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Fulltext It was a fungal culprit all along - a case report

Navin Kumar Devaraj, Syafinaz Amin Nordin

Malaysian Journal of Medicine and Health Sciences, 2020;16(201):35-37.
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Sporotrichosis is a relatively uncommon fungal infection in human as compared to other fungal infectiction such as tinea corporis or cruris. The fungus can be found in the environment and on plant matter. Sporotrichosis usually results from trauma to the skin followed by exposure to the fungus. It can also be spread by cat scratch or bite. Sporotrichosis usually presents as multiple skin nodules arranged in a linear fashion over the limbs, often with associated lymphadenopathy. This calls for importance of full physical examination and a high index of suspicion in order to diagnose this infection that can either involve the skin or the lymphatic channel or both. If misdiagnosed, treatment can be delayed and lead to prolonged suffering of the patient. This is an interesting case report about a 43-year-old woman who presented with left axillary swelling and decreased range of movement of the correspond- ing shoulder which was feared initially to be linked to breast cancer. However, good clinal acumen lead to the actual diagnosis of sporotrichosis.
Fulltext A rare case of Haemophilus parahaemolyticus pneumonia

Navin Kumar Devaraj, Syafinaz Amin Nordin

Malaysian Journal of Medicine and Health Sciences, 2020;16(201):41-43.
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Pneumonia is a common lung infection. Common bacterial cause of this serious lung infection includes Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae. Haemophilus parahaemolyticus pneumonia is an uncommon cause of bacterial pneumonia, occurring mainly as an opportunistic pathogen in immunocompromised patients as in this case, diabetes mellitus. Therefore, this case report will look at a case of 49-year-old man who was diagnosed with this uncommon pathogen which was successfully eradicated with antibiotics. This case report will look at a case of 49 years old who was diagnosed with this uncommon pathogen which was successfully eradicated with antibiotics.
Fulltext Optimization of cell density and LPS concentration for the evaluation of nitric oxide production on BV-2 cells in a griess assay

Nasim Karim Hosseini, Jose, Shinsmon, Vidyadaran, S., Syafinaz Amin Nordin

Malaysian Journal of Medicine and Health Sciences, 2014;10(2):1-8.
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Introduction: Production of nitric oxide (NO) is one of the main responses elicited by a variety of
immune cells such as macrophages (e.g. microglia, resident macrophages of brain), during inflammation. Evaluation of NO levels in the inflammatory milieu is considered important to the understanding of the intensity of an immune response; and has been performed using different methods including the Griess assay. To assay NO in culture, an appropriate number of cells are stimulated into an inflammatory phenotype. Common stimuli include lipopolysaccharide (LPS), IFN-γ and TNF-α. However, overt stimulation could cause cell cytotoxicity therefore an ideal concentration of LPS should be used. Objective: To set-up a model of BV-2 cell activation that allows the assay of detectable levels of NO. Optimization of BV-2 microglia cell density and LPS concentrations after stimulation by bacterial lipopolysaccharide (LPS) for the Griess assay is demonstrated in this study. Methods: BV-2 microglia were cultured at different cell densities, and treated with LPS at three concentrations (1, 5, 10 μg/ml). NO production in culture supernatants were then measured at 18, 24, 48 and 72 hours. Moreover, methyl tetrazolium assay (MTT) was also performed to ensure that NO measurement is performed at no-cytotoxic concentrations of LPS. Results and Conclusions: NO production follows a temporal pattern. The density of 25000 cells/ well was the ideal seeding density for NO evaluation in BV-2 cells. BV-2 stimulation by LPS is dose dependent, and NO levels are increased proportional to the LPS concentration up to 1.0μg/ml, whereas the higher LPS concentrations are associated with decreased cell viability may be caused by the high toxic levels of LPS or NO. Although Griess assay has been commonly used by the scientists, however, optimization of its parameters on BV-2 cells will be useful for the experiments which will be performed on this particular cell line. The optimized pattern of Griess assay on BV-2 cells was achieved in this study, hence easier and more practical for the future scientists to perform Griess assay on BV-2 cells.
Fulltext Prevalence of Chlamydia trachomatis among subfertile couples of LPPKN subfertility clinic

