Cytogenomic Profiling of Chronic Lymphocytic Leukaemia Patients Using DNA Microarray

@#Introduction: Chronic lymphocytic leukaemia (CLL) is the most frequent adult leukaemia in the Western world. The clinical presentation varies greatly, from very indolent cases to those with aggressive and fast advancing disease. This variation has significant implications for clinical approaches, therapeutic tactics, and, ultimately, survival durations from diagnosis. Acquired chromosomal aberrations play a key role in CLL aetiology. Due to difficulty to obtain abnormal metaphases for analysis, few methods such as fluorescence in-situ hybridization (FISH) and multiplex ligation-dependent probe assay (MLPA) were employed to detect chromosomal aberration however the methods are limited to specific locus only. Thus, this study is aimed to detect the chromosomal aberrations using DNA microarray platform. Methods: In this retrospective study, DNA archive obtained from 7 CLL patients which collected at diagnosis and subjected to Affymetrix CytoScan® 750K single nucleotide polymorphism (SNP) array following the manufacture procedure. The raw data obtained were analysed using the Chromosome Analysis Suite (ChAS) software (Affymetrix) using annotations of genome version GRCh38 (hg38). Result: Out of 7 patients, 4 of them showing deletion of 13q while 3 of them showing deletion of 14q in various region . Some of the deleted loci were too small (0.42-0.6Mb) to be detected by conventional cytogenetic analysis (CCA). There was also the presence of additional chromosomal aberrations that could be missed by CCA, FISH, or MLPA due to cryptic deletion or duplication that was as small as 0.4MB in size. Conclusion: The present study showed that low resolution chromosomal aberration was able to be detected using DNA microarray platform in comparison to CCA, FISH and MLPA.

Prevalence and Susceptibility of Staphylococcus aureus Nasal Carriage Strains Isolated from Haemodialysis Patients

@#Introduction: Staphylococcus aureus is part of the normal human flora that can commonly be found on the skin and mucous membranes of the nasal area. However, in immunosuppressed patients such as those with kidney failures, colonization can potentially lead to infection. There is a concern of increasing antibiotic resistance in S. aureus. This study aimed to determine the prevalence of S. aureus nasal colonization and its antimicrobial susceptibility among haemodialysis-dependent populations. Methods: A cross-sectional study at the Nephrology Unit, Hospital Canselori Tuanku Mukhriz (HCTM) was conducted among haemodialysis-dependent patients between February 2017 to February 2018. Nasal swabs were obtained and cultured on mannitol salt agar. S. aureus isolates were identified by gram staining, tube coagulase and Deoxyribonuclease (DNase). Cefoxitin disc (30 µg) were used to identified the presence of MRSA (methicillin-resistance S. aureus). The S. aureus colonies were further tested against six antibiotics using Kirby Bauer disc diffusion. Result: A total of 134 patients were recruited. S. aureus isolates were detected from 27 patients (20.1%). All S. aureus were phenotypically identified as methicillin-sensitive S. aureus (MSSA) based on the cefoxitin disc. Teicoplanin and linezolid were the most effective with 100% susceptibility. S. aureus exhibited a high resistance rate towards erythromycin (29.6%). No MRSA was isolated in this study. Conclusion: This study highlighted the high prevalence of S. aureus nasal colonization in haemodialysis patients. Teicoplanin and linezolid were found to be the most effective antibiotics against isolated S. aureus.

