Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Finding from National Obstetric Registry

@#Introduction: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia. Methods: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis. Results: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001). Conclusion: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.

Effectiveness of selective risk based screening for Gestational Diabetes (GDM) in Malaysia: A retrospective cohort study based on the National Obstetric Registry (NOR) of Malaysia

Introduction: Gestational diabetes (GDM) has significant maternal and foetal implications. screening allows active interventions which significantly improves pregnancy outcomes. Despite World Health Organization (WHO), FIGO and National Institute of clinical Excellence (NIcE) recommendations for universal screening especially among high risk population; Malaysia currently adopts a selective risk based screening for GDM. Objective: the objective is to audit the effectiveness of the current practice of selective risk based screening in detection of GDM in Malaysia. Methodology: this is a retrospective cohort study based on the National Obstetric Registry (NOR) which comprises of 14 major tertiary hospitals in Malaysia. the study period was from 1st January 2011 till 31st December 2012 and a total of 22,044 patients with GDM were analysed. Logistic regression analysis was used to calculate the crude odd ratio. Results: the incidence of GDM in Malaysia is 8.4%. Maternal age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg and previous hypertension are non-significant risk of developing GDM in Malaysia. Parity 5 and more was only associated with an odds-ratio of 1.02 (95% confidence Interval: 0.90-1.17) as compared to parity below 5. the association of women with previous stillbirth with GDM was not significant. conclusion: current risk based screening for GDM based on maternal age, booking bMI, weight and hypertension is inappropriate. An ideal screening tool should precede disease complications, which is the novel objective of screening. Universal screening for GDM in Malaysia may be a more accurate measure, especially with regards to reducing maternal and foetal complications.

Anti-encystment and amoebicidal activity of Lonicera japonica Thunb. and its major constituent chlorogenic acid in vitro

Objective To examine the acanthamoebicidal effects of ethyl acetate, aqueous and butanol fractions of dried flower buds of Lonicera japonica (L. japonica) Thunb. (Flos Lonicerae) in vitro. Methods Acanthamoeba triangularis isolates were obtained from environmental water samples and identified by PCR. They were exposed to ethyl acetate, water and butanol fractions of L. japonica Thunb. at concentrations ranging from 0.5 mg/mL to 1.5 mg/mL. The extracts were evaluated for growth inhibition at 24, 48 and 72 h, respectively. Chlorogenic acid at a concentration of 1 mg/mL was examined for inhibition of encystment. Results Ethyl acetate fraction at a concentration of 1.5 mg/mL evoked a significant reduction of trophozoite viability by 48.9% after 24 h, 49.2% after 48 h and 33.7% after 72 h chlorogenic acid, the major active constituent of L. japonica Thunb. at the concentration of 1 mg/mL reduced the cysts/trophozoite ratio by 100% after 24 h, 84.0% after 48 h and 72.3% after 72 h. This phenolic compound at concentration of 1 mg/mL concurrent with 0.6% hydrogen peroxide inhibited hydrogen peroxide-induced encystment by 92.8% at 72 h. Conclusions Results obtained from this study show that ethyl acetate fraction at 1.5 mg/mL is the most potent fraction of L. japonica Thunb. and its major constituent chlorogenic acid showed the remarkable inhibition of encystment at a concentration of 1 mg/mL.

Anti-encystment and amoebicidal activity of Lonicera japonica Thunb. and its major constituent chlorogenic acid in vitro

OBJECTIVE@#To examine the acanthamoebicidal effects of ethyl acetate, aqueous and butanol fractions of dried flower buds of Lonicera japonica (L. japonica) Thunb. (Flos Lonicerae) in vitro.@*METHODS@#Acanthamoeba triangularis isolates were obtained from environmental water samples and identified by PCR. They were exposed to ethyl acetate, water and butanol fractions of L. japonica Thunb. at concentrations ranging from 0.5 mg/mL to 1.5 mg/mL. The extracts were evaluated for growth inhibition at 24, 48 and 72 h, respectively. Chlorogenic acid at a concentration of 1 mg/mL was examined for inhibition of encystment.@*RESULTS@#Ethyl acetate fraction at a concentration of 1.5 mg/mL evoked a significant reduction of trophozoite viability by 48.9% after 24 h, 49.2% after 48 h and 33.7% after 72 h chlorogenic acid, the major active constituent of L. japonica Thunb. at the concentration of 1 mg/mL reduced the cysts/trophozoite ratio by 100% after 24 h, 84.0% after 48 h and 72.3% after 72 h. This phenolic compound at concentration of 1 mg/mL concurrent with 0.6% hydrogen peroxide inhibited hydrogen peroxide-induced encystment by 92.8% at 72 h.@*CONCLUSIONS@#Results obtained from this study show that ethyl acetate fraction at 1.5 mg/mL is the most potent fraction of L. japonica Thunb. and its major constituent chlorogenic acid showed the remarkable inhibition of encystment at a concentration of 1 mg/mL.

