IMR Quarterly Bulletin Apr 2003

G 1 F Apr. 2503

No. 54

CONTENTS From the Editor-in-Chief.. ........................................................................................

Notice to contributors.. ............................................................................................

ARTICLES

Cyclophosphamide therapy: A retrospective review of 4 1 cases of Lupus Nephritis Dr Go Kuan Weng & Dr Teo Sue Mei.. ...........................................................................

In Search of the Ideal "Fat Combo" for Cardiovascular Health Dr. Tony Ng Kock Wai. ..............................................................................................

Filariasis in Pahang: Towards Elimination .............. Mohamed Sapian M, Masran. M, Abdul Rahim A., Siti Zubaidah AR, Marlia MS, Sarah Y..

Situational Analysis of Ambulance Usage in Hospital Tapah (8 Years Analysis). K. K. Murth, Omar S. A, Sukdershan S. .............................................................................

Management of Severe Laryngomalacia in Otorhinolaryngology Department of Hospital Melaka Abdul Razak, S. Subramaniaan, Mohamed Khir A.. ............................................................

A Review of Tuberculosis Incidence in Kinta District Noridah 0, Hairul Izwan AR, Hazlee AH.. .......................................................................

Why do we need a Healthy Workplace? Dr Leela Anthony & Dr Arumugam Lingam.S.. .................................................................

PUBLISHED ABSTRACTS

contamination of breast milk obtained by manual expression and breast pumps in mothers of very low birth weight infants N. Y. Boo, A.J. Nordiah, H. AIJizah, A.H. Nor-Rohani & V.K.E. Lim ..........................................

Potential larvicides from Malaysian plants Ee G. C. L., Lim C. K., Cheow Y. L., Kamanrlzaman N. H., Taufig Yap Y. H , Ramli I. & Lee H. L.. .................................................................................................

Borrelia burgdorferi (strain 6. aJielii) antibodies among Malaysian blood donors and patients S. T. Tay, M. Kamalanathan & M. Y. Rohani.. ...................................................................

Isolation and PCR detection of rickettsiae fiom clinical and rodent samples in Malaysia S. T. Tay, M. Y. Rohani, T. M. Ho and S. Devi.. ..................................................................

An unusual mutation in RECQ4 gene leading to Rothmund-Thomson syndrome Pauline Balraj, Pat Concannon, Rahman Jamal, Alessandro Beghini, T.S. Hoe, Alan Soobeng Khoo & Ludovica Volpi .....................................................................................................

Laboratory evaluation of three herbal repellents against mosquitoes of public health importance in Malaysia Latipah Omar & I. Vythilingam .....................................................................................

Type of diabetes and waist-hip ratio are important determinants of serum lipoprotein (a) levels in diabetic patients Hapizah M Nawawi, Musilawati Muhajir, Yeo Chee Kian, Wan Nazaimoon Wan Mohamud, Khalid Yusog B. A. K. Khalid.. ..............................................................................................

Staphylococcus aureus cairiage in selected communities and their antibiotic susceptibility patterns A. Norazah, V.K. E. Lim, S.N. Munirah, A.G. M. Kamel.. .......................................................

HIV infection among fishermen in Terengganu Fauziah M.N., Anita S., Shaari N., Ahamad J., Pratap Senan & Muhammad Amir K.. ....................

Increasing genetic diversity of Salmonella enterica Serovar Typhi isolates from Papua New Guinea over the Period from 1992 to 1 999 Kwai-Lin Thong, Yee-Ling Goh, Rohani M. Yasin, Ming Guek Lau, Megan Pmsey, Gibson Winston, Mition Yoannes, Tikki Pang & John C. Reeder.. ................................................................

The prevalence of Anopheles (Diptera:Culicidae) mosquitoes in Sekong Province, Lao PDR: In relation to malaria transmission I. Vythilingam, R Phetsouvanh, K. Keokenchanh, V. Yengmala, V. Vanismeth, S. Phompida and S. Lokman Hakim.. ......................................................................................................

Genetic diversity of clinical cand environmental strains of Salmonella enterica serotype weltevreden isolated in Malaysia K. L. Thong, Y. L. Goh, S. Radu, S. Noorzaleha, R. Yassin, K T. Koh, V. K. E. Lim, G. Rusul & S. D. Puthucheary.. ....................................................................................................

Durability of Red Blood Cells to Lipid Peroxidation in Haemodialysis Patients A.S. Santhana Raj a4 Louis Masalamany.. .......................................................................

REPORTS

Kajian Anemia di antara Ibu-ibu pada 36 Minggu Kehamilan di Daerah Sik Kedah Chelladurai E, Habsoh H & Rosmiah M. .........................................................................

IMR AVTlVlTlES

Laporan Mengenai Unit Mikroskopi Elektron Pusat Surnber Penyelidikan Perubatan, IMR.. .............

EDITORIAL BOARD 49

IMR Quarterly Bulletin No. 54: Apr. 2003

From the Editor-in-Chief

This is the 54" Issue of the IMR Quarterly Bulletin for the 2"* Quarter of 2003. We are grateful to many contributors who have made the 54" issue a success. The contents of the bulletin will continue to include original research articles, reports, and abstracts of published scientific papers as well as calendar of events of research interests.

From the Editor's desk I would like to highlight the importance of emerging diseases such as the 'Severe Acute Respiratory Syndrome (SARS)' which has had such a tremendous effect on global public health in such a short span of time. For the first time in recent history, people from all walks of life stood still to take note of a disease, an unseen pathogen, which threatened their very existence.

Our closest neighbour, Singapore faced the brunt of the disease in our region. In order to contain future outbreaks and protect health workers, a special panel of foreign and local experts has developed a document on 'Biosafety and SARS Incident in Singapore September 2003' (Director of Medical Services, Epidemiology and Disease Control, Ministry of Health, Singapore). This will be a good source of information on biosafety for those involved in public health activities. The report highlights a large range of biosafety structures and practices that are essential for laboratories, laboratory workers, health workers, scientists and students.

Notice to Contributors

The article should have the following sections: Brief Abstract, Introduction; Materials and methods; Results; Discussion; Acknowledgements and References. Illustrations should be drawn clearly and not photocopied. Care should be taken that illustrations do not exceed a maximum size of 12.0 x 18.5cm. The Editorial Board reserves the right to arrange drawings and photographs in a manner so as to make a composite plate to avoid undue wastage of space. References should be given in alphabetical order with the full title of the journal.

The articles can be written in Bahasa Malaysia or in English with double spacing and submitted as a typescript, on size A4 paper to Pn. Siti Rodziah, Unit Perpustakaan, Maklumat dm Penerbitan, Institute Penyelidikan Perubatan or transmitted electronically to the following e-mail address: rodziah@imr.~ov.m~

It is assumed that all articles submitted for publication have the prior approval of their respective Directors. The Editorial Board takes no responsibility for the accuracy of statements made by the author(s) and the views expressed in the articles are not to be taken as that of the Institute for Medical Research or the Ministry of Health Malaysia.

ARTICLES


Cyclophosphamide therapy: A retrospective review of 41 cases of Lupus Nephritis.

Go Kuan Weng, Teo Sue Mei

Clinical Specialis in Nephrology, Nephrology Unit, Hospital Ipoh, Jalan Hospital, 30990 Ipoh, Perak.

Abstract

OBJECTIVES: To analyze the treatment and renal outcome of patient with lupus nephritis (LN) WHO class 111 and IV on cyclophospharnide (CYC).

PATIENTS AND METHODS: A retrospective study of patients with biopsy-proven LN who were given oral or intravenous CYC.

RESULTS: 41 patients with a male: female ratio of 4:37; comprising of 36 cases (87.8%) of WHO class IV and 5 cases (12.2%) of WHO class I11 LN. Mean age at presentation was 31.7 * 9.8 years with mean serum creatinine of 87.4 * 37.2 pmoVL and mean follow-up of 84 & 78 months. A total of 30 patients (73.2%) completed 12 courses of IV CYC and one patient (2.4%) completed three months of oral CYC with complete response (CR) rate of 71.0% (n=22), partial response rate of 25.8% (n=8) and no response (NR) rate of 3.2% (n=l). Of the remaining 11 patients, two patients (4.9%) died during treatment, three patients (7.3%) defaulted treatment and five patients (12.2%) still receiving on-going treatment. Presence of hypertension (p<0.003) and evidence of chronicity on renal biopsy ( ~ ~ 0 . 0 1 6 ) were significantly correlated with the progressive deterioration of renal function in our population.

CONCLUSION: Hypertension and evidence of chronicity on renal biopsy, proved to be risk factors for progressive renal impairment in our study population. The achieved global outcome can be considered good.

Keywords: Cyclophosphamide (CYC); Lupus nephritis (LN); Complete response (CR); Partial response (PR); Non response (NR).

Introduction

Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease with renal involvement being one of the most frequent and serious manifestations of the disease. Nephritis in SLE carries significant morbidity and mortality and is an important determinant for survival. '" Among the different World Health Organization (WHO) histological classes of lupus nephritis, diffise proliferative glomerulonephritis (DPGN) is associated with the worst prognosis in terms of both progression to end stage renal disease (ESRD) and survival." 6 Because of the ominous prognosis of DPGN, it is universally agreed that treatment of this histological type of nephritis has to be aggressive.

The clinical experience with cyclophosphamide in SLE now extends well over several decades. ' The drug has been best studied in lupus nephritis, where there is unequivocal evidence

that it modifies the long-term course of the Intermittent monthly boluses of

intravenous cyclophosphamide have become the standard treatment for DPGN (WHO class 1V) lupus nephritis. In a series of randomized controlled trials conducted at the National Institutes of Health, statistically significant differences between cyclophosphamide and corticosteroids alone have been shown for the prevention of progressive scarring within the kidney, lo preservation of renal function, induction of renal remission, l 1 and reduction in the risk of end-stage renal failure requiring dialysis or renal transplantation. These studies provide evidence in favor of intravenous cyclophosphamide for most of the major renal outcomes associated with lupus nephritis. With this in mind we hope to evaluate and analyze our local experience with cyclophosphamide in treatment of lupus nephritis and to search for risk factors for renal and patient survival.


Ward MM, Pyun E, Studenski S: Mortality risks associated with specific clinical manifestations of systemic lupus erythematosus. Arch Intern Med 156: 1337- 1344, 1996 Vu TV, Escalante A:Acomparison of the quality of life of patients with systemic lupus erythematosus with and without end- stage renal disease. J Rheumatol 26:2595- 260 1, 1999 Appel GB. Cohen DJ, Pirani CL, Meltzer JI, Estes D:Long-term follow-up of patients with lupus nephritis. A study based on the classification of the World Health Organization. Am J Med 83:877-885, 1987 Baldwin DS: Clinical usefulness of the morphological classification of lupus nephritis. Am J Kidney Dis 2:142-149, 1982 Mok CC, Wong RWS, Lau CS: Lupus nephritis in southern Chinese patients: Clinicopathological findings and long-term outcome. Am J Kidney Dis 34:315-323, 1999 Hill RD, Scott GW: Cytotoxic drugs for systemic lupus erythematosus [letter]. BMJ 1:370, 1964

8. Appel GB, Valeri A: The course and treatment of lupus nephritis. Annu Rev Med 45525-536, 1994

9. Rahman P, Humphrey-Murto S, Glandman DD, et al: Cytotoxic therapy in systemic lupus erythematosus: Experience from a single center. Medicine 76:432-437, 1997

10. Balow JE, Austin HA, et al: Effect of treatment on the evolution of renal abnormalities in lupus nephritis. N Engl J Med 3 1 1 :491-495, 1984

11. Gourley MF, Austin HA, Scott D, et al: Methyiprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis. A randomized, controlled trial. Ann Intern Med 125549-557, 1996

12. Boumpas DT, Balow JE: Outcome criteria for Lupus nephritis trials: A critical overview. Lupus 7:622-629, 1998

13. Bournpas DT, Austin HA, Vaughn EM, Klippel JH, Steinberg AD, Yarboro CH Balow JE: Controlled trial of pulse methyprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis. Lancet 340:74 1-745, 1992


In Search of the Ideal "Fat Combon for Cardiovascular Health

Tony Ng Kock Wai

Head, Cardiovascular Disease Unit Institute for Medical Research, Kuala Lumpur

Abstract

The ideal "fat combo" for the world population may be illusive because of the great variance in population energy and nutrient needs, sources of dietary fats, and socioeconomic and political influences. We can do the next best thing though, i.e. to find a "fat combo" that best suits the local population. Towards this end, it is recommended that Malaysians (2->60 years) consume 2030% energy as total fat, containing 4-7% energy omega-6 polyunsaturated fatty acids (PUFA) [linoleic acid, LA], 0.4-1.0% energy omega3 PUFA (alpha-linolenic acid andor EPA + DHA). Since cooking oils form the major source of dietary fat in habitual Malaysian diets, any modification in the fat composition of the cooking oil would have a pronounce effect on the resultant dietary fatty acid profile. Capitalising on this strategy, the judicious blending of palm olein with monounsaturated and polyunsaturated oils to produce a desired blend consisting of 30% saturated fatty acids (SFA), 50% monounsaturated fatty acid (MUFA) and 20% PUFA serves not only to promote our own national oil, but also come up with a palm olein blend close to ideal for the Malaysian population. The above approach should be coupled with a food-based strategy that emphasises plenty of vegetables and fruits, pulses, fish, and taufu products in the daily menu. The end fat combo we are looking for is one that consists of about 9 SFA: 13 MUFA: 5 PUFA, which should be appropriate for the general Malaysian population. Hydrogenated fats should be avoided and cholesterol intake limited to <300 mg/day. For hypercholesterolemic individuals, the dietary LA level should be raised to 6-7% energy with minor adjustments in the 7-day rotation menu as well as the cooking oil blend.

