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Fulltext Comparison on the Effects and Safety of Tualang Honey and Tribestan in Sperm Parameters, Erectile Function, and Hormonal Profiles among Oligospermic Males

Ismail SB, Bakar MB, Nik Hussain NH, Norhayati MN, Sulaiman SA, Jaafar H, et al.

Evid Based Complement Alternat Med, 2014;2014:126138.
PMID: 25505918 DOI: 10.1155/2014/126138

Introduction. This study aims to evaluate the effectiveness of Tualang honey on sperm parameters, erectile function, and hormonal and safety profiles. Methodology. A randomized control trial was done using Tualang honey (20 grams) and Tribestan (750 mg) over a period of 12 weeks. Sperm parameters including sperm concentration, motility, and morphology were analyzed and erectile function was assessed using IIEF-5 questionnaire. Hormonal profiles of testosterone, FSH, and LH were studied. The volunteers were randomized into two groups and the outcomes were analyzed using SPSS version 18. Results. A total of 66 participants were involved. A significant increment of mean sperm concentration (P < 0.001), motility (P = 0.015) and morphology (P = 0.008) was seen in Tualang honey group. In Tribestan group, a significant increment of mean sperm concentration (P = 0.007), and morphology (P = 0.009) was seen. No significant differences of sperm concentration, motility, and morphology were seen between Tualang honey and Tribestan group and similar results were also seen in erectile function and hormonal profile. All safety profiles were normal and no adverse event was reported. Conclusion. Tualang honey effect among oligospermic males was comparable with Tribestan in improving sperm concentration, motility, and morphology. The usage of Tualang honey was also safe with no reported adverse event.
Fulltext Ameliorative Effects of Aquilaria malaccensis Leaves Aqueous Extract on Reproductive Toxicity Induced by Cyclophosphamide in Male Rats

Razak RNHA, Ismail F, Isa MLM, Wahab AYA, Muhammad H, Ramli R, et al.

Malays J Med Sci, 2019 Jan;26(1):44-57.
PMID: 30914892 MyJurnal DOI: 10.21315/mjms2019.26.1.4

Background: Cyclophosphamide (CP) is a widely used anti-neoplastic and immunosuppressive agent that is associated with adverse side effects including reproductive toxicity. Aquilaria malaccensis (AM) is a traditional medicinal plant which was reported to exhibit high anti-oxidant and free radical scavenging properties. The present study was aimed to evaluate the protective effects of AM leaves extract on sperm quality following toxic exposure to CP.
Methods: Forty-eight male Sprague Dawley rats were allocated into eight groups of six rats (n = 6): control, CP only (200 mg kg-1), AM only (100 mg kg-1, 300 mg kg-1 and 500 mg kg-1) and CP + AM (100 mg kg-1, 300 mg kg-1 and 500 mg kg-1). Animals were sacrificed after 63 days of treatment and the sperm from the caudal epididymis was taken for sperm analysis.
Results: The body and the reproductive organs weight, sperm count and motility did not differ between CP and other groups (P > 0.05). A significant increase (P < 0.05) in percentage of the dead and abnormal sperm were seen in the CP alone treated group compared to the control group. Co-administration of AM to the CP exposed rats significantly reduced the (P < 0.05) percentage of abnormal sperm as compared to the CP only group.
Conclusion: Overall, the present results represent the potential of AM to protect against CP induced reproductive toxicity.
Fulltext New zoonotic cases of Onchocerca dewittei japonica (Nematoda: Onchocercidae) in Honshu, Japan

Uni S, Fukuda M, Otsuka Y, Hiramatsu N, Yokobayashi K, Takahashi H, et al.

Parasit Vectors, 2015;8:59.
PMID: 25623081 DOI: 10.1186/s13071-015-0655-2

Zoonotic infections with Onchocerca species are uncommon, and to date only 25 clinical cases have been reported worldwide. In Japan, five previous zoonotic infections were concentrated in Oita, Kyushu (the southern island), with one previous case in Hiroshima in the western part of Honshu (the main island). The causative agent in Japan was identified as Onchocerca dewittei japonica Uni, Bain & Takaoka, 2001 from Japanese wild boars (Sus scrofa leucomystax Temminck, 1842). Here we report two infections caused by a female and male O. dewittei japonica, respectively, among residents of Hiroshima and Shimane Prefectures in the western part of Honshu.
Fulltext Delineating taxonomic boundaries in the largest species complex of black flies (Simuliidae) in the Oriental Region

Low VL, Takaoka H, Pramual P, Adler PH, Ya'cob Z, Huang YT, et al.

