MRSA Infections in Malaysian Healthcare Settings

By: Mohd Azrul Hisham bin Ismail, Rosniza binti Mohamad Hussain, Nurul Amirah Mohamad Farook, Hui-min Neoh

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Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria associated with a wide range of clinical diseases that can range from simple infections such as folliculitis to potentially fatal conditions in healthcare settings such as sepsis (Afatemi & Motamedifar, 2014). The bacteria are Gram-positive, and can be found at various niches on the human body such as axillae, groin, perineal area, nose, mouth, mucus membrane, intestinal, hair, upper respiratory tract, and mammary glands. MRSA can spread in many ways either by water, food, contaminated surface and also direct contact between human and animals (Silva et al., 2021). According to Kim et al., 2025, MRSA infection is increasing in global nosocomial prevalence and remains a “high” priority bacteria in need of antibiotic innovation in the World Health Organization, 2024.

MRSA has been present long time ago since the mid-1970s in Malaysia (Cheong et al., 1994). The earliest study in 1984 found 53 out of 858 babies at Kuala Lumpur Maternity Hospital colonized or infected by MRSA (Lim & Zulkifli, 1987). By 1990, MRSA prevalence was growing in various hospital wards. In the 2000s, studies found that ST239-III has become predominant MRSA clone in Klang Valley area (Ting et al., 2013). Neela et al., 2010 reported ST239-III or IIIa with spa t037 as the dominant clone in 2006. Further investigations confirmed ST239 predominance (Ghaznavi-Rad et al., 2010). This clone showed high resistance to beta-lactam antibiotics (Ting et al., 2013). Around 2010, the proportion of ST22-IV in Malaysian hospitals increased, suggesting a shift in MRSA epidemiology. ST22 clones exhibited high resistance to ciprofloxacin and susceptibility to multiple non-beta-lactam antibiotics. From 2016 to 2017, most MRSA isolates in Kelantan were ST22 (68.2%), followed by ST239 (29.5%) (Alam et al., 2022). By then, SCCmec type IV MRSA was predominant in Malaysia.

We performed MRSA surveillance on the bacteria isolated from Hospital Canselor Tuanku Muhriz (HCTM), the teaching hospital of �����鶹. The first MRSA molecular surveillance at HCTM in 2009 identified SCCmec type III-SCCmercury as the dominant clone. The second surveillance in 2017, involving 222 MRSA strains, revealed a shift to SCCmec type IV, spa type t032, and seg+sei toxin genes. Most strains were resistant to multiple antibiotics (Ismail et al., 2021). Later, genome and phenotype surveillance identify factors associated with this clonal replacement using whole genomic sequencing and phenotypic investigations of HCTM MRSA strains from 2005-2017. Genomic analyses revealed three major MRSA lineages circulating in HCTM: ST239-III, ST22-IV, and ST6-IV. ST239-III strains were more antibiotic-resistant and harbored more AMR genes (Antimicrobial Resistant gene) compared to ST22-IV and ST6-IV. However, ST22-IV and ST6-IV grew faster and were more desiccation-resistant. Reduced antibiotic pressure and higher desiccation tolerance probably gave ST22-IV a competitive edge to become the dominant clone in HCTM from 2017 (). Our investigation highlights the importance of MRSA surveillance and provides baseline genomic data for future studies.

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SDG 3 | SDG 4

Keywords: Methicillin-resistant-MRSA | Staphylococcus-aureus | Diseases | Health | Wellbeing | Education

More relevant readings:

1. MRSA: The superbug
2. Replacement under our noses: it’s a different MRSA now!
3. Methicillin-Resistant Staphylococcus aureus (MRSA) dan Kesihatan

Date published: 23rd April 2020

It has been 5 days since I posted about Covid-19. This one is a bit technical but I hope it will be simple enough for the public layperson to understand. Everyone is looking for an effective treatment for Covid-19 infection especially for those very sick ones in intensive care and requiring respiratory support. There are the anti-viral therapies and drugs such as hydroxychloroquine which have shown promising results. In the past few weeks, stem cells have entered the ring. Stem cells are the mother cells from which all other cells are derived. Mesenchymal stem cells (MSCs) are a type of stem cells which can be obtained from bone marrow or umbilical cord blood. The interest for MSCs in the treatment for Covid-19 began with the first reported case where a 65-year-old patient in China in ICU was given three infusions of 50 million MSCs (derived from human umbilical cord blood) 3 days apart. She made full recovery. In medicine, one case is considered anecdotal in nature, nevertheless, this case attracted attention and triggered it all. The next report came very soon and this time seven patients were treated (one critically ill, 4 severe cases and 2 non-severe cases). All patients received a single dose of 1 million cells per kg body weight. The results were positive in all cases and no adverse events were recorded and all the main inflammatory markers decreased.

The basis for treatment using MSCs is simple and attractive. MSCs is considered an immunomodulatory and anti-inflammatory agent. In Covid-19 patients with pneumonia, it is believed that the acute respiratory distress syndrome (ARDS) is caused by the overwhelming presence of a cytokine storm with widespread inflammation. MSCs when given are believed to home in to the lungs and counter the inflammation quickly and effectively. Magical right? Sounds like good science too. But let’s not make a quick conclusion.