Introduction

Now that we know that there is a direct influence of dietary fat on serum lipids, lipoproteins, and haemostatic variables, the search is on for the ideal fat combo which would keep heart disease at bay. There has been numerous reports on the topic, with different "shapes and pieces" to the jig-saw puzzle to the extent that both health professionals and the public are getting confused! That stops right here for this article intends to put some oily issues in their right perspective.

Mention heart disease and the fingers are pointed at saturated fats, while the monounsaturated and polyunsaturated fats get a pat on the back! This is an over-simplistic view which has been perpetuated over the last 50 years and naturally, has become skin-deep and difficult to rub off.

It does not help matters when pretenders of the nutrition profession unwittingly fan the confusion as they sit in related technical committees or work on the keyboard to beat the deadline for a feature article.

In the quest for the ideal fat combo, it is important to keep in mind that a nutrient-based

approach alone against heart disease would probably have little impact. For the best results with regards to cardiovascular health, it is wise to combine this approach with one that is food- based which emphasises consumption of plenty of vegetables and fruits, pulses, fish, and taufu products, as well as non-food messages such as balancing your energy needs with physical activity, or maintaining ideal bodyweight.

How much fat?

There is some uncertainty over the optimal dietary fat level but the 30% energy "target" set by FAOIWHO and the American Heart Association (AHA) in the early 1980s appears a reasonable estimate. However, the issue is complicated by the fact that the optimal dietary fat level may not be the same for different populations across the globe, or for developed versus developing nations.

In the 1980s, populations in the United States and Europe were consuming dietary fats in the region of a high 40-42% energy. Highly concerned with this scenario, authoritative national and international bodies had


recommended cutting fat intake, first to an interim level of 35% energy, and fmally to 30% energy (Rizek. et al., 1983; James WPT, et a1 1988). After more than two decades, the more successful nations have reduced the fat intake of its population to about 35% energy, while for the majority of developed nations, fat intake has hovered at -40% energy and the 30% energy "target" looks more elusive then ever.

Fat is an essential nutrient and its dietary level should not fall too low, otherwise the diet prepared may become monotonous, has low palatability, low energy density, and the amount

. of essential fatty acids (mainly the PUFA, LA) can become limiting. The minimum dietary fat

- level is set as 15% energy by WHORAO (1990, 2003) and 20% energy by the Food and Nutrition Board (FNB, 2002).

The uRper tolerable limit for dietary fat is not clearly defmed. If you take too much of this energy-rich macronutrient (9.0 kcal/g), you would probably put on weight as your body would get more calories than what it actually needs.

At the high intake end, the FNB (2002) has adopted 35% energy as the upper limit for fat intake for Americans. Interestingly, FAOrWHO (1993, 2003) considers this upper limit acceptable for active individuals who have a balanced diet. However, the introduction of the 35% energy fat as acceptable in the 1993 FAOIWHO Report may be mistaken for an upward trend in the recommendation for fat intake.

The Malaysian Dietary Guidelines (NCCFN, 1999) has recommended a desirable fat intake range of 20%-30% energy from 2 years onwards, which is within the range of 1530% energy recommended by several FAOIWHO Expert Consultations over the years. '

Regarding dietary fats and cardiovascular health in infants and very young children, the recommended intake for, milk fats should provide about 50-60% of the energy requirements in 0-5.9 months infants. During weaning, the fat component should provide 30- 40% of the dietary energy and similar levels of essential fatty acids as are found in breast milk (1 1 % LA and 1 % omega-3 PUFA) from appropriate foods until at least 2 years of age (FAOiWHO, 1993).

What is the ideal "fat combo"

"Fat combo", mean a mix of different dietary fats, but more specifically, the balance of the different categories of fatty acids, namely SFA, MUFA, and PUFA.

Early recommendations for dietary fats have centred on the concept of a balance of the different categories of fatty acids. Since "30% energy" was the popular target set by FAOIWHO and the AHA in the 1980s, the balance of 1 :1: 1 for SFA:MUFA:PUFA advocated by these authoritative bodies seemed attractive. Based on 30% enerh from fat, this would mean 10% SFA, 10% MUFA, and 10% PUFA. The AHA has since modified its recommendation to 9:12:9, i.e. 9% SFA:12% MUFA:9% PUFA.

The current palm oil-based habitual diets of Malaysians contain about 26% energy (-66g) total fat, with an approximate 3:3:1 fatty acid ratio (Ng, 1995). The LA intake here appears marginal and moderate increase in the intake of this PUFA, keeping total SFA at about lo%, should improve the fat combo for Malaysians.

Since cooking oils form the major source of fat in habitual Malaysian diets, the judicious blending of palm olein with monounsaturated and polyunsaturated oils to produce a cooking oil blend containing about 30% SFA, 50% MUFA, and 20% PUFA have been recommended (Ng, 1995). The use of this palm olem blend in food preparation is estimated to produce local diets containing a fatty acid profile approximating 9- 10 SFA:12-14 MUFA: 4.5-5.5 PUFA.

The impatient housewife would be tempted to say "Wah! very complicated the above ratio. Don't understand!". But if a cooking oil of the above fatty acid composition is available, then it's just a matter of reaching out to a bottle and use this in cooking.

How much dietary LA?

The FAOIWHO (1977) has meticulously estimated the intake of LA as an essential fatty acid, namely: basal 3% energy, 4.5% energy during pregnancy, and 5 7 % energy during lactation. These estimates have remained largely unchanged and it would appear that human's greatest physiological need for the PUFA, LA, is during lactation when 3-5g LA are secreted into breast milk a day.


However, the above recommended LA intakes are complicated by the overly concern for the cholesterol-raising effects of dietary SFA. As LA is the chief cholesterol-lowering agent in food, its proposed intake has been raised to counter the cholesterolemic effects of the (212-16 SFA (lauric, myristic, and palmitic acids). In this regard, recommended LA intakes by FAOIWHO have in pendulum-fashion, changed over the years, i.e. 10% energy in 1986, 3-7% energy in l99O,4- 10% in 1993, and 5-8% in 2003.

It would seem that there has been a "harmonisation" of the requirements of LA, both as the main essential fatty acid and as chief cholesterol-lowering agent, with emphasis being given to the latter role. This "SFA phobia syndrome" pushes dietary LA to unrealistically high levels (7-10% energy), when it is more logical to reduce intakes of the "offending" SFA. Also, the "LA threshold" (maximum cholesterol- lowering potential) reported for LA which approximates 5-6% energy (Hayes and Khosla, 1992), argues against LA intakes above 7% energy which would represent a "metabolic overkill" with respect to cholesterol reduction.

The potential adverse effects of high intakes of PUFA have not be completely ruled out. It would be simple to say that there is insufficient evidence for adverse effects of high LA intakes, or put the "safe" upper limit of LA so high (eg. 10-15% kcal), that the issue is no longer relevant. Is this going to be a case of the "Peoples' health versus TFA" revisited?

For individuals with raised plasma cholesterol concentrations (>240 mgldL or >6.2 mM/L), a 20-30% energy total fat diet, containing a variety of foods with plenty of vegetables and fruits, and about 6-7% energy LA, are recommended.

Viewing all the evidence, and particularly the fact that habitual Malaysian diets contain: a) only traces of the chief atherogenic fatty acids, trans fatty acids (TFA, contained in hydrogenated fats) and myristic acid (SFA, found mainly in coconut oil and palm kernel oil), and b) the present average PUFA content of habitual Malaysian diets is about 3.5-4.0% energy, dietary LA intakes are recommended at 4-7% energy.

Omega-6.Omega-3 PUFA balance

The omega-6 PUFA in the diet consists of mainly LA, and to a lesser extent preformed

arachidonic acid (AA), while the omega-3 PUFA comprises alpha-linolenic acid (ALA), and preformed eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Currently, the omega-6lomega-3 PUFA ratio of the typical Malaysian diet is about 3.510.4 or 10 (Ng, 1995), while in the diets of western populations this ratio is much higher, i.e. 15-20.

The FAOIWHO Expert Consultation on Fats and Oils in Human Nutrition (1993) recommends an omega-6lomega-3 PUFA ratio of 5- 10, which is also reflected in the PUFA recommendations of 5-8% energy LA and 1-2% energy omega-3 PUFA by the WHORAO Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases (2003).

Both the absolute amounts of omega-6 and omega-3 PUFA, as well as their ratio are important nutritional considerations. Increasing the intake of omega-3 poses a serious dietary challenge and any excess intake of LA (>7% energy) would make achieving the recommended omegadlomega-3 PUFA ratio even more difficult. In the conversion of LA and ALA into their respective long-chain PUFA, they both inhibit each other's desaturation and elongation with the competition favouring LA because of LA'S sheer greater abundance. One adverse effect of this competition is already noted in the negative association of neonatal head circumference with maternal LA consumption (Hornstra, 200 I).

In the Malaysian context, omega-6 PUFA (LA) intakes are recommended at 4-7% energy, while omega3 PUFA at 0.4-1.0% energy. This range of omega3 FA intakes is recommended with due consideration to the present omega-3 PUFA content of habitual Malaysian diets and the practicability of increasing substantially this PUFA intake, which requires substantial change in dietary habits.

SFA, MUFA and TFA

The C 12- 16 SFA (lauric, myristic, and palmitic acid) do not have the same cholesterol-raising potential. Myristic acid has at least 4 times the cholesterol-raising potential of palmitic acid (Hegsted et a1 1965). Of interest, much evidence has accumulated to show that palm-based diets, which are high in palmitic and oleic acids, tend to be non-cholesterol raising when consumed by different populations across the globe (Hayes et


al., 1991; Ng et al. 1991 & 1992, Sundram et al., 1995).

Conclusion

WHOfFAO (2003) has reiterated that as a population nutrient intake goal, total SFA should be <lo% kcal and this level of SFA approximates the amount found in habitual Malaysian diets containing a variety of food components and prepared with the popular palm olein cooking blends (palm olein-groundnut- sesame) available in the market.

It is important to note that although SFA raise total cholesterol (TC) and LDL-cholesterol, they also raise plasma levels of the protective high- density lipoproteins (HDL) which then "buffers" any serious rise in the LDLJHDL ratio as a result of increased intakes of fats rich. in SFA. Also, the LDLIHDL ratio may not necessarily improve when dietary SFA levels go too low (<7% kcal) as happens during high LA intakes. Having SFA in the diet is important, to maintain healthy plasma HDL levels and to prevent the plasma LDL particles generated from being small and dense- the LDL type that are more more atherogenic (Hayes, 2002). Now, who says that SFA are "bad"?

TFA are approximately twice as "bad" as the C12-16 SFA (Ascherio et al., 1999). These deviant trans raise not only TC and LDL- cholesterol, but also elevate the dreaded risk factor, lipoprotein(a). The Nurses Health Study conducted by the Harvard School of Public Health showed that a 2% increase in calories from TFA raised the risk of type I1 diabetes by 39% (Hu et al., 1997).

Monounsaturated FA (MUFA) are largely "neutral" (Hegsted et al, 1965) and it would be prudent to maximise their level in the diet (12- 15% energy) as they tend to displace the harmful fatty acids.

After years of "lurking in the shadows", TFA has finally been officially recognised as the chief villains of heart disease by FAOIWHO (2003) which recommends that dietary TFA should be below 1% energy (i.e. < 2-3 glday). Despite this, it is disturbing to note that at a recent international meeting on drafting food standards, delegations of certain countries still maintain that there is insufficient evidence to label TFA as bad for your heart!

In searching for the ideal "fat combo", we have to ask the very fimdamental question of "ideal for who?'. We also have to grapple with what is "ideal" versus "what is practical" for the local population. Perhaps, the best solution is to harmonise the two concepts.

Two very important issues come to mind: Firstly, palm oil and its hctions (particularly palm olein) form the major fat in the diet of Malaysians, and secondly, the cooking oil used in food preparation form the main source of dietary fat.

Therefore, any recommendation of food choices with the view of obtaining the "ideal fat combo" would necessarily involve using a palm cooking oil blend of an appropriate fatty acid composition. Ng (1995) has recommended a palm olein blend with common monounsaturated and polyunsaturated vegetable oils such that the resultant cooking oil blend has a fatty acid composition approximating 30% SFA, 50% MUFA and 20% PUFA. When this blend is used in food preparation with common food items, the resulting diet should contain a fatty acid profile which approximates 9 SFA, 13 MUFA, 5 PUFA.

Considering the importance of palm oil in the diet of Malaysians, and other evidence available as reported in this article, it would not be appropriate to recommend LA intakes beyond 7% energy. As such, dietary LA is recommended a t 4-7% energy with omega-3 PUFA providing 0.4-1.0% energy, for the local population.