Sci Rep, 2016 Feb 03;6:20346.
PMID: 26839292 DOI: 10.1038/srep20346

Perspicuous assessments of taxonomic boundaries and discovery of cryptic taxa are of paramount importance in interpreting ecological and evolutionary phenomena among black flies (Simuliidae) and combating associated vector-borne diseases. Simulium tani Takaoka & Davies is the largest and perhaps the most taxonomically challenging species complex of black flies in the Oriental Region. We use a DNA sequence-based method to delineate currently recognized chromosomal and morphological taxa in the S. tani complex on the Southeast Asian mainland and Taiwan, while elucidating their phylogenetic relationships. A molecular approach using multiple genes, coupled with morphological and chromosomal data, supported recognition of cytoform K and morphoform 'b' as valid species; indicated that S. xuandei, cytoform L, and morphoform 'a' contain possible cryptic species; and suggested that cytoform B is in the early stages of reproductive isolation whereas lineage sorting is incomplete in cytoforms A, C, and G.
Onchocerca takaokai n. sp. (Nematoda: Filarioidea) in Japanese wild boars (Sus scrofa leucomystax): Description and molecular identification of intradermal females

Uni S, Fukuda M, Agatsuma T, Bain O, Otsuka Y, Nakatani J, et al.

Parasitol Int, 2015 Dec;64(6):493-502.
PMID: 26165205 DOI: 10.1016/j.parint.2015.07.001

Human zoonotic onchocercosis is caused by Onchocerca dewittei japonica, parasitic in wild boars (Sus scrofa leucomystax) in Japan. Previously, microfilariae longer than those of Onchocerca dewittei japonica were observed in skin snips from wild boars during the study of O. dewittei japonica. Moreover, the third-stage larvae (L3) of these longer microfilariae were obtained from the blackfly Simulium bidentatum after experimental injections. Based on morphometric and molecular studies, similar L3 were found in blackflies during fieldwork in Oita, Japan. However, except for O. dewittei japonica, adult worms of Onchocerca have not been found in wild boars. In this study, we discovered adult females of a novel Onchocerca species in the skin of a wild boar in Oita, and named it Onchocerca takaokai n. sp. Females of this new species had longer microfilariae and differed from O. dewittei japonica in terms of their morphological characteristics and parasitic location. The molecular characteristics of the cytochrome c oxidase subunit 1 and 12S rRNA genes of the new species were identical to those of the longer microfilariae and L3 previously detected, but they differed from those of O. dewittei japonica at the species level. However, both species indicated a close affinity among their congeners and Onchocerca ramachandrini, parasitic in the warthog in Africa, was basal in the Suidae cluster of the 12S rRNA tree.
Fulltext Mesenchymal stem cells: A comprehensive methods for odontoblastic induction

Koh B, Sulaiman N, Ismadi SNSW, Ramli R, Yunus SSM, Idrus RBH, et al.

Biol Proced Online, 2021 Sep 15;23(1):18.
PMID: 34521356 DOI: 10.1186/s12575-021-00155-7

BACKGROUND: In the area of oral and maxillofacial surgery, regenerative endodontics aims to present alternative options to conventional treatment strategies. With continuous advances in regenerative medicine, the source of cells used for pulp tissue regeneration is not only limited to mesenchymal stem cells as the non-mesenchymal stem cells have shown capabilities too. In this review, we are systematically assessing the recent findings on odontoblastic differentiation induction with scaffold and non-scaffold approaches.
METHODS: A comprehensive search was conducted in Pubmed, and Scopus, and relevant studies published between 2015 and 2020 were selected following the PRISMA guideline. The main inclusion criteria were that articles must be revolving on method for osteoblast differentiation in vitro study. Therefore, in vivo and human or animal clinical studies were excluded. The search outcomes identified all articles containing the word "odontoblast", "differentiation", and "mesenchymal stem cell".
RESULTS: The literature search identified 99 related studies, but only 11 articles met the inclusion criteria. These include 5 odontoblastic differentiation induction with scaffold, 6 inductions without scaffolds. The data collected were characterised into two main categories: type of cells undergo odontoblastic differentiation, and odontoblastic differentiation techniques using scaffolds or non-scaffold.
CONCLUSION: Based on the data analysis, the scaffold-based odontoblastic induction method seems to be a better option compared to the non-scaffold method. In addition of that, the combination of growth factors in scaffold-based methods could possibly enhance the differentiation. Thus, further detailed studies are still required to understand the mechanism and the way to enhance odontoblastic differentiation.
Fulltext A preliminary report on ants (Hymenoptera: Formicidae) recovered from forensic entomological studies conducted in different ecological habitats in Malaysia

Chen CD, Nazni WA, Lee HL, Hashim R, Abdullah NA, Ramli R, et al.

