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Quantitative Hepatitis B e Antigen: A Better Predictor of Hepatitis B Virus DNA than Quantitative Hepatitis B Surface Antigen

Hudu SA, Niazlin MT, Nordin SA, Saeed MI, Tan SS, Omar H, et al.

Clin. Lab., 2018 Apr 01;64(4):443-449.
PMID: 29739076 DOI: 10.7754/Clin.Lab.2017.170916

BACKGROUND: Hepatitis B surface antigen is usually secreted by infected hepatocytes in the form of subviral particles rather than infectious virions, while the hepatitis B e antigen originates from the core gene and is modified and secreted by hepatocytes into the circulation and functions as a marker of active viral replication. This study aimed to study the relationship between HBV DNA and quantitative hepatitis B surface and e antigen in Malaysian patients.
METHODS: A total of 82 chronic hepatitis B patients were recruited for this study from the Hepatology Department of Selayang Hospital. Quantitative hepatitis surface and e antigen was performed retrospectively on frozen plasma using enzyme linked immunosorbent assay according to the manufacturer's instructions. Hepatitis B viral DNA was extracted from all plasma samples and quantified using real-time PCR.
RESULTS: Quantitative hepatitis B surface and e antigens were found be high in 54.9% and 52.4% of the patients, respectively, while hepatitis B virus DNA level was high in 70.7%. The median of the viral load of HBV was 8,934.89 IU/mL and both hepatitis B surface and e antigens were also found to be high on average for qHBsAg (M = 5.19 IU/mL, SD ± 4. 33) and qHBeAg (M = 4.74IU/mL, SD ± 4.20), with qHBeAg being more strongly correlated to HBV DNA than qHBsAg (r = 0.893; p < 0.01).
CONCLUSIONS: This study revealed HBeAg to be the most appropriate marker that correlates well with HBV DNA, thus not completely novel but confirmative, and related to the Malaysian situation.
Fulltext Rapid detection and identification of pathogens in patients with continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis by 16s rRNA gene sequencing

Ahmadi SH, Neela V, Hamat RA, Goh BL, Syafinaz AN

Trop Biomed, 2013 Dec;30(4):602-7.
PMID: 24522129 MyJurnal

Peritonitis still remains a serious complication with high rate of morbidity and mortality in patients on CAPD. Rapid and accurate identification of pathogens causing peritonitis in a CAPD patient is essential for early and optimal treatment. The aim of this study was to use 16S rRNA and ITS gene sequencing to identify common bacterial and fungal pathogens directly from the peritoneal fluid without culturing. Ninety one peritoneal fluids obtained from 91 different patients on CAPD suspected for peritonitis were investigated for etiological agents by 16S rRNA and ITS gene sequencing. Data obtained by molecular method was compared with the results obtained by culture method. Among the 45 patients confirmed for peritonitis based on international society of peritoneal dialysis (ISPD) guidelines, the etiological agents were identified in 37(82.2%) samples by culture method, while molecular method identified the etiological agents in 40(88.9%) samples. Despite the high potential application of the 16S rRNA and ITS gene sequencing in comparison to culture method to detect the vast majority of etiological agents directly from peritoneal fluids; it could not be used as a standalone test as it lacks sensitivity to identify some bacterial species due to high genetic similarity in some cases and inadequate database in Gene Bank. However, it could be used as a supplementary test to the culture method especially in the diagnosis of culture negative peritonitis.
Fulltext Characterization of a Group B Streptococcus infection based on the demographics, serotypes, antimicrobial susceptibility and genotypes of selected isolates from sterile and non-sterile isolation sites in three major hospitals in Malaysia

Suhaimi MES, Desa MNM, Eskandarian N, Pillay SG, Ismail Z, Neela VK, et al.

J Infect Public Health, 2017 Jan-Feb;10(1):14-21.
PMID: 27095302 DOI: 10.1016/j.jiph.2016.01.009

BACKGROUND/PURPOSE: The purpose of this study is to characterize GBS isolates that were collected from three major hospitals in a densely populated area of Klang Valley for their demographics, serotypes, antibiotic susceptibility patterns and genetic background.

METHODS: Sixty GBS isolates from sterile and non-sterile samples in three major hospitals in the Klang Valley area of Malaysia were collected by convenience sampling from 2012 until March 2014. These isolates were studied for their antimicrobial susceptibilities, serotypes and genotypes. Patients' demographic data and clinical information were collected from lab request forms.

RESULTS: Diabetes mellitus was the only underlying condition (7 patients, 23.3%); the remaining samples were from patients who were immunocompromised due to medications. Fifty-nine (98%) isolates were sensitive to penicillin, while 78.3% and 88.3% of the isolates were sensitive to erythromycin and clindamycin, respectively. Serotype Ia was the most common serotype (n=27, 45%), followed by serotype III (n=10, 16.7%), V (n=9, 15%), VI (n=8, 13.3%), VIII (n=2, 3.3%) and VII (n=1, 1.7%). Random Amplified Polymorphic DNA (RAPD) typing showed a diverse genetic pedigree for all isolates, including four major groups that clustered according to geographical location.