As recommended by the Expert Group on Malaysian Dietary Guidelines (NCCFN, 1999), dietary cholesterol should be 0 0 0 mglday. This restriction is easily manageable even when you treat yourself to an egg every other day.

Acknowledgement

Some information reported in this article was extracted from the Draft Report on Recommended Nutrient Intakes for Dietary Fat submitted by the present author to the National Technical Committee on Energy and Protein Requirements, 30 May 2003.


References

Ascherio A, Katan MB, Stampfer MJ et al. (1999) Trans fatty acids and coronary heart disease. N Engl J Med, 340(25): 1994-1998.

FAOIWHO (1977) Dietary fats and oils in human nutrition, a Joint FAOIWHO Report, Food and Agricultural Organisation, Rome. Food and Nutrition Paper No. 3.

FAOIWHOIUNU Expert Consultation (1985) Energy and protein requirements. WHO Technical Report Series 724, Geneva, World Health Organisation.

FAOIWHO Expert Consultation (1993) Fats and oils in human nutrition. World Health Organisation, Rome 1993. Food and Nutrition Paper 57.

Food and Nutrition Board, Institute of Medicine, USA, 2002.

Hayes KC (2002) Dietary fat and heart health: in search of the ideal fat. Asia Paci@c J Clin Nutr, 11 :S394-S400.

Hayes KC, Pronczuk A, Lindsey S et al. (1991) Dietary saturated fatty acids (12:0, 14:0, 16:O) differ in their impact on plasma cholesterol and lipoproteins in nonhuman primates. Am J Clin Nutr, 53:491-498.

Hayes KC, Khosla P (1992). Dietary fatty acid thresholds and cholesterolemia. FASEB J, 6(8):2600-2607.

Hegsted DM, McGandy RB, Myers ML et al. (1965) Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr, 27:28 1-295.

Hornstra G (2001) Linoleic acid and trans fatty acid consumption and the LC-PUFA status in man: possible implications for human development and health. Proceedings of the PIPOC International Palm Oil Congress, 20-22 August 200 1, Kuala Lumpur, Malaysia; pp 1 19- 123.

Hu FB, Stampfer MJ, Manson JE et al. (1997) Dietary fat intake and the risk of coronary heart disease in women. N Engl J Med, 357:1491- 1499.

James WPT et al. (1988) Healthy nutrition: preventing nutrition-related diseases in Europe. Copenhagen, WHO Regional Ofice for Europe. WHO Regional Publications, European Series No. 24.

National Coordinating Committee on Food and Nutrition (NCCFN), Ministry of Health Malaysia. Malaysian Dietary Guidelines, 1999

Ng TKW (1995) Towards improved fat intake and nutrition for Malaysians. Ma1 J Nutr, 1(1):21-30.

Ng TKW (1997) Dietary fat and fibre intakes of Malaysian adults: issues and implications when 'western targets' are set as dietary goals. Ma1 J Nutr, 3(2):137-147.

Ng TKW, Khalid H, Lim JB et al. (1991) Nonhypercholesterolemic effects of a palm-oil diet in Malaysian volunteers. Am J Clin Nutr, 53:1015S-1020s.

Ng TKW, Hayes KC, De Witt GF et al. (1992) Dietary palmitic and oleic acids exert similar effects on serum cholesterol and lipoprotein profiles in normocholesterolemic men and women. J Am Coll Nutr, 1 1 (4):3 83-390.

Rizek RL, Welsh SO, Marston RM et al. (1983) Levels and sources of fat in the United States food supply and in diets of individuals. Chapter 2 In: Dietary Fats and Health, Perkins EG, Visek WJ (eds.), American Oil Chemist Society, USA; pp13-43.

Sundrarn K, Hayes KC, Othman HS (1995) Both dietary 18:2 and 16:O may be required to improve the serum LDLMDL cholesterol ratio in normocholesterolemic men. J Nutr Biochem, 6(4): 179-1 87.

WHO (1985) The quantity and quality of breast milk: Second Report on the Collaborative Study, WHO, Geneva.

WHO (1990). Diet, nutrition, and the prevention of chronic diseases. World Health Organisation, Geneva. Technical Report Series 797.

WHO/FAO Expert Consultation (2003). Diet, nutrition and the prevention of chronic diseases. World Health Organisation, Geneva. Technical Report Series 916.


Filariasis in Pahang: Towards Elimination

Mohamed Sapian b. Mohamed, Masran b. Mohamad, Abdul Rahim b. Abdullah Siti Zubaidah bt Abdul Rahman, Marlia bt Mohammed Salleh, Sarah bt Yacob

Jabatan Kesihatan Negeri Pahang, Tingkat 12, Wisma Persekutuan, Jalan Gambut, 25000 Kuantan, Pahang

Abstract

Filiariasis control programme has improved in Pahang. In 1999 it has been decentralized to the districts. More villages were probed and the number of people examined were also increased. The microfilarial rate was higher in 1999 ( 0.96% or 9.6 per 1000 population ) as compared to previous years but it has reduced to 0.4% or 4 per 1000 population in the year 2000 but still higher than the national target of less than 0.1% or 1 per 1000 population in the National Programme to Eliminate Lymphatic Filariasis introduced in 2001. In preparation for phase 2 of the programme, activities done found out that 35 IU from 8 districts in Pahang are still endemic with Filariasis and will proceed to the following phases in the programme.

Introduction

Filariasis is still a public health problem in Malaysia. It is endemic in Sabah, Sarawak, Johor, Pahang, Perak and Terengganu. It is caused by the appearance of nematode filarial worms in the lymph vessels. In Malaysia there are 3 spesies of filarial worms reported; Brugia maluyi, Wuchereria bancrofti and Brugia timori in which Brugia maluyi predominates.

Filariasis affects 120 million people from 73 countries worldwide. Even though the disease is not fatal, it can cause disability, physical disfigurement and suffering to the patient. Recent development of effective single-dose drug combination of albendazole and diethylcarbamazine for reducing microfilaremia and of new tools for monitoring infections in human and mosquito population led to hope that transmission of lymphatic filariasis can be interrupted. In May 1997, the 5oth World Health Assembly passed a resolution which urged member states to strengthen activities toward eliminating lymphatic filariasis as a public health problem and to achieve global goal of elimination by the year 2020. In Malaysia, the Ministry of Health has introduced the National Programme to Eliminate Lymphatic Filariasis (NPELF) in 2000 with the goal of achieving filariasis elimination by the year 2015 which means reducing the incidence rate of cases in endemic areas to less than 1 per 1,000 population.

Filariasis control programme in Malaysia began in the early 1960's. The main strategies then

were case detection through probe survey and selective treatment. The programme has been

successful in controlling the disease to a very low level, in which the microfilarial rate(mf) reduced from 6.0% in early 1960's to 0.3% in the year 2000. In Pahang the mf rate was 0.41% which was above the national level. The prevalence of filariasis in Malaysia was 2.17 per 100 000 population in year 2000.

In Pahang, the filariasis control programme was initially started by one team based in Kuantan. Later it was expanded to 2 teams which covered districts in Pahang Timur and Pahang Barat until year 1998 when it was decentialized to every districts.

Strategies including in the NPELF are divided into 4 phases: i. Phase 1 (2001-May2002) :

Evaluation and Mapping of Endemic Area. ii. Phase 2 (2002-2006) :

Mass Drug Administration iii. Phase 3 (2002-2007) :

Monitoring and Evaluation iv. Phase 4 (2008-20 10) :

Confirmation of Elimination Status.

Objectives

The objectives of this study are: a. .To describe the sociodemographic features,

and distribution of filariasis cases in Pahang from 1996-2000


Table 1: Distrobution of Filariasis Cases in Pahang from Year 1996-2000


Table 2: Status of Implementation Units By District Before and After Phase One of National Lymphatic Filariasis Elimination Program in Pahang.

Highlands Lipis 4 8 0 4 0

L I I I I

Jerantut 4 6 0 4 0

Raub 0 7 0 0 0 1 1 I I

Bentong 1 - 0 3 0 1 0 I 0

Kuantan 5 2 0 5 0

Pekan 10 1 0 11 0

Rompin 4 1 0 4 0

Maran 4 0 0 4 0

Discussion

Filariasis cases detected showed an increase in number in the year 1999. This was due to the fact that this programme has been decentralized to the districts f?om the year 1999. Every district had their own filariasis control team. This lead to increased number of villages and population probed as compared to previous years where teams from Kuantan and Temerloh did the task throughout the state. In the year 2000, even though the number of villages probed and population being examined increases the cases detected were lower. The microfilarial rate was also reduced (0.43% or 4.31 per 1000 population) . This was probably due to more new areas were covered by the teams which were of lower prevalence .

From the results, it was noted that the microfilarial rate was still above the national target which is 0.1% or I per 1000 population. If the analysis is done at the endemic IU level only, the the rate might be higher.

The Phase 2 NPELF will commenced in July 2003. Mass drug administration was deemed necessary for Pahang because of high endemicity and limited manpower in the present control programme to cover all endemic areas.

Other measures which may prove useful in the elimination programme are such as participation from government, NGO's and politician as well as community leaders of affected population.

We anticipate the cost to run the programme will be high in terms of personnel, time and financing resources. However, benefits of NPELF far outweigh its disadvantages. For example, use of albendazole as combination therapy in filariasis management is also usehl to decrease other intestinal helminthes and anaemia that they produced. Furthermore intestinal helminthes is still a neglected public health problem in Malaysia.

With proper planning and adequate training and implementation of this programme it is hope that filariasis will be eliminated in Pahang by the year 201 5.


References 7. Program Eliminasi Limfatik Filariasis

Pelan Tindakan Kawalan Filariasis (1984) Rancangan Kawalan Penyakit Bawaan Vektor . W.H.0 (1992) Fifth Report of the WHO Expert Committee On Filariasis, Geneva J.W.Mak (1983) The Current Status of Filariasis in Malaysia. Proceeding South East Asian Parasitology Simposium Dec.9- 12,1993, Hong Kong. Jit Singh (1985) Filariasis Control in Malaysia Proceeding of the W.H.0 Regional seminar 1-5 July 1985 Laporan Tahunan (1 995), Cawangan Penyakit Bawaan Vektor, Kuala Lumpur. J.W.Mak " (2000) Surveillance of Filariasish: Mosquito and mosquito-borne diseases (ed.F.S.P and H.S.Yong) pp.161- 166.

(2000) Cawangan Penyakit Bawaan Vektor Kementerian Kesihatan Malaysia.

8. W.H.0 (1998) Report of a WHO Informal Consultation on Epidemiologic Approaches to Lymphatic Filariasis Elimination: Initial Assessment, Monitoring, and Certification, Atlanta.

9. C.P Ramachandran (1999) Recent Advances in the Control of Lymphatic Filariasis" Despair to Hope "in Emerging Trend in the Diagnosis of Infectious Disease.

10. E.A Ottesen , M.M Ismail, J.Horton(1999). The Role of Albendazole in Programmes to Eliminate Lymphatic Filariasis. Parasitology Today,15,382-386

1 1. E.A Ottesen, B.0.L Duke, M.Karam, K. Beh Behani.(1997) Strategies and Tools for the Control/Elimination of Lymphatic Filariasis. Bulletin of the World Health Organisation.

IMR Quarterly Bulletin No. 5 4 Apr. 2003

Situational Analysis of Ambulance Usage in Hospital Tapah (8 Years Analysis).

K. K. Murthi; Omar S.A; Sukdershan S.

Hospital Tapah, Jalan Temoh, 35000 Tapah, Perak

Introduction

Hospital Tapah is a 120 bedded non-specialist public hospital situated along the busy IpohKuala Lumpur trunk road (Federal Route I) and exit to the North South Expressway just 2 kilometers away. Built in 1917, it has an area of 23 acres with a built up area of 40 percent. The emergency unit, the wards and all the supportive units are individually built at a distance of between 30 to 300 meters of each other, scattered and occupying most of the area.

This hospital serves a population of about 1 10,000 in the surrounding towns and outskirts of the northern and central region of the Batang Padang District in Perak. Being situated at a strategic location along the expressway, the federal route and the gateway to Cameron Highlands in the east and an access road to Teluk Intan in the west, the hospital is kept busy handling a high number of motor vehicle accident emergencies, in addition to the other medical and obstetric emergencies.

A common pool of 3 ambulances and subsequently 4 ambulances as from the year 1998 are being used for the following purpose:

1. Inter-hospital transfer.

Transfer of cases to specialist hospitals like Hospital Ipoh, Hospital Teluk Intan, Hospital Bahagia and others for further management.

2. Emergency ambulance sewice in the designated area.

b. 15 kilometer stretch of North and 32 kilometer stretch of the South of the Federal Route one.

c. 40 kilometers stretch of the Tapah-Cemeron Highlands road.

d. 32 kilometers stretch of the Tapah-Tapah Road-Teluk Intan road.

e. The vicinity of the Tapah, Bidor and Chenderiang area including Orang Asli settlements in the interior.

3. Intra-hospital transfer of cases.

Transfer of cases fi-om emergency unit to wards, wards to x-ray unit and back. This service is provided, as there are no covered ways connecting all the wards, emergency unit and the x-ray department due to the presence of roads criss crossing in the vicinity.