Nily Waheeda Nekmat, Syafinaz Amin Nordin, Rosliza Abdul Manaf, Maiza Tusimin

Malaysian Journal of Medicine and Health Sciences, 2020;16(201):23-31.
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Introduction: Chlamydia trachomatis is the most prevalent sexually transmitted infection world wide caused by the bacterial agent named Chlamydia trachomatis. Long term chlamydial infection has a negative impact on the female reproductive system and often leads to infertility. We determined the prevalence of Chlamydia trachomatis and its associated factors among subfertile couples attending the Lembaga Penduduk dan Pembangunan Keluarga Negara (LPPKN) Subfertility Clinic. Method: Blood samples were collected from 95 couples (190 respondents) for Chlamydia trachomatis IgG antibody testing. The Enzyme-Linked Immunosorbent Assay (ELISA) technique was used to detect outer membrane protein complexes of Chlamydia trachomatis in the assay. Results: Chlamydia trachomatis IgG antibody seropositivity was detected in 14 husbands (14.7%) and 17 wives (17.9%). The prevalence of Chlamydia trachomatis among these couples was 22.1%. Our findings found no significant association between Chlamydia trachomatis and its associated factors, but the prevalence rate among the studied population is of concern. Conclusion: The screening of Chlamydia trachomatis among couples is recommended for integration in the subfertility investigation procedure. It is crucial, particularly for women with tubal factor infertility (TFI).
Fulltext Comparative analysis of inflammatory markers produced by Macrophages Inoculated with Invasive and Colonizing Strains of Streptococcus Agalactiae (Group B Streptococcus) and evaluation of patients’ clinical data

Nassim Karimi Hosseini, Eskandarian, Narges, Syafinaz Amin Nordin, Vidyadaran, Sharmili, Jose, Shinsmon, Zalina Ismail

Malaysian Journal of Medicine and Health Sciences, 2017;13(1):55-60.
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Introduction: Group B Streptococcus (GBS), infection and recurrence in newborns and pregnant women can lead to
chronic medical illness resulting in significant morbidity, and mortality. Pathogenesis of GBS may be due to reasons
such as activation of the immune system, followed by the production of inflammatory markers and toxic components
by immune cells including macrophages. Methods: The studies on invasive and colonizing GBS strains inoculated
either with peripheral or brain macrophages, the expression of nitric oxide (NO), cell viability, and CD40 were
also measured by Griess assay, methyl tetrazolium assay (MTT), and flow cytometry, respectively. Furthermore, the
clinical manifestations of the selected patients were also assessed for this study. Results: Outcome of inflammatory
markers studies, after GBS inoculation indicated that, invasive GBS strains induced higher inflammatory markers
in comparison to colonizing GBS strains. Furthermore, patients’ clinical data showed that patients with invasive
GBS infections had severe condition unlike among patients with colonizing GBS strains. The fatality rate in patients
with invasive GBS strain were 30.8% while there was no death among carriers. Conclusion: This study, aimed to
understand the immune response to GBS, and strengthen the knowledge on GBS pathogenesis. It was concluded
that invasive GBS strains not only showed higher expression of inflammatory markers on immune cells but also had
higher pathogenesis effect in comparison to colonizing GBS strains.
Fulltext Approaches of learning among medical undergraduates of faculty of medicine and health sciences, Universiti Putra Malaysia in 2016

Nurul Mursyidah Zakaria, Nur Asyiqin Jasman Farok, Siti Khadijah Adam, Syafinaz Amin Nordin

