Displaying publications 1 - 20 of 198 in total

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  1. Lung cancer in patients younger than 40 years in a multiracial Asian country
    Liam CK, Lim KH, Wong CM
    Respirology, 2000 Dec;5(4):355-61.
    PMID: 11192546
    This study aimed to determine whether the clinicopathological features of lung cancer in patients younger than 40 years differ from that of older patients in an Asian country.
    Matched MeSH terms: Population Surveillance
  2. Liver cancer in Malaysia: epidemiology and clinical presentation in a multiracial Asian population
    Goh KL, Razlan H, Hartono JL, Qua CS, Yoong BK, Koh PS, et al.
    J Dig Dis, 2015 Mar;16(3):152-8.
    PMID: 25512092 DOI: 10.1111/1751-2980.12223
    Hepatocellular carcinoma (HCC) is an important cancer in Malaysia. This study aimed to determine the epidemiological characteristics and clinical presentations of patients in a multiracial population consisting of three major Asian races: Malays, Chinese and Indians.
    Matched MeSH terms: Population Surveillance
  3. Women are at a higher risk of metabolic syndrome in rural Malaysia
    Jan Mohamed HJ, Mitra AK, Zainuddin LR, Leng SK, Wan Muda WM
    Women Health, 2013;53(4):335-48.
    PMID: 23751089 DOI: 10.1080/03630242.2013.788120
    Metabolic syndrome has been associated with an increased risk of cardiovascular disease and diabetes mellitus. The objective of this study was to determine gender differences in the prevalence and factors associated with metabolic syndrome in a rural Malay population. This cross-sectional study, conducted in Bachok, Kelantan, involved 306 respondents aged 18 to 70 years. The survey used a structured questionnaire to collect information on demographics, lifestyle, and medical history. Anthropometric measurements, such as weight, height, body mass index, waist and hip circumference, and blood pressure were measured. Venous blood samples were taken by a doctor or nurses and analyzed for lipid profile and fasting glucose. The overall prevalence of metabolic syndrome was 37.5% and was higher among females (42.9%). Being unemployed or a housewife and being of older age were independently associated with metabolic syndrome in a multivariate analysis. Weight management and preventive community-based programs involving housewives, the unemployed, and adults of poor education must be reinforced to prevent and manage metabolic syndrome effectively in adults.
    Matched MeSH terms: Population Surveillance
  4. Fulltext Emergence of Japanese encephalitis virus genotype V in the Republic of Korea
    Takhampunya R, Kim HC, Tippayachai B, Kengluecha A, Klein TA, Lee WJ, et al.
    Virol J, 2011;8:449.
    PMID: 21943222 DOI: 10.1186/1743-422X-8-449
    Japanese encephalitis virus (JEV) genotype V reemerged in Asia (China) in 2009 after a 57-year hiatus from the continent, thereby emphasizing a need to increase regional surveillance efforts. Genotypic characterization was performed on 19 JEV-positive mosquito pools (18 pools of Culex tritaeniorhynchus and 1 pool of Cx. bitaeniorhynchus) from a total of 64 positive pools collected from geographically different locations throughout the Republic of Korea (ROK) during 2008 and 2010.
    Matched MeSH terms: Population Surveillance
  5. Fulltext National Trauma Database (NTrD)--improving trauma care: first year report
    Sabariah FJ, Ramesh N, Mahathar AW
    Med J Malaysia, 2008 Sep;63 Suppl C:45-9.
    PMID: 19227673
    The first Malaysian National Trauma Database was launched in May 2006 with five tertiary referral centres to determine the fundamental data on major trauma, subsequently to evaluate the major trauma management and to come up with guidelines for improved trauma care. A prospective study, using standardized and validated questionnaires, was carried out from May 2006 till April 2007 for all cases admitted and referred to the participating hospitals. During the one year period, 123,916 trauma patients were registered, of which 933 (0.75%) were classified as major trauma. Patients with blunt injury made up for 83.9% of cases and RTA accounted for 72.6% of injuries with 64.9% involving motorcyclist and pillion rider. 42.8% had severe head injury with an admission Glasgow Coma Scale (GCS) of 3-8 and the Revised Trauma Score (RTS) of 5-6 were recorded in 28.8% of patients. The distribution of Injury Severity Score (ISS) showed that 42.9% of cases were in the range of 16-24. Only 1.9% and 6.3% of the patients were reviewed by the Emergency Physician and Surgeon respectively. Patients with admission systolic blood pressure of less than 90 mmHg had a death rate of 54.6%. Patients with severe head injury (GCS < 9), 45.1% died while 79% patients with moderate head injury survived. There were more survivors within the higher RTS range compared to the lower RTS. Patients with direct admission accounted for 52.3% of survivors and there were 61.7% survivors for referred cases. In conclusion, NTrD first report has successfully demonstrated its significance in giving essential data on major trauma in Malaysia, however further expansion of the study may reflect more comprehensive trauma database in this country.