Objective

The main objective of this analysis is to highlight the usage of ambulances for various purposes in Hospital Tapah and to identify the issues encountered in ensuring an effective and efficient ambulance service.

Materials and Methods

The following materials are used for the analysis:

1. Record of ambulance movement. 2. Vehicle Log book. 3. Emergency Ambulance Call record books 4. Master record of vehicle usage. 5. The authors years of experience in managing

the ambulance services. a. 70 kilometer stretch of North South

Expressway (40 kilometers up to the Gopeng toll plaza and 30 kilometers South up to the Sungkai Toll Plaza).


Notes: - i. Time taken for inter transfer varies for each

hospital depending on the type of case sent. Staff accompanying cases have to wait until certain procedures, like C. T. Scans, are done.

ii. Time taken for emergency ambulance calls are the North South Expressway takes much longer time as there are no openings at the road dividers for the ambulances to turn and the only way turning points are at the toll plazas.

The National Indicator Approach

In patient care services (Emergency Services), efficiency of emergency ambulance services is measured with the time taken for an ambulance to leave the hospital after a call is received. The maximum response time should not be more than 5 minutes and the standard set is not more than 10 percent of the calls.

For Hospital Tapah, the delay in ambulance response time as follows:

Duration

January to June, 2002

Performance Achieved

I 1

Age of Ambulance in Service with Hospital Tapah.

Shortfall in Quality

0.78 %

July to December, 2002 I I

No.

January to March 2003

0.36 %

Ambulance Registration Number

No

4.83 %

Age I I

No

1 I I

2 I I

(*Borrowed from Slim River Hospital due to shortage of ambulances while awaiting replacement of condemned vehicles)

WCG 2254

3 I I

Discussion:

In public hospitals, ambulances are allocated in norms according to the number of beds in a hospital. Hospitals with 250 beds and below are allocated 3 ambulances.

With the limited number, the ambulances are grouped in a common pool to provide the various services. This system restricts the quality of service provided.

5 years

WDQ 1954

4

There is no designated ambulance for emergency ambulance service. Emergency equipment had to be loaded into the ambulance each time while responding to a call thus causing delay in dispatching an ambulance promptly The recommended list of emergency equipment to be equipped in an ambulance occupies a great deal of space in the ambulance. The ambulances provided are not user friendly. If all ambulances in the pool are to be fully equipped to be used promptly in an emergency, ambulances on inter-hospital transfer will have space constraints as a patient needs to be accompanied by 2 or more staff depending on the condition of the patient. Space is congested to initiate resuscitation procedures more often, two cases are sent in one ambulance. The high cost of emergency equipment is also a factor to be considered if all ambulances are fully equipped. Frequently all the ambulances are on the move at one time and the duration of time taken by the ambulances to return from the various destinations is long. When there is a shortage, assistance from Hospital Kampar and other local agencies such as the Royal Malay Regiment base, Police Field Force base and Klinik Tenaga National are sought for ambulances and this causes a delay in giving prompt service. Two way communication &om ambulances to the emergency unit are not standardized for the whole of Ministry of Health. In comparison, the Police and the Armed Forces have better communications system. There is a delay in ambulances reaching accident victims on the North South Expressways as the turning points are only at the toll plazas. Hence, the life of victims are at stake and the ambulance crew is often blamed for being late.

8 years

WDM 2716 9 years

*WBL 7436 15 years


8. The heavy workload on the vehicles, causes these vehicles off the road frequently due to frequent maintenance services and also breakdowns; thus this affects the services.

9. Applications to the Ministry of Health to increase the standard of ambulances due to the heavy workload has been considered but the allocation of ambulances has been delayed. For Hospital Tapah the number was increased to 4 in the year 1998. A hither increase is being sought.

10. The number of registered vehicles on the roads have increased over time. This in turn adds to increased traffic congestion on the roads.

Conclusion

1. Dedicated ambulances for emergency ambulance calls should be made available. The ambulances are to be filly equipped with emergency equipment to give prompt and efficient service.

2. Phasing out of the Ministry of Health ambulances and replacing them with state- of-the-art ambulances.

3. Priority is to be given according to the demands or needs of hospitals along the North-South Expressway by increasing the number of ambulances as studies have shown the higher number of cases due to motor vehicle accidents at these hospitals.

4. Emergency ambulance services to be privatized to ease the burden of the hospitals with regards to manpower and materials. Medical staff and ambulances can be better utilized in the hospitals.

5. Medical staff accompanying patients on inter-hospital transfers should be released once cases are handed over to the receiving hospital and should not be made to wait. The services of ambulances and the staff are much needed in the referring hospital.

6. Plus Concessionaire should have a good and rapid response team to open up turning points at road dividers on the expressway and control the traffic near an accident site so that the ambulances may reach the victims promptly for treatment and evacuation.

7. Covered ways connecting the emergency unit, wards and the X-ray department of the hospital should be provided for transporting patients in wheel chairs and patient trolleys to ease the burden on the ambulance.


Management of Severe Laryngomalacia in Otorhinolaryngology Department of Hospital Melaka

Abdul Razak M. S. (ORL) Hns. (UKM), S. Subramaniaan M. S. (ORL)(UM), Mohamed Khir bin Abdullah M. S. (ORL) Hns. (UKM)

Department of Otorhinolaryngology, Hospital Melaka, Jalan Batu Berendam 75400, Melaka.

Abstract

OBJECTIVE: To study laryngomalacia in this patient-population, their clinical presentations and managemant in the Otorhinolaryngology Department of Haspital Melaka over a two years period.

METHODS O F STUDY: Retrospective analysis of case notes of all infants' endoscopies performed between January 200 1 -December 2002.

RESULTS: 21 cases underwent airway assessment. Out of 21 patients 8 patients were diagnosed to have laryngomalacia. Six were female and two were males. The age of infants ranges from 1 to 3 months and they were 6 Malays, 1 Chinese and 1 Indian. Three patients were treated conservatively and the remaining five patients underwent aryepiglottoplasty for severe laryngomalacia. Endoscopic aryepiglottoplasty resulted in improvement of airway in all five infants.

CONCLUSION: All infants with airway symptoms should have a thorough flexible or rigid endoscopy evaluation of their upper and lower airways. These patients need to be assessed in regional centers. Aryepiglottoplasty is an effective to tracheostomy in carefully evaluated patients with severe laryngomalacia.

Key words: Infant-laryngomalacia-aryepiglonoplasty

Introduction

Laryngomalacia is a common cause of pediatric stridor seen in newborn. The condition usually becomes apparent shortly after birth and worsen over the next few months and usually resolves by eighteen months. Local neurological factors have been implicated in the flaccidity of the supra glottis in these infants. Flexible nasopharyngolaryngoscopy reveals inward collapse of the aryepiglottic folds and cartilages. The stridor worsened while crying or in excited state, often in supine position where the supraglottic structures may collapse inwards. The neuromuscular theory is enhanced by fact that gastro-esophageal reflw disease sometimes coexists. If feeding difficulties, apnea, cyanosis or failure to thrive develop, surgical measures may be necessary. Although the laryngomalacia is usually self limited, the symptoms may become severe that operative procedure cannot be avoided. The endoscopic aryepiglottoplasty has been advocated recently. The short aryepiglottic folds are incised, resulting in epiglottic release and the redundant supra- arytenoids mucosa and submucosa in trimmed ensuring that an intact inter-arytenoids mucosal

bridge is left at the posterior commissure to prevent inter arytenoids scarring6. in most patients associated symptoms improved or completely resolved after surgical treatment.

Endoscopic aryepiglottoplasty is an effective alternative to tracheostomy in carefully evaluated patients with severe laryngomalacia.

Materials and Methods

Retrospective analysis of cases notes of all infants' endoscopies performed between January 2001-December 2002 was carried out. The data were collected from the operative notes, clinic outpatient unit and special care nursery. All cases below one year who has been referred to the Otorhinolaryngology department for airway problem were included in the study. Most of them underwent flexible nasopharyngoscopy for diagnosis in the clinic or in the operation theatre before proceeding for futher intervention. Indications for surgical intervention for laryngomalacia include severe stridor with chest wall retraction, failure to thrive or cyanotic


attack. The infants were followed up at 2, 4, 12 weeks' interval.

Results

In this study, 21 cases underwent airway assessment. Out of 21 patients 8 infants were diagnosed to have laryngomalacia. Six of them were females and 2 of them were males. The age of infants ranges from 1 to 3 monts. Out of 8 infants majorities 6 were Malays, with 1 Chinese and 1 Indian. All eight cases presented with stridor. 5 cases presented with chest wall retraction while 2 cases presented with failure to thrive.

Out of the eight, three patients were treated conservatively and the remaining five patients underwent bilateral aryepiglottoplasty for severe laryngomalacia. Endoscopic aryepiglottoplasty resulted in improvement of airway in all the five infants. The infants were followed up at 2, 4, 12 weekly interval. During follow-up, the improvement of stridor, absence of chest wall retraction and weight gain were noted as good prognostic indicators. Five infants who underwent surgery improved dramatically within 24 hours. There was no stridor noted in all 5 infants but all were still having chest wall retraction. During first follow-up after 2 weeks, four infants were still having chest wall retraction. After 4 weeks all infants showed signs of improvement insluding weight gain, absence of chest wall retraction and absence of stridor. At the end of 12 weeks the infant's weight gain were dramatically improved.

Discussion

Laryngomalacia in the most common cause of neonatal and infantile stridor and is responsible for 59.8% of congenital laryngeal abnormalities presenting with airway obstruction'. Mcswinsy et al described three variations of normal supraglottic anatomy, which predispose to laryngomalacia: (1) A long curled (omega shape) epiglottis which prolapses posteriorly on inspiration. (2) Short aryepiglottic folds and (3) bulky arytenoids capable of prolapsing forwards on inspiration. Endoscopic appearance often shows combination of these features. Large series of congenital anomalies cite a 50% to 70% incidence of laryngomalacia (Ferguson 1972, Holinger et al 1954, Narcy et al 1984). Holinger (1980) reported 605 cases of congenital laryngeal abnormalities in children result fiom

laryngomalacia and congenital subglottic stenosis is the second most common cause of stridor in neonates, infants and children.

In the past tracheostomy was one of the options for the most severe cases of laryngomalacia, although this procedure carries a recognized morbidity and significant mortality. No patient requires tracheostomy in our series. The first endoscopic procedure was undertaken by Iglauer and involved partial epiglottic resection. In 1984 Lane described excision of supra glottic tissue4 and in 1985 Seid described the incision of the aryepiglottic folds5. we incised the aryepiglottic fold on both sides and trim the redundant tissue in supra glottic region whenever necessary.

All infants improved with stridor absence at chest wall retraction and gained weight considerably. Another reason for the complete recovery in all may be that there were no neurological or neuro muscular deficits.

After the surgery, three patients developed pneumonia as complication. This was a result of early oral feeding. It was noted that after surgery the reflexes are poor and early oral feeding and up with aspiration pneumonia.

Conclusion

All infants with airway symptoms should have a thorough flexible or rigid endoscopy evaluation of their upper and lower airways. These patients need to be assessed in regional centers. Aryepiglottoplasty is an effective alternative ti tracheostomy in carefully evaluated patients with severe laryngomalacia.

Acknowledgements

The authors wish to thank the Director of Hospital Melaka and the Director of the State Health Department for giving permission to publish this paper.

References

1. Holinger LD. Etiology of stridor in neonate, infants and child. Ann.Otol.Rhino1 Laryngol 1980; 89:397-400

2. McSwiney PF, Cavanagh NP, Languth P. 0u:come in the congenital stridor (laryngomalacia) Arch Dis Child 1977; 52:2 15-8


Ferguson CF pediatric otolaryngology, Vol 2. Philadelphia; Saunders 1972; P 1 168 Hollinger PH, Johnson KC, Schiller F. Congenotal anamalies of the larynx. Ann otol rhino1 laryngol 1954; 63-581 Narcy P, Bobin S, Contencin P et al Anomalies laryngies du nauveau-ne apropos de 687 Observations. Ann otolaryngol chir cervicofac 1984; 10 1 :363 Iglauer S. Epiglotidectomy for the relief of congenital laryngeal stridor with a report of a case laryngoscope 1922; 3256-9

7. Lane RW, Weider DJ, Steinem C, Marin- Padilla M. Laryngomalacia. A review and case report of surgical treatment with resolution of pectus excavaturn. Arch Otolaryngol 1984; 1 10546-5 1

8. Seid AB, Park SM, Kearns MJ, Gugenheim S. Laser division of the aryepiglottic folds for severe laryngomalacia. Int J Pediatric Otorhinolaryngol 1985; 10; 153-8

9. Toynton SC, Saunders MW, bailey CM. Aryepiglottoplasty for laryngomalacia: 100 consecutive cases. J Laryngol Otol. 2001 Jan; 1 15(1):35-8


A Review of Tuberculosis Incidence in Kinta District

Noridah Othman, Hairul Izwan Abdul Rahman, Hazlee Abdul Hadi

Pejabat Kesihatan Kinta, Jalan Aman, 3 1000 Batu Gajah, Perak

Abstract

Tuberculosis has been noted to increase progressively for the last 5 years in Malaysia (except in 2002). There is increased incidence in the elderly and the socio-economically deprived. In Kinta District there is high incidence among the aborigines, however in numbers, the Chinese have more infected cases. The setback to the control programme is the lack of early diagnosis and incompleteness of treatment. For success in the control programme, there should be active co-operation from the public, health workers and non-governmental organizations.