Malaysian Journal of Medicine and Health Sciences, 2018;14(1):1-6.
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Introduction: Challenge arises for medical undergraduates as the subject of medicine is intricate and extensive. Although students come from the same pool of excellent academic background, the medical undergraduates are still prone to failure in exams, resulting in them repeating the year of study or even having the thought of changing to other courses. In order to cope with the programme, students may adopt learning approaches that would help them to go through the programme. Therefore, it would be interesting to explore the learning approaches of medical students in Universiti Putra Malaysia. Methods: The purposes of this study were to determine the learning approach of medical undergraduates of Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (FMHS, UPM) together with its associated factors, which were socio-demographic characteristics and learning environment. This research was a cross-sectional study where the sample size calculated was 554. Self-administered questionnaires were given to the respondents chosen by simple random sampling. The socio-demographic characteristics were analysed using descriptive statistics such as frequency and percentage. Chi-square test was used to analyse the association between the variables. Results: The response rate was 83% (460 respondents agreed to participate). The majority of the respondents were females (73.7%), Malay (67%), and in their clinical years of study (58.7%). Overall, most students preferred deep approach (DA) of learning (49.6%), followed by strategic approach (29.1%) and surface apathetic approach (21.3%) of learning. There were statistically significant associations between learning approach and gender (p=0.005), as well as between learning approach and year of study (p=0.037). Conclusion: Our study showed an association between learning approaches and year of study and gender. DA of learning was the preferred learning approach in medical students at FMHS, UPM. This approach of learning, where students learn to understand the subject matter, may result in students become effective learners. Their understanding about the subject matter will be applicable to their clinical practice in the future.
Fulltext Post-partum invasive group b Streptococcus infection with fatal outcome: a case report

Siti Zulaikha Zakariah, Syafinaz Amin Nordin, Khairul Anuar Zainun, Asyraff Md Najib

Malaysian Journal of Medicine and Health Sciences, 2018;14(3):57-59.
MyJurnal

Group B streptococcus (GBS) is generally known to cause severe disease in the neonate and immunocompromised adults. GBS in the pregnant mother is rare and can potentially be fatal. Clinical presentation can be as mild as an uncomplicated urinary tract infection or serious invasive disease in the form of bacteremia, chorioamnionitis, endometritis and septic abortion. We report a case of a 46-year-old Para 3 lady, post-partum day 12, whom was found dead at home. Prior to her death, she had intermittent fever and abnormal lochia. Autopsy findings indicate GBS endometritis and bacteraemia. She was never screened for GBS. The cost-effectiveness of universal GBS screening needs to be explored to reduce maternal and neonatal morbidity due to GBS.
Fulltext Circulating interleukins in leptospirosis with pulmonary involvement patients

Wan Shahriman Yushdie Wan Yusoff, Maha Abdullah, Fairuz Amran, Zamberi Sekawi, Muhammad Yazli Yuhana, Syafinaz Amin Nordin

Malaysian Journal of Medicine and Health Sciences, 2019;15(108):48-48.
MyJurnal

Introduction: Leptospirosis is a re-emerging zoonotic disease caused by Leptospira bacteria. The clinical manifes-tations of leptospirosis include mild-fever to a severe or even fatal. Increased levels of inflammatory cytokines pro-duced in response to the Leptospira infection by the host immune system were hypothesized as among the causes of severity in leptospirosis. Besides the classical presentation with the triad of febrile, jaundice, and renal failure, patients with leptospirosis also can pose with predominant sign and symptoms of pulmonary involvement. This study aimed to compare the levels of TNF-α, IL-1b, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, IL-17A, IL-18, and IL-22 In the plasma of samples of leptospirosis patients with and without pneumonia. Methods: Circulating cytokine levels in plasma were measured in seventeen patients hospitalized and diagnosed with leptospirosis in Malaysia (January 2016 – December 2017) and nineteen healthy individuals as controls. Patients were categorized into leptospirosis without pneumonia (n=12) and with pneumonia (n=5). Cytokine was measured using SimplePlexTM assays (San Jose, CA, USA). Measurement was performed in triplicate and statistical analysis was conducted using Graphpad® Prism v6 (San Diego, CA, USA). Results: Elevation of plasma TNF-α, IL-6, IL-8, IL-10, IL-18, and IL-22 levels were observed among leptospirosis patients with pneumonia compared to without, although no statistical differences were observed between these two groups. Conclusion: There are no significant differences observed between the levels of plasma TNF-α, IL-6, IL-8, IL-10, IL-18, and IL-22 in patients with pneumonia compared to without.
Fulltext Knowledge and attitude towards vaccine preventable diseases and vaccination among prospective Malaysian Hajj Pilgrims in Klang Valley, Malaysia

