-92% of BC in TCC. These underutilized fruits have an acceptable amount of carotenoids that are potential antioxidant fruits.
Anthropogenic impacts on heavy metal concentrations in the coastal sediments of Dumai, Indonesia

Amin B, Ismail A, Arshad A, Yap CK, Kamarudin MS

Environ Monit Assess, 2009 Jan;148(1-4):291-305.
PMID: 18274874 DOI: 10.1007/s10661-008-0159-z

Concentrations of Cd, Cu, Pb, Zn, Ni and Fe were determined in the surface sediments to investigate the distributions, concentrations and the pollution status of heavy metals in Dumai coastal waters. Sediment samples from 23 stations, representing 5 different site groups of eastern, central and western Dumai and southern and northern Rupat Island, were collected in May 2005. The results showed that heavy metal concentrations (in microg/g dry weight; Fe in %) were 0.88 (0.46-1.89); 6.08 (1.61-13.84); 32.34 (14.63-84.90); 53.89 (31.49-87.11); 11.48 (7.26-19.97) and 3.01 (2.10-3.92) for Cd, Cu, Pb, Zn, Ni and Fe, respectively. Generally, metal concentrations in the coastal sediments near Dumai city center (eastern and central Dumai) which have more anthropogenic activities were higher than those at other stations. Average concentration of Cd in the eastern Dumai was slightly higher than effective range low (ERL) but still below effective range medium (ERM) value established by Long et al. (Environmental Management 19(1):81-97, 1995; Environmental Toxicology Chemistry 17(4):714-727, 1997). All other metals were still below ERL and ERM. Calculated enrichment factor (EF), especially for Cd and Pb, and the Pollution load index (PLI) value in the eastern Dumai were also higher than other sites. Cd showed higher EF when compared to other metals. Geo-accumulation indices (I(geo)) in most of the stations (all site groups) were categorized as class 1 (unpolluted to moderately polluted environment) and only Cd in Cargo Port was in class 2 (moderately polluted). Heavy metal concentrations found in the present study were comparable to other regions of the world and based on the calculated indices it can be classified as unpolluted to moderately polluted coastal environment.
Baseline assessment of intensive care-acquired nosocomial infection surveillancein three adult intensive care units in Malaysia

Katherason SG, Naing L, Jaalam K, Ismail A

J Infect Dev Ctries, 2008 Oct 01;2(5):364-8.
PMID: 19745504

BACKGROUND: Nosocomial infections (NIs) have a serious impact on patient outcomes in Intensive Care Units (ICUs).
METHOD: A prospective cohort-targeted comprehensive surveillance study on NI associated with usage of devices was conducted in three ICUs in Malaysia using a developed NI surveillance form. Patients who developed infection outside an ICU were excluded from the study.
RESULTS: The device associated NI was 21.1%. The mean duration for development of NI was 10.0 +/- 7.44 days in ICU. The major device-associated infections were nosocomial pneumonia (18.7%) followed by bacteremia (8.5%) and urinary tract infections (4.7%) respectively. NI incidence density rate was 20.6 per 1,000 patient-days. Bacteremia, urinary tract infection (UTI) and nosocomial pneumonia (NP) rates were 8.9, 4.7 and 20.5 per 1,000 patient-days, respectively. Acinetobacter species, Klebseilla pneumoniae, Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus were the predominant pathogens isolated from the NIs subjects during the study period in the three ICUs.
CONCLUSION: Analysis of the rate of the NIs associated with usage of devices in the three ICUs showed that it is highly correlated with the use of mechanical ventilation devices, followed by intravascular devices and usage of indwelling urinary catheters.
Patterns of rapd markers and heavy metal concentrations in Perna viridis (L.), collected from metal-contaminated and uncontaminated coastal waters: are they correlated with each other?