    Matched MeSH terms: Population Surveillance
  6. Fulltext Hospital-acquired vancomycin-resistant enterococci: now appearing in Kuala Lumpur Hospital
    Zubaidah AW, Ariza A, Azmi S
    Med J Malaysia, 2006 Oct;61(4):487-9.
    PMID: 17243529 MyJurnal
    Hospital-acquired vancomycin-resistant enterococci (VRE) were first reported in the late 1980s and have since been an increasing problem worldwide. Kuala Lumpur Hospital thus far, to the best of our knowledge has been spared from this pathogen. We describe the first confirmed case of Enterococcus faecium exhibiting the van A phenotype in our hospital, in a patient with chronic renal failure who was successfully treated with linezolid. The microbiology laboratory plays an important role in the identification and detection of VRE.
    Matched MeSH terms: Population Surveillance
  7. Time trends in upper gastrointestinal diseases and Helicobacter pylori infection in a multiracial Asian population--a 20-year experience over three time periods
    Leow AH, Lim YY, Liew WC, Goh KL
    Aliment Pharmacol Ther, 2016 Apr;43(7):831-7.
    PMID: 26847417 DOI: 10.1111/apt.13550
    Marked epidemiological changes in upper gastrointestinal diseases and Helicobacter pylori infection have taken place in the Asian Pacific region. In particular, differences with respect to race in the multiracial Asian population in Malaysia have been important and interesting.
    Matched MeSH terms: Population Surveillance
  8. Isolation and PCR detection of rickettsiae from clinical and rodent samples in Malaysia
    Tay ST, Rohani MY, Ho TM, Devi S
    Southeast Asian J. Trop. Med. Public Health, 2002 Dec;33(4):772-9.
    PMID: 12757225
    Isolation of rickettsiae from patients' blood samples and organ samples of wild rodents from areas with high seroprevalence of rickettsial infections was attempted using cell culture assay and animal passages. L929 mouse fibroblast cells grown in 24 well tissue culture plate were inoculated with buffy coat of febrile patients and examined for the growth of rickettsiae by Giemsa, Gimenez staining and direct immunofluorescence assay. No rickettsiae were isolated from 48 patients' blood samples. No symptomatic infections were noted in mice or guinea pigs infected with 50 organ samples of wild rodents. There was no rickettsial DNA amplified from these samples using various PCR detection systems for Orientia tsutsugamushi, typhus and spotted fever group rickettsiae.
    Matched MeSH terms: Population Surveillance
  9. Nipah virus outbreak in Malaysia
    Chua KB
    J Clin Virol, 2003 Apr;26(3):265-75.
    PMID: 12637075
    Nipah virus, a novel paramyxovirus, closely related to Hendra virus emerged in northern part of Peninsular Malaysia in 1998. The virus caused an outbreak of severe febrile encephalitis in humans with a high mortality rate, whereas, in pigs, encephalitis and respiratory diseases but with a relatively low mortality rate. The outbreak subsequently spread to various regions of the country and Singapore in the south due to the movement of infected pigs. Nipah virus caused systemic infections in humans, pigs and other mammals. Histopathological and radiological findings were characteristic of the disease. Fruitbats of Pteropid species were identified as the natural reservoir hosts. Evidence suggested that climatic and anthropogenic driven ecological changes coupled with the location of piggeries in orchard and the design of pigsties allowed the spill-over of this novel paramyxovirus from its reservoir host into the domestic pigs and ultimately to humans and other animals.
