A case series of pulmonary alveolar proteinosis: Response differently to whole lung lavage.

Pulmonary alveolar proteinosis (PAP) is a rare disease and its prognosis can be improved by whole lung lavage (WLL). Herein, we present three cases with idiopathic PAP treated successfully with either single or double WLL in the same setting. All three of them presented with exertional dyspnoea with radiographic findings of pulmonary infiltrates. They showed a marked clinical and physiologic improvement post WLL. Two of them were in remission. These three cases were diagnosed using different lung biopsy modalities, including video-assisted thoracoscopic lung biopsy, computed tomography-guided percutaneous transthoracic tru-cut needle lung biopsy, and transbronchial forceps lung biopsy (TBLB), respectively. The current cases have shown that TBLB may provide adequate diagnostic yield, and the invasive surgical lung biopsy may not be necessary to achieve a definitive diagnosis.

COVID-19 screening test by using random oropharyngeal saliva.

An optimal clinical specimen for accurate detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by minimizing the usage of consumables and reduce hazard exposure to healthcare workers is an urgent priority. The diagnostic performance of SARS-CoV-2 detection between healthcare worker-collected nasopharyngeal and oropharyngeal (NP + OP) swabs and patient performed self-collected random saliva was assessed. Paired NP + OP swabs and random saliva were collected and processed within 48 h of specimen collection from two cohort studies which recruited 562 asymptomatic adult candidates. Real-time reverse-transcription polymerase chain reaction targeting Open reading frame 1a (ORF1a) and nucleocapsid (N) genes was performed and the results were compared. Overall, 65 of 562 (28.1%) candidates tested positive for COVID-19 based on random saliva, NP + OP swabs, or both testing techniques. The detection rate of SARS-CoV-2 was higher in random saliva compared to NP + OP testing (92.3%; 60/65 vs. 73.8%; 48/65; p < .05). The estimated sensitivity and specificity of random saliva were higher than NP + OP swabs (95.0; 99.9 vs. 72.2; 99.4). The Ct  values of ORF1a and N genes were significantly lower in random saliva compared to NP + OP swabs specimens. Our findings demonstrate that random saliva is an alternative diagnostic specimen for the detection of SARS-CoV-2. Self-collected random oropharyngeal saliva is a valuable specimen that provides accurate SARS-CoV-2 surveillance testing of a community.

Comparing Nasopharyngeal Swab and Early Morning Saliva for the Identification of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

BACKGROUND: The ideal severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) testing method would be accurate and also be patient-performed to reduce exposure to healthcare workers. The aim of this study was to compare patient-performed testing based on a morning saliva sample with the current standard testing method, healthcare worker-collected sampling via a nasopharyngeal swab (NPS). METHODS: This was a prospective single center study which recruited 217 asymptomatic adult male participants in a coronavirus disease 2019 (COVID-19) quarantine center who had tested positive for SARS-CoV-2 8-10 days prior to isolation. Paired NPS and saliva specimens were collected and processed within 5 hours of sample collection. Real time reverse transcription polymerase chain reaction (RT-PCR) targeting Envelope (E) and RNA-dependent RNA polymerase (RdRp) genes was performed and the results were compared. RESULTS: Overall, 160 of the 217 (74%) participants tested positive for COVID-19 based on saliva, NPS, or both testing methods. The detection rate for SARS-CoV-2 was higher in saliva compared to NPS testing (93.1%, 149/160 vs 52.5%, 84/160, P < .001). The concordance between the 2 tests was 45.6% (virus was detected in both saliva and NPS in 73/160), whereas 47.5% were discordant (87/160 tested positive for 1 whereas negative for the other). The cycle threshold (Ct) values for E and RdRp genes were significantly lower in saliva specimens compared to NP swab specimens. CONCLUSIONS: Our findings demonstrate that saliva is a better alternative specimen for detection of SARS-CoV-2. Taking into consideration, the simplicity of specimen collection, shortage of PPE and the transmissibility of the virus, saliva could enable self-collection for an accurate SARS-CoV-2 surveillance testing.

Detection of Antimicrobial Resistance Genes Associated with Carbapenem Resistance from the Whole-Genome Sequence of Acinetobacter baumannii Isolates from Malaysia.