CONCLUSION: This preliminary study determines the prevalence of limited common serotypes and antimicrobial resistance in distinct GBS isolates. Nonetheless, the RAPD clustering pattern suggests a close genetic lineage of the GBS isolates based on their isolation sites and location of hospitals.
Physiological and proteomic analysis of Stenotrophomonas maltophilia grown under the iron-limited condition

Azman A, Vasodavan K, Joseph N, Kumar S, Hamat RA, Nordin SA, et al.

Future Microbiol, 2019 Nov;14:1417-1428.
PMID: 31777284 DOI: 10.2217/fmb-2019-0174

Aims: To study physiological and proteomic analysis of Stenotrophomonas maltophilia grown under iron-limited condition. Methods: One clinical and environmental S. maltophilia isolates grown under iron-depleted conditions were studied for siderophore production, ability to kill nematodes and alteration in protein expression using isobaric tags for relative and absolute quantification (ITRAQ). Results & conclusions: Siderophore production was observed in both clinical and environmental strains under iron-depleted conditions. Caenorhabditis elegans assay showed higher killing rate under iron-depleted (96%) compared with normal condition (76%). The proteins identified revealed, 96 proteins upregulated and 26 proteins downregulated for the two isolates under iron depletion. The upregulated proteins included several iron acquisition proteins, metabolic proteins and putative virulence proteins.
Fulltext Staphylococcus aureus Nasal Carriers Among Medical Students in A Medical School

Syafinaz AM, Nur Ain NZ, Nadzirahi SN, Fatimah JS, Shahram A, Nasir MD

Med J Malaysia, 2012 Dec;67(6):636-8.
PMID: 23770966 MyJurnal

Staphylococcus aureus is usually considered a colonizer but can result in infections under favourable conditions, especially in the healthcare setting. Healthcare workers can be colonized by S. aureus, and may transmit them to patients under their care. We conducted a cross sectional study to determine the prevalence of S. aureus nasal carriers among medical students in Universiti Putra Malaysia (UPM) (from January to June 2011). Our study involved 209 medical students comprising of 111 and 97 preclinical and clinical students respectively. A selfadministered questionnaire was distributed and nasal swabs were collected. Upon identification, the antibiotic susceptibility of the isolates was examined followed by categorical analysis (Chi-square and Fisher's exact tests) with factors associated with S. aureus nasal carriage. Twenty one (10%) S. aureus strains were isolated from 209 nasal swab samples. 14 isolates were from pre-clinical students while the remaining seven were from clinical students. There was no significant association between gender, ethnicity, health status, skin infection and students' exposure to hospital environment with S. aureus nasal carriage (p>0.05). Nineteen (90.5%) isolates were resistant to penicillin and there was also no significant association between penicillin resistant and the students' groups. One (5.3%) isolate was resistant to erythromycin. There was no methicillin-resistant S. aureus isolated in this study.
Fulltext Hymenolepis nana in a renal transplant recipient: to treat or not to treat?

Syafinaz AN, Hamat RA, Malina O, Siti NM, Niazlin MT, Jamal F

Med J Malaysia, 2011 Aug;66(3):259-60.
PMID: 22111454 MyJurnal

A case of hymenolepiasis in a renal transplant recipient. Issues discussed include the benefit of anti-parasitic agents as well as the preventive measures.
Fulltext Clinical presentation and microorganisms sensitivity profile for diabetic foot ulcers: a pilot study

Nur Hilda Hanina AW, Intan NS, Syafinaz AN, Zalinah A, Lailatul Akmar MN, Devnani AS

Med J Malaysia, 2015 Jun;70(3):182-7.
PMID: 26248782 MyJurnal

INTRODUCTION: Patients suffering from diabetes mellitus (DM) frequently present with infected diabetic foot ulcers (DFU). This study was done to record the anatomical site and the grade of ulcers according to Wagner's classification and to culture the microorganisms from the ulcers and determine their antibiotic sensitivity.
MATERIALS AND METHODS: Prospective study was conducted on 77 diabetic patients who were admitted with DFU from June until December 2011. Patients with end stage renal failure, those who had previous vascular surgery on the involved limb, or hyperbaric oxygen or maggot therapy for the ulcers, or had unrelated skin diseases around the involved foot were excluded from the study. Specimens for culture were obtained by a sterile swab stick or tissue sample was taken from the wound with sterile surgical instruments.
RESULTS: Wagner's grade III and IV ulcers were most common. Majority of the ulcers involved toes (48%). Gram negative microorganisms were predominantly isolated (71.1%). Gram positive microorganisms were less frequently cultured (27.7%). Fungus was cultured from one sample (1.2%). Gram negative microorganisms were sensitive to aminoglycosides, cephalosporins or β-lactamase inhibitors. More than 40% were resistant to ampicillin. Gram positive microorganisms were sensitive to cloxacillin. MRSA were sensitive to vancomycin.
CONCLUSION: Empirical use of antibiotics should be curtailed to prevent development of drug resistant strains of microorganisms and MRSA. We suggest use of antiseptic solutions to clean the ulcers until antibiotic sensitivity report is available. Results of our altered treatment regimen we plan to publish in a later study.
Fulltext Prevalence and characteristics of e-cigarette users among Malaysian current and ex-smokers