Since the case report and the cases series involving the 7 patients, many stem cell researchers all over the world are embarking on clinical trials of MSCs. More than 20 clinical trials using MSCs have been registered worldwide. The FDA itself has approved a 24-patient clinical trials to test the safety and efficacy of UC-MSCs (from umbilical cord) based at the University of Miami Health System. The University of Texas also recently announced a Phase 2B randomised trial using BM-MSCs (from bone marrow), with the aim to recruit 120 patients. The bulk of clinical trials are in China.

However, not everyone is impressed, even top professors and researchers working with stem cells and regenerative medicine (many reviews and comments available online). Some of them say the stem cell studies are small and many are conducted without controls (a group of patients not given stem cell therapy but given standard treatment so that efficacy can be compared). Some say the therapeutic effect of MSCs on any clinical condition (other than Covid-19) has not be shown convincingly.

As doctors, we have vowed to do no harm, and not to subject sick and vulnerable patients to unnecessary studies. MSCs may sound very fashionable but the rush to test for the best treatment should not be done at the expense of rigorous science. Many of the clinical trials do not have a control arm; hence, the likelihood for false positives (stating a good outcome when in fact the same outcome will happen even without MSC treatment) and over-interpretation is high. Even those clinical trials with a control arm are mostly underpowered. Many of us doctors were taught statistics, sampling, sample size, effect size and study power. Those conducting clinical trials are also trained in Good Clinical Practice. We should not forget these principles of good experimental approach and study design. Poor design will allow for the opportunity for bias hence giving false results and worse, false hopes, whilst wasting public funding and resource.

My take on this is simple. There is a need to show and prove clearly the science first before embarking on human studies. For the Covid-19 trials, somehow many are bypassing the pre-clinical studies in the name of emergency and compassion. Quoting the safety evidence from other studies is easy, but for many ethics committees, it is a requirement that this should be shown from the research team’s own research work. The clinical trials design must state clearly outcomes related to safety and efficacy. The trials should have enough number of patients and should be at multiple site (again to avoid bias), and standardisation of protocols is a must including dosing (how many million cells to give and how many infusions). There is hope and potential of MSCs, but we cannot rush things through at the expense of good science and research quality.

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Penyakit jantung koronari dan strok merupakan pembunuh utama di dunia dan juga di rantau Asia Tenggara (1). Penyebab utama kepada penyakit jantung adalah hiperkolesterolemia, diabetes, hipertensi dan juga merokok. Berdasarkan kepada ‘National Health and Morbidity Survey’ pada tahun 2011, terdapat peningkatan sebanyak 57% kes hiperkolesterolemia di Malaysia dan sebanyak 38.4% adalah berbangsa Melayu (2). Data prevalen untuk penyakit diabetes, hipertension, hiperkolesterolemia dan obesiti daripada projek ‘The Malaysian Cohort’ atau TMC adalah sebanyak 16.6%, 46.5%, 44.9% dan 17.7% (3). Daripada 44.9% individu dengan hiperkolesterolemia sebanyak 51% adalah Melayu (3).

Apakah hiperkolesterolemia? Ia didefinasikan sebagai peningkatan tahap kolesterol yang melibatkan ‘total cholesterol’ (TC>5.2 mmol/l) dan juga kolesterol lipoprotein berketumpatan rendah (LDLC> 2.6 mmol/l). Hiperkolesterolemia boleh disebabkan oleh pelbagai faktor termasuk persekitaran, gaya hidup dan juga genetik. Hiperkolesterolemia yang disebabkan oleh faktor genetik dikenali sebagai Hiperkolesterolemia Famili (FH) (4). Disamping peningkatan tahap kolesterol, pesakit FH juga mempunyai ciri klinikal seperti pendepositan lipid pada tendon yang dikenali sebagai xanthomata, pada kelopak mata dikenali sebagai xanthelasma dan juga disekeliling kornea iaitu arkus kornea. Faktor genetik FH melibatkan mutasi titisan germa (germline mutation) yang menjejaskan fungsi reseptor LDL yang seterusnya mengakibatkan kesan klinikal dan metabolik (5). Bagi kesan metabolik, pesakit mempunyai paras kolesterol, kolesterol berketumpatan rendah dan Lp(a) yang tinggi, kekurangan kolesterol yang baik iaitu lipoprotein berketumpatan tinggi dan pengurangan  pelepasan IDL. Kesan klinikal termasuk seperti yang telah dinyatakan diatas disamping peningkatan risiko terhadap penyakit jantung seperti penyakit koronari arteri, penyakit kardiovaskular, penyakit jantung periferi. Pesakit FH boleh diklasifikasikan berdasarkan kepada paras kolesterol, faktor klinikal tendon xanthomata, sejarah keluarga dengan hiperkolesterolemia dan infarksi miokardium dan juga ujian diagnosis molekular (6). Kriteria utama yang biasa digunakan adalah Kriteria Simon Broome seperti pada Jadual 1.

