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Cryotherapy: A Successful Monotherapy for Earlobe Keloids

Muthanna AM, Al-Qubati YA

Malays Fam Physician, 2020;15(3):83-85.
PMID: 33329867

A keloid represents an excessive overgrowth of skin beyond the boundaries of an injury. Earlobe keloids usually follow ear piercing and can become large, sometimes producing remarkable disfigurement. Surgical excision, pressure dressing, intralesional corticosteroid injection, cryosurgery, radiation, and lasers have all been used to treat earlobe keloids. However, none has produced uniformly satisfactory results. Combinations of more than one modality have also been employed to yield successful outcomes. We describe cryotherapy as a single modality to treat seven-year-old, multiple earlobe keloids. Three cryotherapy sessions with two freezing-thawing cycles of 30-40 seconds' freezing time and two minutes' thawing time, undertaken one month apart, resulted in complete flatness of the keloids and no recurrence after 5 years. We also evaluate keloid-related and operational factors that determine the success of cryotherapy as a monotherapy for earlobe keloids.
Immunisation coverage and its determinants among Rohingya refugee children in Malaysia

Al-Haroni H, Muthanna A, Nasir Mohd Desa M, Azzani M

Aust J Gen Pract, 2023 Oct;52(10):712-719.
PMID: 37788693 DOI: 10.31128/AJGP-01-23-6676

BACKGROUND AND OBJECTIVES: The displacement of populations due to humanitarian emergencies has an adverse impact on the global elimination of vaccine-preventable diseases. However, the level of immunisation coverage among Rohingya refugee children remains unknown. Therefore, this study investigated immunisation coverage and its determinants among Rohingya refugee children in Malaysia.
METHOD: A cross-sectional study was conducted from September to November 2020 among the guardians of 243 Rohingya refugee children studying under the sponsorship of the King Salman Humanitarian Aid and Relief Center, Malaysia.
RESULTS: Among the 243 children, 90 (37%) were unimmunised, 147 (60.5%) were partially immunised and only 6 (2.5%) were fully immunised. The country of child's birth, the child's age and access to healthcare services were significantly associated with unimmunisation (all P<0.05).
DISCUSSION: This study found low immunisation coverage among Rohingya refugee children in Malaysia. Given the low level of coverage, a public health intervention, such as a vaccination program, for this refugee population is necessary.
Fulltext Multilocus Sequence Typing Analysis of Invasive and Non-Invasive Group B Streptococcus of Hospital Origin in Malaysia

Ezhumalai M, Muthanna A, Suhaili Z, Dzaraly ND, Amin-Nordin S, Amal MNA, et al.

Malays J Med Sci, 2020 Feb;27(1):134-138.
PMID: 32158353 MyJurnal DOI: 10.21315/mjms2020.27.1.14

The aim of this study was to study the genotype of a hospital collection of Group B Streptococcus (GBS) from invasive and non-invasive sites. Fifty-one pre-characterised human of GBS were re-identified and further analysed by multilocus sequence typing (MLST) in relation to previously published serotypes. Fifteen sequence types (ST) were found with ST1 being the most predominant. ST1 was also associated with majority of the invasive isolates. The genotypic distribution patterns of GBS in this study were largely in agreement with previous reports from other countries indicating the tendency of certain genotypes to prevail in human infection settings.
Fulltext Clinical Screening Tools to Diagnose Group A Streptococcal Pharyngotonsillitis in Primary Care Clinics to Improve Prescribing Habits

Muthanna A, Salim HS, Hamat RA, Shamsuddin NH, Zakariah SZ

Malays J Med Sci, 2018 Nov;25(6):6-21.
PMID: 30914875 MyJurnal DOI: 10.21315/mjms2018.25.6.2

This review highlights the clinical scoring tools used for the management of acute pharyngotonsillitis in primary care clinics. It will include the prevalence of group A pharyngotonsillitis among children and adults worldwide and the selective tests employed for diagnosing group A streptococcal pharyngotonsillitis. Pharyngotonsillitis is one of the common reasons for visits to primary care clinics worldwide, and physicians tend to prescribe antibiotics according to the clinical symptoms, which leads to overprescribing antibiotics. This in turn may lead to serious health impacts and severe reactions and may promote antibiotic resistance. These significantly add on to the health care costs. The available information from health organisations and previous studies has indicated the need to manage the diagnosis of pharyngotonsillitis to improve prescribing habits in primary care clinics.
Pilus islets and the clonal spread of piliated Streptococcus pneumoniae: A review

Dzaraly ND, Muthanna A, Mohd Desa MN, Taib NM, Masri SN, Rahman NIA, et al.

Int J Med Microbiol, 2020 Oct;310(7):151449.
PMID: 33092697 DOI: 10.1016/j.ijmm.2020.151449

Pneumococci are a common cause of severe infections, such as otitis media, pneumonia, meningitis and bacteremia. Pili are detected in a small proportion of pneumococcal population, but these structures have recently been associated with bacterial virulence in humans. Therefore, the epidemiological relationships between pneumococcal pili, serotype and antimicrobial resistance are of interest. This study aims to discuss the virulence contribution of the Streptococcus pneumoniae pili and the epidemiological relationships among the pilus genes, antimicrobial resistance trends, regional serotypes and genotypic variations. Previous reports have characterized the pneumococcal pilus islet as a clonal feature in the pneumococcal serotypes that are covered by the pneumococcal conjugate vaccine (PCV), including serotypes 19A, 19F, 23F and 7F. Many of the pneumococcal molecular epidemiology network (PMEN) clones are piliated isolates that are also strongly associated with a high frequency of multidrug resistance. Most of these piliated pneumococcal isolates belong to a few clonal complexes (CC), such as CC320, CC199, CC271, CC191 and CC156. Additional molecular epidemiology and genomic studies, particularly whole genome sequence analysis (WGS), are needed to develop an in-depth understanding of the piliated pneumococcal isolates.
Fish-associated Streptococcus agalactiae ST283: first human cases reported from Malaysia

Zohari Z, Barkham T, Mohamad Maswan N, Chen SL, Muthanna A, Lee KW, et al.

