The home remedy of taking honey along with a citrus juice of lemon, lime or calamansi to soothe sore throat has long been practiced in many cultures across the world since ancient times. This paper aims to systematically review the antibacterial effect of honey and citrus juice on Streptococcus pyogenes by means of a systematic search in EBSCOhost, Medline, Scopus and ISI Web of Science databases for reports of studies investigating the antibacterial effects of honey and citrus fruit juice on S. pyogenes. A total of 415 publications were initially identified out of which, 20 were finally chosen and reviewed by looking at the tittles, abstracts and fullpaper usingpre-determined inclusion and exclusion criteria in relation to honey (n=16) and citrus (n=4). The majority of the studies showed that both honey and citrus have significant antimicrobial effect on S. pyogenes. There are still not many available data though on the combined effect of honey and citrus on the bacterium. This knowledge gap offers an opportunity to investigate those effects with the purpose of supporting traditional practice with scientific evidences.

This is a case of a 2-month-old infant who had suppurative lymphadenitis at left axilla after Bacille Calmette Guerin (BCG) vaccination. She presented with a non-healing BCG wound and left axillary swelling associated with one-week fever at 2 months of age. Aspiration under general anaesthesia was done and pus sent for mycobacterium culture grew Mycobacterium tuberculosis complex. The patient improved without anti-tuberculosis treatment.

Since its first discovery in 1996, Carbapenem-resistant Enterobactericeae (CRE) has been increasingly reported as a cause of infections particularly in immuno-compromised patients. With limited treatment options, these multidrug-resistant organisms are associated with high mortality rates and are now recognized as an important cause of health-care associated infections. This study aimed to determine the prevalence of CRE at a 500-bedded tertiary hospital in Selangor, Malaysia. This study identified and analyzed CRE culture results from January 2015 to December 2016. The isolates were identified by conventional and Vitek 2 (R) methods. Susceptibility tests were done by disk diffusion technique and confirmed by E-test. Polymerase chain reaction was performed to identify NDM-1, KPC, OXA-48, VIM and IMP genes. Demographic data and clinical characteristics were collected from the Hospital Information System. The prevalence of CRE in 2015 and 2016 was 0.3% (5/1590) and 1.2% (17/1402) respectively. 65% of the patients had underlying haematological disorders. Majority (81.8%) of the isolates were Klebsiella pneumoniae, followed by Serratia marcescens, Escherichia coli, and Citrobacter koseri. Klebsiella pneumoniae that co-produced NDM-1 and OXA48 genes were the most common encounter (41%), followed by OXA-48 (35%), NDM-1 (12%) and KPC (6%). All isolates were resistant to all generations of cephalosporin and carbapenem. The rate of resistance to tigecycline, polymyxin B and colistin were quite high; 46% (5 from 12 isolates), 17% (2/12) and 17% (3/17) respectively. The prevalence of CRE in this institution was relatively low. However, there is a high prevalence of OXA-48 and NDM co-producer amongst CRE isolates. Physicians should have high index of CRE suspicion in hematological patients.

Vibrio alginolyticus is a halophilic gram-negative marine pathogen. The modes of transmission are mainly via direct contact with seawater and indirect contact through marine creatures. We report here a 28-year-old accountant diagnosed with right leg abscess after being bitten and scratched by a stray cat. Vibrio alginolyticus was isolated from the pus sample. The patient gave no history of contact with ocean water immediately before or after the cat scratch episode. The patient did apply commercial sea cucumber oil to the wound; we presume this is the cause of the Vibrio alginolyticus wound infection. To the best of our knowledge, this is the first reported case of Vibrio alginolyticus wound infection caused by commercially available sea cucumber oil.

Vibrio alginolyticus is a halophilic gram-negative marine pathogen. The modes of transmission are mainly via direct contact with seawater and indirect contact through marine creatures. We report here a 28-year-old accountant diagnosed with right leg abscess after being bitten and scratched by a stray cat. Vibrio alginolyticus was isolated from the pus sample. The patient gave no history of contact with ocean water immediately before or after the cat scratch episode. The patient did apply commercial sea cucumber oil to the wound; we presume this is the cause of the Vibrio alginolyticus wound infection. To the best of our knowledge, this is the first reported case of Vibrio alginolyticus wound infection caused by commercially available sea cucumber oil.