Klasifikasi FH berdasarkan Kriteria Simon Broome

FH diwarisi secara autosomal dominant yang melibatkan hanya seorang pesakit sama ada ibu atau bapa. Sebanyak 50% anak-anak akan menghidap FH dan kadar keterukan adalah berdasarkan ‘gene dosage effect’, individu homozigus adalah lebih teruk berbanding dengan heterozigus (7). Mutasi genetik pada FH boleh diklasifikasikan kepada 3, peringkat 1, 2 dan 3. Gen dalam peringkat 1 termasuklah LDLR, APOB, LDLRAP1 dan PCSK9 (8). Gen-gen ini terlibat secara langsung dalam metabolism LDL. FH disebabkan mutasi pada keempat-empat gen ini dikenali sebagai FH Monogenik. Secara amnya, sebanyak 90% pesakit FH mempunyai mutasi di dalam LDLR (8). Kolesterol LDL mempunyai APOB pada permukaannya dan APOB bertindak sebagai ligand untuk melekat kepada LDLR di bahagian ekstraselular. Kompleks reseptor-ligand ini akan memasuki sel melalui ‘clathrin-coated pit’ semasa proses endositosis yang dimangkinkan oleh LDLRAP1. Di dalam persekitaran yang berasid, kompleks ini akan berpecah dan kolesterol LDL akan dipecahkan di dalam lisosom. LDLR akan dikitarkan semula kepada permukaan sel. PCSK9 terlibat di dalam proses degradasi LDLR (9). Mutasi gen peringkat kedua melibatkan gen-gen yang terlibat secara tidak langsung dalam metabolism LDL. Fungsi gen yang diklasifikasikan pada peringkat 3 adalah tidak diketahui.

Mutasi pada gen yang terlibat dalam FH adalah spesifik terhadap populasi dan juga kumpulan etnik. Di Malaysia, kajian tentang mutasi pada gen yang terlibat dengan FH telah dikaji. Walaubagaimanapun, kajian ini masih berskala kecil dan mutasi yang dikaji adalah hanya pada gen peringkat pertama iaitu LDLR, APOB. Sebagai contoh, Khoo et al., telah mengenalpasti mutasi -152G>T, 77delGA, p.C308Y, p.Q357X, p.L393R, 2108ins7bp, p.A663T, p.C675Y dikalangan bangsa Cina dan K372N pada etnik Melayu (10). Khateb et al, 2011 menemui mutasi p.Asp100Asp, p.Asp139His, p.Arg471Gly, c.1705+117T>G, c.1186 +41T>A, 1705+112C>G, Dup exon 12, p.Trp666ProfsX45 di kalangan etnik Melayu (11). Chalil et al., 2012 menjumpai mutasi C711Y pada etnik Melayu (12). Abdul Murad et. al., 2006 menemui mutasi C234S pada etnik Melayu (13). Dengan perkembangan teknologi terkini di dalam penjujukan DNA, mutasi pada pesakit FH boleh dikenalpasti dengan mudah. Teknik seperti penjujukan keseluruhan genom, penjujukan eksom dan juga penjujukan sasaran (mensasarkan kepada beberapa gen yang spesifik, contoh, gen FH peringkat pertama dan kedua) boleh dilakukan. Walaupun kos teknik-teknik ini masih mahal, ia dapat membantu dalam diagnosis molekular bagi FH. Pengenalpastian mutasi pada pesakit indeks adalah penting bagi diagnosis dan rawatan awal, intervensi melalui pengubahsuaian cara hidup dan diet yang sihat. Di samping itu, saringan kepada ahli keluarga juga dapat dilakukan bagi mengenalpasti pesakit FH dikalangan ahli keluarga. Pengenalpastian awal dapat membantu bagi mengurangkan kadar kematian disebabkan oleh penyakit jantung yang berhubung secara rapat dengan penyakit FH, terutamanya bagi pesakit dengan mutasi homozigus.

Bidang farmakogenetik dan farmacgenomik adalah bidang yang mengkaji respon pesakit terhadap rawatan ubatan serta reaksi ubatan (adverse drug reaction) yang diberikan (14). Kajian di dalam bidang ini pada FH telah dikaji dan variasi dengan impak farmakogenetik telah dikenalpasti. Sebagai contoh varian rs2738466, LDLR, c.*773A>G pada kawasan UTR, alel G akan meningkatkan risiko penyakit jantung (CHD atau CVD) kepada lelaki apabila dirawat dengan pravastatin (15). Bagi varian LDLR, c.C1773T:p.N591N, rs688, genotip TT akan meningkatkan respon terhadap rawatan dengan lovastatin berbanding genotip CT (16). Bagi varian yang sama, pesakit hiperkolesterolemia dengan genotip CC akan meningkatkan efikasi rawatan bagi tekanan darah sistolik dengan menggunakan atenolol. Bagi varian c.T1959C:p.V563V, LDLR, pesakit dengan genotip CC mempunyai kesan penurunan jumlah kolesterol (total cholesterol) yang lebih tinggi apabila dirawat dengan lovastatin (15).
Kesimpulannya, FH adalah penyakit yang merbahaya kerana ia berkait rapat dengan peningkatan risiko penyakit jantung. Pengesanan awal dengan menggunakan kaedah molekular bagi mengenalpasti mutasi pada pesakit FH serta ahli keluarga adalah penting bagi diagnosis dan rawatan awal, intervensi melalui perubahan gaya hidup dan diet. Disamping itu, rawatan secara ‘personalized & precision medicine’ dapat dilakukan bagi mengenalpasti ubatan statin terbaik untuk pesakit.