Yap CK, Chua BH, Teh CH, Tan SG, Ismail A

Genetika, 2007 May;43(5):668-74.
PMID: 17633561

Genetic variation due to heavy metal contamination has always been an interesting topic of study. Because of the numerous contaminants being found in coastal and intertidal waters, there is always much discussion and argument as to which contaminant(s) caused the variations in the genetic structures of biomonitors. This study used a Single Primer Amplification Reaction (SPAR) technique namely Random Amplified Polymorphic DNA (RAPD) to determine the genetic diversity of the populations of the green-lipped mussel Perna viridis collected from a metal-contaminated site at Kg. Pasir Puteh and those from four relatively' uncontaminated sites (reference sites). Heavy metal levels (Cd, Cu, Pb and Zn) were also measured in the soft tissues and byssus of the mussels from all the sites. Cluster analyses employing UPGMA done based on the RAPD makers grouped the populations into two major clusters; the Bagan Tiang, Pantai Lido, Pontian and Kg. Pasir Puteh populations were in one cluster, while the Sg. Belungkor population clustered by itself. This indicated that the genetic diversity based on bands resulting from the use of all four RAPD primers on P. viridis did not indicate its potential use as a biomarker of heavy metal pollution in coastal waters. However, based on a correlation analysis between a particular metal and a band resulting from a specific RAPD primer revealed some significant (P < 0.01) correlations between the primers and the heavy metal concentrations in the byssus and soft tissues. Thus, the correlation between a particular metal and the bands resulting from the use of a specific RAPD primer on P. viridis could be used as biomonitoring tool of heavy metal pollution.
The reliability and validity of the Malay version of the 18-item audit of Diabetes Dependent Quality of Life (the Malay ADDQOL) questionnaire

Kamarul Imran M, Ismail AA, Naing L, Wan Mohamad WB

Southeast Asian J. Trop. Med. Public Health, 2007 Mar;38(2):398-405.
PMID: 17539293

The objective of this study was to examine the reliability and validity of the Malay version of the 18-item Audit of Diabetes Dependent Quality of Life (the Malay ADDQOL). Patients with type 2 diabetes mellitus who fulfilled the inclusion criteria were systematically selected. The Malay ADDQOL linguistically validated from the 18-item English version ADDQOL was self-administered twice at a 1-week interval. Two hundred eighty-eight respondents were included in the study. Analysis involved checking the feasibility, floor and ceiling effects, internal consistency, test-retest reliability and factor analysis. Item means and standard deviations fulfilled the Likert scale assumptions. The Cronbach's alpha was 0.943 (lower bound of the 95% CI of 0.935) and the intraclass correlation coefficient was 0.81 (95% CI from 0.72 to 0.87). Exploratory one factor analysis showed factor loadings above 0.5 for all the 18 items. The Malay ADDQOL has acceptable linguistic validity. It is feasible, has excellent reliability, content, construct validity, and is recommended to be used among Malay-speaking diabetic patients.
Crystalline style and tissue redistribution in Perna viridis as indicators of Cu and Pb bioavailabilities and contamination in coastal waters

Yap CK, Ismail A, Cheng WH, Tan SG

Ecotoxicol Environ Saf, 2006 Mar;63(3):413-23.
PMID: 16406592

The concentrations of Cu, Pb, and Zn in the crystalline style (CS) and in the remaining soft tissues (ST) of the green-lipped mussel Perna viridis from 10 geographical sites along the coastal waters off peninsular Malaysia were determined. The CS, compared with the remaining ST, accumulated higher levels of Cu in both contaminated and uncontaminated samples, indicating that the style has a higher affinity for the essential Cu to bind with metallothioneins. The similar pattern of Cu accumulation in the different ST of mussels collected from clean and Cu-contaminated sites indicated that the detoxification capacity of the metallothioneins had not been overloaded. For Pb, higher levels of the metal in the CS than in the remaining ST were found only in mussels collected from a contaminated site at Kg. Pasir Puteh. This indicated a tissue redistribution of Pb due to its binding to metallothioneins for Pb detoxification and the potential of the CS as an indicator organ of Pb bioavailability and contamination. For Zn, the above two phenomena were not found since no obvious patterns were observed (lower levels of Zn in the CS than in the remaining ST) in contaminated and uncontaminated samples due to the mechanism of partial regulation. Generally, all the different STs studied (foot, mantle, gonad, CS, gill, muscle, and byssus) are good biomonitoring tissues for Cu and Pb bioavailabilities and contamination. Among these organs, the CS was found to be the best organ for biomonitoring Cu. The present data also suggest the use of the tissue redistribution of Pb in P. viridis as an indicator of Pb bioavailability and contamination in coastal waters.
Health Related Quality of Life in Malaysian children with thalassaemia