Introduction: Invasive Candida infections cause significant mortality and morbidity worldwide. Information on recent trends in species distribution and antifungal resistance in local settings is essential. Methodology: Yeast isolates identified through standard culture methods throughout 2014 and 2015 from Hospital Ampang, Malaysia were retrospectively studied. The antifungal susceptibility of Candida species was determined using colorimetric broth microdilution method and MIC values interpreted according to CLSI breakpoints. Results: Out of all the 149 yeast cultures collected, most were from blood (55.7%) and respiratory specimens (33.6%). Candida tropicalis was the most common (28.9%), followed by C. albicans (26.2%), C. parapsilosis (15.4%), C. glabrata (14.1%), Crytococcus neoformans (6.7%), Trichosporon asahi (3.4%), C. krusei (2.0%), C. famata, C. rugose, C. guilliermondii, C. dublinensis and Trichosporon spp. (0.7% each). Occurrence of C. tropicalis in candidaemia cases was significantly associated to presence of an underlying haematological disorder, while C. albicans isolates in blood were significantly found in absence of such disorders. The four most common Candida species isolated showed high susceptibility to amphotericin B (100%), anidulafungin (100%), micafungin (100%), caspofungin (98.4%), flucytosine (98.4%) and voriconazole (84.1%). However, drug susceptibility to itraconazole and fluconazole was comparatively lower (57.9% and 72.2%, respectively). C. glabrata and C. tropicalis were the least susceptible to these azoles. Conclusion: Prevalence of the high number of non-albicans Candida species with slight predominance of C. tropicalis over C. albicans was observed. Low susceptibility to itraconazole among C. glabrata and C. tropicalis isolates and to fluconazole among C. glabrata isolates warrants for continued surveillance to monitor emerging antifungal resistance.

Background and objective: Through contaminated hands, number of infectious disease can be transmitted from one person to another. Salmonella spp, E. coli O157, norovirus and adenovirus that can cause diarrheal and respiratory infections are transmitted either directly or indirectly via contaminated objects. Children are at higher risk of getting such infections as they lack natural immunity and understanding of the importance of good hygiene. Hand washing is one of the most important factors in controlling the spread of the microorganisms. This study aimed to determine the knowledge and attitude of hand washing and the hand washing technique, in relation to "Bacterfree Hand Intervention" among pre-schoolers. Materials and methods: This cluster-randomized trial involved 146 pre-schoolers from 3 different pre-schools in Wilayah Persekutuan was conducted from April to August 2015. Participants were interviewed twice; pre and post intervention. Face-to-face interview was done using guided questionnaires that include questions on knowledge and attitude of hand washing and its techniques. A group of students were given single intervention i.e. posters and the other group participated in "Bacterfree Hand Intervention" program which consisted of storytelling, posters and demonstration. Results: There were significant increase of knowledge (median (10.00 vs 11.00, P < 0.001) and technique(6.00 vs 6.00, P = 0.020) after intervention in single intervention group while the attitude (median 6.00 vs 6.00, P= 0.871) was remained unchanged. Meanwhile, the median of knowledge, attitude and hand washing techniques in multiple intervention group increased significantly after intervention. Conclusions: This study highlighted the need of comprehensive educational programs that include various mode of delivery to create awareness regarding the importance of hand hygiene among pre-school children. This is very important to establish healthy environment and eventually prevent communicable diseases in the community.

Objectives: Hepatitis C virus (HCV) genotyping is important for treatment and epidemiological purposes. The objective was to determine HCV genotype and their associations with certain risk factors at University Kebangsaan Malaysia Medical Centre (UKMMC). Methods: A total of 89 samples were collected from December 2009 to January 2011. Demographic data of patients were collected from medical record. Reverse Transcriptase Polymerase chain reaction (RT PCR) was performed and sixty-four samples yielded positive for HCV. Sequencing was performed and analyzed based on sequence information in GenBank. Statistical analysis were done using SPSS version 15. Results: HCV genotype 3 (73%) was the most frequent genotype, followed by genotype 1(27%). The distribution of HCV genotype/subtype was as follows: 3a (64.8%), 1a (13.5%), 1 (10.8%), 3 (8.1%) and 1b (2.7%). Conclusions: HCV subtypes 3a, 1a, and 1b were identified in patients at UKMMC, Malaysia with subtype 3a being the most prevalent. No significant association was found between HCV genotypes and patients' demographic data.

