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Md Hanif SA, Hassan MR, Rafi’i MR, Abdul Halim AFN, Ahmad Zamzuri M‘AI, Ismail M, Ibrahim SS, Mihat M, Rejali L, Zubir MH, Mahadi MS, Ahmad Ismail S, Ganesan V, Mohd Fadzil MF. Understanding The Mimicker: Epidemiological Pattern and Determinant of Melioidosis Mortality in Negeri Sembilan, Malaysia. PLoS Negl Trop Dis 2024; 18:e0012147. [PMID: 38709822 PMCID: PMC11098469 DOI: 10.1371/journal.pntd.0012147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/16/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Melioidosis, a tropical infectious disease caused by Burkholderia pseudomallei, is epidemic in most region in Southeast Asia with high case fatality. However, there is scanty information regarding the disease's epidemiological pattern, demographics, and underlying risk factors. METHOD This 5-year retrospective study of 185 confirmed cases which were taken from the Negeri Sembilan Melioidosis Registry between 2018 and 2022. We aim to describe the incidence, mortality rate, case fatality, relationship with meteorology, and factors that influence mortality in this central region of Peninsular Malaysia. RESULTS Incidence rate (IR) of melioidosis in Negeri Sembilan is varied at 1.9 to 5.1 with mean of 3.1 in 100,000 population per year. IR varied between districts in the state from zero to 22.01 in 100,000 population per year. Mortality rate were ranged from 0.17 to 0.74 cases with mean of 0.44 cases in 100,000 population per year. The case fatality rate of this state scattered from 8.70% to 16.67%. There were no significant linear associations between cases and deaths with monthly rainfall and humidity. The mean age of patients was 52.8 years, predominated with age around 41-60 years old. Males (77.8%) predominated, and the majority of cases were Malays (88.9%) and had exposed to soil related activities (74.6%). Mortality from melioidosis was more likely in Bumiputera and non-Malaysians (p<0.05). Patients who had at least one comorbidity were at a higher risk of death from melioidosis (p<0.05). Diabetes mellitus was found in 41.1% of all identified cases, making it a major underlying risk factor for both developing and dying from melioidosis (aOR:19.32, 95%CI:1.91-195.59, p<0.05). Hypertension and mortality status in melioidosis are also significantly correlated (aOR: 7.75, 95% CI: 2.26-26.61, p<0.05). CONCLUSION The epidemiological patterns of cases reported from Negeri Sembilan are consistent for the most part from previous studies in other states in Malaysia and global with regard to its incidence, case fatality, demographic and predisposing chronic diseases. Diabetes mellitus and hypertension were significantly linked to increased mortality among all determinants.
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Affiliation(s)
- Shahrul Azhar Md Hanif
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Muhammad Ridzwan Rafi’i
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Ahmad Farid Nazmi Abdul Halim
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | | | - Muhammad Ismail
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | - Siti Salwa Ibrahim
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | - Massitah Mihat
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | - Lokman Rejali
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | - Muhammad Habiruddin Zubir
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | | | - Shazwanis Ahmad Ismail
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Veshny Ganesan
- Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, Malaysia
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Hussin A, Nor Rahim MY, Dalusim F, Shahidan MA, Nathan S, Ibrahim N. Improving the clinical recognition, prognosis, and treatment of melioidosis through epidemiology and clinical findings: The Sabah perspective. PLoS Negl Trop Dis 2023; 17:e0011696. [PMID: 37844130 PMCID: PMC10602235 DOI: 10.1371/journal.pntd.0011696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/26/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Melioidosis is a deadly endemic disease in northern Australia and Southeast Asia, including Sabah, Malaysia, which is caused by the bacterium Burkholderia pseudomallei. It contributes to high fatality rates, mainly due to misdiagnosis leading to the wrong treatment being administered to the patients. Local epidemiology and data on clinical features could assist clinicians during diagnosis and treatment. However, these details are still scarce, particularly in Sabah. METHODS A retrospective study of 246 culture-confirmed melioidosis cases in Queen Elizabeth Hospital, Sabah, Malaysia was performed between 2016 and 2018. The epidemiological data and clinical and laboratory findings were extracted and analysed. RESULTS The annual incidence of culture-confirmed melioidosis cases was estimated to be 4.97 per 100,000 people. The mean age of the patients was 50±15 years. Males and members of the Kadazan-Dusun ethnic group accounted for the majority of the melioidosis cases. The odds ratio analysis indicated that bacteraemic melioidosis in this region was significantly associated with fever (76%), and patients having at least one underlying illness (43%), including diabetes mellitus (32%). Sixty-eight patients (28%) succumbed to melioidosis. Contrary to what is known regarding factors that promote bacteraemic melioidosis, neither patients with fever nor patients with at least one comorbid disease, including diabetes mellitus, were significantly associated with death from melioidosis. There was no statistically significant difference between patients without comorbidities (24, 27%) and those with at least one comorbid disease (26, 25%), including diabetes mellitus (18, 23%). The odds ratios indicate that melioidosis mortality in this region is related to patients showing respiratory organ-associated symptoms (29%), bacteraemia (30%), and septic shock (47%). Burkholderia pseudomallei isolates in this study were highly susceptible to ceftazidime (100%), imipenem (100%), and trimethoprim-sulfamethoxazole (98%). CONCLUSIONS Information obtained from this study can be used by clinicians to recognise individuals with the highest risk of acquiring melioidosis, estimate an accurate prognosis, and provide effective treatment for melioidosis patients to reduce death from melioidosis.