Rujukan
1. http://www.who.int
2. National Health and Morbidity Survey Report, 2011. Non Communicable Diseases
3. Jamal R et al. Cohort profile: The Malaysian Cohort (TMC) project: a prospective study of non-communicable diseases. Int J Epidemiol. 2015. 44(2): 423–431.
4. McGawon MP et al. Pathophysiology of severe familial hypercholesterolemia. J of Clinical Lipidology. 2012. 6 (6): S4
5. Day I et al., Spectrum of LDL receptor gene mutations in heterozygous familial hypercholesterolemia. Human Mutation. 1997. 10(2): 116 – 127
6. Wierzbicki AS et al. Familial Hypercholesterolemia: summary of NICE guidance. BMJ. 2008. 223:a1095
7. Raal FJ and Santa RD. Homozygous familial hypercholesterolemia: current perspectives
on diagnosis and treatment. Atherosclerosis. 2012. 223 (2): 262 – 268
8.Pirillo A et al. Spectrum of mutations in Italian patients with familial hypercholesterolemia: New results from the LIPIGEN study. Atheroscler Suppl. 2017. 29: 17 – 24
9. Soutar AK and Naoumova. Mechanisms of disease: genetic causes of familial hypercholesterolemia. Nat Clin Pract Cardiovasc Med. 2007. 4(4):214-25
10. Khoo et al. Low-density lipoprotein receptor gene mutations in a Southeast Asian population with familial hypercholesterolemia. Clin Genet. 2000. 58(2):98-105.
11. Khateb et al. Analysis of sequence variations in low-density lipoprotein receptor gene among Malaysian patients with familial hypercholesterolemia.
BMC Med Genet. 2011. 19 (12):40
12. Chalil et al. A novel pathogenic variant of the LDLR gene in the Asian population and its clinical correlation with familial hypercholesterolemia. Molecular Biology Reports. 2012. 39 (7): 7831 – 7838
13. Abdul Murad et al. Use of the denaturing gradient gel electrophoresis (DGGE) method for mutational screening of patients with familial hypercholesterolaemia (FH) and Familial defective apolipoprotein B100 (FDB). The Malaysian journal of pathology. 2006. 28 (1): 7-15
14. Cacabelos R. et.al. The role of pharmacogenomics in adverse drug reactions. Expert Rev Clin Pharmacol. 2019. doi: 10.1080/17512433.2019.1597706
15. Thompson JF et al. Pharmacogenomics J. An association study of 43 SNPs in 16 candidate genes with atorvastatin response. 2001. 5(6): 352 – 8
16. Eliana P et al. Genetic variation at the LDL receptor and HMG-CoA reductase gene loci, lipid levels, statin response, and cardiovascular disease incidence in PROSPER
Atherosclerosis. 2008. 200(1): 109 –

Rajah: Pengesanan awal Familial Hypercholesterolemia (FH) boleh dilakukan dengan menggunakan kaedah genotiping menggunakan mesin MassARRAY^® Agena Masspectrometry

After spending nearly 6 years in the United States for my Bachelors and Masters, I decided that I was going to settle down and find a decent job in Malaysia. But that was not the case. Circa 2012, I stumbled upon the UMBI website while doing a little bit of research on Malaysia’s background in the Molecular Biology and Biotechnology fields. At that time (I still do, now), I personally thought that UMBI has one of the best facilities and laboratories in Molecular Biology and Medicine in Malaysia, and notably, it houses The Malaysian Cohort Biobank, the largest repository of biospecimens in the country. I tried my luck and applied for a research fellow position in UMBI. Shortly after, I was selected for an interview. Unfortunately, I was told during the interview that the position is for a PhD holder. Nevertheless, I was offered the new fellowship scheme from �����鶹 with a full scholarship abroad if I wanted to further my PhD. After the completion of my PhD, I would then be hired as a research fellow in UMBI. After thinking for a long time, I decided to accept the offer, though I would have to leave my family and country for the third time.

I chose to work in the field of cancer because it is one of the most notorious medical diseases which has been studied extensively in the era of modern medicine. Cancer is generally deemed a single disease, but in fact, it is not. There are more than 200 types of cancer, each type is different and has a unique genetic landscape which would require its own specific approach for treatment. My interest to work in cancer fits well with UMBI’s core research theme. I applied to several labs working on cancer biology in the UK (away from London). Professor Dr Ted Hupp from University of Edinburgh, UK replied to my application. After a chat with him and inspired by his excellent track record of publishing in over 130 international peer-reviewed interdisciplinary journals, I determined to join his lab. Professor Hupp is the Chair of Experimental Cancer Research and group leader for the cancer cell signalling unit at the Institute of Genetics and Molecular Medicine, University of Edinburgh, UK. I had another strong reason for joining his team: the lab is located in the historic city of Edinburgh, capital city of Scotland, and houses one of the best medical school in the UK. Professor Hupp himself did his post-doc in the famous lab of David Lane, working on the p53 tumour suppressor protein.

