Salmonella infections occur worldwide, in both developed and developing countries, and a major contributor to morbidity and economic costs. A total of 32 Salmonella isolates isolated from dogs (n=15/162), cats (n=1/126) and snakes (n=16/42) in the Klang valley, Peninsular Malaysia during 2012-2013, were used in this study and 6 serovars were identified. The isolates were then characterized for their susceptibility to commonly used antimicrobial agents using the standard disk diffusion method. The presence of relevant resistance genes and class 1 integrons were investigated by using PCR. Pulsed-field gel electrophoresis (PFGE) was carried out to determine the genetic diversity of these Salmonella strains. Higher resistance rates were observed for tetracycline (40.6%), nalidixic acid (21.9%), sulphamethazole-trimethoprim (18.7%), ampicillin (18.7%) followed by chloramphenicol (15.6%), streptomycin (6.25%), enrofloxacin (12.5%), cephalexin (6.25%), cephalothin (6.25%) and amoxicillin-clavulanic acid (3.12%). Nine percent (3/32) presented a single type of resistance, 6% (2/32) showed resistance to two classes of antimicrobials and 34% (11/32) were multidrugresistant (MDR) (resistant to 3 or more antimicrobials). Analysis of the carriage of resistance genes in the isolates revealed that seven (blaTEM-1, strA, strB, sulII, dfrhI, tetA, and cmlA) out of 10 resistance genes were present. Classes 1 integrons were present in 68.75% (11/16) of the resistance strains. PFGE analysis showed that the strains were very diverse and certain PFGE pattern clusters correlated well with antimicrobial resistance phenotypes. In conclusion, high rates of multidrug resistance were found among the dogs Salmonella strains.

A total of 46 isolates of Fusarium were isolated from six forest soil samples in Muka Head, Teluk Bahang, Pulau Pinang. Two Fusarium species were identified from the soil samples namely, F. solani (93.5%) and F. oxysporum (6.5%). The present study showed that the diversity and occurrences of Fusarium species in forest soil was low compared to cultivated soils.

: The psychological impact of care giving responsibility for dementia patients is significant regardless of the cultural background. Most of the current advanced caregivers’ interventions, originating from developed western countries, do not necessarily apply to local settings. Hence, there is a need for an effective culturally competent psychological intervention for these caregivers. The aim of the study is to assess the effectiveness of the cultural-based support group for Malay caregivers of dementia patients in Kelantan towards their burden, anxiety and depression level, and quality of life. Methods: This was an experimental study, without control, investigating pre and post support group intervention effectiveness in reducing caregiver burden, anxiety and depression, and improving the quality of life. Sixteen caregivers completed the program, which involved seven fortnightly support group sessions with duration of 2 hours each, conducted over twelve weeks. Caregivers’ burden was assessed using Caregiver Strain Index (CSI) while their psychological well-being was objectively assessed using Hospital Anxiety and Depression Scale (HADS). WHO Quality of Life questionnaire (WHOQOL-BREF) was used to measure the quality of life. The validated Malay versions of the questionnaires were used. Results: There was a statistically significant reduction in the level of caregiver burden (p = or < 0.001). Measurement of both scores of anxiety and depression comparing pre and post intervention also showed improvement, but statistically were not significant. Assessment of caregivers’ quality of life showed statistically significant improvement in the domains of social, psychological and physical (all with the p-value <0.05). Discussion: Our cultural-based support group is an effective intervention to improve burden, psychological well-being and quality of life among local caregivers of dementia patients. ASEAN Journal of Psychiatry, Vol. 18 (1): January – June 2017: XX XX.

Stress modulates pain perception, resulting in either stress-induced analgesia or stress-induced hyperalgesia, as reported in both animal and human studies. The responses to stress include neural, endocrine, and behavioural changes, and built-in coping strategies are in place to address stressors. Peculiar to humans are additional factors that modulate pain that are experienced in times of stress, notably psychological factors that potentially influence the directionality of pain perception.

The preceding DIN 6800-2 (1997) protocol has been revised by a German task group and its latest version was published in March 2008 as the national standard dosimetry protocol DIN 6800-2 (2008 March). Since then, in Germany the determination of absorbed dose to water for high-energy photon and electron beams has to be performed according to this new German dosimetry protocol. The IAEA Code of Practice TRS 398 (2000) and the AAPM TG-51 are the two main protocols applied internationally. The new German version has widely adapted the methodology and dosimetric data of TRS-398. This paper investigates systematically the DIN 6800-2 protocol and compares it with the procedures and results obtained by using the international protocols. The investigation was performed with 6 MV and 18 MV photon beams as well as with electron beams from 5 MeV to 21 MeV. While only cylindrical chambers were used for photon beams, the measurements of electron beams were performed by using cylindrical and plane-parallel chambers. It was found that the discrepancies in the determination of absorbed dose to water among the three protocols were 0.23% for photon beams and 1.2% for electron beams. The determination of water absorbed dose was also checked by a national audit procedure using TLDs. The comparison between the measurements following the DIN 6800-2 protocol and the TLD audit-procedure confirmed a difference of less than 2%. The advantage of the new German protocol DIN 6800-2 lies in the renouncement on the cross calibration procedure as well as its clear presentation of formulas and parameters. In the past, the different protocols evoluted differently from time to time. Fortunately today, a good convergence has been obtained in concepts and methods.