Ismail A, Campbell MJ, Ibrahim HM, Jones GL

Health Qual Life Outcomes, 2006;4:39.
PMID: 16813662

Health Related Quality of Life (HRQoL) studies on children with chronic illness such as thalassaemia are limited. We conducted the first study to investigate if children with thalassaemia have a lower quality of life in the four dimensions as measured using the PedsQL 4.0 generic Scale Score: physical, emotional, social and role (school) functioning compared to the healthy controls allowing for age, gender, ethnicity and household income.
Fulltext Actinopyga lecanora hydrolysates as natural antibacterial agents

Ghanbari R, Ebrahimpour A, Abdul-Hamid A, Ismail A, Saari N

Int J Mol Sci, 2012;13(12):16796-811.
PMID: 23222684 DOI: 10.3390/ijms131216796

Actinopyga lecanora, a type of sea cucumber commonly known as stone fish with relatively high protein content, was explored as raw material for bioactive peptides production. Six proteolytic enzymes, namely alcalase, papain, pepsin, trypsin, bromelain and flavourzyme were used to hydrolyze A. lecanora at different times and their respective degrees of hydrolysis (DH) were calculated. Subsequently, antibacterial activity of the A. lecanora hydrolysates, against some common pathogenic Gram positive bacteria (Bacillus subtilis and Staphylococcus aureus) and Gram negative bacteria (Escherichia coli, Pseudomonas aeruginosa, and Pseudomonas sp.) were evaluated. Papain hydrolysis showed the highest DH value (89.44%), followed by alcalase hydrolysis (83.35%). Bromelain hydrolysate after one and seven hours of hydrolysis exhibited the highest antibacterial activities against Pseudomonas sp., P. aeruginosa and E. coli at 51.85%, 30.07% and 30.45%, respectively compared to the other hydrolysates. Protein hydrolysate generated by papain after 8 h hydrolysis showed maximum antibacterial activity against S. aureus at 20.19%. The potent hydrolysates were further fractionated using RP-HPLC and antibacterial activity of the collected fractions from each hydrolysate were evaluated, wherein among them only three fractions from the bromelain hydrolysates exhibited inhibitory activities against Pseudomonas sp., P. aeruginosa and E. coli at 24%, 25.5% and 27.1%, respectively and one fraction of papain hydrolysate showed antibacterial activity of 33.1% against S. aureus. The evaluation of the relationship between DH and antibacterial activities of papain and bromelain hydrolysates revealed a meaningful correlation of four and six order functions.
Optimization of polyvinylidene fluoride (PVDF) membrane fabrication for protein binding using statistical experimental design

Ahmad AL, Ideris N, Ooi BS, Low SC, Ismail A

J Immunoassay Immunochem, 2016;37(4):421-37.
PMID: 27088961 DOI: 10.1080/15321819.2016.1157489

Statistical experimental design was employed to optimize the preparation conditions of polyvinylidenefluoride (PVDF) membranes. Three variables considered were polymer concentration, dissolving temperature, and casting thickness, whereby the response variable was membrane-protein binding. The optimum preparation for the PVDF membrane was a polymer concentration of 16.55 wt%, a dissolving temperature of 27.5°C, and a casting thickness of 450 µm. The statistical model exhibits a deviation between the predicted and actual responses of less than 5%. Further characterization of the formed PVDF membrane showed that the morphology of the membrane was in line with the membrane-protein binding performance.
Fulltext The inhibitory activity of cocoa phenolic extract against pro-inflammatory mediators secretion induced by lipopolysaccharide in RAW 264.7 cells

Ranneh Y, Ali F, Al-Qubaisi M, Esa NM, Ismail A

Springerplus, 2016;5:547.
PMID: 27190746 DOI: 10.1186/s40064-016-2138-0

Cocoa is a rich source of polyphenols that has been traditionally used as the treatment of several types of inflammation related disease. The response to inflammation comprises the consecutive release of mediators and the enlistment of circulating leukocytes, such as macrophages. Currently, Cocoa-derived polyphenolics have shown anti-inflammatory effects in vivo, but the therapeutic benefits in vitro remain unclear. Therefore, in this study, the effect of cocoa polyphenolic extract (CPE) on RAW 264.7 macrophage cells sensitized by lipopolysaccharide as in vitro inflammatory model was investigated. The anti-inflammatory activity of CPE was assessed by measuring its ability to inhibit the pro-inflammatory enzyme 5-lipoxygenase (5-LOX) and the pro-inflammatory mediators prostaglandin E2 (PGE2), reactive oxygen species (ROS), nitric oxide (NO) and tumor necrosis factor-alpha (TNF-α). The results show that CPE significantly inhibits 5-LOX activity (p
Health risk assessments of heavy metal exposure via consumption of marine mussels collected from anthropogenic sites

