The incidence of humeral osteomyelitis is relatively rare as compared to incidence of lower limb osteomyelitis. Despite having no guideline in the management of humeral osteomyelitis, surgeons have utilised their experience in managing lower limb osteomyelitis to treat humeral osteomyelitis. By adhering to principles including thorough debridement of necrotic bone and soft tissue, staged bony and/or soft tissue reconstruction, and targeted antimicrobial therapy, a good outcome can be achieved in the management of humeral osteomyelitis. We report a case of Cierny-Mader type IV proximal humeral osteomyelitis after a severe crush injury of the left shoulder and its subsequent two-stage reconstruction using internal fixation and pedicled Latissimus dorsi musculocutaneous flap.

Chikungunya virus (CHIKV) infection is the cause of acute symptoms and chronic symmetrical polyarthritis associated with long-term morbidity and mortality. Currently, there is no available licensed vaccine or particularly useful drug for human use against CHIKV infection. This study was conducted to evaluate the efficacy of antibodies produced by papaya mosaic virus (PapMV) nanoparticles fused to E2EP3 peptide of CHIKV envelope as a recombinant CHIKV vaccine. PapMV, PapMV-C- E2EP3, and E2EP3-N-PapMV were produced in E. coli with an approximate size of 27 to 30 kDa. ICR mice (5 to 6 weeks of age) were injected subcutaneously with 25 micrograms of vaccine construct, and ELISA measured the titer of CHIKV specific IgG antibodies. The results showed that both recombinant proteins E2EP3-N-PapMV and PapMVC-E2EP3 were able to induce IgG antibodies production in immunized mice against CHIKV while immunization with recombinant PapMV showed no IgG antibodies induction. The neutralizing activity of the antibodies generated by either E2EP3-N-PapMV or PapMV-C-E2EP3 exhibited similar inhibition to CHIKV replication in Vero cells using the cells based antibody neutralizing assay and analyzed by plaque formation assay. This study showed the effectiveness of nanoparticles vaccine generated by fusing epitope peptide of CHIKV envelope to papaya mosaic virus envelope in inducing a robust immune response in mice against CHIKV. The data showed that levels of neutralizing antibodies correlate with a protective immune response CHIKV replication

Japanese encephalitis virus (JEV), a member of the family Flaviviridae, causes severe neurological disorders in humans. JEV infections represent one of the most widely spread mosquito-borne diseases, and therefore, it has been considered as an endemic disease. An effective antiviral drug is still unavailable to treat JEV, and current drugs only provide supportive treatment to alleviate the symptoms and stabilize patients’ conditions. This study was designed to evaluate the antiviral activity of the sulphated polysaccharides “Carrageenan,” a linear sulphated polysaccharide that is extracted from red edible seaweeds against JEV replication in vitro. Viral inactivation, attachment, and post-infection assays were used to determine the mode of inhibition of Carrageenan. Virus titters after each application were evaluated by plaque formation assay. MTT assay was used to determine the 50% cytotoxic concentration (CC50), and ELISA-like cell-based assay and immunostaining and immunostaining techniques were used to evaluate the 50% effective concentration (EC50). This study showed that Carrageenan inhibited JEV at an EC50 of 15 µg/mL in a dose-dependent manner with CC50 more than 200 µg/mL in healthy human liver cells (WRL68). The mode of inhibition assay showed that the antiviral effects of Carrageenan are mainly due to their ability to inhibit the early stages of virus infection such as the viral attachment and the cellular entry stages. Our investigation showed that Carrageenan could be considered as a potent antiviral agent to JEV infection. Further experimental and clinical studies are needed to investigate the potential applications of Carrageenan for clinical intervention against JEV infection.