Aim: To describe the clinical characteristic of hepatitis C (HCV) patients and the results of pegylated interferon and ribavirin (PegIFN/RBV) therapy in a routine clinical practice. Methods: A retrospective review of consecutive HCV patients treated with PegIFN/RBV in 2004 to 2012. Results: A total of 273 patients received treatment. The mean age was 44.16 ± 10.5 years and 76% were male. The top 2 self-reported risks were blood or blood product transfusion before 1994 and injection drug use, found in 57.1% of patients. The predominant HCV genotype (GT) was 3 at 60.6%, second was GT1 at 36.1% and other GTs were uncommon at about 1% or less. About half of our patients have high baseline viral load (>800,000 iu/ml), 18.3% had liver cirrhosis and 22.3% had HIV co-infection. Co-morbid illness was found in 42.9%, hypertension and type 2 diabetes were the two most common. The overall sustained virological response (SVR) by intention-to-treat analysis were 54.9% (n=150/273), 41.2% (40/97) for GT1, 100% (5/5) for GT2 and 62% (101/163) for GT3. Subgroup analysis for HCV monoinfected, treatment naïve showed SVR of 49.2% (31/63) for GT1, 100% (5/5) for GT2 and 67% (69/103) for GT3. In HCV mono-infected and treatment experienced (n=29), the SVR was 28.6% (4/14) for GT1, 21.4% (69/103) for GT3. In the HIV/HCV co-infected, treatment naïve (n=56), the SVR was 28.6% (4/14) for GT1 and 64.3% (27/42) for GT3. Treatment naïve GT3 mono-infected patients had a statistically significant higher SVR compared to treatment experienced patients (P=0.001). In GT3 patients who achieved rapid virological response, the SVR was significantly higher at 85.2% (P< 0.001). The SVR for cirrhotics were low especially for GT1 at 21% (4/19) and 31% (4/13) based on all patients and treatment naïve HCV monoinfected respectively. In GT3 cirrhotics the corresponding SVR were 57.1% (16/28) and 60.9% (14/23). Premature discontinuation rate was 21.2% with the majority due to intolerable adverse events at 12.1%. Conclusions: In our routine clinical practice, the HCV patients we treated were young, predominantly of GT3 and many had difficult-to-treat clinical characteristics. The SVR of our patients were below those reported in Asian clinical trials but in keeping with some “real world” data.

Objectives: Accurate medical information is essential among health care professionals to aid dissemination of information to the public. This study aimed to determine the level of knowledge about breast cancer and to identify related factors among undergraduate health sciences students in a public university in Terengganu, Malaysia. Methods: The respondents included students aged 18 years old or older who were enrolled in nursing, medical laboratory technician (MLT) and radiography diploma programmes. A Breast Cancer and Chemotherapy Questionnaire (BCCQ) was administered; higher scores on it indicated better knowledge. The reliability and validity of the BCCQ was considered adequate. Descriptive statistics, independent t test, one-way analysis of variance (ANOVA) and multiple logistic regressions were employed (SPSS 16). Results: A total of 239 respondents participated (mean age = 19.8 ± 0.1 years; females = 83.7%). The knowledge level was moderate. Females, nursing, and final-year students possessed significantly better knowledge. After adjusting for covariates, significant factors determining good breast cancer knowledge include being in the nursing discipline and years of study. Conclusion: This study has generally ascertained that knowledge related to breast cancer and chemotherapy among this sample population remains moderate and is not uniformly disseminated. An increase in knowledge is required to ensure an optimal level of knowledge, particularly for the junior students and those from courses other than nursing.

Background: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. Methods: A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King’s classification respectively. Results: The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King’s classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Conclusion: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot.

Objective: To determine the major changes in the microstructure of Candida albicans (C. albicans) after treatment with Euphorbia hirta (E. hirta) L. leaf extract. Methods: Transmission electron microscopy was used to study the ultrastructural changes caused by E. hirta extract on C.albicans cells at various exposure time. Results: It was found that the main abnormalities were the alterations in morphology, lysis and complete collapse of the yeast cells after 36 h of exposure to the extract. Whereas the control cultures showed a typical morphology of Candida with a uniform central density, typically structured nucleus, and a cytoplasm with several elements of endomembrane system and enveloped by a regular, intact cell wall. Conclusions: The significant antifungal activity shown by this methanol extract of E. hirta L. suggests its potential against infections caused by C. albicans. The extract may be developed as an anticandidal agent.

Objective: To study the effect of depressive disorders, severity of depression and, sociodemographic factors on drug compliance among hypertensive patients at primary care clinics. Methods: A total of 201 hypertensive patients on treatment for at least 3 months who attended the HUKM Primary Care Clinic and Salak Polyclinic were selected for this study. Patients were screened for depressive disorders using the Hospital Anxiety Depression Scale (HADS) and those who scored 8 and more were further interviewed to establish a diagnosis using the Mini International Neuropsychiatric Interview (MINI). Patients who were diagnosed to have depressive disorders were further rated for the severity of the illness by using Hamilton Rating Scale for Depression (HAMD). Drug compliance was assessed during a 2 month follow up using the pill counting method (ratio 0.8 – 1.2 considered as compliant). Results: The prevalence of non-compliance among hypertensive patients was 38.3%. There was no association between the diagnosis of depressive disorders and drug compliance. Among the 12 patients who had depressive disorders, severity of depression as rated by HAMD, showed significant association with drug compliance (Mann-Whitney test z = -2.083, p<0.05).Conclusion: The results suggested that severity of depression has significant association with poor compliance to medical treatment. It is therefore very important to identify and treat depression to avoid poor drug compliance and further complications related to hypertension.