Yap CK, Cheng WH, Karami A, Ismail A

Sci Total Environ, 2016 May 15;553:285-96.
PMID: 26925739 DOI: 10.1016/j.scitotenv.2016.02.092

A total of 40 marine mussel Perna viridis populations collected (2002-2009) from 20 geographical sites located in two busy shipping lanes namely the Straits of Malacca (10 sites; 16 populations) and the Straits of Johore (8 sites; 21 populations) and three populations (2 sites) on the east coast of Peninsular Malaysia, was determined for Cd, Cu, Fe, Ni, Pb and Zn concentrations. In comparison with the maximum permissible limits (MPLs) set by existing food safety guidelines, all metal concentrations found in all the mussel populations were lower than the prescribed MPLs. In terms of the provisional tolerable weekly intake prescribed by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) and oral reference doses (ORDs) by the USEPA, all the studied metals (except for Pb) were unlikely to become the limiting factors or unlikely to pose a risk for the consumption of the mussel populations. The estimated daily intake (EDI) for average level mussel (ALM) and high level mussel (HLM) consumers of mussels was found to be lower than the ORD guidelines for Cd, Cu, Fe, Ni and Zn. Furthermore, the target hazard quotient (THQ) was found to be less than 1 for ALM consumers but higher than 1 for HLM consumers in some sites. Therefore, there were no potential human health risks to the ALM consumers of the mussels. However, for Pb THQ values, the Pb levels in some mussel populations could create a health risk problem. Present results indicate that the consumption amounts of mussels should be limited for minimizing potential health risks of heavy metals to the HLM consumers.
Metabolic alteration in obese diabetes rats upon treatment with Centella asiatica extract

Maulidiani, Abas F, Khatib A, Perumal V, Suppaiah V, Ismail A, et al.

J Ethnopharmacol, 2016 Mar 2;180:60-9.
PMID: 26775274 DOI: 10.1016/j.jep.2016.01.001

'Pegaga' is a traditional Malay remedy for a wide range of complaints. Among the 'pegaga', Centella asiatica has been used as a remedy for diabetes mellitus. Thus, we decided to validate this claim by evaluating the in vivo antidiabetic property of C. asiatica (CA) on T2DM rat model using the holistic (1)H NMR-based metabolomics approach.
Fulltext A higher sensitivity and efficiency of common primer multiplex PCR assay in identification of meat origin using NADH dehydrogenase subunit 4 gene

Hanapi UK, Desa MN, Ismail A, Mustafa S

J Food Sci Technol, 2015 Jul;52(7):4166-75.
PMID: 26139881 DOI: 10.1007/s13197-014-1459-7

A Common Primer Multiplex PCR (CP-M-PCR) was developed to detect meat origin of four groups of animal (pig, ruminant, avian and rabbit). This method demonstrated higher sensitivity and efficiency than the conventional multiplex PCR. In this approach, a common forward primer was designed in the 5' end of a homologous region of mitochondrial NADH dehyrogenase subunit 4 (Nad 4) gene sequences of all the animal groups. Specific adapter reverse primers were designed by adding an adapter sequence at the 5' end. The same adapter sequence was used as the common adapter reverse primer. The primers generated specific fragments of 267, 370, 504, and 548 bp lengths for pig, ruminant, avian and rabbit meats, respectively. The use of adapter sequence at the 5' end of the common adapter reverse primers increased the efficiency of the amplification and the application of a common forward primer solved the complexity in multiplex PCR system. Bands of specific amplification can be detected in the PCR assays containing as low as 10(-6) μM of adapter reverse primer. This result indicated that the sensitivity was tremendously increased as compared to the conventional multiplex PCR (10(-3) μM). CP-M-PCR detection limit of the DNA samples was 0.1 ng for the four groups of meats. CP-M-PCR has greatly improved the sensitivity and efficiency of the PCR system for a more reliable and accurate outcome than conventional multiplex PCR system.
Influence of bentonite in polymer membranes for effective treatment of car wash effluent to protect the ecosystem

