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Clinical characteristics and outcomes of bacteraemic melioidosis in a teaching hospital in a northeastern state of Malaysia: a five-year review

Deris ZZ, Hasan H, Siti Suraiya MN

J Infect Dev Ctries, 2010 Aug 04;4(7):430-5.
PMID: 20818090

BACKGROUND: Melioidosis is an important public health problem causing community acquired sepsis in the northeastern part of Malaysia.
METHODOLOGY: From January 2001 to December 2005, we reviewed case reports of all bacteraemic melioidosis admitted to a tertiary teaching hospital, Hospital Universiti Sains Malaysia.
RESULTS: Thirty-five patients had positive blood culture for meliodosis and 27 case reports were traceable for further analysis. The mean age was 46.8 + 20.0 years. Twenty patients (74.1%) were male. The main clinical presentation was fever that occurred in 23 (85.2%) patients. Eighteen patients (66.7%) had lung involvement and three patients had liver abscess. Two patients presented with scrotal swelling, one of whom further developed Fournier's Gangrene. Nineteen (70.4%) patients had underlying diabetes, five of whom were newly diagnosed during the admission. Thirteen (48.1%) patients were treated with high-dose ceftazidime and six (22.2%) patients were treated with imipenem. Eight (29.6%) patients were not given anti-melioidosis therapy because the causative agents were not identified until after the patients died. The patients were admitted 16.8 days + 18.1. Seventeen patients (63.0%) died in this series, 13 patients of whom died within four days of admission.
CONCLUSIONS: The wide range of clinical presentations and the fatal outcomes of melioidosis require a high level of suspicion among physicians to develop an early appropriate therapy and reduce the mortality rate.
Fulltext Comparison of antimicrobial activity of crude extracts of piper betle, aloe vera, solanum lycopersicum, cinnamomum zeylanicum and cucumis sativus against acne inducing bacteria

Aiza Izyani Aminuddin, Siti Suraiya, Ruzilawati Abu Bakar

Asian Journal of Medicine and Biomedicine, 2018;2(1):0-0.
MyJurnal

Acne vulgaris is a typical skin disorder among adolescence, causing inflammation of pilosebaceous follicle
which characterized by comedones, papules, pustules, cysts, nodules and often scars in face, neck, upper trunk
and arms. Propionibacterium acnes and Staphylococcus epidermidis have been recognized that play as a major
role in acne formation. This study was conducted to compare the antimicrobial activity of five plant extracts
namely Piper betle, Aloe vera, Solanum lycopersicum, Cinnamomum zeylanicum and Cucumis sativus against P.
acnes and S. epidermidis. The well diffusion assay was used to determine the sensitivity of the samples, while
the liquid dilution method was used for the determination of the minimal inhibition concentration (MIC). The
result showed a remarkable antibacterial activity of Piper betle extract compared to other plant extracts and
Doxycycline (positive control) against both of acne-inducing bacteria, P. acnes and S. epidermidis.
Fulltext Antimicrobial Effects of Peperomia Pellucida (Ketumpang Air) Against Multidrug Resistant and Foodborne Organisms Including Toxicity Study in Sprague Dawley Rats

Nurul Alia Farhah Mohd Zamri, Ruzilawati Abu Bakar, Siti Suraiya Mohd Noor, Wan Ezumi Mohd Fuad1

Asian Journal of Medicine and Biomedicine, 2020;4(1):1-11.
MyJurnal

The objective of this study was to evaluate the in vitro antibacterial activities of methanol and aqueous extracts of P. pellucida aerial part (PPAP) against four multi-drug resistant organisms; methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, extended-spectrum beta-lactamase and carbapenem-resistant Enterobacteriaceae and four foodborne pathogens; Staphylococcus aureus, Bacillus cereus, Escherichia coli and Salmonella typhimurium. The antibacterial potentialities of the plant extracts were evaluated at 250 mg/ml and 500 mg/ml. Only susceptible bacteria were further determined for minimum inhibitory (MIC) and minimum bactericidal (MBC) concentrations. The best extract of a single dose of 5000 mg/kg PPAP methanol extract was acutely tested on female rats by adapting the OECD guidelines No 425. Findings obtained indicated that only PPAP methanol extract was found to be a potent inhibitor towards Bacillus cereus with the MIC and MBC values at 3.91 mg/ml and 7.81 mg/ml respectively. Toxicity study revealed that there was neither mortality nor morbidity and absent of abnormalities on all rats examined.
Fulltext Sensitivity Evaluation of SYBR Green I, SYBR Safe and Calcein Dyes for Detection of Human Papillomavirus 16 by Loop-Mediated Isothermal Amplification

Nuur Ezzatyhusna, M. K., Nurul Izzati, H., Siti Suraiya M. N., Suharni, M.