Introduction

Tuberculosis (TB) affects about 8 million individuals worldwide with an estimated 3 million deaths a year and is expected to rise to 5 million by the year 2050'. The treatment of TB is considerably cheap but yet the disease remains a serious cause of death. Even though TB is treatable, not all nations can afford to get the drugs. Principally, it is the disease of poverty with 95 % of cases and 98 % of deaths occurring in developing countries. In 1993, it was so serious that the World Health Organisation (WHO) had to declare a 'global emergency'.

There are 4 principle reasons for the increasing incidence of tuberculosis2:

The increase of world population Poverty Co-infection with HIVIAIDS The emergence of multidrug resistant tuberculosis (MDRTB)

With the rapid increase in world population and disparity in income, more people are falling into the poverty trap. Several studies in developing countries show that there is a strong association between incidence of TB and poverty and this remains unchanged until today3. People who are infected with TB may infect others. Due to financial constraint, some are unable to obtain proper medical treatment for TB. Perhaps, the incidence of TB can be controlled and reduced with the eradication of poverty and the improvement of social conditions.

The co-infection with HIV greatly enhances the risk of overt tuberculosis. Susceptible individuals

are more likely to suffer from active (contagious) TB after being infected with Mycobacterium tuberculosis. In developing countries, ther are evidence suggesting that dual infectious of HIV and TB are increasing and this is contributing to increase in morbidity and mortality. Currently, it is estimated that 30 % of deaths are related to this group3. Early health interventions and improved method of detecting HIVIAIDS related TB may reduce the incidence of TB in this group-

The emergence of MDRTB is an increasing threat to tuberculosis control worldwide4. The practical solution is to concentrate on the completeness of correct tuberculosis treatment particularly in those with positive sputum smear. In view of the global emergency of tuberculosis, WHO is vigorously promoting the Directly Observed Therapy Short Course (DOTS) strategy.

In Perak, the incidence of TB in the Kinta District is the highest, where it contributes more than half of the new cases in Perak. Therefore, the objectives of this study are:

To study the magnitude of TB incidence in Kinta District To assess the achievement of case detection program in Kinta District

Methodology

We have reviewed the distribution of all tuberculosis cases in the district of Kinta from year 1998 to 2002. The data was extracted from the TB notification records in the Kinta Health Office and Chest Clinic, Ipoh General Hospital.


Epidemiology

From Table 1, there is a apparent reduction of TB incidence rate in Perak from 79.4% in 1998 to 64.6% in 2002. In Kinta, the TB incidence rate increased from 43.96% in 1999 to 49.5% in 200 1 but reduced to 3 1.62%, in 2002.

Table 1: TB Incidence ate^'^

From Table 2, it in apparent that the number of cases for the age group less than 10 years old reduced fiom 12 cases in 2000 to none in 2002. The number of TB cases remained high in the older group (age 2 1 to 40 years old) i.e from 103 cases in 1998 to 152 cases in 2002. However, for all age groups, there are marked reduction of TB cases, (380 cases in 2001 and 247 cases in 2002).

PERAK KINTA

From Table 3, the analysis shows that the number of TB cases involving males is greater than that of females. In 1998, 218 TB cases reported were of the male gender while only 96 were females. This trend is continuous throughout the following years until the year 2002. As can be seen, in 2002, TB cases involving males are still greater than that of females although the number has reduced considerably compared to the previous years.

(30.57 %)

*TB incidence rate in 2001 according to race specific: aborigine (orang asti) 0.2%, Indian 0.07%, Chinese 0.04% and Malay 0.03%.

1998 79.4 48.4

From Table 4, we can conclude that those patients from the Chinese ethnic background constitute the highest number of TB cases in the Kinta district. The data shows 148 cases of TB among the Chinese in 1998 and this number increased to 156 cases in 1999. However, according to the race specific ratio in 200 1, the highest TB incidence was among the 'orang asli' ethnic group (0.2%) followed by the Indian (0.07%), Chinese (0.04%) and Malays (0.03%)~.

2000 75.5 46.55

1999 77.4 43.96

(34.88 Yo)

Table 5: Distribution of cases by Types of

2001 73.8 49.5

(42%)

C: TB with HIVIAIDS

2002 64.6 31.62

C

From Table 5, Pulmonary TB cases contributed 90.76% of TB cases in 1998 and reached up to 93.23% in 2001 but later decreased to 88.26% in 2002. The proportion of extra-pulmonary TB doubled in 2002 compared to that in 2001. The trend is also similar for TB with HIVIAIDS.

(30%)

Achievement in contact measures

*A: Pulmonary TB, B: Extra Pulmonary TB,

4.46% 15

4.77%

(27.1%) For a period of 5 years, the number of contacts examined was rather low, ranging from 661 from the total of 1257 cases in 1998 (i.e. about 52.6%) to 1187 from the total of 1577 cases in 2001 (i.e. about 75.2%). The percentage of TB cases detected from examining the contacts was 0.8% in 1998,2% in 1999, 1.5% in 2000 and 1% in 2001. In 2002, only 58% of contacts were examined and only 0.52% was detected positive

In hospital, the percentage of sputum smear test has reduced from 1.5% in 1998 to 0.9% in 2002. However, in Health Centres, the percentage of sputum smear test only ranged from 0.2% to 0.8%. In 1998, 7.4% of sputum smear test was positive in hospital setting compared to 0.2% in health centers setting. However, in 2002, 4.4% of sputum smear test was positive in hospital setting compared to 1.7% of sputum smear test in Health Centres setting.

4.65% 10

2.91%

5.14% 12

3.43%

3.65% 12

3.13%

6.48% 13

5.26%


Discussion

Tuberculosis has been noted to increase progressively for the last 5 years even though there was a marked reduction of TB cases in 2002. Furthermore, TB has been reported to be the highest communicable disease in the district. Although the trend is difficult to understand, the possible reasons include lack of emphasis on TB programmes, the HIV pandemic and the influx of foreign workers.

In a developing country, such as Malaysia, longevity is increasing. The trend of TB incidence in the elderly has increased with age. Elderly people are more likely to suffer from TB due to reasons which include gradual shift of TB to socio-economically deprived people and behavioural changes causing delay in case- finding7. Elderly group can also be classified in the poverty group and may be living in the high TB prevalence communities and when infected with the disease, most of them very rarely turn up for treatment.

It is also noted that males are more likely to suffer from TB compared to females8. There are socio-economic and cultural factors which determine gender differentials in TB. There was a suggestion that the exposure to tuberculosis bacilli differs between male and female where there are difference in socio-economic roles and activities. The responses to illness also differ in male and female, and the barrier for early detection and treatment are probably greater for females than males. The general condition and health status of TB-infected persons also affect the progression of the disease. In areas where the female's health is worse than male's, female's risk of contracting the disease may be increased. Therefore, it is important to put an effort to identi@ and address gender differentials in the control of TB.

In Kinta, the incidence rate of TB cases is the highest in aborigines. However in numbers of TB cases, the highest is in the Chinese ethnic group. Poverty and overcrowd may contribute to the highest TB incidence in the aboriginal group. A study in the United State shows that there is an increase of TB incidence within the minority group especially among immigrants9. Factors include the prevalence of TB in the country of origin, duration of stay in the United States after immigration, inadequate screening of TB and inadequate follow-up of those who have entered

the United States with non-infectious TB. However, they have common factors, which include overcrowded and poverty. Thus, reasons for high incidence rate in aborigines and immigrants can be used for comparison due to similar circumstances in our study.

The achievement of contact investigation for TB was not improved ffom 1998 to 2002. The percentage of contacts examined was ranging only from 52.6% to 75.2%. According to the policy, all contacts should be examined for TB. Furthermore, a contact to a case of positive sputum smear test is much more likely to become infected with Mycobacterium tuberculosis. Therefore, there is a needed, in order of priority, to perform contact evaluation based on characteristics of the known or suspect TB Index case as well as the characteristics of the contact.

TI3 Smear Test is the cheapest way and a simple method to detect pulmonary TB which is widely used in developing countries. However, only half of TB patients are detected by using this methodlo. The other half would continue to propagate the disease. Indirectly, this could have grave implication on TB control programmes worldwide. In Kinta, the achievement of Sputum Smear Test was still very low compared to the requirement by the Ministry of Health which are 10% for hospital and 5% for health centres. If the requirement is not initiated proactively, the TB incidence rate will not decline.

Various strategies have been implemented to check this trend but lack of early diagnosis of cases and completeness of treatment are the setback of the programme. If we can manage these problems, the number of cases and deaths would be reduced to half within a decade. This can only be accomplished through increasing awareness among the public, health workers and non-governmental organizations. However, without active co-operation from the tuberculosis patients, the battle against TB cannot be won.

References

1. Arnadottir T. Tuberculosis: trends in the twenty-first century. Scandinavia Journal of Infectious Disease 2001; 33 (8): 563-567

2. Grange JM, Zumla A. The global emergency of tuberculosis: what is the cause? Journal of Research Soc Health 2002 June; 122 (2): 78- 81.


Davies PD. Tuberculosis: the global epidemic. J Indian Med Association 2000 March; 98 (3): 100-1 02. Bastian I, Stapledon R, Colebunders R. Current thinking on the management of Tuberculosis. Current Opinion in Pulmonary Medicine 2003 May; 9(3): 186-1 92. Kejadian Penyakit Immunisasi. Laporan Tahunan Pejabat Kesihatan Kinta 1998- 2002. Laporan Tahunan Rancangan Kawalan TB Kebangsaan, Negeri Perak 1998-2002. Davies PD. The Effects of Poverty and ageing on the imcrease in tuberculosis. Monaldi Archieve Chest Disease 1999 April; 54(2): 168- 17 1

8. Hudelson P. Gender differentials in tuberculosis: the role of socio-economic and cultural factors. Tuberculosis Lung Disease 1996 October; 77(5): 391 -400.

9. McCray E, Weinbaum CM, Braden CR, Onorato IM. The Epidemiology of tuberculosis in the United States. Clinical Chest Medicine 1997 March; 1 8(1): 99-1 13.

10. Karnholz SL. Resurgence of tuberculosis: the perspective a dozen years later. Journal Assoc Acad Minor Physician 1996; 7(3): 83- 86.


Why do we need a Healthy Workplace?

Dr Leela ~nthony' and Dr Arurnugam ~ i n g a m . ~ '

I Epidemiology Officer National Public Health Laboratory, Sungai Buloh. 2 Director, National Public Health Laboratory, Sungai Buloh.

Abstract

This paper discuss the importance of healthy workplace practices to attain sustainable organizational performance, the growing interest in this programme, processes for implementation and evaluation, problems, cost implications and success stories.

Introduction

Many organizations throughout the world are aware that healthy workplace practices achieve sustainable organizational performance and health and safety at workplaces are a growing concern for all nations. Failure to address these issues could have a significant impact on the health of the workers as well as on the productivity, business of the enterprises and the economy of the country.

There are a number of factors that determine the health of the workers. These include occupational and environmental hazards, lifestyle changes, strength of the organization and social support. It is estimated that there are two million work related deaths, 271 million injuries and 160 million occupational diseases per year ( 1 )

Workplace injuries and occupational diseases are both financial burden to the employers as well as employees. The employer has to pay the employees' salary, insurance premium, medical expenses, loss of productivity, replacement of the sick or injured worker and so on. As for the employee he has to suffer the physical pain, loss of wages in some and possible loss of his job and failure to get another job. Thus workplace is an ideal setting to promote and protect the health of the workers.

Why the growing interest in Healthy Workplace?

In the past many organizations and enterprises have been concentrating only on improving the workplace through the traditional occupational health and safety measures. Recent studies and reviews have shown that health issues have an impact on the workplace and the organization. Research has shown that an unhealthy workplace

can contribute to heart disease, emotional and mental problems and an increase in likelihood of accidents at the workplace.

The traditional methods of safety and health used in the past are now found to be insufficient due to lifestyle changes, new problems have emerged and new technologies are being introduced at the workplace. Thus one of the methods that can be used to reduce the problems at the workplace is to cany out healthy workplace programmes.

What are the problems at the workplace?

Innumerable problems exists at the workplace and they are:

e Poor occupational health services. Presence of hazards - noise, chemicals, biological, ergonomics, dangerous machinery to name a few Occupational diseases Stress at work Violence Children at work etc

How to develop a healthy workplace?

WHO in 1999 had produced guidelines for developing a healthy workplace. It considers the workplace a priority setting for health protection and heath promotion. It has clearly identified the steps that need to be taken at the national, state, local and enterprise level. Details of steps are given in the healthy workplace guidelines. (2)

What are the cost implications?