Ho BK, Mohamad Haniki NM, Jamalludin AR, Samsul D, Mira K, Norny Syafinaz AR, et al.

Malays Fam Physician, 2019;14(2):10-17.
PMID: 31827730

Introduction: Electronic cigarettes (ECs) are new devices that have been accepted widely by both smokers and non-smokers. However, the evidence on EC used in Malaysia is scarce. The objective of this study was to determine the prevalence of EC use and the socio-demographic and smoking characteristics associated with current EC use among Malaysian current and ex-smokers.

Methods: This was a sub-analysis of data from a cross-sectional, national-population- based EC study conducted from May to June in 2016 in Malaysia. A detailed description of the sampling methods can be found in the National E-cigarette Survey (NECS) 2016 report. Briefly, data were obtained from 1396 individuals who had ever been smokers, i.e., 957 (68.6%) current smokers and 439 (31.4%) ex-smokers.

Results: Current EC use was found predominantly among current smokers (8.0%) as compared with ex-smokers (4.3%). Among current smokers, the main reasons given for smoking ECs were wanting to try it (44.7%), followed by intention to quit tobacco smoking (15.8%) and to reduce tobacco smoking (10.5%). Using multiple logistic regression analysis, we found that among current smokers, current EC users were more likely to be younger, i.e., 18-44 years (aOR= 4.83, 95% CI= 1.97-11.86, p=0.001), urban residents (aOR= 1.89, 95% CI= 1.15-3.11, p=0.012), single/ divorced/ widowed (aOR= 2.11, 95% CI= 1.24-3.61, p=0.006) and students (aOR= 2.25, 95% CI= 1.01-5.01, p=0.048). Among exsmokers, only younger respondents (18-44 years old) was reported as being more likely to be current EC users (aOR= 3.81, 95% CI= 1.14-12.76, p=0.030).

Conclusion: This study showed that currently using and ever having used ECs were more prevalent among current smokers. The reasons given for initiating EC use among current smokers were mainly wanting to try it, followed by intention to quit and to reduce tobacco smoking. Current EC use appears to be common among current smokers who are younger, urban residents, single/divorced/widowed and students. Therefore, EC cessation intervention strategies and policies should target these high-prevalence groups.
Humoral response to SARS-CoV-2 vaccines among healthcare workers in a tertiary hospital in Malaysia

Amrina MA, Shahidah M, Sofiah HR, Mirlia SCM, Thilakaveni R, Chong ZL, et al.

Med J Malaysia, 2023 Jan;78(1):20-24.
PMID: 36715186

INTRODUCTION: Healthcare workers (HCWs) were among the first to be fully vaccinated against SARS-CoV-2. However, the antibody responses to the vaccines and potential decline among Malaysian HCW are still unclear. The objective of this study is to follow-up anti-S antibody levels among HCW vaccinated with mRNA vaccine (BTN162b2) and inactivated vaccine (CoronaVac).
MATERIALS AND METHODS: Plasma samples were collected prevaccination, 2 weeks and 6 months post-vaccination and tested for total immunoglobulin levels using ELISA method.
RESULTS: A small percentage of HCW (2.2%, 15/677) had elevated anti-S antibody levels in their pre-vaccination plasma samples (median 20.4, IQR 5.8), indicating that they were exposed to SARS-CoV-2 infection prior to vaccination. The mRNA vaccine significantly increased anti-S levels of both previously infected and uninfected individuals to saturation levels (median 21.88, IQR.0.88) at 2 weeks postsecond dose of the vaccine. At 6 months post-vaccination, the antibody levels appeared to be maintained among the recipients of the mRNA vaccine. However, at this time point, anti-S antibody levels were lower in individuals given inactivated vaccine (median 20.39, IQR 7.31, n=28), and interestingly, their antibody levels were similar to anti-S levels in pre-vaccination exposed individuals. Antibody levels were not different between the sexes.
CONCLUSION: Anti-S levels differ in individuals given the different vaccines. While further study is required to determine the threshold level for protection against SARSCoV- 2, individuals with low antibody levels may be considered for boosters.