Medicine & Health, 2017;12(2):220-229.
MyJurnal

Amplikasi isoterma berpengantara gelung (LAMP) merupakan teknik amplifikasi gen
yang menghasilkan produk akhir iaitu mendapan keruh magnesium pirofosfat yang
boleh dianalisis dengan hanya menggunakan mata kasar. Penggunaan pewarna
interkalat yang sesuai adalah penting kerana ia boleh meningkatkan sensitiviti dan
mengurangkan keputusan positif palsu dan negatif palsu untuk pengesanan. Kajian
ini bertujuan untuk membandingkan prestasi tiga pewarna interkalat yang berbeza;
SYBR Green I, SYBR Safe dan pewarna berasaskan calcein di dalam asai LAMP
HPV-16 melalui visualisasi oleh mata kasar, elektroforesis gel dan mesin masanyata
turbidimeter. Reaksi LAMP dilakukan menggunakan amplifikasi kit Loopamp
DNA berisipadu sebanyak 25 μl. Campuran reaksi dieram pada suhu 60�C selama
60 minit dan ditamatkan menggunakan suhu 80�C selama 5 minit dalam mesin
masa-nyata turbidimeter. Untuk pengesanan menggunakan mata kasar, SYBR
Green I dan SYBR Safe telah dicairkan dalam 1:10 DMSO dan telah ditambah ke
dalam tiub yang mengandungi campuran reaksi selepas proses amplifikasi berlaku
manakala calcein ditambah sebelum proses amplifikasi. Sensitiviti asai telah disiasat
menggunakan pencairan DNA HPV-16 yang berkepekatan bermula dari 101
salinan/
μl to 108
salinan/μl. Ketiga-tiga pewarna mempamerkan keputusan yang sama
dari segi sensitiviti dengan had pengesanan adalah 103
salinan/μl. Penambahan
calcein di dalam asai menunjukkan masa pengesanan bertambah selama 10 minit
dengan menggunakan mesin nyata-masa turbidimeter. Prestasi ketiga-tiga pewarna
interkalat untuk pengesanan mata kasar adalah setanding dan boleh digunakan
untuk aplikasi pemeriksaan titik akhir dalam asai HPV-16, manakala dengan mesin nyata-masa turb
Fulltext Predictors of Self-Reported Hand Hygiene Performance among Nurses at Tertiary Care Hospitals in East Coast Malaysia

Rahim MHA, Ibrahim MI, Noor SSM, Fadzil NM

Int J Environ Res Public Health, 2021 01 07;18(2).
PMID: 33430195 DOI: 10.3390/ijerph18020409

BACKGROUND: Hand hygiene (HH) is the simplest and most effective way to reduce the incidence of healthcare-associated infections (HCAIs).
METHODS: This cross-sectional study aimed to determine factors associated with self-reported HH performance among nurses at Kelantan tertiary care hospitals. A sample of 438 registered nurses was selected through a stratified random sampling method. Self-reported HH performance was assessed using a validated WHO self-administered HH knowledge and perception questionnaire for healthcare workers.
RESULTS: A multiple linear regression analysis was performed to identify the predictors. The factors that significantly predicted self-reported HH performance among nurses included perception score (beta coefficient (β) = 0.260; 95% CI: 0.200, 0.417; p < 0.001), pediatric department (β = -0.104; 95% CI: -9.335, -2.467; p < 0.001), and orthopedic department (β = -5.957; 95% CI: -9.539, -0.720; p < 0.023), adjusted R2 = 0.102; p < 0.001. Nurses with a strong perception and belief in HH were more likely to have better HH performance. Compared to pediatric and orthopedic, surgical departments were associated with better self-reported HH performance.
CONCLUSIONS: This study showed the importance of factors that could improve the intervention's performance in HH strategy. Lack of perception and HH program intervention in departments engaged in patient care could lead to poor HH practices, thus increasing HCAIs and antimicrobial resistance (AMR).
Fulltext The deadly ebola threat in the midst of an overwhelming dengue epidemic