Background: Most postpartum women are prescribed at least one medication; so the safety of the medication is a major concern. In 2017, 11% of 815 questions received by the Pharmacy Drug Information Services at seven clinics in Dungun is related to medication use in breastfeeding. Thus, this study was carried out to evaluate the attitudes of healthcare providers (HCPs) and to investigate the effect of knowledge about medication use in breastfeeding among HCPs; pre- and post-educational intervention.Methods: An interventional study was carried out among medical officers, assistant medical officers, pharmacists and pharmacist assistants from seven clinics in the district of Dungun, Malaysia. The questionnaires were distributed during pre- and post-intervention period. The interventions in this study included continuous medical education (CME) and the use of a booklet regarding medication use for breastfeeding women. The data collected were analyzed using Statistical Package for Social Studies (SPSS) and presented as frequencies, means, and standard deviations.Results: Fifty HCPs were enrolled in this study and over 20% of them advised mothers to discontinue breastfeeding whenever they are prescribed any medication. The knowledge of HCPs about medication use in breastfeeding women was significantly improved (Z= -5.917, p<0.001) following the educational intervention.Conclusion: CME and a simplified booklet appeared to have a positive impact on the knowledge of HCPs regarding medication use in breastfeeding

Freeze drying is a dehydration method to dry bone under freezing environment, enabling removal of water with no or minimial effects on bone strength and durability. Larger size bones obviously require longer freeze drying time to reduce water content to the required level for long term storage at room temperature. For small size bone cubes or chips, it is a normal practice to pool cortical and cancellous bones for freeze drying. The study was aimed at determining if different type of bones of the same size influence the drying time. Human bone cubes of 10 mm x 10 mm x 10 mm were prepared from cortical bone of tibiae and cancellous bone from femoral heads. The bone cubes were freeze dried to reduce water content to less than 6%. Moisture content was monitored using gravimetric method.Weight and density of cortical bone were significantly higher than cancellous bone despite of having similar small size (p<0.05). Cortical bones (density 2.05 ± 0.35 g/cm3) with initial water content of 10.93% required 5 hours to freeze dry, while cancellous bone cubes (density 0.72 ± 0.44 g/cm3) with initial water content of 78.95% required only 1.87 hours. This study confirmed that the structure hence density of human bone cubes determine the freeze drying time. Therefore in the standard operating procedure for freeze drying of bone allograft cubes, high density cortical bone cubes and low density cancellous bone cubes must be freeze dried separately despite being of similar small size

Despite increasing use of bone graft in Malaysia, there was still lack of data to quantify knowledge level on bone banking among orthopaedic community who are involved in transplantation related work. Therefore, a survey on awareness in tissue banking specifically bone banking, usage and choice of bone grafts was conducted. From 80 respondents, 82.5% were aware about tissue banking however only 12.5% knew of the existence of tissue banks in Malaysia. Femoral head was the bone allograft most often used as a substitute to autograft. Only 34.8% respondents preferred irradiated bone grafts whilst 46.9% preferred nonirradiated, indicating the need to educate the importance of radiation for sterilising tissues. Exhibition was the most preferred medium for awareness programme to disseminate information about bone banking in the orthopaedic community. The professional awareness is necessary to increase the knowledge on the use of bone graft, hence to increase bone transplantation for musculoskeletal surgeries in the country.

Long term evaluations of impacts of communitybased health promotion programmes are not an easy orstraightforward task to do due to lack of validated andreliable indices. Objective: To develop and test an indexto measure schoolchildren’s oral health knowledge,attitudes, and behaviour as a result of a school-based healthpromotion programme in Malaysia called the DoktorMuda (Junior Doctor) Programme (DMP). Materials andMethods: The index was developed in English based onthe DMP module and translated into Malay. The Malayversion was tested on 174, 11-12 year old schoolchildren.Psychometric analysis of the index involved content andface validity tests as well as factor analysis, internal andtest-retest reliability. Results: Factor analysis yielded 3factors with groups of items viz. oral health knowledge(OHK), oral health attitudes (OHA) and oral healthbehaviour (OHB). The Cronbach’s alpha coefficients of thethree factors were 0.61, 0.73, and 0.64, respectively. TheKappa coefficients were 0.70, 0.77 and 0.73, respectively(intraclass correlation coefficients = 0.72, 0.70 and 0.78).The final questionnaire comprised 33 items, namely; OHK11 items, OHA 15 items, and OHB 7 items. Conclusion:The Health Promotion Questionnaire Index (HPQI) tomeasure the DMP impact on schoolchildren’s oral healthknowledge, attitudes, and behaviours was empiricallyverified to be valid and reliable for use among 11-12 yearold Malaysian schoolchildren.