Photo: Cancer cell signalling unit annual Christmas dinner

I embarked on the journey of my PhD on October 2013. This time I was not alone because I brought along my newly-wedded wife, who supported me immensely during my studies. During the early days, I was given several projects where I would later choose one which best suit my interest and has the potential to be developed into a PhD thesis. I decided to study the biology of the anterior gradient-2 protein (AGR2), a protein which the lab has been studying for more than 10 years. AGR2 is an endoplasmic reticulum-resident protein that is a member of the protein disulphide isomerase (PDI) superfamily. It has been postulated as a clinically important protein as it is upregulated in various types of cancer and demonstrated tumour-promoting features. The role of AGR2 is not fully understood, and it is the aim of my thesis to elucidate the role of AGR2 in cancer development. I focused on identifying novel AGR2 interacting proteins (termed interactome) by looking at the functional consequences of some of these interactions to deduce the role of AGR2. I used two approaches to identify the AGR2 interactome; 1) database mining of AGR2 sequence-specific peptide motif; 2) quantitative mass spectrometry analysis of cell models with a controlled expression of AGR2. The key AGR2 client proteins were then validated using both in-vitro and cell-based assays. I also developed synthetic tools to further dissect the pro-oncogenic role of AGR2. These tools include: 1) developing AGR2 monoclonal antibodies in the format of the scFv fragment; 2) engineering synthetic mini-protein containing AGR2 sequence-specific peptide motif and; 3) engineering synthetic membrane proteins that optimally bind to AGR2. This work leads to the notion that AGR2 has a novel role in cancer cell signalling: it possesses an intrinsic sequence-specific peptide binding for a subset of its client proteins, and one function of this motif is to ensure proper maturation of client proteins for their final destination.

During the course of my PhD, I have been exposed to many laboratory techniques such as protein purification, confocal microscopy, peptide-phage display, and protein-protein interaction assays. I was the first lab member of the lab to try out the CRISPR/Cas9 genome editing tools for my project. Additionally, I had the chance to work on hydrogen-deuterium mass spectrometry with our collaborators in Czech Republic. I was also involved in mentoring exchange students from Germany (Erasmus), India, and A*Star Singapore.  Towards the end of my PhD, I presented my work at a conference in Girona, Spain. I managed to finish my thesis and successfully ‘survived’ my viva in March 2017.

Photo: The iconic Scottish Great Highland bagpipe near Edinburgh Castle

Overall, it has been a challenging journey for me, yet a very wonderful and memorable experience. I received tremendous support from my team members and especially from my supervisor who gave me valuable advice. Professor Hupp prefers the term ‘encouraging results’ in otherwise disastrous experimental failures – this has kept me going when results were not forthcoming. More importantly, I was blessed with having my first child in Scotland; she cheered me every day, her growth and development mirroring my PhD journey. I am now back in Malaysia and about to start my lab at UMBI. I hope I can contribute as much as I can to cancer research and impart the experience that I have had in Edinburgh to UMBI and to help develop UMBI as one of the finest cancer research institutes in the country.

By

M Aimanuddin Mohtar, PhD

Last night, I did a quick read the book by Dr. Spencer Johnson entitled “Who Moved My Cheese”. The book is less than 100 pages and it took me less than an hour to finish reading it. To me it is really a good book as the story is written for all ages. The uniqueness of the vision and message in the story will last a lifetime. This book tells us how to effectively deal with changes and to positively accept changes in our lives.

The writer begins by introducing the four characters who lives in a maze: the mice Scurry and Sniff and two “little people”’, Hem and Haw. Every day the mice and the little people spent most of their time in the maze looking for cheese. Early on in their lives, all four characters discover a place with great wealth of cheese that they can enjoy for a very long time.  One day, the cheese disappears. Both mice did not analyze the situation too much. For them the solution for the problem was simple. The place which had a large source of their food has changed. Therefore Scurry and Sniff decided to change their strategy. They set out to find new cheese. Hem and Haw on the other hand, think that they are the victims of some kind of fraud or theft. Hem and Haw waste many days thinking about the situation and wondering when the old cheese stock might return. One day Haw realizes that he has to change, and accept the fact the old cheese is not going to return. He decided to set out into the maze and start searching for a new cheese. Meanwhile Hem was so covered up with fear of change. Yet this only makes things worse, as he had to battle with stress and hunger each day. Finally, Haw finds his way to a new place, which is piled high with all different types of cheese, enough to last a lifetime.  Scurry and Sniff, had arrived at the same place long before.

The story tells us that changes will always happen. We have to stand up quickly, adapt and to keep going. We need to always be prepared for changes in life towards achieving our goals. When faced with changes or challenges, try to look at them as opportunities for personal growth. Look for the upside. Don’t try to control the uncontrollable. Focus on the things you can control such as the way you choose to react to the changes. Ultimately, the way we react to these changes will determine our success in life. Are we going to be like the mice, who decided quickly to move on and look for new cheese? Or are we going to be like the little people who were stuck in denial and were afraid to set out into the maze looking for new cheese? Like one of the Malay proverb which said “waiting for the moon to fall onto your lap”. If you are looking for best Caishen’s Fortune Pokie for free visit Alternatively, are we going to be like Haw? Scared at first, but builds up the courage to move from the safe harbours of the known and venture out in the maze to look for new cheese? I leave these questions to all my fellow friends out there to think and decide.