BACKGROUND: The spread of carbapenem-resistant A. baumannii (CrAb) is gaining worldwide attention. The spread of this pathogen is largely due to its ability to acquire various resistance genes of intrinsic and extrinsic origins that confer unpredictable susceptibility to ß-lactams. The aim of this study was to analyze ß-lactamase genetic compositions of CrAb in Malaysia. METHODS: Whole-genome sequencing (WGS) was carried out on 13 CrAb isolates from clinical samples in Malaysia from 2011 to 2016. RESULTS: Endotracheal aspirate was the dominant clinical sample source (n = 6), and only one isolate was obtained from wound swab. A total of 6 sequence types (STs) of the Oxford scheme were identified, including 4 reported STs and 2 novel STs. Eleven isolates were classified into clonal complex 92 (CC92/ICII), among which ST195 and ST208 were the most prevalent STs. All 13 CrAb isolates harbored multiple ß-lactamase genes. bla OXA-23 (n = 13) and bla OXA-66 (n = 11) were the dominant carbapenemase gene families found in these isolates. All isolates harbor bla ADC, bla OXA-51-like, and bla OXA-23-like genes. bla TEM (n = 7), bla NDM-1 (n = 3), bla CARB-8 (n = 1), and bla PER-3 (n = 1) are amongst other ß-lactamase genes found in this study. ISAba1 was found upstream to bla OXA-23 (n = 13), bla OXA-66 (n = 1), and bla ADC (n = 11). All bla NDM-1 isolates had ISAba125 (mobile genetic element) upstream to the genes. All isolates were positive for Tn2006/2008 and Tn2009 but were negative for Tn2007. CONCLUSION: Most of the isolates were grouped under the CC92 clonal complex which belongs to international clonal lineage 2. These findings predict that carriage of carbapenem-resistant genes possibly constitutes the underlying basis of high level of international clone II prevalence. Therefore, molecular surveillance and antimicrobial stewardship are essential in implementing policies to prevent and control the spread of CrAb in hospital settings.

Serological survey of Leptospirosis in high-risk rangers and wild animals from ex-situ captive centers.

Leptospirosis is a bacterial disease caused by pathogenic Leptospira that infect both human and animals. This study was conducted to determine the seroprevalence of leptospirosis among rangers and wild animals in two ex-situ captive centers, Bukit Merah Orangutan Island (BMOUI) and Taiping Zoo, Perak and to identify the risk factors responsible for the leptospiral seropositivity. Blood samples from rangers and animals of BMOUI and Taiping Zoo were taken to determine the presence of antibodies against Leptospira through microscopic agglutination test (MAT) using 21 serovars of Leptospira commonly found in Malaysia as antigens. Structured surveys in identifying risk factors were given to each ranger from both study sites. It was observed that Rattus exulans (1/10) (10.0%), Rattus rattus (1/5) (20.0%), Niniventer fulvescens (1/1) (100.0%), Callosciurus notatus (0/6) (0.0%), Tupaia tana (1/1) (100.0%), Pongo pygmaeus (5/10) (50.0%) and BMOUI rangers (8/18) (44.4%) were positive for leptospiral antibodies. Samples obtained from Taiping Zoo also revealed the presence of leptospiral antibodies in R. rattus (0/19) (0.0%), R. exulans (1/2) (50.0%) and rangers (2/5) (40.0%). Among the positive cases, most human and animal samples from both study sites reacted with serovar Lepto 175. Our surveys indicated no significant associations between seroprevalence of leptospiral antibodies with rangers' age (p = 0.82), sex (p = 0.85), ethnicity (p = 0.65), educational level (p = 0.88) and working experience (p = 0.82). In terms of risk factors, no significant associations between seroprevalence of leptospiral antibodies with knowledge on leptospirosis (p = 0.82), working hours (p = 0.53), smoking (p = 0.85), crossing rivers/pools/stagnant water while working (p = 0.90) and wearing full personal protective equipment (PPE) (p = 0.73). This study provides epidemiological data on leptospirosis in rangers and animals from BMOUI and Taiping Zoo which is of paramount importance for improving strategies in prevention of the disease.