Evaluation of Visual Acuity, Macular Thickness, and Level of Proteinuria in Children with Nephrotic Syndrome

Purpose@#Macular edema, serous retinal detachment, and retinal pigment epithelial detachment have been reported in patients with nephrotic syndrome. However, there is limited data about macular thickness in children with nephrotic syndrome. The aim of this study was to compare the mean macular thickness in children with nephrotic syndrome and in a control group and to correlate it with visual acuity and level of proteinuria. @*Methods@#The comparative cross-sectional study included 66 children aged 6 to 17 years with nephrotic syndrome and healthy control seen in two tertiary centers in Malaysia. We recorded demographic data, as well as visual acuity, level of proteinuria, and the mean macular thicknesses in both groups. The mean macular thickness was measured using Stratus optical coherence tomography according to nine areas of the Early Treatment Diabetic Retinopathy Study map. @*Results@#The mean foveal thickness was 238.15 ± 22.98 µm for children with nephrotic syndrome and 237.01 ± 22.60 µm for the control group. There was no significant difference in the mean macular thickness between the groups (p = 0.843). A significant correlation with visual acuity was observed in the superior outer macula (r = –0.41, p = 0.019), the nasal outer macula (r = –0.41, p = 0.019), and the inferior outer macula (r = –0.40, p = 0.021). There was no significant correlation between the mean macular thickness and level of proteinuria (p = 0.338), although those with higher levels of proteinuria demonstrated a trend towards increased macular thickness. @*Conclusions@#The mean macular thickness in children with nephrotic syndrome was similar to that of healthy children. A significant correlation between the mean thickness of the outer macular layer and the presenting visual acuity was observed. There was no correlation between the mean macular thickness and the level of proteinuria.

Cytotoxic Activity of Ethanolic Extract Aquilaria malaccensis Leaves Against MCF-7 Cells

@#Introduction: Aquilaria malaccensis, also known as “Pokok Karas” in Malaysia, is widely used in Southeast Asian countries for the treatment of joint pain, diarrhoea and inflammatory diseases, and has shown beneficial effects as an anticancer agent. The aim of this study was to investigate the effect of ethanol leaf extracts of A. malaccensis on MCF-7 cells. Methods: MTT-based cytotoxic and antiproliferative assay was used to determine the outcome of ethanolic extract toward MCF-7 cells. The mode of cell death was determined by the AO/PI double staining assay and the depolarisation of the mitochondria membrane potential. Results: IC50 value of the extract against MCF-7 cells treated for 72 hours was 4.1 ± 2.08 µg/mL, while the IC50 value for doxorubicin was 2.92 ± 0.12 µg/mL. The extract showed a lower cytotoxic effect against the NIH/3T3 cells and inhibited the growth of MCF-7 cells in a dose dependent manner. AO/PI double stain showed that the ethanolic extract of A. malaccensis leaves induced MCF-7 cells into apoptotic cell death. The present study showed that the ethanolic extract of A. malaccensis induced apoptosis through mitochondrial pathway as indicated by its ability to take up JC-1. Conclusion: The study found that ethanolic extract obtained from A. malaccensis leaves is cytotoxic on MCF-7 cells, resulting to apoptotic cell death of the cells.

A Case of Lymphoma with Multiple Identities

@#Discordant lymphoma (DL) is the coexistence of two or more distinct subtypes in separate anatomic sites. There are limited reports on DL cases especially involving more than two subtypes in more than two sites. We report a 76-year-old man who presented with constitutional symptoms, flank mass and painless lymphadenopathies for six months. Laboratory tests revealed moderate anaemia, markedly elevated serum IgM (13400 mg/dL), IgM Lambda paraproteinemia and Lambda light chain paraproteinuria with unmeasurable serum lactate dehydrogenase due to hyperviscous sample. CT scan showed multiple subcutaneous masses over chest wall and retroperitoneum, with lytic bone lesions, and hepatosplenomegaly. Further biopsy findings with morphological, immunohistochemical and molecular analysis of the tissue sections revealed diffuse large B-Cell lymphoma in the chest wall mass, follicular lymphoma in the inguinal lymph node and lymphoplasmacytic lymphoma in the bone marrow. This case highlights the rare DL. The importance of histopathological evaluation of lymphoma despite the availability of PET-CT scans for disease staging is undeniable.