Besari AM, Md Noor SS, Lee YY

Malays J Med Sci, 2014 Nov-Dec;21(6):9-13.
PMID: 25897277 MyJurnal

The recent death tolls and morbidities associated with two deadly viral haemorrhagic fevers (VHFs), i.e., Ebola and dengue, are simply shocking. By the end of August 2014, 65 672 people were afflicted with dengue fever (DF) in Malaysia, with 9505 from Kelantan, and there were 128 reported deaths. More astounding are the death tolls associated with Ebola: 3091 deaths from 6574 reported cases so far. It is not difficult to imagine the potential disaster if Ebola spreads beyond Africa. VHFs are characterised by an acute onset of fever, vascular disruption and a rapid progression to shock and death. The revised World Health Organization (WHO) 2012 classification (dengue with and without warning signs and severe dengue) is more clinically relevant and allows more streamlined admission. With good administrative support and public health and governmental efforts, the dengue epidemic in Malaysia is now more contained. However, there should be no laxity with the imminent lethal Ebola threat. Human-to-human transmission is an important mechanism for the spread of Ebola, and this calls for strict precautions regarding contact with any suspected cases. In contrast, the control and elimination of dengue would require successful control of the vectors and their breeding sites.
Fulltext Genotypic Detection of rpoB and katG Gene Mutations Associated with Rifampicin and Isoniazid Resistance in Mycobacterium Tuberculosis Isolates: A Local Scenario (Kelantan)

Ismail NA, Ismail MF, Noor SS, Camalxaman SN

Malays J Med Sci, 2016 Jan;23(1):22-6.
PMID: 27540322 MyJurnal

Drug resistant tuberculosis (DR-TB) remains a public health issue that is of major concern on a global scale. The characterisation of clinical isolates may provide key information regarding the underlying mechanisms of drug resistance, and helps to augment therapeutic options. This study aims to evaluate the frequency of gene mutations associated with Rifampicin (RIF) and Isoniazid (INH) resistance among nine clinical isolates.
Fulltext Detection of human papillomavirus types 16 and 18 in oral squamous cell carcinoma samples in Malaysia

Fatin Hazwani Fauzia, Nurul Izzati Hamzana, Nurhayu Ab. Rahmana, Irfan Mohamadb, Siti Suraiya, Thomas George Kallarakkald, et al.

Archives of Orofacial Sciences, 2019;14(1):1-29.
MyJurnal

Infection of the oral cavity with high-risk human papillomavirus (HPV) has been implicated as one of the risk factors for the development of oral squamous cell carcinoma (OSCC). Among the high-risk HPV types, HPV 16 and 18 are the most common infective agents in oral cancers. This study aimed to compare the presence of high-risk HPV in genetic materials obtained from saliva, blood and tissues of OSCC patients in Malaysia. The genomic DNA was extracted from saliva (n=13), blood (n=59) and tissue (n=63) and subjected to polymerase chain reaction (PCR) amplification of human beta globin gene to confirm the presence and integrity of DNA. Positive amplification was then screened for high-risk HPV by nested PCR using MY11/09 and GP5+/6+ consensus primers, followed by a further confirmation by DNA sequencing of the positive samples. As a result, two saliva samples (2/13; 15.4%) were found to harbour HPV 16 and one tissue sample (1/63; 1.6%) was shown to be positive for HPV 18. However, none of the blood samples were positive for high-risk HPV. Thus, HPV is more likely to be found in the saliva of OSCC patients as compared to blood and tissue samples. The detection of high-risk HPV in OSCC patients is useful in deciding how to manage the patient as HPV-associated OSCC has better prognosis.
Analysis of lolB gene sequence and its use in the development of a PCR assay for the detection of Vibrio cholerae

Lalitha P, Siti Suraiya MN, Lim KL, Lee SY, Nur Haslindawaty AR, Chan YY, et al.

J Microbiol Methods, 2008 Sep;75(1):142-4.
PMID: 18579241 DOI: 10.1016/j.mimet.2008.05.001

A PCR assay has been developed based on a lolB (hemM) gene, which was found to be highly conserved among the Vibrio cholerae species but non-conserved among the other enteric bacteria. The lolB PCR detected all O1, O139 and non-O1/non-O139 serogroup and biotypes of V. cholerae. The analytical specificity of this assay was 100% while the analytical sensitivity was 10 pg/microL and 10(3) CFU/mL at DNA and bacterial level respectively. The diagnostic sensitivity and specificity was 98.5% and 100% respectively.
Fulltext The significance of coagulase-negative staphylococci bacteremia in a low resource setting