Serological survey of Leptospirosis in high-risk rangers and wild animals from ex-situ captive centers

@#Leptospirosis is a bacterial disease caused by pathogenic Leptospira that infect both human and animals. This study was conducted to determine the seroprevalence of leptospirosis among rangers and wild animals in two ex-situ captive centers, Bukit Merah Orangutan Island (BMOUI) and Taiping Zoo, Perak and to identify the risk factors responsible for the leptospiral seropositivity. Blood samples from rangers and animals of BMOUI and Taiping Zoo were taken to determine the presence of antibodies against Leptospira through microscopic agglutination test (MAT) using 21 serovars of Leptospira commonly found in Malaysia as antigens. Structured surveys in identifying risk factors were given to each ranger from both study sites. It was observed that Rattus exulans (1/10) (10.0%), Rattus rattus (1/5) (20.0%), Niniventer fulvescens (1/1) (100.0%), Callosciurus notatus (0/6) (0.0%), Tupaia tana (1/1) (100.0%), Pongo pygmaeus (5/10) (50.0%) and BMOUI rangers (8/18) (44.4%) were positive for leptospiral antibodies. Samples obtained from Taiping Zoo also revealed the presence of leptospiral antibodies in R. rattus (0/19) (0.0%), R. exulans (1/2) (50.0%) and rangers (2/5) (40.0%). Among the positive cases, most human and animal samples from both study sites reacted with serovar Lepto 175. Our surveys indicated no significant associations between seroprevalence of leptospiral antibodies with rangers’ age (p = 0.82), sex (p = 0.85), ethnicity (p = 0.65), educational level (p = 0.88) and working experience (p = 0.82). In terms of risk factors, no significant associations between seroprevalence of leptospiral antibodies with knowledge on leptospirosis (p = 0.82), working hours (p = 0.53), smoking (p = 0.85), crossing rivers/pools/stagnant water while working (p = 0.90) and wearing full personal protective equipment (PPE) (p = 0.73). This study provides epidemiological data on leptospirosis in rangers and animals from BMOUI and Taiping Zoo which is of paramount importance for improving strategies in prevention of the disease.

Seroprevalence of leptospiral antibodies among market workers and food handlers in the central state of Malaysia.

OBJECTIVE: The high prevalence of leptospirosis in humans is of great public health concern, particularly in tropical and subtropical regions. This study aimed to determine the seroprevalence of leptospiral antibodies and distribution of serovars, and to assess the usefulness of enzyme-linked immunosorbent assay (ELISA) as a screening method for leptospiral antibodies in a high-risk healthy community. METHODS: Cross-sectional study of 231 market workers and food handlers in wet markets and food premises from two localities in central Malaysia. Respondents' background information was obtained using a questionnaire. Serum samples were tested for leptospiral antibodies using ELISA and microscopic agglutination test (MAT). RESULTS: Seroprevalence of leptospirosis among healthy workers was 46.3%. Detection of seropositivity was higher by MAT (46%) than ELISA (15%). We observed high seropositivity among local workers (49%), food handlers (49.5%), females (60.8%) and those aged 34 years and older (46.3%). Local strain LEP175 was the predominant serovar, followed by WHO strain Patoc. CONCLUSION: Overall seroprevalence among healthy food handlers and market workers was high in this study. The workplace places susceptible individuals at risk of leptospirosis.

Evaluation of Conventional PCR for Detection of Toxigenic Corynebacterium diphtheriae Strains in Malaysia.

Diphtheria is an infectious but vaccine preventable disease caused by Corynebacterium diphtheriae and humans are the only reservoir. While toxigenic strains most frequently cause pharyngeal diphtheria, non-toxigenic strains commonly cause cutaneous infections. In 2016, there was a sudden increase in cases of C. diphtheriae reported in Malaysia. The toxigenic strains are currently determined using Elek's test and are carried out only in the reference laboratory. With the sudden increase in diphtheria cases in Malaysia, it is important for local laboratories in state hospitals to be able to perform a rapid, reliable diagnostic test for the detection of the exotoxin. In this study, we aimed to evaluate the application of conventional PCR method to detect toxigenic strains of C. diphtheriae compared to the Elek's test. Forty-eight C. diphtheriae strains were subjected to PCR detection of toxin gene A and B subunits, and also Elek's test. The A and B subunits of the toxin gene were detected in all C. diphtheriae strains except for one strain which was isolated from a foot ulcer. Elek's test was also positive for all the PCR positive strains. This study showed 100% corelation between the results of PCR and Elek's test assay. The conventional PCR can be used at the state laboratories for rapid detection of toxin genes in toxigenic C. diphtheriae cultures, thus early treatment can be given to the patients while waiting for Elek's test results.