Zhi Han Tan, Fatin Nor Aisyah Mohammed Zamli, Lukman Hariz Mohd Izal, Narcisse Joseph, Nurul Azmawati Mohamed, Syafinaz Amin Nordin

Malaysian Journal of Medicine and Health Sciences, 2020;16(201):2-8.
MyJurnal

Introduction: Hajj is a unique religious mass gathering among Muslims hosted by Kingdom of Saudi Arabia (KSA) annually. It is a fifth pillar that is compulsory to be carried among muslim. Infections due to Neisseria meningitidis, Streptococcus Pneumoniae and Influenza virus are very high among Hajj pilgrims in KSA. Study shows knowledge and attitude towards vaccine preventable disease and vaccination which is very important for the prevention of these infectious diseases. This study aims to determine knowledge and attitude among the prospective Malaysian hajj pilgrims on vaccine preventable disease and vaccination. Method: A cross sectional study was conducted among prospective hajj pilgrims in June 2019. Self-administered questionnaires were given to the respondents through simple random sampling. The socio-demographic characteristics were described using descriptive analysis. Chi-square test was used to analyse the association between the socio-demographic and Malaysian hajj pilgrims’ knowledge and attitude towards the vaccine preventable diseases and vaccination. Results: A total of 135 respondents were recruited in the study. There were statistically significant associations between the knowledge and the highest education level (p=0.01), and also between the knowledge and the occupation (p=0.02) on vaccine preventable disease and vaccination. Conclusion: There is a lack of knowledge among the Malaysian hajj pilgrims about these vaccine preventable diseases and vaccination, especially those who have lower education level and also unemployed. Tabung Haji are highly advised to focus on these group and prepare a special course that focused on these vaccine preventable diseases so that Malaysian Hajj pilgrims will be protected.
Fulltext Suppurative BCG lymphadenitis and the importance of microbiology investigations – a case report

Fatimahtuz Zahrah Muhamad Damanhuri, Hasni Mahayidin, Thenmalar Kandasamy, Adilahtul Bushro Zaini, Siti Norbaya Masri, Syafinaz Amin Nordin

Malaysian Journal of Medicine and Health Sciences, 2020;16(201):38-40.
MyJurnal

Suppurative BCG lymphadenitis can easily be overlooked, as it mimics other diseases such as tuberculous lymphadenitis. A case of a three-month old female infant who received the BCG vaccination at birth presented with isolated left axillary mass at two months of age. She was initially treated as lymph node abscess but was referred to the hospital due to the increasing size of the swelling. Needle aspiration was done and the microbiology analysis came out positive for acid-fast bacilli. She was planned for syrup isoniazid; however, the management team withheld treatment until they were certain of the identity of the bacteria. The bacteria was confirmed by the molecular method to be Mycobacterium bovis BCG strain. The case report highlights the importance of the microbiology investigations for appropriate management in this case.
Fulltext Occupational exposure and challenges in tackling M. bovis at human-animal interface: a narrative review

Devi KR, Lee LJ, Yan LT, Syafinaz AN, Rosnah I, Chin VK

Int Arch Occup Environ Health, 2021 08;94(6):1147-1171.
PMID: 33725176 DOI: 10.1007/s00420-021-01677-z