The Sanitary Conditions of Bakeries and Food Safety Practices Assessment of Bakers in Tamale Metropolis, Ghana

There is a lack of research on the safety of bread in Ghana, although it is one of the foods consumed by most Ghanaians daily. The study, therefore, assessed the sanitary conditions of bakeries in the Tamale Metropolis and further evaluated the food safety practices of bakers in these bakeries. The study employed the use of a questionnaire to collect data in 24 carefully selected bakeries and then the food safety practices of bakers in these bakeries. Results showed that 91.7% of the bakeries had bakers wearing protective gears while working. All (100%) the bakeries were free of domestic animals and a visible presence of insects, rodents or vectors. However, 6(25%) bakeries placed their solid waste containers in the bakery premises. Also, 89.5% of the bakers indicated that they always wash their hands with soap and water before working or handling baking ingredients and materials. All (100%) bakers indicated that they check the expiry dates of their bakery ingredients before using them. 29.8% of the bakers, however, did not make it a practice of refrigerating bakery ingredients that require to be stored in the fridge when not in use. In conclusion, most bakeries had good sanitary conditions and were managed in a manner that ensure food safety. Bakers also exhibited a good level of food safety adherence. Managers should continue to ensure that good sanitary standards are followed and food risk analysis concepts like HACCP are implemented in the bakery to check new and complex food safety threats.

Laplace-Based Interpolation Method in Reduction of Metal Artifact in Computed Tomography Imaging

@#Introduction: Metal artifacts can degrade the image quality of computed tomography (CT) images which lead to errors in diagnosis. This study aims to evaluate the performance of Laplace interpolation (LI) method for metal artifacts reduction (MAR) in CT images in comparison with cubic spline (CS) interpolation. Methods: In this study, the proposed MAR algorithm was developed using MATLAB platform. Firstly, the virtual sinogram was acquired from CT image using Radon transform function. Then, dual-adaptive thresholding detected and segmented the metal part within the CT sinogram. Performance of the two interpolation methods to replace the missing part of segmented sinogram were evaluated. The interpolated sinogram was reconstructed, prior to image fusion to obtain the final corrected image. The qualitative and quantitative evaluations were performed on the corrected CT images (both phantom and clinical images) to evaluate the effectiveness of the proposed MAR technique. Results: From the findings, LI method had successfully replaced the missing data on both simple and complex thresholded sinogram as compared to CS method (p-value = 0.17). The artifact index was significantly reduced by LI method (p-value = 0.02). For qualitative analysis, the mean scores by radiologists for LI-corrected images were higher than original image and CS-corrected images. Conclusion: In conclusion, LI method for MAR produced better results as compared to CS interpolation method, as it worked more effective by successfully interpolated all the missing data within sinogram in most of the CT images.

Projection of Infant Mortality Rate in Malaysia using R (Unjuran kadar kematian bayi di Malaysia menggunakan R) / Jurnal Sains Kesihatan Malaysia

@#Projecting future infant mortality rate (IMR) is an important subject in ensuring the stability of health in one nation or a specific region in general. Secondary data of IMR from December 1950 until December 2020 from United NationsWorld Population Prospects were used to project the trend of IMR in Malaysia up to 2023. In this study, five different forecasting models were adopted including Mean model, Naïve model, Autoregressive Integrated Moving Average (ARIMA) model, Exponential State Space model and Neural Network model. The results were analyzed using R programing and RStudio. The out-sample forecasts of mortality rates were evaluated using six error measures namely, Mean Error (ME), Root Mean Square Error (RMSE), Mean Absolute Error (MAE), Mean Percentage Error (MPE), Mean Absolute Percentage Error (MAPE) and Mean Absolute Scaled Error (MASE). Consequently, the keen analysis was focused on the trend and projection of infant mortality rate in the future using the most accurate model. The results showed that the “win” model for this study is ARIMA (0,2,0) model. The model provided a consistent estimate of IMR in relation to a similar decreasing pattern as shown by the original data and hence a reliable projection of IMR. The three ahead forecast values showed that IMR is likely to keep on continuously decreasing in the future. This study could become a guideline for human resource management and health care allocation planning. A forecast of IMR can help the implementation of interventions to reduce the burden of infant mortality within the target range.