Trop Biomed, 2014 Jun;31(2):381-6.
PMID: 25134909 MyJurnal

This study reported the ant species that were recovered from monkey carcasses in three different ecological habitats in Malaysia. The study was conducted from 9 May - 10 October 2007, 6 May - 6 August 2008 and 26 May - 14 July 2009 in forested area (Gombak, Selangor), coastal area (Tanjong Sepat, Selangor) and highland area (Bukit Cincin, Pahang), respectively. Monkey carcass was used as a model for human decomposition in this study. A total of 4 replicates were used in each of the study sites. Ants were observed to prey on eggs, larvae, pupae and newly emerged flies. This study found that ant species could be found at all stages of decomposition, indicating that ants were not a significant indicator for faunal succession. However, different species of ants were obtained from monkey carcasses placed in different ecological habitats. Cardiocondyla sp. was only found on carcasses placed in the coastal area; while Pheidole longipes, Hypoponera sp. and Pachycondyla sp. were solely found on carcasses placed in the highland area. On the other hand, Pheidologeton diversus and Paratrechina longicornis were found in several ecological habitats. These data suggests that specific ant species can act as geographic indicators for different ecological habitats in forensic entomology cases in Malaysia.
Fulltext Synthesis and Characterization of Porous, Electro-Conductive Chitosan-Gelatin-Agar-Based PEDOT: PSS Scaffolds for Potential Use in Tissue Engineering

Ahmad Ruzaidi DA, Mahat MM, Mohamed Sofian Z, Nor Hashim NA, Osman H, Nawawi MA, et al.

Polymers (Basel), 2021 Aug 28;13(17).
PMID: 34502941 DOI: 10.3390/polym13172901

Herein we report the synthesis and characterization of electro-conductive chitosan-gelatin-agar (Cs-Gel-Agar) based PEDOT: PSS hydrogels for tissue engineering. Cs-Gel-Agar porous hydrogels with 0-2.0% (v/v) PEDOT: PSS were fabricated using a thermal reverse casting method where low melting agarose served as the pore template. Sample characterizations were performed by means of scanning electron microscopy (SEM), attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR), X-ray diffraction analysis (XRD) and electrochemical impedance spectroscopy (EIS). Our results showed enhanced electrical conductivity of the cs-gel-agar hydrogels when mixed with DMSO-doped PEDOT: PSS wherein the optimum mixing ratio was observed at 1% (v/v) with a conductivity value of 3.35 × 10-4 S cm-1. However, increasing the PEDOT: PSS content up to 1.5 % (v/v) resulted in reduced conductivity to 3.28 × 10-4 S cm-1. We conducted in vitro stability tests on the porous hydrogels using phosphate-buffered saline (PBS) solution and investigated the hydrogels' performances through physical observations and ATR-FTIR characterization. The present study provides promising preliminary data on the potential use of Cs-Gel-Agar-based PEDOT: PSS hydrogel for tissue engineering, and these, hence, warrant further investigation to assess their capability as biocompatible scaffolds.
Supporting family doctors to address elder abuse: a quasi-experimental study in Malaysia

Mohd Mydin FH, Othman S, Choo WY, Hairi NNM, Hairi FM, Syed Karim SN, et al.

J Elder Abuse Negl, 2021 04 25;33(2):151-167.
PMID: 33899705 DOI: 10.1080/08946566.2021.1919272

This quasi-experimental study examined the effect of Supporting Family Doctors to Address Elder Abuse (SAFE) educational intervention among family doctors practicing at public primary care clinics in Malaysia. SAFE is an intensive, multimodal, locally tailored, and culturally sensitive face-to-face educational intervention on elder abuse. A significant mean score improvement of knowledge [Baseline: 5.33 (SD:1.33) to 6-month post-intervention: 6.45 (SD: 1.35); p<0.001] and perceived behavioral control [Baseline: 50.83 (SD: 8.87) to six-month post-intervention: 56.16 (SD: 9.56); p<0.001] observed in the intervention group compared to the control group. No significant difference in attitude, subjective norm, and practice scores between the two groups over time. SAFE educational intervention for family doctors was effective to improve but not sustainable knowledge and perceived behavioral control toward elder abuse identification and management. We recommend SAFE educational intervention as part of the continuous medical education for family doctors supplemented with a change in organization and national policy.
Advocating Electrically Conductive Scaffolds with Low Immunogenicity for Biomedical Applications: A Review

Ahmad Ruzaidi DA, Mahat MM, Shafiee SA, Mohamed Sofian Z, Mohmad Sabere AS, Ramli R, et al.