Inspired from: Who Moved My Cheese? By Spenser Johnson

The post Who Moved My Cheese? – Accepting Changes Positively first appeared on �����鶹 Medical Molecular Biology Institute.]]> /umbi/news/20141217-membentuk-pekerja-cemerlang-dalam-perspektif-islam/ Thu, 23 Feb 2017 07:22:16 +0000 /umbi/?post_type=news&p=5423 By : Norsuzana Abdul Rahman (Pembantu Tadbir N17) Pekerja yang mempunyai prestasi kerja cemerlang akan sentiasa menjadi buruan organisasi. Organisasi mahu menggunakan pengetahuan, kemahiran, pengalaman, ...

The Quality Management Unit was established in 2007 and is spearheaded by the Head of Quality Management. The main focus in its early days was to undertake the process of laboratory accreditation for standard MS ISO/IEC 17025:2005 (Testing/Calibration Laboratory) and MS ISO 15189:2007 (Medical Laboratory). Currently, the quality management is led by the Head of Quality Assurance who is now in charge of planning, coordinating, implementing and monitoring all activities related to the Quality Management System (QMS) as a whole.

��)�� Certification and accreditation

 There are three accreditation standards that have been implemented in UMBI namely the MS ISO 9001:2008, MS ISO 15189:2007 (currently upgraded to version 2014) and MS ISO/IEC 17025:2005.

 The MS ISO 9001:2008 focuses on the processes involved in the post-graduate program ranging from the interview, the registration, the supervision, assessment of performance, submission of thesis and the viva examination. As with other accreditation standards, compliance to quality will ensure customer satisfaction. The post-graduate program in UMBI has received re-certification for standard MS ISO 9001:2008 on the 18^th January 2013 and will expire on the 17^th January 2016.

The MS ISO 15189:2007 (upgraded to version 2014 recently) is the main standard that define the requirements for quality management systems in medical laboratories. The laboratory accreditation in UMBI is for the Bioanalytical Laboratory (Haematology and Chemical Pathology) under The Malaysian Cohort Project Biobank. The laboratory has been granted accreditation on the 1^st November 2011 and has expired on the 1^st November 2014. Re-assessment for re-certification of accreditation has been conducted on the 13^th – 15^th October 2014.

 The MS ISO/IEC 17025:2005 is the main standard used for laboratories dealing with testing and calibration. The laboratory accredited in UMBI is the Genomic Laboratory [covering DNA extraction from Blood, polymerase chain reaction, gel electrophoresis, and DNA sequencing]. The laboratory has been granted accreditation on the 20^th March 2012 and will expire on the 20^th March 2015. Re-assessment for re-certification of accreditation is scheduled on the 22^nd – 23^rd January 2015.

The external organization which conducts the assessment for the certification of MS ISO 9001:2005 is SIRIM QAS International. For the certification of MS ISO 15189:2007 (upgrade to version 2014) and MS ISO/IEC 17025:2005 the assessment is conducted by Standards Malaysia. The secretariat of graduate program and accreditation will perform a self-assessment and internal audit at least once a year to ensure the system is implemented in accordance with established procedures.

b) Amalan 5S

The �����鶹 Medical Centre approved the ‘5S PP�����鶹’ program on the 4th September 2006. A working committee was established on the 28th November 2006 followed by the appointment of the Malaysia Productivity Corporation (MPC) as the consultant on 29^th November 2006. PP�����鶹 received its first 5S certification on 20^th May 2010. The re-certification of the MPC is done every year. UMBI was involved the 5S activities from the 2^nd April 2007 with the launch of phase 1 ‘5S PP�����鶹’. UMBI has two 5S management zones 5S i.e. the administrative zone and the laboratory zone. One of the main activities is the ‘major spring cleaning’ held every last Friday of each month. All staff, research assistants and students are involved in this monthly activity.

c) Kumpulan Inovatif & Kreatif (KIK)

 The KIK refers to the innovative and creative group activity which has proven to be an effective mechanism to help realize the aspirations of the government to improve the efficiency and effectiveness of government agencies in delivering services to the people. The KIK UMBI was first established on the 10^th of October 2006. The group was named SENTROMER, which reflects the strong and solid relationship between the group members in UMBI. The KIK group in UMBI has successfully implemented two projects within the institute; (1) the inventory management system and (2) the research log book for post-graduate students.

d) Jawatankuasa Aduan dan Maklumbalas

This committee which deals with complaints and feedback was established on the 16^th of March, 2012. This committee is chaired by the Head of Quality Assurance and the members include 1 research fellow, 2 members of the management and 1 support staff. The committee is responsible for managing complaints and feedback from customers including those related to the scope of certification and laboratory accreditation. Complaints and feedback can be channeled using: (1) e-FACT system, (2) e-QUEST system, (3) Complaints Form, (4) e-mail/letters/Facebook and (5) phone calls.

One of the things that I really enjoy besides science is cooking. Well, one would argue that there is also science in cooking too. I have learned to realise that there are many similarities between cooking and conducting research. They both require the following ingredients.

• Interest/Passion

A high level of interest is important. Nothing goes without having an interest in pursuing what you love to do. Without interest or passion, you can easily be broken and give up. Be it cooking or research.