No programme can be carried out without any costs and all organizations would like to cany out projects that will maximize the productivity and minimize the costs. The costs involved in


developing a healthy workplace can be direct or indirect and they are: Direct Costs:

New Infrastructure Renovation Training courses Training materials New equipment, furniture etc Maintenance of equipment Medical supplies Medical care Health insurance Disability insurance Money spent on installing safety measures (e.g machine guards) Managing workplace hazards Others

Indirect health related costs to employers Increases sickness absenteeism, man days loss per year Reduced productivity Increased staff turnover Increased accidents Increased injuries Reduced well being of the workers Possible premature deaths of employees.

What are the benefits of healthy workplaces?

The benefits outlay the cost. No organization will under take any projects if there are no benefits. There are many benefits of developing a healthy workplace, some can be seen immediately while the others may take a while to see. The benefits are given below:

An improvement of the workplace Reduced absenteeism Reduced staff turnover Increased productivity Reduced health costs and insurance Increased safety at workplace Increased morale and self esteem of the staffs. A healthier workforce etc

How can we evaluate healthy workplaces?

Evaluation of healthy workplace is complex in nature. Many different methodologies, both qualitative as well as quantitative can be used to evaluate its success. Healthy workplaces can also be evaluated according to the outcomes, which can either be short, medium or long term or by

using input, process and output indicators. The intervention methods using a checklist and monitoring of the workplace can also be evaluated.

Are there any success projects of healthy workplaces?

Since the development of the healthy workplaces guidelines by WHO, many countries have implemented healthy workplaces in their countries. In Vietnam healthy workplaces has been implemented in small and medium scaled enterprises in Ngo Quyen District, Haipong city and Hue City. It had resulted in a change in the workplace culture, improvement of the working environment, increased health awareness and increased productivity. (3) In China it had produced improved health services, decreased prevalence of target diseases, clean, safe and healthy environment and increased well being of the employees. In Singapore similar achievements were also attained. Besides they also have introduced an award system called "The Singapore Health Award" This system has created friendly competitions among the workplaces and the best healthy workplace is given an award based upon a number of criteria. (4). In Malaysia, we do have many healthy workplaces and some of them have won awards at the National level and a good example is the Huntsman Tioxide enterprise in Terengganu.

Conclusion

Healthy workplaces are becoming a priority to a number of organizations. The benefits outnumber the costs. The success stories of the many enterprises that had benefited fiom the healthy workplaces had lead to the development of healthy workplaces in a number of countries. So why don't you start a healthy workplace in your organization today?

References.

1. ILO 2002. 2. Regional guidelines for the development of

healthy workplace WHO. 3. Evaluation of 1 year implementation of the

Regional Guidelines for healthy workplaces . in small and medium scale enterprises in

Ngo Quyen District, Haipong City and in Hue City.

4. Health Promotion Board: The Singapore Health Award.

PUBLISHED ABSTRACTS


Contamination of breast milk obtained by manual expression and breast pumps in mothers of very low birthweight infants

N-Y. Boo, A.J. Nordiah, H. Alfizah, A.H. Nor-Rohani & V.K.E. Lim.

Journal of Hospital Infection, Vol. 49, 2001

Departments of Paediatrics and Microbiology, Faculty of Medicine, Hospital University Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak,

Cheras, 56000 Kuala Lumpur, Malaysia.

Abstract

The objective of this study was to compare the rates of bacterial contamination of expressed breast milk (EBM) obtained by manual expression and breast pumps in mothers of very low birthweight (VLBW) infants (<1501g). This was randomized, controlled study carried out on 28 mothers of such babies and 92 specimens of EBM were collected: 41 specimens fi-om 13 mothers assigned to the manual group and 51 specimens fi-om 15 mothers in the breast-pump group. EBM was cultured quantitatively by the Miles and Misra method. Breast milk expressed by breast pumps (86.3% or 44/51 specimens) had a significantly higher rate of bacterial contamination than milk expressed by the manual method (61.0% or 25/41 specimens) (P=0.005). When breast milk was expressed in the hospital, there was no significant difference in contamination rates between the two methods. When breast milk was expressed at home, the rates of bacterial contamination by staphylococci (P=0.003) and Gram-negative bacilli (P=0.002) were significantly higher in the breast-pump group than the manual group. In conclusion, the rate of bacterial contamination of EBM of mothers of VLBW infants was high, especially when EBM was obtained by the breast pump or when expression was carried out at home.

Keywords: YLB W Infants; EBM; bacterial contamination

Potential larvicides from Malaysian plants

Ee G.C.L., Lim C.K., Cheow Y .L., Kamarulzaman N.H., Taufiq-Yap Y .H., Ramli I. & Lee H.L.

Tropical Biomedicine, Vol. 19(1&2), 2002

Department of Chemistry, University Putra Malaysia, 43400, Serdang, Selangor. Division of Medical Entomology, Institute for Medical Research,

Jalan Pahang, 50588, Kuala Lumpur.

Abstract

Fourteen crude extracts from seven plants of the Guttiferae, Euphorbiaceae, Annonaceae and Rutaceae families were screened for their larvicidal activity againts larvae of Aedes aegypti. Most of these plants were toxic to the mosquito larvae and indicated good LC50 values of mostly less than 200 mgml-'. Among the seven plants the ethyl acetate root extract of Mezzetia umbrellata exhibited high potential to be a natural larvicide with a very good LCso value of below 5 mogml-'.


Borrelia burgdorferi (strain B afzelio antibodies among Malaysian blood donors and patients

St. Tay, M. Kamalanathan & M.Y. Rohani.

Southest Asian Journal ofTropica1 Medicine & Public Health, Vol. 33, no. 4, 2002

Department of Medical Microbiology, Faculty of Medicine, University of Malaya; Bacteriology Unit, Infectious Disease Research center,

Institute for Medical Research, Kuala Lumpur 50588, Malaysia.

Abstract

In this study, the presence of igG and IgM antibodies against Borrelia burgdorfri (strain B. afielii) among Malaysian blood donors and patients admitted to hospital with various infectious diseases was determined. Sera were screened using enzyme-linked immunosorbent assay (ELISA); positive sera were then subjected to Western blot testing. All but one of the blood donors were negative for borrelial antibodies. Of 121 patients sera IgM antibodies were detected in 24 (19.8%) and IgM antibodies were detected in 5 (4.1%) sera. Only one of two patients with skin manifestation suggestive of Lyme disease had IgM antibody against B. afzelii. Of 30 patients with exposure to tick typhus, 4 (13.3%) were IgM positive and 1 (3.3%) was IgG positive. Based on the detection of antigenic bands by Western blot, 6 patients' sera showed positive reactions. Antigenic of bands p39,p41 and ~59162 kDa were the commonest findings of Western blotting. This study provides serological evidence of B. afielii infections in Malaysia; further investigation is needed to correlate serological and clinical findings.

Isolation and PCR detection of rickettsiae from clinical and rodent samples in Malaysia

S.T. Tay, M.Y. Rohani, T.M. Ho and S. Devi.

Southeast Asian Journal of Tropical Medicine & Public Health, Vo1.33 no.4, 2002

Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Malaysia;

Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia.

Absract

Isolation of rickettsiae from patients blood samples and organ samples of wild rodents from areas with high seroprevalence of rickettsia] in fections was attemped using cell culture assay and animal passages. L929 mouse fibroblast cells grown in 24 well tissue culture plate were inoculated with b u m coat of febrile patients and examined for the growth of reikettsiae by Giemsa, Gimenez staining and direct immunofluorescence assay. No rickettsiae were isolated from 48 patients'blood samples. No symptomatic infections were noted in mice or guine pigs infected with 50 organ samples of wild rodents. There was no rickettsial DNA amplified from these samples using various PCR detection systems for Orientia tsutsugamushi, typhus and spotted fever group rickettsiae.


An unusual mutation in RECQ4 gene leading to Rothmund-Thomson syndrome

Pauline Balraj, Pat Concannon, Rahman Jarnal, Alessandro Beghini, T.S. Hoe, Alan Soobeng Khoo & Ludovica Volpi.

Mutation ResearcWFundamental and Molecular Mechanisms ofMutagenesis, Vol. 508, Issuesl-2, 2002

Division of Molecular Pathology, Cancer Cntre, Institute for Medical Research, 50588, Kuala Lumpur, Malaysia.,

Molecular Genetics Program, Virginia Mason Research Centre, 120 1 Ninth Avenue, Seattle, WA 98101-2795, USA.,

Department of Paediatrics, Faculty of Medicine, National University of Milan, Via Viotti 5,20133, Milan, Italy.,

Paediatrics Clinic, Selangor Medical Centre, Selangor, Malaysia.

Abstract

Rothmund-Thomson syndrome (OMIM #268400) is severe autosomal recessive genodennatosis: characterized by growth retardation, hyperpigmentation and frequently accompanied by congenital bone defects, brittle hair and hypogonadism. Mutations in helicase RECQ4 gene are responsible for a subset of cases of RTS. Only six mutations have been reported, Thus, far and each affecting the coding sequence or the splice junctions. We report the first homozygous mutation in RECQ4 helicase: 2746-2756- delTGGGCTGAGGC in IVS8 responsible for the severe phenotype associated with RTS in a Malaysian pedigree. We report also a 5321 G----A transition in exon 17 and the updated list of the RECQ4 gene mutations.

Keywords: Rothmund-Thomson syndrome; RECQ4; Intronic mutation; Slicing

Laboratory evaluation of three herbal repellents against mosquitoes of public health importance in Malaysia

Latipah Omar and I. Vythilingam.

Tropical Biomedicine, Vol. 19(1&2), 2002

Vector Borne Disease Control Programme, Seremban, Negeri Sembilan. Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur.

Abstract

A laboratory study was carried out to evaluate the efficacy of herbal repellents and to compare protection time ofier application. Two commercially available repellents (Mosi Guard Natural, and Nn Herbal Mosquito and Insect Repellent) and one under evaluation(Durascent band) were tested against three species of mosquitoes. Forty % DEET was used as the standard. The rasults demonstrated that Nn Herbal and Mosi guard were as effective as DEET. However, durascent band gave only 60-70% protection against all three species of mosquitoes tested. The longest mean protection time was obtained by Nn Herbal against Cx. quinquefasciatus while DEET provided the longest protection time for Ae. Aegvpti and Ae. Albopictus.


Type of diabetes and waist-hip ratio are important determinants of serum lipoprotein (a) levels in diabetic patients

Hapizah M. Nawawi, Musilawati Muhajir, Yeo Chee Kian, Wan Nazaimoon Wan Mohamud, Khalid Yusoff, B.A.K. Khalid

Diabetes Research and Clinical Practice, Vol. 56, 2002

Chemical Pathology Unit, Department of Pathology, Faculty of Medicine, University Kebangsaan Malaysia (UKM), Jalan Yaacob Latif,

Cheras, 56000 Kuala Lumpur, Malaysia., Institute of Medical Research, Jalan Pahang

50588 Kuala Lumpur, Malaysia.

Abstract

This cross-sectional study compared serum lipoprotein (a) [Lp(a)] concentrations in type 1 and type 2 diabetic subjects and examined the determinants of Lp(a) concerntrations in both types of diabetes. Serum Lp(a) was measured in 26 type 1 and 107 type 2 diabetec patients and 126 non- diabetic controls. HbA, fasting lipids and urinary albumin were also assayed. Lp(a) concerntrations were higher in both type 1 and type 2 diabetic patients compared with controls (P<0.0001 and PO.OOO1, respectively), and were higher in type I than type 2 diabetic patients (Pc0.05). Waist-hip ratio (WHR) was an independent determinant of Lp(a) concerntrations in both type 1 and type 2 diabetes.

Keywords: Lipoprotein (a); Diabetes; Waist-hip ratio

Staphylococcus aureus carriage in selected communities and their antibiotic susceptibility patterns

A. Norazah, V.K.E. Lim, S.N. Munirah, A.G.M. Kame1

Medical Journal of Malaysia, Vol. 58, no. 2, 2003

Bacteriology Unit, Infectious Diseases Research Centre, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur,

Department of Biomedical Sciences, Faculty of Allied Health Sciences, University Kebangsaan Malaysia, Jalan Raja Muda Abd. Aziz, 50300 Kuala Lumpur.

Abstract

The carriage an antibiotic susceptibility patterns of Staphylococcus aureus in the community were determined. Nasal, throat and axillary swabs were taken from 100 health adults and 90 disabled nursing home inmates. Antibiotic disc susceptibility testing was conducted following the NCCLS method. Staphyloccus aureus carriage was noted in 29% of healthy adults and 47.7% of nursing home inmates. Out of 79 strains, resistance to antibiotics were as follows; penicillin (92.4%), gentamicin (2.5%), tetracycline (6.3%), fusidic acid (1 l.3%), erythromycin (3.8%), pefloxacin (5.1%), mupirocin (3.8%), amikacin (3.8%), ciprofloxacin (2.5%) and chloramphenicol (2.5%). Methicillin-resistant Staphylococcus aureus were shown to occur in healthy individuals without factors and not previously hospitalized.

Keywords: Staphylococcus aureus carriage, Community, Antibiotic susceptibil@


HIV infection among fishermen in Terengganu

Fauziah M.N., Anita S., Shaari N., Ahamad J., Pratap Senan & Muhammad Amir K.

Malaysian Journal of Public Health Medicine, Vol. 2, 2002

Disease Control Division, Department of Public Health, Ministry of Health, Malaysia. Selangor State Health department., Pahang State Health Department.,

Kelantan State Health Department., Division of Epidemiology, Institute for Medical Research, Ministry of Health, Malaysia.