Polymers (Basel), 2021 Oct 02;13(19).
PMID: 34641210 DOI: 10.3390/polym13193395

Scaffolds support and promote the formation of new functional tissues through cellular interactions with living cells. Various types of scaffolds have found their way into biomedical science, particularly in tissue engineering. Scaffolds with a superior tissue regenerative capacity must be biocompatible and biodegradable, and must possess excellent functionality and bioactivity. The different polymers that are used in fabricating scaffolds can influence these parameters. Polysaccharide-based polymers, such as collagen and chitosan, exhibit exceptional biocompatibility and biodegradability, while the degradability of synthetic polymers can be improved using chemical modifications. However, these modifications require multiple steps of chemical reactions to be carried out, which could potentially compromise the end product's biosafety. At present, conducting polymers, such as poly(3,4-ethylenedioxythiophene) poly(4-styrenesulfonate) (PEDOT: PSS), polyaniline, and polypyrrole, are often incorporated into matrix scaffolds to produce electrically conductive scaffold composites. However, this will reduce the biodegradability rate of scaffolds and, therefore, agitate their biocompatibility. This article discusses the current trends in fabricating electrically conductive scaffolds, and provides some insight regarding how their immunogenicity performance can be interlinked with their physical and biodegradability properties.
Fulltext Cost analysis of facial injury treatment in two university hospitals in Malaysia: a prospective study

Saperi BS, Ramli R, Ahmed Z, Muhd Nur A, Ibrahim MI, Rashdi MF, et al.

Clinicoecon Outcomes Res, 2017;9:107-113.
PMID: 28223831 DOI: 10.2147/CEOR.S119910

OBJECTIVE: Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma.
MATERIALS AND METHODS: A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed.
RESULTS: A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia.
CONCLUSION: Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia.
Barriers to and Facilitators of Asthma Care For Malaysian Hajj Pilgrims: A Qualitative Study

Ramli R, Hanafi NS, Hussein N, Lee PY, Shariff Ghazali S, Cheong AT, et al.

Asia Pac J Public Health, 2023 Feb 28.
PMID: 36852891 DOI: 10.1177/10105395231158684

Asthma exacerbations are among the commonest reasons for hospitalizations in Malaysian pilgrims during the Hajj. We interviewed 21 stakeholders involved in the pre-Hajj health examination at 14 primary care clinics, to explore their perceptions on barriers to and facilitators of asthma care for Hajj pilgrims. The disadvantages of the short time frame and centralized organization of the pre-Hajj health examinations were viewed as compromising clinicians' level of competencies in asthma care, which could potentially be enhanced through more training, audit, and supervision by specialists. Longer time frame to permit sufficient disease control, provision of care by a dedicated asthma team, asthma registry to support continuous care, more resources of long-acting β-agonist/inhaled corticosteroid, and provision of influenza and pneumococcal vaccines at no cost were the perceived facilitators. Delivery of asthma education, especially the asthma action plan, should be tailored to the level of the pilgrim's health literacy and facilitated by educational resources, family engagement, and regular health briefing.
Diagnostic value of serum and tissue eosinophil in diagnosis of asthma among patients with chronic rhinosinusitis

Che Mat CMH, Md Shukri N, Mohamad S, Tuan Sharif SE, Ramli R, Jais MH, et al.