    Matched MeSH terms: Population Surveillance
  10. Fulltext The Role of Genetic Polymorphism and Other Factors on Clopidogrel Resistance (CR) in an Asian Population with Coronary Heart Disease (CHD)
    Akkaif MA, Daud NAA, Sha'aban A, Ng ML, Abdul Kader MAS, Noor DAM, et al.
    Molecules, 2021 Apr 01;26(7).
    PMID: 33915807 DOI: 10.3390/molecules26071987
    Clopidogrel is a widely-used antiplatelet drug. It is important for the treatment and prevention of coronary heart disease. Clopidogrel can effectively reduce platelet activity and therefore reduce stent thrombosis. However, some patients still have ischemic events despite taking the clopidogrel due to the alteration in clopidogrel metabolism attributable to various genetic and non-genetic factors. This review aims to summarise the mechanisms and causes of clopidogrel resistance (CR) and potential strategies to overcome it. This review summarised the possible effects of genetic polymorphism on CR among the Asian population, especially CYP2C19 *2 / *3 / *17, where the prevalence rate among Asians was 23.00%, 4.61%, 15.18%, respectively. The review also studied the effects of other factors and appropriate strategies used to overcome CR. Generally, CR among the Asian population was estimated at 17.2-81.6%. Therefore, our overview provides valuable insight into the causes of RC. In conclusion, understanding the prevalence of drug metabolism-related genetic polymorphism, especially CYP2C19 alleles, will enhance clinical understanding of racial differences in drug reactions, contributing to the development of personalised medicine in Asia.
    Matched MeSH terms: Population Surveillance
  11. Fulltext Antimicrobial Polymers: The Potential Replacement of Existing Antibiotics?
    Kamaruzzaman NF, Tan LP, Hamdan RH, Choong SS, Wong WK, Gibson AJ, et al.
    Int J Mol Sci, 2019 Jun 04;20(11).
    PMID: 31167476 DOI: 10.3390/ijms20112747
    Antimicrobial resistance is now considered a major global challenge; compromising medical advancements and our ability to treat infectious disease. Increased antimicrobial resistance has resulted in increased morbidity and mortality due to infectious diseases worldwide. The lack of discovery of novel compounds from natural products or new classes of antimicrobials, encouraged us to recycle discontinued antimicrobials that were previously removed from routine use due to their toxicity, e.g., colistin. Since the discovery of new classes of compounds is extremely expensive and has very little success, one strategy to overcome this issue could be the application of synthetic compounds that possess antimicrobial activities. Polymers with innate antimicrobial properties or that have the ability to be conjugated with other antimicrobial compounds create the possibility for replacement of antimicrobials either for the direct application as medicine or implanted on medical devices to control infection. Here, we provide the latest update on research related to antimicrobial polymers in the context of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pathogens. We summarise polymer subgroups: compounds containing natural peptides, halogens, phosphor and sulfo derivatives and phenol and benzoic derivatives, organometalic polymers, metal nanoparticles incorporated into polymeric carriers, dendrimers and polymer-based guanidine. We intend to enhance understanding in the field and promote further work on the development of polymer based antimicrobial compounds.
    Matched MeSH terms: Population Surveillance
  12. Fulltext Turner syndrome in diverse populations
    Kruszka P, Addissie YA, Tekendo-Ngongang C, Jones KL, Savage SK, Gupta N, et al.
    Am J Med Genet A, 2020 Feb;182(2):303-313.
    PMID: 31854143 DOI: 10.1002/ajmg.a.61461
    Turner syndrome (TS) is a common multiple congenital anomaly syndrome resulting from complete or partial absence of the second X chromosome. In this study, we explore the phenotype of TS in diverse populations using clinical examination and facial analysis technology. Clinical data from 78 individuals and images from 108 individuals with TS from 19 different countries were analyzed. Individuals were grouped into categories of African descent (African), Asian, Latin American, Caucasian (European descent), and Middle Eastern. The most common phenotype features across all population groups were short stature (86%), cubitus valgus (76%), and low posterior hairline 70%. Two facial analysis technology experiments were conducted: TS versus general population and TS versus Noonan syndrome. Across all ethnicities, facial analysis was accurate in diagnosing TS from frontal facial images as measured by the area under the curve (AUC). An AUC of 0.903 (p < .001) was found for TS versus general population controls and 0.925 (p < .001) for TS versus individuals with Noonan syndrome. In summary, we present consistent clinical findings from global populations with TS and additionally demonstrate that facial analysis technology can accurately distinguish TS from the general population and Noonan syndrome.