Abstract

The objectives of this study were to determine the prevalence of HIV infection, risk factors and to measure the knowledge on AIDS among fishemen in Terengganu. In this survey fishermen registered with the Malaysian Fishery Development Board in Terengganu were studied. There were 600 eligible fishermen based on a list provided by the Malaysian Fishery Development Board (MFDB). Study sites were at 6 loading centres where health personnel awaited returning fishermen between 4.00pm-7.00pm during a period of one month. A total of 542 registered fishermen were studied and this corresponded to a response rate of 90.3%. The majority of the fishermen were Malays (98.6%). Nine fishermen were tested positive to HIV antibody and this corresponds to a prevalence of 1.7%. Prevalence of HIV is higher among those with a positive history of drug use, single marital status and also among the unskilled workers who represented the socio-economically poorer group of fishermen. Almost 89% of respondents have heard about HIVIAIDS and among these, 93% received information through TV and radio. The mean knowledge score was significantly higher among fishermen admitting to drug taking, sex with prostitutes, and those who have had at least secondary school education. The Prevalence of HIV infection among fishermen is higher than in the general population. Risk characterization of HIV infection was statistically significant only among fishermen who gave positive history of drug used. Findings also suggest that poorer fishermen based on multiple indicators to socioeconomic status had a higher risk of being HIV positive as well as being less knowledgeable about AIDS. Health promotion strategies should focus on the use of TV and radio as an interactive medium to reach out to risk groups among fishermen as its popularity has been determined by this study.

Keywords: HZV, occupational, epidemiology, prevalence, f~hermen, Terengganu


Increasing genetic diversity of Salmonella enterica Serovar Typhi isolates from Papua New Guinea over the Period from 1992 to 1999

Kwai-Lin Thong, Yee-Ling Goh, Rohani M. Yasin, Ming Guek Lau, Megan Passey, Gibson Winston, Mition Yoannes, Tikki Pang & John C. Reeder.

Journal of Clinical Microbiology, Vol. 40, no. 1 1,

Institute of Postgraduate Studies, University of Malaya, Bacteriology Division, Institute of Medical Reseach, Kuala Lumpur, Malaysia;

Southern Cross Institute of Medical Research, Lismore, Australia, PNG Institute of Medical Research, Goroka, Papua New Guine,

and World Health Organization, Geneva, Switzerland.

Abstract

Pulsed-field gel electrophoresis (PFGE) of XbaI-digested chromosomal DNA was performed on 133 strains of Salmonella enterica serovar Typhi obtained from Papua New Guine, with the objective of assessing the temporal variation of these strains. Fifty-two strains that were isolated in 1992 and 1994 were of one phage type, D2, and only two predominant PFGE profiles, X1 and X2, were present. Another 81 strains isolated between 1997 and 1999 have shown divergence, with four new phage types, UVS I (n=63), UVS (n=5), VNS (n=4), and Dl (n=9), and more genetic variability as evidenced by the multiple and new PFGE Xbal profiles (21 profiles; Dice coefficient, F=0.71 to 0.97). The two profiles XI and X2 have remained the stable, dominant subtypes since 1992. Cluster analysis based on the Inweighted pair group method using arithmetic averages algorithm identifies two main clusters (at 87% similarity), indicating that the divergence of the PFGE subtypes was probably derived from some genomic mutations of the XI and X2 subtypes. The majority of isolates were from patient with fatal typhoid fever had a unique X11 profiles, while four of six isolates from patients with severe typhoid fever had the X1 pattern. In addition, 12 paired serovar Typhi isolates recovered from the blood and fecal swabs of individual patients exhibited similar PFGE patterns, while in another 11 individuals had different phage types and PFGE patterns, indicating infection with multiple strains. The study reiterates the usefulness of PFGE in assessing the genetic diversity of S. enterica serovar Typhi for both long-term epidemiology and in vivo stability and instability within an individual patient.


The prevalence of Anopheles (Diptera: Culicidae) mosquitoes in Sekong Province, Lao PDR:

In relation to malaria transmission.

I. Vythilingam, R Phetsouvanh, K. Keokenchanh, V. Yengmala, V. Vanisaveth, S. Phompida and S. Lokman Hakim.

Tropical Medicine and International Health, Vol. 8, 2003

Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia. Centre for Malaria, Parasitology and Entomology, Vientiane, Lao PDR.

Abstract

A longitudinal study was carried out in three malaria endemic villages in Sekong province in the southern region of Lao PDR from August 2000 to October 2001. All night human landing collections were performed in August and October 20000 and April and October 2001. Blood snears for malaria parasites were also carried out during the same period. Mosquitoes were tested for sporozoite antigen using ALISA. In August 2000 (wet season) and April 2001 (dry season) the ovaries of the mosquitoes were examined for parity. A total of 16 species of Anopheles were caught in the study sites of which An. Dirus A, An. Maculatus sl and An. Jeyporiensis were positive for sporozoites. The Entomological Inoculation Rate (EIR) ranged from 0.06 to 0.25. There was a good correlation between EIR and vectorial capacity in the wet season, especially in Pai Mai where the prevalence of malaria was also high during the wet seasons (1 1.8 & 10.53). An. Dirus A showed ambivalence in their choice of feeding since approximately 50% bit man indoors and an equal proportion outdoors. An dirus A was the main vector in Pai Mai. Parous rate was not significantly different between the wet and dry season although it was higher in the dry season. In Takaio the parasite prevalence ranged from 8.7% (dry season) to 37.1% (wet season) and An. Jeyporiensis was the vector and the risk of infection was 0.85% in the dry season while in the wet season it was 0.99. In Toumgno An. Maculatus sl was the vector and infection was found only in August and October 2000. However, malaria prevalence ranged from 9.69 to 20.4% and was equally high in the dry season. Cattle were also present close to the houses in all villages and this might be a contributory factor for the prevalence of malaria.


Genetic diversity of clinical cand environmental strains of Salmonella enterica serotype weltevreden isolated in Malaysia

K.L. Thong, Y.L. Goh, S. Radu, S. Noorzaleha, R. Yassin, Y.T. Koh, V.K.E. Lim, G. Rusul & S.D. Puthucheary.

Journal of Clinical Microbiology, Vol. 40, no. 7, 2002

Institute of Biological Science, Faculty of Science and Department of Medical Microbiology, Faculty of Medicine, University of Malaya,

Bacteriology Division, Institute of Medical Research, Kuala Lumpur, and Department of Bacteriology and Department of Food Science,

Faculty of Food Science and Biotechnology, University Putra Malaysia, Selangor, Malaysia

AbstracThe incidence of food-borne salmonellosis due to Salmonella enterica serotype Weltevreden is reported to be on the increase in Malaysia. The pulsed-field gel electrophoresis (PFGE) subtyping method was used to assess the extent of genetic diversity and clonality of Salmonella serotype weltevreden strains from humans and the environment. PFGE of Xbal-digeasted chromosomal DNA from 95 strains of Salmonella serotype Weltevreden gave 39 distinct profiles with a wide range of Dice coeffients (0.27 to 1.00), indicating that PFGE is very discriminative and that multiple clones of Salmonella serotype Weltevreden exist among clinical and environmental isolates. Strains of one dominant pulsotype (pulsotype X 11x2) appeared to be endemic in this region, as they were consistently recovered from humans with salmonellosis between 1996 and 2001 and from raw vegetables. In addition, the sharing of similar PFGE profiles among isolates from humans, vegetables, and beef provides indirect evidence of the possible transmission of salmonellosis from contaminated raw vegetables and meat to humans. Furthermore, the recurrence of PFGE profiles X21 among isolates found in samples of vegetables from one wet market indicated the persistence of this clone. The environment in the wet markets may represent a major sourse of cross-contamination of vegetables with Salmonella serotype Weltevreden. Antibiotic sensitivity tests showed that the clinical isolates of Salmonella serotype Weltevreden remained drug sensitive but that the vegetable isolates were resistant to at least two antibiotics. To the best of our knowledge, this is the first study to compare clinical and environmental isolates of Salmonella serotype Weltevreden in Malaysia.


Durability of Red Blood Cells to Lipid Peroxidation in Haemodialysis Patients

A.S. Santhana Raj d l Louis Masalamany

[Abstract of thesis submitted to the National University of Malaysia for the degree of Bachelor of Biomedical Sciences (Honours)]

Abstract

Lipid peroxidation (LPx) in human is believed to contribute to pathological effects in patients with chronic renal failure (CRF) undergoing hemodialysis treatment. The indicator for LPx is malondialdehyde (MDA) in red blood cells. Other parameters measured in this experiment are plasma albumin, plasma protein, specific activity enzyme superoxide dismutase (SOD), specific activity enzyme catalase (CAT) and total antioxidant capacity (TAC). A comparison study was done between 30 samples from Department of Nephrology, Kuala Lumpur General Hospital and 25 controls from National Blood Bank, Kuala Lumpur General Hospital. This experiment showed a significant increase in MDA red blood cells of patients (35.2 f 1.9 nmoVg Hb) as compared to MDA red blood cells of controls (6.2 f 0.8 nmoYg Hb). Patients' TAC (60.9 f 2.1 %) is much lower compared to the controls' TAC (86.9 5 2.9 %). The difference shown was significant (p<O.OS). Specific activity of enzyme SOD (47.8 f 2.2 IU/minlg protein) and enzyme CAT (9.1 f 0.8 mmol/min/g Hb) of patients were very low compared to the specific activity of enzyme SOD (124.5 f 12.3 IU/min/g protein) and enzyme CAT (59.8 f 8.2 mmol/min/g Hb) of controls and difference was significant (p<0.05). Plasma protein (69.1 f 0.9 gll) and plasma albumin (32.9 f 0.6 gll) of patients were lower compared to plasma protein (79.5 f 0.6 d l ) and plasma albumin (39.4 f 0.7 d l ) of controls and the difference was significant ( ~ ~ 0 . 0 5 ) . This experiment also showed that there was no significant difference in patients according to their age group. Overall, this experiment showed that reduced activity of antioxidant system was the main factor causing LPx which lead to many complications in the patients undergoing hemodialysis treatment besides the disease itself.

REPORTS


Kajian Anemia di antara Ibu-ibu pada 36 Minggu Kehamilan di Daerah Sik Kedah

Chelladurai E, Habsoh H dan Rosmiah M

Jabatan Kesihatan Negeri Kedah Darul Aman, Jalan Perak Off Seberang Jalan Putra, 05 150 Alor Star, Kedah.

Abstract

Anaemia among antenatal mothers has been found to be high in the district of Sik,Kedah since the year 1999. In the year 2001, 2.3% of all registered antenatal cases in Sik was diagnosed with anaemia in contrast to Kedah with only 1.6% antenatal. This study, conducted as a District Specific Approach project, was to ascertain the causes of anaemia as well as to plan remedial actions to improve the situation. A retrospective study of 38 cases of anaemia as well as assessment for KAP (Knowledge, Attitude and Practice) among staff and the mothers were conducted. Result indicated that factors contributing or leading to anaemia in patients were late bookings for antenatal visit (42%), poor spacing (39.5%), haemoglobin examination not done as scheduled (1 8%), late referral to a medical officer when anaemia detected (26%), no further investigations for anaemia (39%) mothers from poor socio-economic group (68%) and 7.9% were not given appropriate treatment for anaemia. The KAP Study on health staff revealed that while 5% of Jururawat Desa had poor knowledge and 14.7% had poor attitude and practice in relation to anaemia, on the whole health staff had sufficient knowledge and good attitude and practices. Among the mothers, 1 1% had poor knowledge, 21% poor attitude and 21% had poor practices. Based on the results found, remedial actions were implemented in January 2002, which included creating awareness among the health staff on the effect of anaemia in pregnancy as well as treatment required. Antenatal mothers were also given health talks and cooking demonstrations during their visit to the clinic. Evaluation done in June 2002 showed improvements in all the six weaknesses identified earlier and the percentage of anaemia declined to 1.6%. ~ u k h e r evaluation will be done after 6 months.

Pengenalan

Anemia semasa mengandung merupakan masalah kesihatan di seluruh dunia. Laporan oleh WHO menyatakan prevalen anemia di kalangan ibu mengandung adalah sekitar 55.9 %. Masalah ini juga didapati lebih tinggi pada trimester ketiga berbanding trimester pertama atau kedua.

Anemia akan berlaku jika pemakanan tidak mempunyai cukup zat besi, protin, vitamin B12 dan lain-lain vitamin atau mineral yang diperlukan dalam pembentukan hemoglobin dan eritrosit. Gabungan masalah kurang pemakanan dan kehilangan darah secara kronik meningkatkan lagi risiko tinggi untuk masalah anemia yang teruk.

Anemia mempunyai impak yang signifikan terhadap kesihatan fetus dan juga ibu. Dengan paras hemoglobin < 10 grnldl, 15 hingga 30 % dari kematian ibu adalah disebabkan oleh anemia. Anemia, terutamanya yang teruk akan menyebabkan pengurangan dalarn penghantaran oksigen ke plasenta dan fetus dan ini akan mengganggu perkembangan fetus yang normal.