Bilateral thalamic internal medullary lamina involvement in a case of dengue encephalitis

There are 50-100 million dengue infections each year, but dengue encephalitis is relatively uncommon. The aetiology of neuronal injury is proposed to be due to direct viral neurotropism or host immune response-mediated inflammation causing neuronal damage. We report a case of severe dengue encephalitis, presenting during the acute viraemic phase of the disease. This was associated with inflammation and haemorrhage of the internal medullary lamina of both thalami which, to our knowledge, has not yet been reported in other infections of the central nervous system.

Development of conventional and real-time multiplex PCR assays for the detection of nosocomial pathogens

Nosocomial infections are major clinical threats to hospitalised patients and represent an important source of morbidity and mortality. It is necessary to develop rapid detection assays of nosocomial pathogens for better prognosis and initiation of antimicrobial therapy in patients. In this study, we present the development of molecular methods for the detection of six common nosocomial pathogens including Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter spp. Conventional multiplex PCR and SYBR Green based real time PCR assays were performed using genus and species specific primers. Blind testing with 300 clinical samples was also carried out. The two assays were found to be sensitive and specific. Eubacterial PCR assay exhibited positive results for 46 clinical isolates from which 43 samples were detected by real time PCR assay. The sensitivity of the assay is about 93.7 percent in blind test isolates. The PCR results were reconfirmed using the conventional culture method. This assay has the potential to be a rapid, accurate and highly sensitive molecular diagnostic tool for simultaneous detection of Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter spp. This assay has the potential to detect nosocomial pathogens within 5 to 6 hours, helping to initiate infection control measures and appropriate treatment in paediatric and elderly (old aged) patients, pre-and post surgery patients and organ transplant patients and thus reduces their hospitalization duration .

Pneumococcal replicative state in relation to its adherence capacity to A549-cell line: A preliminary in vitro analysis

This study was to compare the replication capacity of pneumococcal isolates (serotypes 1, 7F, 19F and 23F) with their adherence pattern to monolayer cells (A549). For standardization purposes, all isolates showed a normal growth curve in both bacteriological (THB + 0.5% yeast extract with and without 2% FBS) and cell culture media (RPMI + 2% FBS). In the former media, a shorter lag phase was observed for isolate serotypes 1 and 7F in presence of serum while in the later; growth yield was lower for all isolates with stationary phase approaching OD600 of 0.01 as compared to 1.0 in bacteriological media. In the replicative analysis at different growth phases of the isolates in cell culture media, growth capacity at 3 h post-incubation was frequently twice as that at 1 h, and that at early-log phase was frequently higher than that at mid-log phase at both post-incubation times. Adherence was frequently the least at early-log phase although the isolates were in the most active state of replication to increase the number of pneumococcal cells to adhere. At mid- and late-log phases, pneumococcal adherence was frequently higher although the replication was reduced. This study marks the potential correlation between pneumococcal growth fitness and adherence capacity whereby the later may not be superior during the early growth phase.

Development and evaluation of a one-step SYBR-Green I-based real-time RT-PCR assay for the detection and quantification of Chikungunya virus in human, monkey and mosquito samples

This paper reports the development of a one-step SYBR-Green I-based realtime RT-PCR assay for the detection and quantification of Chikungunya virus (CHIKV) in human, monkey and mosquito samples by targeting the E1 structural gene. A preliminary evaluation of this assay has been successfully completed using 71 samples, consisting of a panel of negative control sera, sera from healthy individuals, sera from patients with acute disease from which CHIKV had been isolated, as well as monkey sera and adult mosquito samples obtained during the chikungunya fever outbreak in Malaysia in 2008. The assay was found to be 100-fold more sensitive than the conventional RT-PCR with a detection limit of 4.12x10(0) RNA copies/μl. The specificity of the assay was tested against other related viruses such as Dengue (serotypes 1-4), Japanese encephalitis, Herpes Simplex, Parainfluenza, Sindbis, Ross River, Yellow fever and West Nile viruses. The sensitivity, specificity and efficiency of this assay were 100%, 100% and 96.8% respectively. This study on early diagnostics is of importance to all endemic countries, especially Malaysia, which has been facing increasingly frequent and bigger outbreaks due to this virus since 1999.