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Affiliation(s)
- Ainulkhir Hussin
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Mohd Yusof Nor Rahim
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Frederick Dalusim
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Muhammad Ashraf Shahidan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Nazlina Ibrahim
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
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Paleiron N, Karkowski L, Bronstein AR, Amabile JC, Delarbre D, Mullot JU, Cazoulat A, Entine F, le Floch Brocquevieille H, Dorandeu F. [The role of the pulmonologist in an armed conflict]. Rev Mal Respir 2023; 40:156-168. [PMID: 36690507 DOI: 10.1016/j.rmr.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Recent news points to the eventuality of an armed conflict on the national territory. STATE OF THE ART In this situation, pulmonologists will in all likelihood have a major role to assume in caring for the injured, especially insofar as chest damage is a major cause of patient death. PERSPECTIVES The main injuries that pulmonologists may be called upon to treat stem not only from explosions, but also from chemical, biological and nuclear hazards. In this article, relevant organizational and pedagogical aspects are addressed. Since exhaustiveness on this subject is unattainable, we are proposing training on specific subjects for interested practitioners. CONCLUSION The resilience of the French health system in a situation of armed conflict depends on the active participation of all concerned parties. With this in mind, it is of prime importance that the pneumological community be sensitized to the potential predictable severity of war-related injuries.
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Affiliation(s)
- N Paleiron
- HIA Sainte-Anne, service de pneumologie, Toulon, France.
| | - L Karkowski
- HIA Sainte-Anne, service de médecine interne-maladies infectieuses, Toulon, France
| | - A-R Bronstein
- HIA Sainte-Anne, service de pneumologie, Toulon, France
| | - J-C Amabile
- Service de protection radiologique des armées, Paris, France
| | - D Delarbre
- HIA Sainte-Anne, service de médecine interne-maladies infectieuses, Toulon, France
| | - J-U Mullot
- Service de santé des armées, Paris, France
| | - A Cazoulat
- Service de santé des armées, service médical de la base opérationnelle de l'Île Longue, Lanveoc Poulmic, France
| | - F Entine
- Service de santé des armées, service médical de la base opérationnelle de l'Île Longue, Lanveoc Poulmic, France
| | | | - F Dorandeu
- Service de santé des armées, Institut de recherche biomédicale des armées, Brétigny, France
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Oslan SNH, Yusoff AH, Mazlan M, Lim SJ, Khoo JJ, Oslan SN, Ismail A. Comprehensive approaches for the detection of Burkholderia pseudomallei and diagnosis of melioidosis in human and environmental samples. Microb Pathog 2022; 169:105637. [PMID: 35710088 DOI: 10.1016/j.micpath.2022.105637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022]
Abstract
Melioidosis is endemic in Southeast Asia and northern Australia. The causative agent of melioidosis is a Gram-negative bacterium, Burkholderia pseudomallei. Its invasion can be fatal if melioidosis is not treated promptly. It is intrinsically resistant to a variety of antibiotics. In this paper, we present a comprehensive overview of the current trends on melioidosis cases, treatments, B. pseudomallei virulence factors, and molecular techniques to detect the bacterium from different samples. The clinical and microbial diagnosis methods of identification and detection of B. pseudomallei are commonly used for the rapid diagnosis and typing of strains, such as polymerase chain reaction or multi-locus sequence typing. The genotyping strategies and techniques have been constantly evolving to identify genomic loci linked to or associated with this human disease. More research strategies for detecting and controlling melioidosis should be encouraged and conducted to understand the current situation. In conclusion, we review existing diagnostic methodologies for melioidosis detection and provide insights on prospective diagnostic methods for the bacterium.