J Med Microbiol, 2023 Jun;72(6).
PMID: 37389575 DOI: 10.1099/jmm.0.001729

In South East Asia, Streptococcus agalactiae ST283 causes sepsis in healthy adults. Raw freshwater fish consumption is the only known risk factor. These two case reports are the first from Malaysia. Although they cluster with Singapore ST283, the epidemiology is complicated by the flow of people and fish across borders.
Fulltext The characteristics and roles of antimicrobial peptides as potential treatment for antibiotic-resistant pathogens: a review

Zainal Baharin NH, Khairil Mokhtar NF, Mohd Desa MN, Gopalsamy B, Mohd Zaki NN, Yuswan MH, et al.

PeerJ, 2021;9:e12193.
PMID: 35003909 DOI: 10.7717/peerj.12193

The emergence of antibiotic-resistant bacteria has become a significant and ever-increasing threat to global public health, increasing both morbidity and mortality rates, and the financial burden on health services. Infection by drug-resistant bacteria is anticipated to contribute to the demise of almost 10 million people by the year 2050 unless a competent and effective response is devised to engage with this issue. The emergence and spread of resistance are commonly caused by the excessive or inappropriate use of antibiotics and substandard pharmaceuticals. It arises when pathogens adapt to different conditions and develop self-defence mechanisms. Currently, novel antimicrobial peptides (AMPs) have been reported to be the sole cure for some clinical cases of infectious diseases such as sepsis and skin infections, although these agents may, on occasion, require administration together with an adjunctive low-dose antibiotic. Although AMPs are a promising alternative form of anti-microbial therapy and easily applied in the medical sector, they still have limitations that should not be taken lightly. Hence, this review explores the characteristics, advantages and disadvantages of AMPs for their potential in treating antibiotic-resistant pathogens.
Phenotypic and genotypic comparison of pathogenic group B Streptococcus isolated from human and cultured tilapia (Oreochromis species) in Malaysia

Muthanna A, Desa MNM, Alsalemi W, Liyana Abd Aziz NA, Dzaraly ND, Baharin NHZ, et al.

Comp Immunol Microbiol Infect Dis, 2023 Jun;97:101993.
PMID: 37167694 DOI: 10.1016/j.cimid.2023.101993

Group B Streptococcus (GBS) is a major cause of several infectious diseases in humans and fish. This study was conducted to compare human and fish-derived GBS in terms of their antimicrobial susceptibility, serotype, virulence and pili genes and sequence type (ST), and to determine whether there is a potential linkage of zoonotic transmission in Malaysia. GBS isolated from humans and fish had similar phenotypic characteristics and differed in virulence gene profile, antimicrobial susceptibility, serotype and sequence type. Fish GBS isolates had lower genetic diversity and higher antibiotic susceptibility than human isolates. We report a rare detection of the potentially fish-adapted ST283 in human GBS isolates. Both human and fish ST283 shared several phenotypic and genotypic features, including virulence and pilus genes and antimicrobial susceptibility, illustrating the value of monitoring GBS within the One Health scope. In this study, two human GBS ST283 isolates belonging to the variant common in fish hosts were identified, raising awareness of the zoonotic potential between the different species in Malaysia.
Fulltext Antimicrobial susceptibility, serotype distribution, virulence profile and molecular typing of piliated clinical isolates of pneumococci from east coast, Peninsular Malaysia

Dzaraly ND, Mohd Desa MN, Muthanna A, Masri SN, Taib NM, Suhaili Z, et al.

Sci Rep, 2021 Apr 15;11(1):8220.
PMID: 33859249 DOI: 10.1038/s41598-021-87428-z

Pilus has been recently associated with pneumococcal pathogenesis in humans. The information regarding piliated isolates in Malaysia is scarce, especially in the less developed states on the east coast of Peninsular Malaysia. Therefore, we studied the characteristics of pneumococci, including the piliated isolates, in relation to antimicrobial susceptibility, serotypes, and genotypes at a major tertiary hospital on the east coast of Peninsular Malaysia. A total of 100 clinical isolates collected between September 2017 and December 2019 were subjected to serotyping, antimicrobial susceptibility test, and detection of pneumococcal virulence and pilus genes. Multilocus sequence typing (MLST) and phylogenetic analysis were performed only for piliated strains. The most frequent serotypes were 14 (17%), 6A/B (16%), 23F (12%), 19A (11%), and 19F (11%). The majority of isolates were resistant to erythromycin (42%), tetracycline (37%), and trimethoprim-sulfamethoxazole (24%). Piliated isolates occurred in a proportion of 19%; 47.3% of them were multidrug-resistant (MDR) and a majority had serotype 19F. This study showed ST236 was the most predominant sequence type (ST) among piliated isolates, which was related to PMEN clone Taiwan19F-14 (CC271). In the phylogenetic analysis, the piliated isolates were grouped into three major clades supported with 100% bootstrap values. Most piliated isolates belonged to internationally disseminated clones of S. pneumoniae, but pneumococcal conjugate vaccines (PCVs) have the potential to control them.