Abdul Rahman Z, Hamzah SH, Hassan SA, Osman S, Md Noor SS

J Infect Dev Ctries, 2013 Jun;7(6):448-52.
PMID: 23771288 DOI: 10.3855/jidc.2535

INTRODUCTION: Coagulase-negative staphylococci (CoNS) are a group of micro-organisms that are increasingly implicated as a cause of significant infection and the leading cause of bloodstream infection (BSI). One important predictor of true BSI is the isolation of CoNS from multiple blood cultures, presuming that the isolates represent the same species. Thus the objective of this study was to determine the significance of repeated CoNS isolated from blood cultures.
METHODOLOGY: This was a prospective laboratory study which was initiated in June 2007 and lasted until July 2008. CoNS isolates were obtained from patients who had two positive blood cultures within a 14-day interval. CoNS were identified to the species level using an API-Staph, and antibiotics susceptibility testing was performed according to Clinical and Laboratory Standards Institute specifications. Strain relatedness was confirmed using pulsed-field gel electrophoresis.
RESULTS: During the study period, 202 CoNS-positive samples were isolated from 101 patients. The most common species isolated was Staphylococcus epidermidis (59.0%), and 83.2% of the patients isolated the same species of CoNS from repeated blood cultures. Among the isolates of the same species, only 40.7% had the same antibiogram. CoNS with the same species and antibiogram had 93.3% probability of belonging to the same strain. Most (65.5%) of the patients were treated with antibiotics, primarily from the glycopeptides group.
CONCLUSION: Speciation and antibiogram of CoNS from repeated blood cultures are adequate in determining the significance of repeated CoNS isolated from blood cultures.
Antituberculosis potential of some ethnobotanically selected Malaysian plants

Mohamad S, Zin NM, Wahab HA, Ibrahim P, Sulaiman SF, Zahariluddin AS, et al.

J Ethnopharmacol, 2011 Feb 16;133(3):1021-6.
PMID: 21094237 DOI: 10.1016/j.jep.2010.11.037

Many local plants are used in Malaysian traditional medicine to treat respiratory diseases including symptoms of tuberculosis. The aim of the study was to screen 78 plant extracts from 70 Malaysian plant species used in traditional medicine to treat respiratory diseases including symptoms of tuberculosis for activity against Mycobacterium tuberculosis H37Rv using a colorimetric microplate-based assay.
Fulltext Immuno Nanosensor for the Ultrasensitive Naked Eye Detection of Tuberculosis

Mohd Bakhori N, Yusof NA, Abdullah J, Wasoh H, Md Noor SS, Ahmad Raston NH, et al.

Sensors (Basel), 2018 Jun 14;18(6).
PMID: 29899214 DOI: 10.3390/s18061932

In the present study, a beneficial approach for the ultrasensitive and affordable naked eye detection and diagnosis of tuberculosis (TB) by utilizing plasmonic enzyme-linked immunosorbent assay (ELISA) via antibody-antigen interaction was studied. Here, the biocatalytic cycle of the intracellular enzymes links to the formation and successive growth of the gold nanoparticles (GNPs) for ultrasensitive detection. The formation of different colored solutions by the plasmonic nanoparticles in the presence of enzyme labels links directly to the existence or non-existence of the TB analytes in the sample solutions. For disease detection, the adapted protocol is based mainly on the conventional ELISA procedure that involves catalase-labeled antibodies, i.e., the enzymes consume hydrogen peroxide and further produce GNPs with the addition of gold (III) chloride. The amount of hydrogen peroxide remaining in the solution determines whether the GNPs solution is to be formed in the color blue or the color red, as it serves as a confirmation for the naked eye detection of TB analytes. However, the conventional ELISA method only shows tonal colors that need a high concentration of analyte to achieve high confidence levels for naked eye detection. Also, in this research, we proposed the incorporation of protein biomarker, Mycobacterium tuberculosis ESAT-6-like protein esxB (CFP-10), as a means of TB detection using plasmonic ELISA. With the use of this technique, the CFP-10 detection limit can be lowered to 0.01 µg/mL by the naked eye. Further, our developed technique was successfully tested and confirmed with sputum samples from patients diagnosed with positive TB, thereby providing enough evidence for the utilization of our technique in the early diagnosis of TB disease.
Human tuberculosis brain promotes neuronal apoptosis but not in astrocytes with high expression of vascular endothelial growth factor

Othman FN, Muthuraju S, Noor SSM, Abdullah S, Mohd Yusoff AA, Tharakan J, et al.