Background Hepatitis C virus (HCV) genotyping is important for treatment and epidemiological purposes. The objective of this study was to evaluate the performance of AmpliSens (R) HCV-1/2/3-FRT kit in comparison to sequencing method for genotyping. Methods A total of 17 samples collected from December 2009 to January 2011 were analyzed. Reverse transcriptase polymerase chain reaction (PCR) was performed, followed by sequencing technique. Results were analyzed based on sequence information in GenBank. A second genotyping method (AmpliSens (R) HCV-1/2/3-FRT) was done, which differentiates HCV genotypes by means of real-time hybridization-fluorescence detection. Results From 17 samples, four were untypeable by AmpliSens (R) HCV-1/2/3-FRT. Eleven of 13 (84.6%) results showed concordant genotypes. A specimen that was determined as genotype 3a by sequencing was genotype 1 by the AmpliSens (R) HCV-1/2/3-FRT. Another specimen that was genotype 1 by sequencing was identified as genotype 3 by AmpliSens (R) HCV-1/2/3-FRT. Conclusion HCV genotyping with AmpliSens (R) HCV-1/2/3-FRT using real-time PCR method provides a much simpler and more feasible workflow with shorter time compared to sequencing method. There was good concordance compared to sequencing method. However, more evaluation studies would be required to show statistical significance, and to troubleshoot discordant results. AmpliSens (R) HCV-1/2/3-FRT does differentiate between genotype but not until subtype level.

Introduction: Malaysia declared its intent to eliminate malaria by 2020, with a phased goal of achieving zero local transmission. Nonetheless, Malaysia is highly susceptible to malaria importation due to geographical proximity to high-burden countries e.g. Thailand, Myanmar and high influx of foreign workers and students from Asia and Africa. Case Series: We accumulated all malaria cases diagnosed in a tertiary hospital within a period of two years. Three cases were reported, where all of the patients were foreigners with recent travel history to African countries. All of them were infected by P. falciparum, responded to treatment and discharged well. Discussion: This case series highlighted the importance of acquiring recent travel history during history taking and having a high index of suspicions on malaria when dealing with feverish patients originated particularly from African countries.

For ages, honey has held a place for their importance in traditional medicine. old folks in this country used honey as a remedy for sore throat. recently, there has been so much interest in research on this natural product. however, the composition and physiochemical properties of honey responsible for antioxidant and antimicrobial effects were variable depending on its floral sources and location. Well-researched honey such as Manuka honey from New Zealand and Australia has been extensively studied and characterized. Unlike Malaysia Tualang Honey, even though it is widely used and consumed in Malaysia, there are limited study reports to support its medical claims. Phenolic acids and flavonoids are two of the most important components responsible for the antioxidant effects in honey. Therefore, in present study, we designed a study to compare the total phenolic content (TPC), total flavonoid content (TFC) and antibacterial potential of Tualang honey with Manuka honey. TPC and TFC of Tualang honey (88.44mg of GAE/100g of Tualang honey; 29.232mg of rutin/100g of Tualang honey) exhibited higher content compared to Manuka honey (83.12mg GAE/100g of Manuka honey; 16.32mg of rutin/100g of Manuka honey0. As for antibacterial assay, Tualang honey (31.67±0.764) shows better inhibition to Streptococcus pyogenes, compared to Manuka honey (31.50±0.500). These findings exhibited promising potential of Tualang honey to be used as an alternative treatment for Streptococcal pharyngitis. Further in-vivo studies in animal and human should be done to ascertain its effectiveness.