    Matched MeSH terms: Population Surveillance
  13. Fulltext Identification of independent association signals and putative functional variants for breast cancer risk through fine-scale mapping of the 12p11 locus
    Zeng C, Guo X, Long J, Kuchenbaecker KB, Droit A, Michailidou K, et al.
    Breast Cancer Res, 2016 06 21;18(1):64.
    PMID: 27459855 DOI: 10.1186/s13058-016-0718-0
    BACKGROUND: Multiple recent genome-wide association studies (GWAS) have identified a single nucleotide polymorphism (SNP), rs10771399, at 12p11 that is associated with breast cancer risk.

    METHOD: We performed a fine-scale mapping study of a 700 kb region including 441 genotyped and more than 1300 imputed genetic variants in 48,155 cases and 43,612 controls of European descent, 6269 cases and 6624 controls of East Asian descent and 1116 cases and 932 controls of African descent in the Breast Cancer Association Consortium (BCAC; http://bcac.ccge.medschl.cam.ac.uk/ ), and in 15,252 BRCA1 mutation carriers in the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). Stepwise regression analyses were performed to identify independent association signals. Data from the Encyclopedia of DNA Elements project (ENCODE) and the Cancer Genome Atlas (TCGA) were used for functional annotation.

    RESULTS: Analysis of data from European descendants found evidence for four independent association signals at 12p11, represented by rs7297051 (odds ratio (OR) = 1.09, 95 % confidence interval (CI) = 1.06-1.12; P = 3 × 10(-9)), rs805510 (OR = 1.08, 95 % CI = 1.04-1.12, P = 2 × 10(-5)), and rs1871152 (OR = 1.04, 95 % CI = 1.02-1.06; P = 2 × 10(-4)) identified in the general populations, and rs113824616 (P = 7 × 10(-5)) identified in the meta-analysis of BCAC ER-negative cases and BRCA1 mutation carriers. SNPs rs7297051, rs805510 and rs113824616 were also associated with breast cancer risk at P 

    Matched MeSH terms: Population Surveillance
  14. Influence of health providers on pediatrics' immunization rate
    Al-lela OQ, Baidi Bahari M, Al-abbassi MG, Salih MR, Basher AY
    J Trop Pediatr, 2012 Dec;58(6):441-5.
    PMID: 22538210 DOI: 10.1093/tropej/fms014
    To identify the immunization providers' characteristics associated with immunization rate in children younger than 2 years. A cohort and a cluster sampling design were implemented; 528 children between 18 and 70 months of age were sampled in five public health clinics in Mosul-Iraq. Providers' characterizations were obtained. Immunization rate for the children was assessed. Risk factors for partial immunization were explored using both bivariate analyses and multi-level logistic regression models. Less than half of the children had one or more than one missed dose, considered as partial immunization cases. The study found significant association of immunization rate with provider's type. Two factors were found that strongly impacted on immunization rate in the presence of other factors: birthplace and immunization providers' type.
    Matched MeSH terms: Population Surveillance
  15. Fulltext The prevalence of acute respiratory symptoms and role of protective measures among Malaysian hajj pilgrims
    Deris ZZ, Hasan H, Sulaiman SA, Wahab MS, Naing NN, Othman NH
    J Travel Med, 2010 Mar-Apr;17(2):82-8.
    PMID: 20412173 DOI: 10.1111/j.1708-8305.2009.00384.x
    BACKGROUND: Respiratory symptoms including cough, runny nose, sore throat, and fever are the most common clinical manifestations faced by hajj pilgrims in Mecca. The aim of the study was to determine the prevalence of respiratory symptoms among Malaysian hajj pilgrims and the effect of a few protective measures taken by hajj pilgrims to reduce respiratory symptoms.
    METHODS: A cross-sectional study was conducted by distributing survey forms to Malaysian hajj pilgrims at transit center before flying back to Malaysia. The recruitment of respondents to the survey was on a voluntary basis.