Eur Arch Otorhinolaryngol, 2023 May;280(5):2283-2291.
PMID: 36401099 DOI: 10.1007/s00405-022-07746-4

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common chronic inflammatory diseases of sinonasal mucosa. Asthma among CRS patients is often underdiagnosed which makes the management of CRS more challenging. Therefore, using serum and tissue eosinophil as an indicator and predictor of asthma in CRS patients is vital for further preventing recurrent and increasing the effectiveness of treatment for CRS.
OBJECTIVE: To determine the association and diagnostic ability of serum and tissue eosinophils in the diagnosis of asthma among CRS patients.
METHODS: A cross-sectional study was conducted involving 24 CRS patients with asthma and without asthma, respectively, from the Otorhinolaryngology clinic of two tertiary hospitals located on the East Coast of Peninsular Malaysia. Serum and tissue eosinophils (obtained from nasal polyp) levels between both groups were compared. Association between serum and tissue eosinophils with asthma was evaluated using logistic regression analysis, adjusting for important sociodemographic characteristics. The diagnostic ability of serum and tissue eosinophil was then evaluated by assessing the receiver operating characteristic curve.
RESULTS: A total of 48 CRS patients with a mean [SD] age of 47.50 [14.99] years were included. Patients with asthma had significantly higher serum [0.48 vs 0.35 × 109/L] and tissue eosinophil [100 vs 8.5 per HPF] levels. Tissue eosinophils were found to be an independent predictor of asthma with adjusted OR 1.05, p 0.375 × 109/L and tissue eosinophil > 58 per HPF.
Healthcare resources, organisational support and practice in asthma in six public health clinics in Malaysia

Hussein N, Ramli R, Liew SM, Hanafi NS, Lee PY, Cheong AT, et al.

NPJ Prim Care Respir Med, 2023 Mar 27;33(1):13.
PMID: 36973274 DOI: 10.1038/s41533-023-00337-8

Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors' practice in managing asthma in a Malaysian primary care setting. A total of six public health clinics participated. We found four clinics had dedicated asthma services. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, but not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in main locations of the clinic. To diagnose asthma, most doctors used clinical judgement and peak flow metre measurements with reversibility test. Although spirometry is recommended to diagnose asthma, it was less practiced, being inaccessible and unskilled in using as the main reasons. Most doctors reported providing asthma self-management; asthma action plan, but for only half of the patients that they encountered. In conclusion, there is still room for improvement in the provision of clinic resources and support for asthma care. Utilising peak flow metre measurement and reversibility test suggest practical alternative in low resource for spirometry. Reinforcing education on asthma action plan is vital to ensure optimal asthma care.
Fulltext Dorsal root ganglia control nociceptive input to the central nervous system

Hao H, Ramli R, Wang C, Liu C, Shah S, Mullen P, et al.

PLoS Biol, 2023 Jan;21(1):e3001958.
PMID: 36603052 DOI: 10.1371/journal.pbio.3001958

Accumulating observations suggest that peripheral somatosensory ganglia may regulate nociceptive transmission, yet direct evidence is sparse. Here, in experiments on rats and mice, we show that the peripheral afferent nociceptive information undergoes dynamic filtering within the dorsal root ganglion (DRG) and suggest that this filtering occurs at the axonal bifurcations (t-junctions). Using synchronous in vivo electrophysiological recordings from the peripheral and central processes of sensory neurons (in the spinal nerve and dorsal root), ganglionic transplantation of GABAergic progenitor cells, and optogenetics, we demonstrate existence of tonic and dynamic filtering of action potentials traveling through the DRG. Filtering induced by focal application of GABA or optogenetic GABA release from the DRG-transplanted GABAergic progenitor cells was specific to nociceptive fibers. Light-sheet imaging and computer modeling demonstrated that, compared to other somatosensory fiber types, nociceptors have shorter stem axons, making somatic control over t-junctional filtering more efficient. Optogenetically induced GABA release within DRG from the transplanted GABAergic cells enhanced filtering and alleviated hypersensitivity to noxious stimulation produced by chronic inflammation and neuropathic injury in vivo. These findings support "gating" of pain information by DRGs and suggest new therapeutic approaches for pain relief.
Fulltext Redescription, molecular characterisation and Wolbachia endosymbionts of Mansonella (Tupainema) dunni (Mullin & Orihel, 1972) (Spirurida: Onchocercidae) from the common treeshrew Tupaia glis Diard & Duvaucel (Mammalia: Scandentia) in Peninsular Malaysia

Mat Udin AS, Uni S, Rodrigues J, Martin C, Junker K, Agatsuma T, et al.