Long-term Safety and Efficacy of Esketamine Nasal Spray Plus an Oral Antidepressant in Patients with Treatment-resistant Depression– an Asian Sub-group Analysis from the SUSTAIN-2 Study

Objective@#To evaluate the long-term safety and efficacy of intranasal esketamine in patients with treatment-resistant depression from the Asian subgroup of the SUSTAIN-2 study. @*Methods@#SUSTAIN-2 was a phase 3, open-label, single-arm, multicenter study comprising a 4-week screening, 4-week induction, 48-week optimization/maintenance, and 4-week follow-up (upon esketamine discontinuation) phase. Patients with treatment-resistant depression received esketamine plus an oral antidepressant during the treatment period. @*Results@#The incidence of ≥ 1 serious treatment-emergent adverse event (TEAE) among the 78 subjects from the Asian subgroup (Taiwan: 33, Korea: 26, Malaysia: 19) was 11.5% (n = 9); with no fatal TEAE. 13 Asian patients (16.7%) discontinued esketamine due to TEAEs. The most common TEAEs were dizziness (37.2%), nausea (29.5%), dissociation (28.2%), and headache (21.8%). Most TEAEs were mild to moderate in severity, transient and resolved on the same day. Upon discontinuation of esketamine, no trend in withdrawal symptoms was observed to associate long-term use of esketamine with withdrawal syndrome. There were no reports of drug seeking, abuse, or overdose. Improvements in symptoms, functioning and quality of life, occurred during in the induction phase and were generally maintained through the optimization/maintenance phases of the study. @*Conclusion@#The safety and efficacy of esketamine in the Asian subgroup was generally consistent with the total SUSTAIN-2 population. There was no new safety signal and no indication of a high potential for abuse with the long-term (up to one year) use of esketamine in the Asian subgroup. Most of the benefits of esketamine occurred early during the induction phase.

Calcium and iron intakes of adolescents in Malaysia and their relationships with body mass index (BMI): Findings from the Adolescent Nutrition Survey 2017

@#Introduction: Adolescent health is a priority considering they represent the future generation. Data from the Adolescent Nutrition Survey 2017 were analysed to determine the prevalence of micronutrient inadequacy, particularly calcium and iron, and the relationship with body mass index (BMI) among Malaysian secondary school students. Methods: This cross-sectional study included students aged 13 to 17 years old studying at public and private schools. Twenty-four hours dietary recall via face-to-face interview was conducted by trained nutritionists to obtain data on dietary intake. For nutritional status, BMI-for-age z-score (BAZ) was analysed using WHO Anthroplus software. Results: From 999 respondents, 449 were boys and 550 were girls. Overall findings indicated that both boys and girls had inadequate intakes of calcium and iron in their daily diet. Mean intakes of calcium (695.7±463.2 mg/day) and iron (23.4±21.0 mg/day) were higher among boys aged 16 to 17 years old. Mean intake of iron were higher among the older age groups. Majority of the respondents (boys: 94%; girls: 97%) did not meet the recommended nutrient intake (RNI) for calcium and more than half (boys: 50%; girl: 80%) did not achieve the RNI for iron. Current findings also found significant positive but weak correlations between calcium (r=0.112, p=0.001) and iron (r=0.084, p=0.008) intakes with BMI-for-age. Conclusion: BMI-for-age was related to calcium and iron intakes among secondary school students in Malaysia. Thus, intervention strategies should focus on early screening and nutrition education on food choices of high calcium and high iron contents, including iron supplementation programmes, if needed.