This study aims to evaluate a continuous flow model that involves a ramp area at kilometer 31.6 on the highway from Shah Alam to Kuala Lumpur, to analyze the findings of numerical results of instantaneous speed ratios and to observe the convergence patterns for each section. The continuous flow model assumes traffic flow to be similar to the heat equation in regard to the concept of the one-dimensional viscous flow of a compressible fluid. For the methodology, for solving an initial value-boundary value problem, an initial condition together with a set of boundary conditions are required to solve the partial differential equation. The boundary conditions are chosen to assess the suitableness of the design of the entrance ramp in Malaysia, which is for right hand drive traffic. Highway traffic data were collected on the tapered acceleration lane and obtained by the videotaping method. The Maple programming language was used to write a numerical code in order to evaluate the instantaneous speed ratio in terms of a Fourier series. Our results show that the realistic results of instantaneous speed ratios on the ramp at kilometer 31.6 from Shah Alam to Kuala Lumpur are acceptable when compared to the theoretical results. Therefore, a very minimal collision rate is expected due to the well-designed ramp at kilometer 31.6 from Shah Alam to Kuala Lumpur. It is beneficial to study the mathematical model and theories of traffic flows on the merging area to enhance the efficiency of the traffic flowing on highways.

Background: In line with Universiti Sains Islam Malaysia's (USIM) tagline 'Exploring Islamic Science, Spearheading Knowledge', we embarked on a new paradigm of teaching by integrating naqli components into the microbiology and immunology curriculum. The main objective of this integration was to enhance students' appreciation towards Islam and Science, so that they would become good Muslim doctors. The naqli components were delivered through various teaching and learning techniques such as lectures, seminars, and online assignments. Methods: A total of eighty year 3 students from Faculty of Medicine and Health Sciences, USIM were involved in this study. They were exposed to the new method of teaching for the whole academic year, session 2014/2015. The effectiveness of this program was evaluated through questionnaires, given at the end of academic session. Outcome: More than 90% students agreed that the integration were clearly delivered, relevant to the topics at hand and enhanced their knowledge. Most students (>90%) preferred interactive lectures rather than students' initiated method such as seminar and speaker's corner. About two third of the students did not prefer online method. Moreover, 15.9% of them said the allotted time was insufficient and 46% agreed that there was inadequate resources in the library. Conclusions: The integration of naqli components into microbiology subject was favoured by students. However, it should be improved with allocation of more slots, upgrading of online system and increment of relevant library resources. Looking forward, we are convinced this is the way to go in producing holistic doctors equipped with necessary knowledge, both in aqli and naqli to further advance Medicine and Islam.

Choosing a course to pursue is an important decision for students to make. A suitable career should correspond to the students' personalitiy for future work satisfaction and success. The objectives of this study were to determine the students' reasons for choosing medicine, their personality traits and aptitude (suitability). This was a cross-sectional study involving all third-year medical students at Universiti Sains Islam Malaysia. A self-administered questionnaire was used, which included questions on demographic data, Sidek Career Interest Inventory and reasons for choosing medicine. The inventory was used to measure the students' personality traits and career suitability. A total of 80 students participated in the study. Majority of them were females (n=56, 70.0%). The findings showed that 45.7% (n=44) of the repondents chose medicine because of 'passion and interest', while 24.7% (n=20) and 19.8% (n=16) because of 'parental influence' and 'to help the society', respectively. For medicine, two personality traits are essential which are investigative and social personality traits. Approximately, 47.5% (n=38) of the respondents had high scores in investigative personality trait. However, only 13.8% (n=11) of them had high scores in social personality trait. Only 12.5% (n=10) of the students had high scores when combining both of the traits. Majority of the students chose medicine for altruistic reasons. However, only a few of them had suitable aptitude for this course namely investigative and social skill. Therefore, the students and the teachers need to be aware of these issues and cultivate the required skills in the students for better career outcome.

In this paper, we present the distribution of some maximal eigenvalues that are obtained numerically from the discrete Dirichlet Boundary Domain Integro-Differential Equation (BDIDE) operator. We also discuss the convergence of the discrete Dirichlet BDIDE that corresponds with the obtained absolute value of the largest eigenvalues of the discrete BDIDE operator. There are three test domains that are considered in this paper, i.e., a square, a circle, and a parallelogram. In our numerical test, the eigenvalues disperse as the power of the variable coefficient increases. Not only that, we also note that the dispersion of the eigenvalues corresponds with the characteristic size of the test domains. It enables us to predict the convergence of an iterative method. This is an advantage as it enables the use of an iterative method in solving Dirichlet BDIDE as an alternative to the direct methods.