    RESULTS: A total of 387 survey forms were available for analysis. The mean age was 50.4 +/- 11.0 years. The common respiratory symptoms among Malaysian hajj pilgrims were: cough 91.5%, runny nose 79.3%, fever 59.2%, and sore throat 57.1%. The prevalence of hajj pilgrims with triad of cough, subjective fever, and sore throat were 40.1%. The symptoms lasted less than 2 weeks in the majority of cases. Only 3.6% did not suffer from any of these symptoms. Seventy-two percent of hajj pilgrims received influenza vaccination before departure and 72.9% wore facemasks. Influenza vaccination was not associated with any of respiratory symptoms but it was significantly associated with longer duration of sore throat. Wearing masks was significantly associated with sore throat and longer duration of sore throat and fever.
    CONCLUSIONS: The prevalence of respiratory symptoms was high among Malaysian hajj pilgrims and the current protective measures seemed inadequate to reduce it. Beside standardization of the term used in hajj studies, more collaborative effort should be taken to reduce respiratory symptoms. The hajj authority should prepare for the challenge of pandemic influenza by providing more healthcare facilities and implementation of more strict measures to reduce the transmission of pandemic influenza strain among hajj pilgrims.
    Matched MeSH terms: Population Surveillance
  16. Fulltext Preliminary results from the pilot study on the National Cancer Patient Registry--Cervical Cancer
    Devi Beena CR, Tang TS, Gerard LC
    Med J Malaysia, 2008 Sep;63 Suppl C:63-5.
    PMID: 19230250
    Carcinoma of the cervix is the most common malignancy in many developing countries. The purpose of this pilot study on cervical cancer patients treated at selected sites in Malaysia is to examine the achievability of collecting information on patients. The data was collected from the medical records of the patients using case report form. The results reveal that more than 90% of the forms had completed data from all sites. The pilot study has demonstrated that it is feasible to register and collect information on cervical cancer patients using the case report forms. Treatment outcome obtained from this data will form the baseline to establish existing clinical practice and will be useful for treating physicians to monitor the treatment outcome and the late complications and with longer followup to measure the disease free and overall survival. In addition, it is an useful tool as the national indicator.
    Matched MeSH terms: Population Surveillance
  17. Fulltext Acute coronary syndrome (ACS) registry--leading the charge for National Cardiovascular Disease (NCVD) Database
    Chin SP, Jeyaindran S, Azhari R, Wan Azman WA, Omar I, Robaayah Z, et al.
    Med J Malaysia, 2008 Sep;63 Suppl C:29-36.
    PMID: 19230244
    Coronary artery disease is one of the most rampant non-communicable diseases in the world. It begins indolently as a fatty streak in the lining of the artery that soon progresses to narrow the coronary arteries and impair myocardial perfusion. Often the atherosclerotic plaque ruptures and causes sudden thrombotic occlusion and acute ST-elevation myocardial infarction (STEMI), non-ST-elevation MI (NSTEMI) or unstable angina (UA). This phenomenon is called acute coronary syndrome (ACS) and is the leading cause of death not only in Malaysia but also globally. In order for us to tackle this threat to the health of our nation we must arm ourselves with reliable and accurate information to assess current burden of disease resources available and success of current strategies. The acute coronary syndrome (ACS) registry is the flagship of the National Cardiovascular Disease Database (NCVD) and is the result of the dedicated and untiring efforts of doctors and nurses in both public and private medical institutions and hospitals around the country, ably guided and supported by the National Heart Association, the National Heart Foundation, the Clinical Research Centre and the Ministry of Health of Malaysia. Analyses of data collected throughout 2006 from 3422 patients with ACS admitted to the 12 tertiary cardiac centres and general hospitals spanning nine states in Malaysia in this first report has already revealed surprising results. Mean age of patients was 59 years while the most consistent risk factor for STEMI was active smoking. Utilization of medications was high generally. Thirty-day mortality for STEMI was 11%, for NSTEMI 8% and UA 4%. Thrombolysis (for STEMI only) reduced in-hospital and 30-day mortality by nearly 50%. Percutaneous coronary intervention or PCI also reduced 30-day mortality for patients with non-ST elevation MI and unstable angina. The strongest determinants of mortality appears to be Killip Class and age of the patient. Fewer women received thrombolysis or underwent PCI on same admission although women make up 25% of the cohort.