Fruit and vegetable intake among overweight and obese school children: A cluster randomised control trial

@#Introduction: Adequate daily intake of fruits and vegetables is crucial for the prevention of chronic diseases. This study aimed to determine the effects of My Body is Fit and Fabulous at School (MyBFF@school) with nutrition education intervention (NEI) on the stages of change for fruit and vegetable intake among overweight and obese secondary school children based on the trans-theoretical model (TTM). Methods: This was a cluster randomised controlled trial involving 15 out of 415 eligible government secondary schools in central Peninsular Malaysia, which were randomly assigned into intervention (six schools; 579 school children) and control (nine schools; 462 school children). The intervention group was given NEI for 24 weeks, while the control group followed the existing school programme by the Ministry of Education. Results: There was no significant difference between the intervention and control groups for the stages of change, with majority at the maintenance stage after six months (intervention: 34.9%; control: 39.0%). The within group analysis showed a significant reduction after six months for those at the action stage (action and maintenance stage) from 68.0% to 60.4% in the intervention group and from 71.4% to 65.6% in the control group. However, there was a significant increase among those with adequate fruit and vegetable intake in the intervention group and no significant increase in the control group. Conclusion: MyBFF@school with NEI based on TTM provided acceptable changes in fruit and vegetable intake among overweight and obese secondary school children.

Factors associated with food safety knowledge and practices among meat handlers in Bangladesh: a cross-sectional study

BACKGROUND@#Food handlers can play a vital role into reducing foodborne diseases by adopting appropriate food handling and sanitation practices in working plants. This study aimed to assess the factors associated with food safety knowledge and practices among meat handlers who work at butcher shops in Bangladesh.@*METHODS@#A cross-sectional study was conducted among 300 meat handlers from January to March, 2021. Data were collected through in-person interviews using a structured questionnaire. The questionnaire consisted of three parts; socio-demographic characteristics, assessments of food safety knowledge, and food safety practices. A multiple logistic regression model was used to identify the factors associated with food safety knowledge and practices.@*RESULTS@#Only 20% [95% confidence interval, (CI) 15.7-24.7] and 16.3% (95% CI 12.3-20.7) of the respondents demonstrated good levels of food safety knowledge and practices, respectively. The factors associated with good levels of food safety knowledge were: having a higher secondary education [adjusted odds ratio (AOR) = 4.57, 95% CI 1.11-18.76], income above 25,000 BDT/month (AOR = 10.52, 95% CI 3.43-32.26), work experience of > 10 years (AOR = 9.31, 95% CI 1.92-45.09), ≥ 8 h per day of work (AOR = 6.14, 95% CI 2.69-13.10), employed on a daily basis (AOR = 4.05, 95% CI 1.16-14.14), and having food safety training (AOR = 8.98 95% CI 2.16-37.32). Good food safety knowledge (AOR = 5.68, 95% CI 2.33-13.87) and working ≥ 8 h per day (AOR = 8.44, 95% CI 3.11-22.91) were significantly associated with a good level of food safety practice.@*CONCLUSIONS@#Poor knowledge and practices regarding food safety were found among Bangladeshi meat handlers. Findings may help public health professionals and practitioners develop targeted strategies to improve food safety knowledge and practices among this population. Such strategies may include education and sensitization on good food safety practices.

Tualang Honey Potentially Delay Deterioration in Haematological and Immunological Parameters in Asymptomatic, Treatment-naïve HIV-infected Patients