Gelam Honey: A Review of Its Antioxidant, Anti-inflammatory, Anticancer and Wound Healing Aspects

In recent years, there is a growing enthusiasm in honey which has potential health benefits, disease prevention and serves as substitution of modern medicine. Honey is a natural sweet product which is produced by honey bees from floral nectar and has been traditionally used to treat several diseases such as cardiovascular disease, diabetes mellitus, cancer and Alzheimer’s disease since ancient times. Gelam honey (GH) is one of the Malaysian wild monofloral honey which is widely used as traditional medicine by the local population. GH is enriched with several therapeutic properties namely, antioxidative, antiinflammatory, anticancer and accelerated wound healing activities. However, there is lack of literature focusing on the overall effects of GH and its medicinal value. This review paper summarises the phytochemistry characteristics of GH along with its therapeutic values which lead to a broad spectrum idea on several diseases. A concise clarification on the therapeutic properties of GH is expected to provide new knowledge to thescientific society in these modern globalization eras.

Seroepidemiological study of leptospirosis among the communities living in periurban areas of Sarawak, Malaysia.

INTRODUCTION: Leptospirosis is endemic to tropical regions of the world and is re-emerging as a new danger to public health in Malaysia. the purpose of this particular study was to determine the common leptospiral serovars present in human communities living around wildlife reserves/disturbed forest habitats. the objective of this study was to estimate the seroprevalence of leptospirosis and finding infecting serovars in villages surrounded habitats where wildlife lives in Sarawak, Malaysia. METHODS: A cross-sectional serological survey of 198 humans was conducted in four villages around Kuching, Sarawak between January 2011 and March 2012. RESULTS: A seroprevalence of 35.9% (95%cI 29.2-43.0) to the MAt was detected in the tested humans. Antibodies to serovar Lepto 175 Sarawak were most commonly detected (31.3%; 95%cI 24.9-38.3) and were detected in individuals at all four locations. the presence of skin wounds (Or 3.1), farm animals (Or 2.5) and rats (Or 11.2) were all significantly associated with seropositivity in a multivariable logistic regression model. CONCLUSIONS: the results of the current study are important as wildlife may act as reservoirs of leptospires for humans. Health authorities should expand disease control measures to minimise the spill-over from wildlife to humans visiting, living or working in the sampled locations. the pathogenic status of serovar Lepto 175 Sarawak also requires further investigation.

Stroke Community Awareness among Public: A Cross Sectional Study

This study assessed the level of public awareness pertaining to risk factors,symptoms, treatment and source of information in relation to stroke and transient ischaemic attack. Stroke risk profile of the respondents was correlated with their level of knowledge. Using a validated pre-tested questionnaire, 112 respondents were recruited during two separate community events. Respondents completed the questionnaire and underwent health screening. The data were analysed using SPSS version 20. Overall knowledge was poor. Only 35% of the respondents had satisfactory knowledge of the warning signs (p= 0.94) and 29% had satisfactory knowledge on the risk factors (p=0.46). When analysed according to risk groups, 26%, 30% and 41% of respondents had satisfactory awareness in the low, intermediate and high risk group, respectively. None of the respondents knew about the availability of treatment of acute stroke in the emergency department or the importance of rehabilitation as part of stroke management. Public awareness on stroke risk factors, symptoms and management is poor.

Leptospirosis, an emerging zoonotic disease in Malaysia.

Leptospirosis is an endemic disease in Malaysia and recently has received increasing attention mainly due to several recent incidents that have resulted in human mortality which have alarmed health professionals in Malaysia. The increasing incidence of leptospirosis in forested regions is associated with the bacteria infecting small wild mammals other than rats. Infection in wildlife could result in the introduction of new serovars to humans and domesticated animals. More research on leptospirosis and the screening of wildlife and humans near wildlife habitats is required to have a better understanding of the involvement of wildlife in the disease.