• Search for information

You need to do some searching before even embarking in the process. In cooking, you usually will search the internet or recipe books for the best recipe for the dish you intend to cook. You may also ask some forums, blogs or even some chefs for some recipes. Similarly in research, we do a literature review where you read everything related to your subject of interest before you embark on doing it. You can also ask for opinion from experts or advice from the Research Gate, scientific forums that are accessible online. You can even watch videos on YouTube on certain techniques for either cooking or a research technique such as for cell culture.

• Planning and organisation

Before you even start cooking, you need to go to the market to buy the ingredients and raw materials that are required in the recipe. You need to plan to get the list of things to buy and have a budget. This could also include some utensils that are necessary for cooking. This is similar with research; you need to purchase chemicals/reagents/consumables from authorised dealers. If this is not planned properly, it will severely delay your experiment as it takes time for things to arrive. You need to plan when to do the purchasing, when you expect it to arrive, allocate budget, etc. In research we have to plan for the achievement of key milestones and also have a Gantt chart. Planning and organisation are both important in cooking and research in order to make sure that you get everything that you need before you embark on the actual task.

• Utensils (Materials and equipment)

Cooking requires all the necessary utensils and equipment e.g. pans, pots, double boiler, blender, oven, etc. Similarly in research one requires equipment such as the mixer, centrifuge, oven, water bath, thermocycler, biosafety cabinet, etc.

• Step wise instructions (Methods)

This instruction details what you have to do and it is called ‘a recipe’ in cooking. It is a step by step information on how to cook the particular dish. Some cookbooks may even have diagrams and photographs to show how to do things the right way e.g. how to fold the dumplings or how to put the icing on the cake. In science, a similar step by step instruction is called the methodology or experimental protocol. An example is the step by step details on how to transfect DNA into mammalian cells.

• Optimisation

Very rarely that you cook the perfect dish the first time. Similarly in a scientific experiment, things may not work at the first attempt. In both examples, it will require troubleshooting and optimisation. If your chicken appears overcooked, you will want to reduce the time for cooking the next time around. Similarly in science, certain cells can express protein at a better level using different incubation times. This can only be known through a series of optimisation of the incubation time. Optimisation also involves critical thinking and problem solving skills in order to trouble shoot the method to get a better result.

• Documentation

For cooks, they record their cooking method or make notes in a recipe book while scientists do it in lab book. They both record the materials (ingredients), methods, techniques, results and discussion in their task for easier reference in future.

• White coats

The chef’s apron and the scientist’s lab coat does not differ much. They are both white in colour with the lab coat slightly longer in length than the apron.

• Multi-techniques

Both cooking and research require knowledge and experience in different techniques. In cooking, this can include pan-frying, grilling, boiling, baking and steaming. One must know each technique and how much time exactly is required for each technique for a variety of dishes. The same goes with research with techniques and analysis ranging from genomics, proteomics, or cell biology.

• Mentor and Motivator

Both cooking and research require a mentor and motivator. A mentor will help you to do things the right way. On the other hand the motivator is the one that motivates you to keep on trying if your cooking or experiments failed. They can be your friends, colleagues, your superior or even your family. If a person praises you for the wonderful dish which you have cooked or the novel finding in your research, you will be smiling all day long and that keeps you motivated.

• Instinct

Instinct is acquired through experience and practice. Hence, the more you cook and the more you do research, the better will be your instinct. In cooking, some cooks just have a good sense of taste. Even if the recipe says to add 2 tablespoons of sugar, they have an instinct that says it is probably too sweet and you need to balance it with the overall taste of your ingredient. The same goes with research. Most protocols will give a range of methods and variables. After many experiment, you will know which particular steps are less necessary or less stringent and can be skipped, or even in terms of the amount of reagents to be added and the suitable incubation times. Once you have developed this instinct, you can then apply to your research the best approach that suits your experiment.

So if you enjoy cooking, you might find doing research is not much far different. The processes and attitude towards both of them are very similar. Perhaps the only difference is you can’t taste your results from the experiment.

The public service has certainly changed with times. The role and duties of civil servants have also changed with new policies, new circulars, new expectations and customer needs. The era of one-job-one-task is no longer relevant today. Today, the burden, urgency and complexity of the working environment have changed. These changes demand that the public servant be able to multitask in their daily work.

The definition of multitasking is the ability to carry out more than one task at a time. For example, an individual can answer phone calls but at the same time reply emails or draft a letter. There is now less number of people to undertake the increasing burden of work. The challenges at work are also far more demanding with the rapid advancement in ICT. Therefore, multitasking is very necessary for civil servants to fulfill this demand without compromising the work quality.

An organization always prefers those who are able to multitask. This skill can help an organization to achieve their goals. It will also maximize the human resource capacity and potential, save cost on the number of employed staff, reduce the time taken to complete certain tasks and minimize bureaucracy. However, multitasking also has a dark side. People can easily lose their focus and fail to fulfill each of the multitasking needs. So, what is the best recipe to perform multitasking?