Aetiology of viral central nervous system infection, a Malaysian study

Over 100 viruses are known to cause acute viral encephalitis in human. In order to diagnose a viral central nervous system infection, various laboratory diagnosis methods have been used. In this study, we examined 220 cerebrospinal fluid samples that were received at the Diagnostic Virology Laboratory of University Malaya Medical Centre between year 2004 to 2006, by viral isolation, pathogen specific antibody ELISA, polymerase chain reaction (PCR) and Real-Time PCR. Majority of the samples were from patients <10 years old. Out of 220 samples, 3 were positive for viral isolation, 27 for PCR (inclusive for the 3 positive for viral isolation) and 39 for pathogen specific ELISA. The total positive detection rate of this study was 30%. Herpes virus was the most important aetiologic agent, responsible for 58% of infection, followed by paramyxovirus (especially measles virus) in 26% of infection, and 14% by enterovirus. Parvovirus and flavivirus were the other common viruses. Among the herpes viruses, herpes simplex and cytomegalovirus were the most common.

incidence of Dengue disease in a University teaching hospital in Malaysia in 2002, 2003 and 2004

Dengue has been increasingly recognised as an emerging infectious disease for the last two decades. The global burden of dengue has grown dramatically in recent years. Several outbreaks have previously been reported from Malaysia. This study aims to determine the annual confirmed cases of dengue in the teaching hospital of University of Malaya, Kuala Lumpur, Malaysia. All cases of confirmed dengue from microbiology laboratory since 2002 to 2004 were included in this study. The dengue disease was confirmed by "Enzyme linked immunosorbent assay" [ELISA] and all patients were positive for the immunoglobulin-M [IgM]. However, virus culture was also performed in patients with negative IgM but with strong clinical suspicion of dengue disease. A total of 4753 confirmed cases of dengue were recorded during the study period. There were 2606 males and 2137 female. The most commonly affected age groups were 1 to 10 years, 21 to 30 and 11 to 20 years with 1630 patients, 880 patients and 662 patients respectively. Of the ethnic groups, Malays were the most affected people in thus study while Indians were least affected. Dengue fever accounted for 91% of the total dengue infections. There were only 5.5% cases classified as dengue haemorrhagic fever and only 15 cases of dengue shock syndrome recorded in 3 years. Serotype dengue-3 was predominant in 2002 and serotype dengue-1 remained the predominant during the rest of the study period. Dengue fever and dengue haemorrhagic fever remain a health problem in Malaysia. Dengue disease should be considered in the differential diagnosis of all patients who present with symptoms compatible with dengue. It is also imperative to implement and maintain an effective community based disease surveillance and prevention program

Negative cross-reactivity of rabbit anti-Malassezia furfur antibodies with other yeasts

Anti-Malassezia furfur monospecific polyclonal antibodies was produced by repeated immunization of rabbit with Malassezia furfur yeast cells mixed with Freud adjuvant. The antibody titres of respective rabbit's serum samples prior to and after each immunization against M. furfur were assayed by indirect immunofluorescence technique using the M. furfur whole yeast antigen fixed in Teflon coated slides. The highest anti-M. furfur antibody titre achieved was 1 in 1280 dilution. At 1:20 dilution, none of the respective serum samples taken at various stages of immunization gave positive immunofluorescent staining against any of the other species of yeasts tested in this study. Anti-M. furfur monospecific polyclonal antibodies produced in rabbit in this study has the potential for diagnostic application in immunohistochemical detection of M. furfur in human tissues.

Seroprevalence of Malassezia furfur in an urban population in Malaysia

An in-house prepared M. furfur antigen was used to carry out a seroprevalence study in an urban population in Malaysia by indirect immunofluorescence assay. Of the 800 serum samples from all ages screened, 738 samples were positive for M. furfur specific IgG, giving an overall seropositive rate of 92.3%. There was no significant difference in the seropositive rates among the different gender group and races. However, there was a statistical significant difference in the seropositive rate among different age groups with a lower rate (73%) for the age group 5 years old and below, which increased rapidly to 99% for the 16 to 20 years old age group but declined slightly for the oldest age group. The degree of seropositivity, which semi-quantitatively reflect the anti-M. furfur specific IgG titre, did not show any significant difference among the gender and racial groups. On the other hand, there was a significant difference in the degree of seropositivity among the various age groups, with the 16 to 20 years old age group having the highest antibody titre and the extreme of age groups having the lower antibody titre.