In vitro antibacterial activity and physicochemical properties of a crude methanol extract of the larvae of the blow fly Lucilia cuprina.

The emergence of multidrug-resistant bacterial strains has prompted the reintroduction of maggot therapy in the treatment of chronic, infected wounds. Many previous studies have demonstrated the potent antibacterial activity of larval excretions/secretions of the blowfly Lucilia sericata (Meigen) (Diptera:Calliphoridae) against bacteria. However, the antibacterial activity of its sibling species, Lucilia cuprina (Wiedemann) (Diptera:Calliphoridae) against a wide range of pathogenic bacteria has never been determined. The aim of this study was to develop a new procedure to produce whole body extract of larvae of L. cuprina via methanol extraction as well as to demonstrate the in vitro antibacterial activity of this extract against seven selected wound pathogens (Staphylococcus aureus, methicillin-resistant S. aureus, S. epidermidis, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli). The turbidimetric assay demonstrated that L. cuprina larval extract was significantly potent against all bacteria tested (P < 0.001). Additionally, colony-forming unit (CFU), agar well diffusion and minimum inhibitory concentration assays have confirmed the apparent potency of larval extract against P. aeruginosa. The reconstituted larval extract was highly robust and thermally stable. These observations substantiated the feasibility of the methanol extraction method in the production of larval extract.

The association between dyslipidaemia and types of antipsychotic medications among patients with chronic schizophrenia.

This cross sectional study aimed to explore the association between dyslipidaemia and types of antipsychotics in 100 patients with chronic schizophrenia. Lipid profile, weight, height and waist circumference together with other relevant factors were measured. We found there was a high rate of dyslipidaemia among patients with chronic schizophrenia treated with antipsychotics (66%), however there was no significant difference found between typical or atypical antipsychotics (OR=1). All sociodemographic and clinical factors were not significantly associated with dyslipidaemia. Only non-Malays were found to have significant dyslipidaemia (p<0.1). Effective management is needed to deal with the dyslipidaemia in this group.

A low molecular weight lipopolysaccharide antigen preparation reactive to acute leptospirosis heterologous sera.

There is a need for identification of new infection markers against common Leptospira isolates in Malaysia. To achieve this goal, seven-day-old cultures of Leptospira interrogans serogroup Icterohemorrhagiae (L44) and Leptospira interrogans serogroup Javanica (L55) were used for antigen preparation by sequential extraction method using 40 mM Tris, 8M Urea and 2M thiourea. Immunoblot analysis of the antigens were performed using serum samples from 46 local patients with confirmed acute leptospirosis, 28 patients with other infections and 14 healthy controls. The patients serum samples used in this study contained heterologous antibody against a number of different leptospira serovars. A strong IgM reactivity to a broad diffuse band of 10-15 kDa was observed. Combining results using L44 and L55 antigens showed sensitivity of 80.4% and specificity of 95.2% for detection of leptospirosis. Proteinase K and periodate treatment indicated that the band is likely to be lipopolysaccharide (LPS) in nature. This study showed that the 10-15 kDa antigen could potentially be useful for serodiagnosis of acute leptospirosis in Malaysia.

Serogroups and antibiotic susceptibility patterns of Neisseria meningitidis isolated from army recruits in a training camp.

Invasive Neisseria meningitidis infection is rare but carries a high mortality rate. The carriage rate in the normal population is around 10% and can be higher in confined populations. A study on the prevalence of carriage of N. meningitidis was conducted among 3195 army recruits after 2 months of intensive training in an army camp. N. meningitidis was isolated from 37.0% of these recruits. Two hundred and ten of N. meningitidis isolates were subjected to serogrouping and 100 to antibiotic sensitivity testing by the disc diffusion method and E-test for penicillin. Ten (4.8%) of 210 Neisseria meningitidis serogrouped belonged to serogroup W135, 3.33% serogroup A and 81.4% belonged to either serogroup X, Y or Z. With the agar disc diffusion method, all the N. meningitidis showed susceptiblity to chloramphenicol, rifampicin, cefotaxime and levofloxacin; 85% of the strains were resistant to cotrimoxazole and 12.5% resistant to penicillin. However, based on minimum inhibitory concentration, none of the Neisseria meningitidis tested was resistant to penicillin.