    Matched MeSH terms: Population Surveillance
  18. How well can signs and symptoms predict AMI in the Malaysian population?
    Bulgiba AM, Razaz M
    Int J Cardiol, 2005 Jun 22;102(1):87-93.
    PMID: 15939103
    The aim of the study was to use data from an electronic medical record system (EMR) to look for factors that would help us diagnose acute myocardial infarction (AMI) with the ultimate aim of using these factors in a decision support system for chest pain. We extracted 887 records from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. We cleaned the data, extracted 69 possible variables and performed univariate and multivariate analysis. From the univariate analysis we find that 22 variables are significantly associated with a diagnosis of AMI. However, multiple logistic regression reveals that only 9 of these 22 variables are significantly related to a diagnosis of AMI. Race (Indian), male sex, sudden onset of persistent crushing pain, associated sweating and a history of diabetes mellitus are significant predictors of AMI. Pain that is relieved by other means and history of heart disease on treatment are important predictors of a diagnosis other than AMI. The degree of accuracy is high at 80.5%. There are 13 factors that are significant in the univariate analysis but are not among the nine significant factors in the multivariate analysis. These are location of pain, associated palpitations, nausea and vomiting; pain relieved by rest, pain aggravated by posture, cough, inspiration and exertion; age more than 40, being a smoker and abnormal chest wall and face examination. We believe that these findings can have important applications in the design of an intelligent decision support system for use in medical care as the predictive capability can be further refined with the use of intelligent computational techniques.
    Matched MeSH terms: Population Surveillance
  19. Cryptocaryon irritans recombinant proteins as potential antigens for sero-surveillance of cryptocaryonosis
    Lokanathan Y, Mohd-Adnan A, Kua BC, Nathan S
    J Fish Dis, 2016 Sep;39(9):1069-83.
    PMID: 27086498 DOI: 10.1111/jfd.12474
    Cryptocaryonosis is a major problem for mariculture, and the absence of suitable sero-surveillance tools for the detection of cryptocaryonosis makes it difficult to screen Cryptocaryon irritans-infected fish, particularly asymptomatic fish. In this study, we proposed a serum-based assay using selected C. irritans proteins to screen infected and asymptomatic fish. Eight highly expressed genes were chosen from an earlier study on C. irritans expressed sequence tags and ciliate glutamine codons were converted to universal glutamine codons. The chemically synthesized C. irritans genes were then expressed in an Escherichia coli expression host under optimized conditions. Five C. irritans proteins were successfully expressed in E. coli and purified by affinity chromatography. These proteins were used as antigens in an enzyme-linked immunosorbent assay (ELISA) to screen sera from experimentally immunized fish and naturally infected fish. Sera from both categories of fish reacted equally well with the expressed C. irritans recombinant proteins as well as with sonicated theronts. This study demonstrated the utility of producing ciliate recombinant proteins in a heterologous expression host. An ELISA was successfully developed to diagnose infected and asymptomatic fish using the recombinant proteins as antigens.
    Matched MeSH terms: Population Surveillance
  20. Borrelia burgdorferi (strain B. afzelii) antibodies among Malaysian blood donors and patients
    Tay ST, Kamalanathan M, Rohani MY
    Southeast Asian J. Trop. Med. Public Health, 2002 Dec;33(4):787-93.
    PMID: 12757227
    In this study, the presence of IgG and IgM antibodies against Borrelia burgdorferi (strain B. afzelii) among Malaysian blood donors and patients admitted to hospital with various infectious diseases was determined. Sera were screened using enzyme-linked immunosorbent assay (ELISA); positive sera were then subjected to Western blot testing. All but one of the blood donors were negative for borrelial antibodies. Of 121 patients' sera, IgM antibodies were detected in 24 (19.8%) and IgG antibodies were detected in 5 (4.1%) sera. Only one of two patients with skin manifestations suggestive of Lyme disease had IgM antibody against B. afzelii. Of 30 patients with exposure to tick typhus, 4 (13.3%) were IgM positive and 1 (3.3%) was IgG positive. Based on the detection of antigenic bands by Western blot, 6 patients' sera showed positive reactions. Antigenic bands of p39, p41 and p59/62 kDa were the commonest findings of Western blotting. This study provides serological evidence of B. afzelii infections in Malaysia; further investigation is needed to correlate serological and clinical findings.
    Matched MeSH terms: Population Surveillance
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