Acanthamoeba is a free-living protozoa which causes serious ocular problem. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers and it can cause loss of vision and blindness if not treated properly. The objective of this research is to determine the effectiveness of gentamicin against six Acanthamoeba spp. isolates, of which three were clinical isolates (HS 6, HKL 95, HTH 73) and three environmental isolates (SMAL 7, SMAL 8, TTT 9). Cyst suspension from the chosen isolates were exposed to gentamicin. After 48 hours of incubation at temperature of 30°C and 37ºC, each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30oC and 37oC and the plates were examined daily until day 14 to look for the presence of Acanthamoeba trophozoites under inverted microscope. The presence of trophozoites indicated the ineffectiveness of gentamicin. Gentamicin was found to be effective against Acanthamoeba cysts from all the test strains at both incubation temperatures. The minimum cysticidal concentration (MCC) mean value of gentamicin was 0.193 mg/mL at 30oC and 0.229 mg/mL at 37oC. So, we concluded that gentamicin has cysticidal potential towards Acanthamoeba.

The increased frequency of antibiotic resistance is known to be associated with the dissemination of integrons in the Enterobacteriaceae. This study determined the prevalence and type of integrons amongst 160 extended-spectrum beta-lactamase producing enterobacterial isolates kept in our culture collection. Integrons were detected in 98(61.3%) isolates, including 28(62.2%) Escherichia coli, 34(64.2%) Klebsiella spp., 27(61.4%), Enterobacter spp. and 9(50.0%) Citrobacter spp. investigated in this study. Restriction analysis of the integron gene fragments revealed that class I integron was the principal integron detected in 92(57.5%) of our isolates. Class II integron was detected in 6(3.8%) of our isolates, while no class III integron was detected in this study. The high rates of integron prevalence particularly of the class I integron in the E. coli and Klebsiella spp. concur with previous studies in other geographical regions. The higher (>50%) integron prevalence of Citrobacter and Enterobacter isolates comparing to previous studies suggests the potential of these isolates as sources for dissemination of resistance determinants. The finding in this study serves as a basis for further study on the antibiotic resistance mechanisms of enterobacterial species in this teaching hospital.

Introduction: Acanthamoeba is an ubiquitous free-living protozoa which causes serious ocular problems. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers. The disease can cause loss of vision and blindness if not treated properly. The objective of this research is to study the sensitivity of six Acanthamoeba spp. isolates, of which three were from the clinical isolates (HKL 95, HTH 40 and HS 6) and the remaining three from environmental isolates (TTT 9, TL 3 and SMAL 8) to antimicrobial agents. Methods: The antimicrobial agents chosen for this purpose were polyhexamethylene biguanide and chlorhexidine. Cyst suspensions from the chosen isolates were exposed to PHMB and chlorhexidine respectively. After 48 hours incubation time at 30°c,each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30°c and examined daily until day 14 to detect the presence of Acanthamoeba trophozoites under the inverted microscope. The presence of thropozoites indicated the ineffectiveness of the antimicrobial agents. Results: Both of the antimicrobial agents tested were found to be effective against Acanthamoeba cysts from all the test starins. Polyhexamethylene biguanide gave minimum cysticidal concentration (MCC) mean value of 2.848mg/mL while chlorhexidine showed MCC mean value at a concentration of 3.988mg/mL. Conclusion: It can be concluded that the Acanthamoeba were sensitive to polyhexamethylene biguanide and chlorhexidine.