@#Introduction: This report aimed to assess the effects of administration of Tualang honey for six months duration on the haematological and immunological parameters in treatment-naïve HIV-infected patients who were asymptomatic. Methods: This was a randomised, controlled, open-labelled study. A total of 95 asymptomatic HIV-positive subjects with low CD4 counts of 250-600 cells/mm3 and not on antiretroviral therapy were recruited. Tualang honey was administered at 20 g each, once daily (HLD; total of 20 g honey), twice daily (HID; total of 40 g honey) or thrice daily (HHD; total of 60 g honey) for six months period. Control (CT) group did not receive any honey supplementation. Haematological and immunological parameters were measured at baseline, three-month and six-month follow-up. The differences within the group (time effect) and between the groups (regardless of time) for all four groups were analysed using Repeated Measures ANOVA followed by a post-hoc test. Results: A significant reduction in total white blood cell, neutrophil and lymphocyte counts were observed at six-month follow-up in CT and HLD groups when compared to baseline. The immunological parameters showed similar trend of reduction in the CT and HLD groups. Meanwhile, the measured parameters were relatively maintained in HID and HHD groups at six-month period when compared to baseline. Conclusion: Tualang honey supplementation at intermediate and high doses for six months delay the deterioration of haematological and immunological parameters in asymptomatic, treatment-naïve HIV subjects.

Effective Atomic Number based on Energy Dispersive X-Ray (EDX) Analysis and Carbon Hydrogen Nitrogen (CHN) Analysis for Phantom Material in Medical Physics Applications

@#Introduction: In medical physics applications, effective atomic numbers are often employed to set apart and specify the interaction of ionizing radiation with matter. Methods: The effective atomic number of soy-lignin bonded with Rhizophora spp. particleboards were analyzed using Energy Dispersive X-ray analysis and Carbon Hydrogen Nitrogen Analyzer. The effective atomic number were compared and recorded with reference to the effective atomic value of water. Results: The result showed that the effective atomic number calculated for adhesive bound Rhizophora spp. samples were close to effective atomic value of water, with 3.34 – 3.47 % differences by using Energy Dispersive X-ray and 6.47 – 6.78 % differences by using Carbon Hydrogen Nitrogen analysis. The result revealed that through Energy Dispersive X-ray method, the effective atomic number was much closer to water compared to Carbon Hydrogen Nitrogen analysis. Conclusion: Despite the availability of hydrogen content in the samples in Carbon Hydrogen Nitrogen analysis, Energy Dispersive X-ray method was much more preferred and gave better result compared to Carbon Hydrogen Nitrogen analysis thus provide a compelling argument for the use of Energy Dispersive X-ray method to measure the effective atomic number of Rhizophora spp. particleboard in medical physics applications.

High Prevalence of Methicillin-resistant Staphylococcus haemolyticus Isolated From Commensals in Healthy Adults

@#Introduction: S. haemolyticus is known to be commensals residing on human skin. However, their ability to develop as pathogens among the healthy community has becoming increasingly vital. Methods: In this study, a total of 49 non-duplicated samples of S. haemolyticus was isolated from the skin of healthy adults and confirmed via sodA gene sequencing method. Cefoxitin (30μg) disc diffusion test was performed to determine methicillin resistance among the S. haemolyticus isolates. The isolates were then subjected to mecA amplification and Staphylococcus Cassette Chromosome (SCCmec) typing of I, II, III, IV and V. Results: Interestingly, 59.2% of the S. haemolyticus commensal isolates were found to be methicillin-resistant (MRSH) while the remaining 40.8% was methicillin-sensitive (MSSH). Amplification of mecA gene showed that 43 isolates (87.8%) were positive while only six isolates were negative for the gene. A majority of the positive mecA isolates (90.7%) were discovered to harbour SCCmec Type II while the remaining 44.2% were Type V followed by 23.3% of Type I and 18.6% of Type IV. Only one of the isolates was found to be SCCmec Type III while another isolate, T187 was non-typeable. Conclusion: The data indicates the acquisition of SCCmec typing circulated among the commensal strains which could be a potential route of pathogenicity among the isolates.

Bite envenomation by Latrodectus geometricus (Araneae: Theridiidae) spiders in Malaysia

@#We report two confirmed human bite cases by Lactrodectus geometricus, also known as the brown widow spider. These are the first reported bite envenomation incidents by L. geometricus in Malaysia. The incidents occurred in Tawau, Sabah and Paka, Terengganu. Both men were bitten on their ear while putting on motorcycle helmets. The spiders appeared to have nested in the helmets. The dead specimens were collected and sent to the Invertebrate and Vertebrate Neurobiology Laboratory, Department of Parasitology, Universiti Malaya for identification. The species identity was confirmed by DNA barcoding.