Kiran SA, Arthanareeswaran G, Thuyavan YL, Ismail AF

Ecotoxicol Environ Saf, 2015 Nov;121:186-92.
PMID: 25869419 DOI: 10.1016/j.ecoenv.2015.04.001

In this study, modified polyethersulfone (PES) and cellulose acetate (CA) membranes were used in the treatment of car wash effluent using ultrafiltration. Hydrophilic sulfonated poly ether ether ketone (SPEEK) and bentonite as nanoclay were used as additives for the PES and CA membrane modification. Performances of modified membranes were compared with commercial PES membrane with 10kDa molecular weight cut off (MWCO). The influencing parameters like stirrer speed (250-750rpm) and transmembrane pressure (100-600kPa) (TMP) were varied and their effects were studied as a function of flux. In the treatment of car wash effluent, a higher permeate flux of 52.3L/m(2)h was obtained for modified CA membrane at TMP of 400kPa and stirrer speed of 750rpm. In comparison with modified PES membrane and commercial PES membrane, modified CA membranes showed better performance in terms of flux and flux recovery ratio. The highest COD removal (60%) was obtained for modified CA membrane and a lowest COD removal (47%) was observed for commercial PES membrane. The modified membranes were better at removing COD, turbidity and maintained more stable flux than commercial PES membrane, suggesting they will provide better economic performance in car wash effluent reclamation.
Enzyme immunoassay for the detection of porcine gelatine in edible bird's nests

Tukiran NA, Ismail A, Mustafa S, Hamid M

Food Addit Contam Part A Chem Anal Control Expo Risk Assess, 2015;32(7):1023-8.
PMID: 25861981 DOI: 10.1080/19440049.2015.1039605

Porcine gelatine is a common adulterant found in edible bird's nests (EBNs) used to increase the net weight prior to sale. This study aimed to develop indirect enzyme-linked immunosorbent assays (ELISAs) for porcine gelatine adulteration using anti-peptide polyclonal antibodies. Three indirect ELISAs were developed (PAB1, 2 and 3), which had limits of detection (LODs) of 0.12, 0.10 and 0.11 µg g(-1), respectively. When applied to standard solutions of porcine gelatine, the inter- and intra-assays showed coefficients of variation (CVs) less than 20% and were able to detect at least 0.5 ng µg(-1) (0.05%) porcine gelatine in spiked samples. The proposed ELISA offers attractions for quality control in the EBN industry.
Fulltext Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia

Lakhwani MN, Ismail AR, Barras CDJ, Tan WJ

Med J Malaysia, 2000 Dec;55(4):498-505.
PMID: 11221164

Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit beds and more active participation of multidisciplinary teams in co-ordinating management are among remedial measures advocated. Broader educational preventive strategies should target the causes of UGI bleeding.
Susceptibility pattern of Streptococcus pneumoniae among pre-school children in Kota Bharu, Malaysia

Malik AS, Ismail A, Pennie RA, Naidu JV

J Trop Pediatr, 1998 02;44(1):10-4.
PMID: 9538599 DOI: 10.1093/tropej/44.1.10

Streptococcus pneumoniae (S. pneumoniae) is the most common bacterial cause of pneumonia, meningitis, and otitis media, with the highest incidence among young children and the elderly. S. pneumoniae was once routinely susceptible to penicillin, but since the mid-1980s the incidence of resistance to penicillin and other antimicrobial agents has been increasing all over the world. To optimize empirical regimens and initial therapy for S. pneumoniae infections, clinical healthcare providers must be informed about the prevalence and pattern of drug resistance among the isolates in their communities. No such data are available for the Malaysian population. Therefore, this study was designed to determine the antibiotic susceptibility pattern of S. pneumoniae among colonized pre-school children in Kota Bharu, Malaysia. Pharyngeal swabs were collected from children 1 month to 6 years of age. S. pneumoniae isolates were identified according to the standard and tested for penicillin resistance with a 1-microgram oxacillin disk by the Kirby-Bauer disk diffusion methods. Of 355 nasopharyngeal specimens obtained from kindergarten students, in-patients and pediatric clinics over a period of 1 year, S. pneumoniae was isolated from 36 (10 per cent). All isolates, except one, were susceptible to penicillin. The resistant isolates was susceptible to erythromycin, chloramphenicol and cephalosporins.
Study site: kindergarten, schools, pediatric outpatients clinics, and in-patient wards of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.

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