Tuberculosis (Edinb), 2018 09;112:45-51.
PMID: 30205968 DOI: 10.1016/j.tube.2018.07.007

The present study aimed to investigate the involvement of the angiogenic marker vascular endothelia growth factor (VEGF) and apoptotic markers of Bcl-2 and Bax in the neurons and astrocytes in the brain infected by Mycobacterium tuberculosis. The immunohistochemistry staining was performed to analyze the expression of the VEGF, Bcl-2 and Bax in the astrocytes and neurons. The expression of VEGF was high in neurons and astrocytes in both the infected brain and control tissues with no difference of angiogenic activity (p = 0.40). Higher Bcl-2 expression was seen in astrocytes of infected brain tissues compared to the control tissues (p = 0.004) promoted a higher anti-apoptotic activity in astrocytes. The neurons expressed strong Bax expression in the infected brain tissues compared to the control tissues (p 
Fulltext Updates on knowledge, attitude and preventive practices on tuberculosis among healthcare workers

Abd Wahab F, Abdullah S, Abdullah JM, Jaafar H, Md Noor SS, Wan Mohammad WMZ, et al.

Malays J Med Sci, 2016 Nov;23(6):25-34.
PMID: 28090176 MyJurnal DOI: 10.21315/mjms2016.23.6.3

Ranking as the most communicable disease killer worldwide, tuberculosis, has accounted with a total of 9.6 million new tuberculosis cases with 1.5 million tuberculosis-related deaths reported globally in 2014. Tuberculosis has remain as an occupational hazard for healthcare workers since 1920s and due to several tuberculosis outbreaks in healthcare settings in the early 1990s, the concern about the transmission to both patients and healthcare workers has been raised. Healthcare workers have two to three folds greater the risk of active tuberculosis than the general population. Several studies on knowledge, attitude and practices on tuberculosis among healthcare workers worldwide have revealed that majority of the participated healthcare workers had good knowledge on tuberculosis. Most of the healthcare workers from South India and South Africa also reported to have positive attitude whereas a study in Thailand reported that most of the healthcare providers have negative attitude towards tuberculosis patients. Nevertheless, majority of the healthcare workers have low level of practice on tuberculosis prevention. An improved communication between healthcare workers and the patients as well as their families is the key to better therapeutic outcomes with good knowledge, attitude and preventive practice towards tuberculosis.
Fulltext A multicentre study to determine the in vitro efficacy of flomoxef against extended-spectrum beta-lactamase producing Escherichia coli in Malaysia

Yap PSX, Chong CW, Ponnampalavanar S, Ramli R, Harun A, Tengku Jamaluddin TZM, et al.

PeerJ, 2023;11:e16393.
PMID: 38047021 DOI: 10.7717/peerj.16393

BACKGROUND: The high burden of extended-spectrum beta-lactamase-producing (ESBL)-producing Enterobacterales worldwide, especially in the densely populated South East Asia poses a significant threat to the global transmission of antibiotic resistance. Molecular surveillance of ESBL-producing pathogens in this region is vital for understanding the local epidemiology, informing treatment choices, and addressing the regional and global implications of antibiotic resistance.
METHODS: Therefore, an inventory surveillance of the ESBL-Escherichia coli (ESBL-EC) isolates responsible for infections in Malaysian hospitals was conducted. Additionally, the in vitro efficacy of flomoxef and other established antibiotics against ESBL-EC was evaluated.
RESULTS: A total of 127 non-repetitive ESBL-EC strains isolated from clinical samples were collected during a multicentre study performed in five representative Malaysian hospitals. Of all the isolates, 33.9% were isolated from surgical site infections and 85.8% were hospital-acquired infections. High rates of resistance to cefotaxime (100%), cefepime (100%), aztreonam (100%) and trimethoprim-sulfamethoxazole (100%) were observed based on the broth microdilution test. Carbapenems remained the most effective antibiotics against the ESBL-EC, followed by flomoxef. Antibiotic resistance genes were identified by PCR. The blaCTX-M-1 was the most prevalent ESBL gene, with 28 isolates (22%) harbouring blaCTX-M-1 only, 27 isolates (21.3%) co-harbouring blaCTX-M-1 and blaTEM, and ten isolates (7.9%) co-harbouring blaCTX-M-1, blaTEM and blaSHV. A generalised linear model showed significant antibacterial activity of imipenem against different types of infection. Besides carbapenems, this study also demonstrated a satisfactory antibacterial activity of flomoxef (81.9%) on ESBL-EC, regardless of the types of ESBL genes.

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