Multitasking is based on two important principles. The first is effective time management. Second is the concentration in equilibrium and individual comfort. Based on these two elements, the following are some guidelines for implementing multitasking;

1. Give priority to the task
Tasks come in various shapes and quantities; can sometimes be planned or unplanned. Classifying tasks by priority is an important step in multitasking. Important and urgent tasks always come first while the less important and light tasks go to the bottom of the list. The efficiency of the individual performing multitasking depends on the level of diversification of their ability to classify tasks. There are many methods that can be used such as the Covey Time Management Matrix, Maslow Theory and Pareto’s Law (80:20 rule).

2. Avoid distractions that prevent multitasking
Within the 8-9 hours working period, there will always be distractions that could disturb you while performing multitasking. These can be unnecessary phone calls, emails or colleagues. Try to avoid these unless they are really important or during an emergency. Focus on your tasks and discipline yourself to say “NO” to distractions.

3. The focus, energy, time and effort at objectivity
Each task performed should have clear objectives. In this case, task-planning is very important to ensure what objectives to be achieved at the end of the day. Therefore, you have to concentrate, focus and optimized your energy at a higher level.

4. Identify task requirement
Preparation is important in any job whatsoever. Planning is everything. List all the tasks by priority and then prepare the requirement to perform the task, physically and mentally.

5. Pay attention to the options available and be ready to make a decision
The effectiveness of multitasking also depends on decision-making skills. Slow and inappropriate decision-making process will disturb the whole system of tasks. A good strategy is to consider all the options available and ready with every possible solution.

6. Be prepared in difficult situations to achieve several things at the same time
The daily task situation will be constantly changing. There are times when tasks are simple but often tasks come with a range of difficulty and more challenging. For that, we should always be prepared and be ready with a systematic plan to ensure that multiple tasks can be done at the same time.

7. To find a job according to your criteria use the filters. If you find a job suitable for you, you can apply to it. Do not forget to fill out your profile before that, you will have more chances to get a job. Multitasking as an opportunity to learn something new
Bear in mind that multitasking is not a burden; it should be seen as a learning process. Maybe the tasks given are outside your comfort or skill zone, but take them as challenges and as opportunities to learn something new. The biggest loser is the one who never try.

In summary, multitasking is a value added skill to an organization. Individuals with these skills will be able to support the direction of the organization better. Everyone is capable of doing multitasking in daily activities depending on how far you want to accept the challenge and dare to walk outside the shell. Without trying we do not know our potentials. Keep on moving forward and be a better personnel each day.

Inspired and Adapted from:
Kursus Peranan Kepelbagaian Tugas Dalam Perkhidmatan Awam

The cells that grow in the flask also need a proper ‘house’ i.e. the CO₂ incubator which provides ideal conditions for the temperature (37.0⁰C), humidity and the appropriate gaseous atmosphere (5-6% CO₂). The condition of CO₂ incubator closely mimics that of the human body. But why 5-6% of CO₂ gas? It is because about 5-6% CO₂ is dissolved in the human blood circulation. Different types of cell lines usually have their own respective growth media as the nutrient source. This is usually based on the recommendations from the American Type Culture Collection (ATTC). Cells need to be fed once in every 3-4 days due to nutrient depletion. Prolonged starvation without replacement of medium will lead to changes in pH media and cell morphology. This can be monitored by the presence of phenol red in the media as an indicator of the pH change. The color of the medium will exhibit a gradual transition from yellow to red over the pH range 6.8 to 8.2. Above the pH 8.2, the phenol red will turn into a bright pink color. The changes in pH are due to the built up of lactic acid, which can be toxic to the cells and affect their growth. The cells may then be altered in terms of the morphology and the efficiency for subsequent manipulation. Therefore it is highly important that the sub-culturing process needs to be done once the cells reached 70-90% confluence. The rule of the thumb is not to leave the cells to be over-confluent. Imagine if you are standing inside a 5 feet x 5 feet room with 25 other people. It may be fun for a while but soon everyone will be very uncomfortable, right? The same goes with the cells. They are not happy at all when there is no more room to grow and expand plus the fact that the nutrients are being depleted rapidly.

When dealing with the cells, strict aseptic techniques are highly required in order to avoid contamination. All cell culture work should be done in the Bio Safety Cabinet Class II (BSC II). Everything that goes into the BSC needs to be sprayed with ethanol. We also treat the BSCs and some of the apparatus with UV before and after each use. The UV light bulb has it own shelf life. Once it has reached its half-life, the light that came out is just a fade blue light which is not an electromagnetic radiation wave anymore. To avoid cross contamination, we handle only one type of cell line at a time. Addition of antibiotic in the growth media is usually not recommended and is an optional step. This is to prevent antibiotic resistance in the cells. If we practice good aseptic techniques, we need not worry about using antibiotics. In UMBI, our standard operating procedure (SOP) requires us to discard any contaminated cells immediately to minimize cross contamination to other cells. How about the humidity in the CO₂ incubator? Water level needs to be monitored every week to ensure the humidity is optimum. We clean the incubator with ethanol and sterilize key apparatus monthly. Following the cleaning and sterilizing processes, a test control needs to be performed, as according to the SOP, before it is allowed to be used. Whether cells are of normal or disease lineage, the cells are important and useful to help scientists to understand better the diseases in terms of cellular mechanisms, in vaccine or drug development, and for discovering molecular markers of diseases.

HANIF ZULKHAIRI, Laboratory Assistant C17 UMBI.