Molecular identification of antibiotic-resistant bacteria isolated from used contact lens cases

Aims@#The contact lens (CL) has become one of the most convenience refractive devices used in vision correction, occupational and in cosmetics purposes. Despite the convenience of CL usage, poor hygiene might cause eye infections due to microbial contamination. In this work, a random collection of used CL cases among Universiti Malaysia Terengganu (UMT) students had shown the emergence of antibiotic-resistant bacteria towards commonly used antibiotics to treat eye infections.@*Methodology and results@#The study was carried out from 28 CL cases samples with the duration of one to three months of use. Bacteria that were successfully isolated from the CL cases were then exposed to the commonly prescribed antibiotics followed by identification through the partial 16S rDNA sequencing. Our finding exhibited that the rate of contamination is over 50% where 32 bacteria were isolated, with 20 (62.5%) of the isolates were Gram-positive bacteria. Approximately 31% of the isolated bacteria are resistant and intermediate resistant to the commonly used antibiotics to treat eye infection, especially erythromycin and chloramphenicol. The isolated bacteria were genotypic identified as Bacillus cereus, B. anthracis, Acinetobacter variabilis, Klebsiella pneumoniae, and Serratia marcescens. These bacteria are known as a common cause for microbial keratitis, except for A. variabilis, where the association of this bacteria in causing microbial keratitis is relatively rare.@*Conclusion, significance and impact of study@#This study highlights the emergence of antibiotic-resistant bacteria that can cause severe eye infections among CL wearer. The high percentage of contamination (>50%) found from the isolates reflected on the lack of hygiene practice on the CL handling. Thus, it is crucial to perceive this study as microbial contamination will lead to more serious eye infection disease such as conjunctivitis and keratitis.

Are Dropped Bone Grafts Safe to be Re-used? - An Experimental Study Comparing Efficacy of Chlorhexidine, Povidone-Iodine and Alcohol

@#Introduction: A dilemma arises when a bone graft or fracture fragment is accidentally dropped on the operation theatre floor and becomes contaminated. This study aimed to determine the efficacy of simple and readily available antiseptic solutions in disinfecting contaminated bones. Materials and methods: This experimental study involved 225 bone specimens prepared from discarded bone fragments during a series of 45 knee and hip arthroplasty surgeries. The bone fragments were cut into five identical cubes and were randomly assigned to either control (positive or negative), or experimental groups (0.5% chlorhexidine, 10% povidone-iodine or 70% alcohol). The control negative was to determine pre-contamination culture. All bone specimens, except the control negative group were uniformly contaminated by dropping on the operation theatre floor. Subsequently, the dropped bone specimens except for the control positive group, were disinfected by immersing in a respective antiseptic solution for 10 minutes, before transported to the microbiology laboratory for incubation. Results: The incidence of a positive culture from a dropped bone fragment was 86.5%. From the 37 specimens sent for each group, the incidence of positive culture was 5.4% (2 specimens) after being disinfected using chlorhexidine, 67.6% (25 specimens) using povidone-iodine and 81.1% (30 specimens) using alcohol. Simple logistic regression analysis demonstrated that chlorhexidine was significantly effective in disinfecting contaminated bones (p-value <0.001, odd ratio 0.009). Povidone-iodine and alcohol were not statistically significant (p-value 0.059 and 0.53, respectively). Organisms identified were Bacillus species and coagulase negative Staphylococcus. No gram-negative bacteria were isolated. Conclusion: A total of 0.5% chlorhexidine is effective and superior in disinfecting contaminated bones.