Zoonotic tuberculosis caused by Mycobacterium bovis (M. bovis), a member of Mycobacterium tuberculosis complex (MTBC) has increasingly gathered attention as a public health risk, particularly in developing countries with higher disease prevalence. M. bovis is capable of infecting multiple hosts encompassing a number of domestic animals, in particular cattle as well as a broad range of wildlife reservoirs. Humans are the incidental hosts of M. bovis whereby its transmission to humans is primarily through the consumption of cattle products such as unpasteurized milk or raw meat products that have been contaminated with M. bovis or the transmission could be due to close contact with infected cattle. Also, the transmission could occur through aerosol inhalation of infective droplets or infected body fluids or tissues in the presence of wound from infected animals. The zoonotic risk of M. bovis in humans exemplified by miscellaneous studies across different countries suggested the risk of occupational exposure towards M. bovis infection, especially those animal handlers that have close and unreserved contact with cattle and wildlife populations These animal handlers comprising of livestock farmers, abattoir workers, veterinarians and their assistants, hunters, wildlife workers as well as other animal handlers are at different risk of contracting M. bovis infection, depending on the nature of their jobs and how close is their interaction with infected animals. It is crucial to identify the underlying transmission risk factors and probable transmission pathways involved in the zoonotic transmission of M. bovis from animals to humans for better designation and development of specific preventive measures and guidelines that could reduce the risk of transmission and to protect these different occupational-related/populations at risk. Effective control and disease management of zoonotic tuberculosis caused by M. bovis in humans are also hindered by various challenges and factors involved at animal-human interface. A closer look into factors affecting proper disease control and management of M. bovis are therefore warranted. Hence, in this narrative review, we have gathered a number of different studies to highlight the risk of occupational exposure to M. bovis infection and addressed the limitations and challenges underlying this context. This review also shed lights on various components and approaches in tackling M. bovis infection at animal-human interface.
Nasal colonisation, antimicrobial susceptibility and genotypic pattern of Staphylococcus aureus among agricultural biotechnology students in Besut, Terengganu, east coast of Malaysia

Zarizal S, Yeo CC, Faizal GM, Chew CH, Zakaria ZA, Jamil Al-Obaidi MM, et al.

Trop Med Int Health, 2018 08;23(8):905-913.
PMID: 29873865 DOI: 10.1111/tmi.13090

BACKGROUND: This study aimed to profile the antimicrobial susceptibility and presence of resistance and virulence genes of methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA nasal carriage, by means of genotypic analyses, in students of a tertiary institution in the state of Terengganu, east coast of Malaysia.
METHODS: A total of 370 agricultural biotechnology students from Universiti Sultan Zainal Abidin in Besut, Terengganu, were enrolled in this study. Antimicrobial susceptibility profiles were evaluated by standard methods. PCR detection of resistance and virulence genes was performed on S. aureus that were methicillin-resistant, macrolide-lincosamide-streptogramin B (MLSB )-positive phenotype and/or positive for the leukocidin (pvl) gene followed by staphylococcal cassette chromosome mec (SCCmec), staphylococcal protein A (spa) and accessory gene regulator (agr) typing.
RESULTS: One hundred and nineteen of 370 students carried S. aureus (32%); 18 of the isolates were MRSA (15%). Erythromycin resistance was detected in 20% (24/119) of which 15% (18/119) were MRSA and 5% (6/119) MSSA. Among the 24 erythromycin-resistant isolates, D-test was positive in 29% (7/24) displaying inducible MLSB , whereas the remaining 71% (17/24) showed constitutive MLSB phenotypes. Nine (7.6%) of 119 isolates were pvl positive: 44% MRSA (4/9) and 56% MSSA (5/9). Staphylococcal surface protein sasX gene was present in 92% of MRSA and 8% of MSSA isolates. The majority of MRSA isolates were agr type I (15/18; 83%). Five spa types identified with spa t037 were predominant, followed by spa types (t304 and t8696) as newly reported Malaysian MRSA in a community setting.
CONCLUSION: The presence of MRSA with SCCmec of hospital-associated features and globally recognised spa types in community setting is worrisome. Furthermore, the presence of MLSB strains among multidrug-resistant (MDR) S. aureus with sasX as well as pvl-positive isolates highlights the potential risk of a community setting in facilitating the dissemination of both virulence and resistance determinants.

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