Curr Res Parasitol Vector Borne Dis, 2024;5:100154.
PMID: 38193019 DOI: 10.1016/j.crpvbd.2023.100154

The genus Mansonella Faust, 1929 includes 29 species, mainly parasites of platyrrhine monkeys in South America and anthropoid apes in Africa. In Malaysia, Mansonella (Tupainema) dunni (Mullin & Orihel, 1972) was described from the common treeshrew Tupaia glis Diard & Duvaucel (Scandentia). In a recent classification of the genus Mansonella, seven subgenera were proposed, with M. (Tup.) dunni as a monotypic species in the subgenus Tupainema. In this study, we collected new material of M. (Tup.) dunni from common treeshrews in Peninsular Malaysia and redescribed the morphological features of this species. We found that M. (Tup.) dunni differs from M. (Cutifilaria) perforata Uni et al., 2004 from sika deer Cervus nippon (Cetartiodactyla) in Japan, with regards to morphological features and predilection sites in their respective hosts. Based on multi-locus sequence analyses, we examined the molecular phylogeny of M. (Tup.) dunni and its Wolbachia genotype. Species of the genus Mansonella grouped monophyletically in clade ONC5 and M. (Tup.) dunni was placed in the most derived position within this genus. Mansonella (Tup.) dunni was closely related to M. (M.) ozzardi (Manson, 1897) from humans in Central and South America, and most distant from M. (C.) perforata. The calculated p-distances between the cox1 gene sequences for M. (Tup.) dunni and its congeners were 13.09% for M. (M.) ozzardi and 15.6-16.15% for M. (C.) perforata. The molecular phylogeny of Mansonella spp. thus corroborates their morphological differences. We determined that M. (Tup.) dunni harbours Wolbachia endosymbionts of the supergroup F genotype, in keeping with all other Mansonella species screened to date.
Fulltext High Prevalence of Toxigenic and Nontoxigenic Clostridium difficile Strains in Malaysia

Riley TV, Collins DA, Karunakaran R, Kahar MA, Adnan A, Hassan SA, et al.

J Clin Microbiol, 2018 Jun;56(6).
PMID: 29563206 DOI: 10.1128/JCM.00170-18

Accumulating evidence shows a high prevalence of Clostridium difficile in Southeast Asia associated with a range of clinical presentations. However, severe infections are rarely reported. We investigated C. difficile infection (CDI) across four hospitals in Kuala Lumpur and Kota Bharu, Malaysia. Enzyme immunoassays for glutamate dehydrogenase (GDH) and toxin A or B were performed on diarrheal stool specimens collected from patients in 2015 and 2016. Specimens were also cultured and isolates of C. difficile characterized by PCR ribotyping and detection of toxin genes. In total, 437 specimens were collected and fecal toxin was detected in 3.0%. A further 16.2% of specimens were GDH positive and toxin negative. After culture, toxigenic strains were isolated from 10.3% and nontoxigenic strains from 12.4% of specimens. The most prevalent PCR ribotypes (RTs) were RT 017 (20.0%) and RT 043 (10.0%). The high prevalence of RT 017 and nontoxigenic strains in Malaysia and in neighboring Thailand and Indonesia suggests that they localize to the region of Southeast Asia, with an implication that they may mediate the burden of CDI in the region.
Fulltext Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

Jamaluddin NAH, Periyasamy P, Lau CL, Ponnampalavanar S, Lai PSM, Ramli R, et al.

Antibiotics (Basel), 2021 May 04;10(5).
PMID: 34064457 DOI: 10.3390/antibiotics10050531

Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/β-lactamase inhibitor (14.8%), piperacillin/β-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients' notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines.
An ionic liquid process for mercury removal from natural gas

Abai M, Atkins MP, Hassan A, Holbrey JD, Kuah Y, Nockemann P, et al.

Dalton Trans, 2015 May 14;44(18):8617-24.
PMID: 25722100 DOI: 10.1039/c4dt03273j

Efficient scrubbing of mercury vapour from natural gas streams has been demonstrated both in the laboratory and on an industrial scale, using chlorocuprate(II) ionic liquids impregnated on high surface area porous solid supports, resulting in the effective removal of mercury vapour from natural gas streams. This material has been commercialised for use within the petroleum gas production industry, and has currently been running continuously for three years on a natural gas plant in Malaysia. Here we report on the chemistry underlying this process, and demonstrate the transfer of this technology from gram to ton scale.
A cluster randomized trial on improving nurses' detection and management of elder abuse and neglect (I-NEED): study protocol

Loh DA, Choo WY, Hairi NN, Othman S, Mohd Hairi F, Mohd Mydin FH, et al.

J Adv Nurs, 2015 Nov;71(11):2661-72.
PMID: 26031344 DOI: 10.1111/jan.12699

The aim of this study was to describe a trial protocol of an educational intervention for nurses to improve their awareness and practice in detecting and managing elder abuse and neglect.

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