Ultra high temperature (UHT) treated milk products and formula milk are known to be
frequently contaminated with Bacillus cereus. Presence of B. cereus in these milk products is
of particular concern considering the majority of consumers are infants and children. Possible
sources of contamination are contaminated raw milk, cross-contamination during processing,
under-processing and mishandling of milk products. This study was conducted to detect the
presence of B. cereus in both formula milk (n=12) and UHT milk (n=20) sold in selected retail
markets. The approach consisted of enumerating by MPN/g followed by PCR assay aimed
at detecting gyrB gene in B. cereus, that encode for the subunit B protein of DNA gyrase
(topoisomerase type II). Contamination level of B. cereus in both types of samples examined
ranged from < 3 to > 1100 MPN/g. The contamination level of B. cereus was found to be
highest in full cream UHT milk (> 1100 MPN/g) and formula milk (> 1100 MPN/g). The PCR
analysis showed that 41.7% (5/12) formula milk and 30% (6/20) UHT milk samples were
detected with B. cereus, respectively. This is the first report of such study demonstrating the
presence of B. cereus in formula milk from Malaysia. Therefore, constant surveillance of these
milk products would reduce the potential risk of B. cereus-linked outbreaks.
Evidence is emerging that rates of adverse events in patients taking warfarin may vary with ethnicity. This study investigated the rates of bleeds and thromboembolic events, the international normalised ratio (INR) status and the relationship between INR and bleeding events in Malaysia. Patients attending INR clinic at the Heart Centre, Sarawak General Hospital were enrolled on an ad hoc basis from May 2010 and followed up for 1 year. At each routine visit, INR was recorded and screening for bleeding or thromboembolism occurred. Variables relating to INR control were used as predictors of bleeds in logistic regression models. 125 patients contributed to 140 person-years of follow-up. The rates of major bleed, thromboembolic event and minor bleed per 100 person-years of follow-up were 1.4, 0.75 and 34.3. The median time at target range calculated using the Rosendaal method was 61.6% (IQR 44.6–74.1%). Of the out-of-range readings, 30.0% were below range and 15.4% were above. INR variability, (standard deviation of individuals’ mean INR), was the best predictor of bleeding events, with an odds ratio of 3.21 (95% CI 1.10–9.38). Low rates of both major bleeds and thromboembolic events were recorded, in addition to a substantial number of INR readings under the recommended target range. This may suggest that the recommended INR ranges may not represent the optimal warfarin intensity for this population and that a lower intensity of therapy, as observed in this cohort, could be beneficial in preventing adverse events.
Study site: INR clinic at the Heart Centre, Sarawak General Hospital
The administration of antimicrobials in aquaculture provides a selective pressure creating a reservoir of multiple resistant bacteria in the cultured fish and shrimps as well as the aquaculture environment. The objective of this study was to determine the extent of antibiotic resistance in aquaculture products and aquaculture's surrounding environment in Sarawak, Malaysian Borneo. Ninety-four identified bacterial isolates constituted of 17 genera were isolated from sediment, water, and cultured organisms (fish and shrimp) in selected aquaculture farms. These isolates were tested for their antibiotic resistance against 22 antibiotics from several groups using the disk diffusion method. The results show that the highest resistance was observed towards streptomycin (85%, n = 20), while the lowest resistance was towards gentamicin (1.1%, n = 90). The multiple antibiotic resistant (MAR) index of the isolates tested ranged between 0 and 0.63. It was suggested that isolates with MAR index > 0.2 were recovered from sources with high risk of antibiotic resistant contamination. This study revealed low level of antibiotic resistance in the aquaculture bacterial isolates except for streptomycin and ampicillin (>50% resistance, n = 94) which have been used in the aquaculture industry for several decades. Antibiotic resistant patterns should be continuously monitored to predict the emergence and widespread of MAR. Effective action is needed to keep the new resistance from further developing and spreading.