Prevalence of insulin resistance in schizophrenia in HUKM.

This is a cross-sectional study to determine the prevalence of insulin resistance and its associated factors in Hospital UKM patients with schizophrenia using the Homeostatic Model Assessment (HOMA) model. Fasting glucose and insulin from 85 patients were obtained. Fasting glucose revealed 15% of the patients were diabetic, while another 15% had impaired fasting glucose. Using the HOMA model, 68% of the patients had insulin resistance. Univariate analyses found BMI (p < 0.001) and waist circumference (p < 0.001) to be associated with insulin resistance. The statistical significance disappeared after multivariate analyses. All patients with schizophrenia should be screened and managed as a group at high risk for development of diabetes with emphasis on body weight management.

Comparative effects of palm vitamin E and alpha-tocopherol on healing and wound tissue antioxidant enzyme levels in diabetic rats.

The effect of supplementing 200 mg/kg body weight palm vitamin E (PVE) and 200 mg/kg body weight alpha-tocopherol (alpha-Toc) on the healing of wounds in streptozotocin-induced diabetic rats was evaluated. The antioxidant potencies of these two preparations of vitamin E were also evaluated by determining the antioxidant enzyme activities, namely, glutathione peroxidase (GPx) and superoxide dismutase (SOD), and malondialdehyde (MDA) levels in the healing of dermal wounds. Healing was evaluated by measuring wound contractions and protein contents in the healing wounds. Cellular redistribution and collagen deposition were assessed morphologically using cross-sections of paraffin-embedded day-10 wounds stained according to the Van Gieson method. GPx and SOD activities as well as MDA levels were determined in homogenates of day-10 dermal wounds. Results showed that PVE had a greater potency to enhance wound repair and induce the increase in free radical-scavenging enzyme activities than alpha-Toc. Both PVE and alpha-Toc, however, were potent antioxidants and significantly reduced the lipid peroxidation levels in the wounds as measured by the reduction in MDA levels.

Primary thrombocythaemia presenting as postpartum haemorrhage: a case report.

A young primigravida presented with postpartum haemorrhage with no apparent cause following a low forceps delivery. She was extremely pale with gross hepatosplenomegaly. Hysterectomy was performed following three episodes of disseminated intravascular coagulation. Investigations revealed an extremely high platelet count with poor aggregatory function. A diagnosis of primary thrombocythaemia was made.

Antimicrobial resistance pattern of bacteria isolated from patients seen by private practitioners in the Klang Valley.

Data on bacterial resistance in patients seen by general practitioners are usually not readily available. The objective of this paper is to present the antimicrobial resistance pattern of bacteria isolated from patients seen by private practitioners in the Klang Valley. A total of 18 clinics participated in this study. From mid August 1991 to end of June 1993, 2,823 specimens were received. Throat swabs and urine specimens constituted 56% of all the specimens. A large proportion of the specimens (55%) yielded no growth or just normal flora. The common bacteria encountered were Staphylococcus aureus (18.4%), Escherichia coli (16.2%), Klebsiella spp (13.7%) and Neisseria gonorrhoeae (9.3%). The S. aureus strains were mainly isolated from wound, pus and ear swabs. Not one out of the 218 strains tested was resistant to methicillin. In vitro susceptibility tests showed that 91% were resistant to penicillin while 23% were resistant to tetracycline and 13% to erythromycin. Eighty-two percent of the E. coli were isolated from urine. It was also the most common isolate from urine. Fifty percent of these strains were resistant to ampicillin, 33% to cotrimoxazole, 17% to cephalothin, 21% to ampicillin-sulbactam, 18% to amoxycillin-clavulanic acid while only 2.3% were resistant to nalidixic acid and nitrofurantoin and none to cefuroxime. Generally the gram negative bacilli encountered in general practice are less resistant to the third generation cephalosporins and aminoglycosides when compared to the hospital strains.