Clinicopathological patterns and survival outcomes of colorectal cancer among young adults in Malaysia: an institutional cohort study

INTRODUCTION@#This study aimed to investigate the clinicopathological patterns and survival outcomes of patients with young-onset colorectal cancer (CRC) in Malaysia.@*METHODS@#A total of 206 patients with young-onset CRC (age < 50 years at diagnosis) and 1,715 patients with late-onset CRC (age ≥ 50 years at diagnosis) diagnosed during 2002-2016 were included. The clinicopathological characteristics of patients with young-onset CRC were compared with those of patients with late-onset CRC during 2009-2013. Kaplan-Meier survival analysis was performed to determine the overall survival (OS) and disease-specific survival (DSS) in these patients.@*RESULTS@#The overall proportion of young-onset CRC was 10.7%. The mean age for young-onset CRC was 39.5 ± 7.4 years, with a male-to-female ratio of 1.2:1. There were more Malay patients with young-onset CRC than late-onset CRC (44.0% vs. 19.9%, p = 0.004). Most CRCs were diagnosed at an advanced stage in both groups. However, young-onset CRC showed more aggressive tumour characteristics, such as poorer differentiation and mucinous subtype. Despite such differences, the OS and DSS in both groups were similar (five-year OS for young-onset CRC vs. late-onset CRC: 44.2% vs. 49.0%, p = 0.40; five-year DSS for young-onset CRC vs. late-onset CRC: 48.8% vs. 57.6%, p = 0.53; mean survival of young-onset CRC vs. late-onset CRC: 4.9 years vs. 5.4 years, p = 0.15). Advanced stage at diagnosis and the treatment modality used were independent prognostic factors.@*CONCLUSION@#The unique ethnic and histological differences between patients with young- and late-onset CRC suggest that young-onset CRC may represent a distinct entity. However, despite such differences, both groups were equivalent.

Clinical outcomes of acute stroke thrombolysis in neurologist and non-neurologist centres – A comparative study in Malaysia

@#Acute ischaemic stroke (AIS) is a devastating disease and one of the leading causes of disabilities worldwide. From 2010 to 2014, the incidence of stroke in Malaysia had increased from 65 to 187 per 100,000 population.1 Thrombolytic therapy with intravenous recombinant tissue plasminogen activator (rtPA) within 4.5 hours of symptom onset has been shown to be an effective treatment for AIS. Patients who receive thrombolysis are 30 percent more likely to achieve excellent functional outcome (modified Rankin scale of 0 to 1) at 3 months compared to placebo.2 Unfortunately, the delivery of stroke thrombolysis service in Malaysia is often limited by the availability of neurologists. To date, the ratio of neurologists capable of performing thrombolysis serving in public hospitals to the Malaysian population is 1:1.4 million.3 To counteract this disparity and to cope with the increasing stroke burden in Malaysia, there has been an advocacy for greater involvement of non-neurologists, i.e., general and emergency physicians in performing of stroke thrombolysis.4 Emerging data based on short term outcomes appear to support this notion. Based on a 2015 single center study on 49 AIS patients in Australia, A. Lee et al., reported that there was no significant difference in door to needle time, rates of symptomatic intracranial bleeding (SICH), and mortality between patients thrombolysed by neurologists versus stroke physicians.5 In 2016, a larger multicentre study in Thailand reported that patients thrombolysed in hospitals without neurologists had lower National Institute of Health Stroke Scale (NIHSS) scores at discharge and lower inpatient mortality rate compared to patients treated in neurologist hospitals.6 Based on these short term outcomes, both studies suggest that nonneurologists are able to thrombolyse AIS patients safely and effectively. Data comparing long term functional outcomes in thrombolysis prescribed by neurologists and nonneurologists are still very limited. The primary objective of this study was to evaluate and compare the 3-month functional outcomes of thrombolytic therapy between hospitals with and without on-site neurologists. The secondary objective was to assess the doorto-needle time and complication rates of thrombolysis service in both hospitals