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Affiliation(s)
- Siti Nur Hazwani Oslan
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia.
| | - Abdul Hafidz Yusoff
- Gold Rare Earth and Material Technopreneurship Centre (GREAT), Faculty of Bioengineering and Technology, Universiti Malaysia Kelantan, Jeli Campus, Jeli, 17600, Kelantan, Malaysia.
| | - Mazlina Mazlan
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, 43400 UPM, Serdang, Selangor, Malaysia.
| | - Si Jie Lim
- Enzyme Technology and X-Ray Crystallography Laboratory, VacBio 5, Institute of Bioscience, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Enzyme and Microbial Technology (EMTech) Research Centre, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Jing Jing Khoo
- Tropical Infectious Diseases Research and Education Centre (TIDREC), High Impact Research Building, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Siti Nurbaya Oslan
- Enzyme Technology and X-Ray Crystallography Laboratory, VacBio 5, Institute of Bioscience, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Enzyme and Microbial Technology (EMTech) Research Centre, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Aziah Ismail
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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Sia TLL, Mohan A, Ooi MH, Chien SL, Tan LS, Goh C, Pang DCL, Currie BJ, Wong JS, Podin Y. Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia. Open Forum Infect Dis 2021; 8:ofab460. [PMID: 34646909 PMCID: PMC8500297 DOI: 10.1093/ofid/ofab460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/02/2021] [Indexed: 12/29/2022] Open
Abstract
Background Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections. Methods We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016. Results One hundred forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B pseudomallei. The average annual incidence of melioidosis was 12.3 per 100 000 population, with marked variation between districts ranging from 5.8 to 29.3 per 100 000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections. Conclusions Gentamicin-susceptible B pseudomallei infections are common in Sarawak and dominate in the high-incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B pseudomallei infections in Sarawak are clonal and to ascertain their environmental drivers and niches.
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Affiliation(s)
- Tonnii L L Sia
- Infectious Disease Unit, Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Anand Mohan
- Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.,Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia.,Department of Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Su-Lin Chien
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Lee-See Tan
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | - Charles Goh
- Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia
| | | | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jin-Shyan Wong
- Borneo Medical Centre, Kuching, Sarawak, Malaysia.,Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
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Mohan A, Podin Y, Liew DW, Mahendra Kumar J, Lau PST, Tan YY, Tai YP, Gill RS, Shanmugam R, Chien SL, Tan LS, Mat Sani NA, Manan K, Ooi MH. Fine-needle aspiration to improve diagnosis of melioidosis of the head and neck in children: a study from Sarawak, Malaysia. BMC Infect Dis 2021; 21:1069. [PMID: 34654392 PMCID: PMC8520244 DOI: 10.1186/s12879-021-06754-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Melioidosis, the infection caused by Burkholderia pseudomallei, is associated with a high case fatality rate, due in part to difficulties in clinical recognition and diagnostic confirmation of the disease. Although head and neck involvement is common in children, specific disease manifestations differ between geographic regions. The aim of this study was to provide a detailed description of melioidosis of the head and neck among children in Sarawak, Malaysia, and determine if fine-needle aspiration of suspected head or neck lesions could improve melioidosis diagnosis. Methods We conducted a retrospective descriptive study of all children aged < 12 years with culture-confirmed melioidosis presenting with head and neck manifestations and admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2020. Fine-needle aspiration of head and neck lesions suspected to be due to melioidosis with inoculation in blood culture bottles (FNA + BCB) was used from the beginning of 2016. Results Of 34 children with culture-confirmed melioidosis, 20 (59%) had an infection involving one or more sites in the head and neck. Of these, 17 (85%) were diagnosed in or after 2016. Cervical lymph nodes were the most common organ or site affected, involved in 19 (95%) children. Clinical presentations of B. pseudomallei lymph node infections were highly variable. Five (25%) children had salivary gland involvement. Lacrimal gland involvement (dacryocystitis) and skin or soft tissue infection (scalp abscess) were less frequent. B. pseudomallei was isolated from the head or neck using FNA + BCB in 15 (75%) children and by standard culture methods of direct plating of pus on agar following incision and drainage in only 2 (10%) children. B. pseudomallei was isolated from non-head or neck specimens or blood in 3 (15%) children. Conclusions Manifestations of pediatric head and neck melioidosis in Sarawak, Malaysia, differ from those of other regions. Fine-needle aspiration, mainly of affected cervical lymph nodes, facilitates B. pseudomallei detection and enables confirmation of melioidosis infections. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06754-9.
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Affiliation(s)
- Anand Mohan
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia.,Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Da-Wei Liew
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Jeevithaa Mahendra Kumar
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Peter Sie-Teck Lau
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Yee-Yen Tan
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Yi-Pinn Tai
- Department of Pediatrics, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Ranveer Singh Gill
- Department of Otorhinolaryngology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Ram Shanmugam
- Department of Otorhinolaryngology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Su-Lin Chien
- Department of Pathology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Lee-See Tan
- Department of Pathology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Nurul Asiah Mat Sani
- Department of Pathology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Kamilah Manan
- Department of Radiology, Bintulu Hospital, Ministry of Health Malaysia, Bintulu, Sarawak, Malaysia
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.,Department of Pediatrics, Sarawak General Hospital, Ministry of Health Malaysia, Kuching, Sarawak, Malaysia
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