Terdapat perbezaan yang ketara di antara purata berat lahir bagi bayi dari ibu yang anemia dengan ibu yang mempunyai tahap hemoglobin yang normal. Ibu-ibu yang mengalami anemia mempunyai lima puluh peratus risiko untuk mendapat bayi yang rendah berat badan. Berat badan yang rendah adalah factor yang utama dalam menentukan peluang 'survival' bagi seseorang bayi. Telah dilaporkan juga, 12 hingga 28 % ibu yang anemia akan mengalami 'fetal loss', 30 % 'perinatal death', dan 7 hingga 10% 'neonatal loss'. Klebanoff et. al melaporkan bahawa anemia semasa trimester kedua dikaitkan dengan kelahiran pramasa. Kelahiran pramasa dilaporkan meningkat sebanyak 5 kali ganda bagi iron deficiency anemia dan 2 kali ganda bagi anemia yang lain. Ia juga meningkatkan morbidity kepada ibu.

Masalah anemia merupakan masalah perubatan yang paling kerap berlaku semasa mengandung. Peratus kejadian anemia di Daerah Sik sentiasa tinggi semenjak 1999 hinggalah tahun 2001 jika d i b a n d i a n dengan peratus kejadian bagi negeri Kedah iaitu 1.5 %.


50% dari mereka mempunyai sikap dan amalan yang lemah.(Jadual8).

16. KAP Pelanggan

Kebanyakan ibu mempunyai pengetahuan, sikap dan amalan yang baik. Walaubagaimanapun masih terdapat sebanyak 1 1% dari mereka rnempunyai pengetahuan yang lemah, 2 1 % menunjukkan sikap yang tidak baik dan 21% mempamirkan amalan yang tidak baik (Jadual 7).

Kajian Susulan

Satu kajian susulan telah dijalankan pada 2hb. Jun 2002. Semua kad bagi kes anemia yang berlaku di Daerah Sik dari Januari hingga Mei 2002 dikumpul untuk disemak menggunakan senarai semak yang sama. Ibu - ibu tersebut diberi soal-selidik yang serupa.

Keputusan kajian adalah seperti berikut: 1. Jumlah kes anemia : 24 kes 2. Jumlah kes anemia hingga 36 minggu

kehamilan : 8 (1.8%) 3. 67% kes anemia berjaya diiawat hingga

sembuh sebelum 36 minggu kehamilan 4. 4 kes (8%) telah menerima tranhsi

darah. 5. 18 kes (75%) telah menerima rawatan

IM Inferon.

Perbincangan

Hasil kajian telah menunjukan bahawa masalah anemia adalah disumbangkan oleh beberapa faktor di Daerah Sik iaitu :

1. Kedatangan lewat untuk pemeriksaan antinatum pertarna iaitu sebanyak 42%. Ini akan melewatkan pemberian hematinik dan seterusnya ibu-ibu yang kurang zat besi,folate atau vitamin B12 akan mendapat anemia.

2. 'Poor spacing' atau kelahiran yang terlalu kerap iaitu kurang dari 2 tahun (39.5% dari kes).

3. Kemungkinan terdapat lewat penesanan disebabkan oleh pemeriksaan hemoglobin tidak dijalankan saperti jadual(18% dari kes).

4. Kelewatan rujukan kepada pegawai perubatanlpakar perubatan keluarga (26% dari kes).

5. Ujian lanjutan tidak dijalankan menyumbang kepada 39% dari kes anemia menyebabkan tiada diagnosis yang tepat dan berkemungkinan menyebabkan masalah dalam rawatan.

6. Rawatan anemia tidak tepat mengikut tahap setiap kes (7.9% dari kes).

7. Masalah sosio ekonomi yang rendah dikalangan penduduk disini dimana 68% dari ibu mempunyai pendapatan keluarga yang kurang dari RM. 500 sebulan. Manakala 45% dari ibu-ibu hanya mendapat pendidikan di tahap sekolah rendah sahaja.

Setelah pelan tindakan dijalankan selama 5 bulan terdapat beberapa perubahan yang menunjukkan peningkatan kualiti dalam pengendalian anemia. Walaupun anemia secara umumnya hanya dapat diturunkan 0.3% tetapi kes anemia pada 36 minggu kehamilan telah dapat diturunkan sebanyak 0.7%. Ini menunjukkan tahap pengendalian yang baik di kalangan kakitangan yang terlibat dalam penjagaan antenatal.

Peningkatan juga dilihat dalam pemeriksaan Harnoglobin mengikut jadual (5.5%), ujian lanjutan dibuat selepas anemia dikesan (3 1.2%), rujukan yang betul (17%), rawatan mengikut 'model of good care' (3.9%) dan KAP pelanggan meningkat sebanyak 18%. Walaubagaimanapun tidak terdapat peningkatan dalam pemeriksaan antinatum pertama yang awal. Faktor sosio ekonomi tidak dapat dikaji semula memandangkan ia tidak dapat diselesaikan dengan pelan tindakan yang dijalankan.

Limitasi

Terdapat beberapa limitasi dalam kajian ini seperti:

1. Tempoh masa kajian susulan yang pendek iaitu 5 bulan.

2. Ibi-ibu mungkii menjawab soal selidik dengan 'bias' kerana ia dibawa oleh anggota kesihatan sendiri, terutarna soalan mengenai sikap dan amalan.

3. Terdapat data-data yang hilang seperti keputusan ujian makmal.


Jadual6: KAP Kakitangan Mengikut Kategori Jawatan

Kap kakitangan

Pengetahuan Baik Sederhana Lemah

Sikapl Baik mia an Sederhana

Lemah

Jadual7: KAP Pelanggan

Jururawat Desa Jlkesihatan

KAP

Pengetahuan Baik Sederhana Lemah

Pembantu Jururawat

Bilangan

Sikap Baik Tidak baik

Jadual8

FAKTOR

Bidan

Peratus

26 8 4

Amalan Baik Tidak baik

1. Lewat pengesanan

68 2 1 1 1

30 8

2. Lewat 'booking'

79 2 1

30 8

3. Masalah perubatan tidak dikesan

79 2 1

4. Rawatan tidak berkesan dan lewat

5. Ibu tidak komplian dengan rawatan

6. Rujukan lewat

INDIKATOR BASELINE

Ujian Hb tidak dijalankan 7 (18%) seperti dijadualkan. Kedatangan pertama < 1 2/52 kehamilan

22 (58%)

Uj ian lanjutan - FBP - Stool for ma & cyst - Se ferritin - Hb electrophoresis bila perlu

KAP kltangan 36 (95%) -rawatan tidak mengikut 3 (7.9%) model of good care

I

KAP ibu KAP baik : K- (66%) A- (79%)

Rujukan mengikut Model Of 28 (74%) ~ o o d Care I

PENILAIAN STANDARD

<5%


Penutup Rujukan

Peratus Anemia di kalangan ibu-ibu hamil adalah 1. yang tertinggi sejak beberapa tahun yang lepas di daerah Sik. Kajian District Specific Approach 2. ini adalah satu kajian retrospektif ke atas kes- kes yang berlaku pada tahun 2001 dan kajian KAP di antara ibu-ibu harnil pada tahun 2001. 3. Kajian ini telah menunjukkan beberapa faktor- faktor yang menyurnbang ke keadaan ini. Di antaranya ialah kelemahan pengendalian kes-kes anemia oleh anggota kesihatan dan faktor-faktor 4. sosial seperti taraf sosio ekonomi yang rendah dan juga sikap sebahagian ibu-ibu yang hamil. Daripada hasil kajian ini beberapa langkah- 5. langkah telah dan sedang diambil yang telah menunjukkan tanda-tanda penurunan peratus anemia dm analisa dibuat akan langkah-langkah susulan tersebut.

6.

WHO Report - Report of working Group On Anaemia, 1992, 1, 17-20 State of India's Health edited by Alok Mukhopadhyay. Voluntary Health Association of India. 1992. Thangaleela & Vijayalakshmi, P: Impact of Anaemia In Pregnancy. The Indian Journal of Nutrition and Dietetics. Sept 1994. 3 l(9). P25 1-256. Agarwal, K.N. Functional Consequences of Nutritional Anaemia. Proc. Nutr. Soc. Ind., 1991.37.pl27-132. Badole.M., Tyagi N.K. and Agarwal, M Foetal Growth, Association with Maternal Dierary Intake, Haemoglobin And Antenatal Care In Rural Area. J.Obest.et.Gynaeco1. Ind., 1992.42,32-34. Klebanoff, M.A. Anaemia And Spontaneous Pretenngaleela, T & Vi Birth. Amer.Obstet.Gynaecol., 1991,164,59-63.

IMR ACTIVITIES


Laporan Mengenai Unit Mikroskopi Elektron Pusat Sumber Penyelidikan Perubatan

lnstitut Penyelidikan Perubatan

Pengenalan

Selepas penstrukturan semula, Unit Elektron Mikroskop (EM) kini adalah sebahagian dari Pusat Sumber Penyelidikan Perubatan (Medical Research Resource Centre, MRRC). Unit ini telah diberi nafas baru dengan pelupusan unit mikroskop elektron yang lama (Model Hitachi S- 300) yang telah rosak dan pembelian dua mikroskop baru serta penempatan sepenuhnya 2 orang staf sokongan dan seorang pegawai penyelidik. Operasi sepenuhnya telah dimulakan pada Januari 2003.

Tujuan unit ini ditubuhkan adalah untuk memberi perkhidmatan sokongan dalam bidang electron mikroskop kepada pelanggan EM yang akan menggunakan peralatan terkini dan canggih sebagai suatu sumber bagi menyokong aktiviti penyelidikan mereka bagi menghasilkan penyelidikan yang lebih berkualiti

Visi - untuk dikenali di kalangan komuniti saintifik sebagai pusat mikroskopi electron yang ulung bagi penyelidikan bioperubatan.

Misi - untuk mempromosi dan menjalankan perkhidmatan mikroskopi elekton yang berkualiti.

Objektif

Unit ini bermatlamat untuk memberikan perkhidmatan terbaik dan berkualiti kepada semua pelanggan-pelanggannya.

Kami juga ingin memberi perkhidmatan yang professional, cemerlang dan menyokong aktiviti penyelidikan sains bioperubatan melalui khidmatsokongan teknikal dan latihan

Memberi pendedahan dan pengalaman kepada setiap pelanggan di dalam mengendalikan peralatan mikroskopi electron sebagai salah satu sumber kajian mereka.

Menawarkan kemudahan perkhidmatan mikroskopi electron kepada institusi lain mengikut keperluan mereka.

o3 Menyediakan keputusan kajian dalam masa satu minggu untuk dianalisa oleh penyelidik.

Perkhidmatan 1 kemudahan peralatan yang disediakan :

i. E-SEM XL-30 Scanning Electron Microscope

ii. Transmission Electron Microscope Philip - Tecnai G . . .

111. Automatic Tissue Processor - Leica iv. Sputter Coater - Baltec 005 v. Automatis Specimen Dryer - Baltec

030 vi. Ultramicrotome - Leica UCT

(ditauliahkan pada Januari 2003) vii. Video Microscope - Hirox (peralatan

terbaru, dipasang pada july 2003)

(i) Mikroskopi Elektron Imbasan (Scanning Electron Microscope, SEM).

High Vacuum

Low Vacuum

Kegunaan

Pengimejan luaran (topografi) spesimen yang konduktif atau 'coated non- conductive specimens' Pengimejan luaran sampel Yang 'outgassing7 dan non konduktif dan tidak mudah kering

Contoh spesimen

Logam Tumbuhan (Coated) Serangga (Coated) Parasit (Coated) Mikroorganisma (Coated) Tumbuhan Serangga Parasit Mikroorganisma


(ii) Mikroskopi Elektron Pancaran (Transmission Electron Microscope, TEM)

Kegunaan Pengimejan struktur dalaman tisdsel (Ultra thin tissue sections)

Tisu tumbuhan Cultured cells

Pengimejan melaui virus

staining)

(iii) Hi-Scope (Video Microscopy)

Kegunaan

Pengimejan struktur luaran sampel (penglihatan imej terus/natural, tanpa peroses)

Contoh s esimen F Bunga-Bungaan Serangga Batu-batan, dan sebagainya

Lain-lain Perkhidmatan

Lain-lain perkhidmatan yang akan disediakan pada masa akan datang adalah seperti berikut:

Memberi nasihat tentang aplikasi, cara-cara penyediaan sample dan pengendalian EM. (Penyelidik yang menggunakan alat EM dan memproses sample untuk pengendalian EM untuk projek penyelidikan hanya boleh mengendalikan alat-alat EM dengan kehadiran kakitangan Unit EM sahaja).

Memberi latihan asas ke atas penggunaan TEM dan SEM dan teknik pemprosesan spesimen.

Pencapaian dari Januari hingga Jun 2003

Laporan Penggunaan Perkhidmatan TEM di IMR Jan-Jun 2003

I Bil I Jenis Penyelidik I Jumlah I Jumlah

2. ~en ie l i d i i dari I I luar IMR l 4 I Penyelidik I sampel

1. 1 Penyelidik IMR I 1

Laporan Perkhidmatan E-SEM di IMR bagi Jan-Jun 2003.

2

(UKW JUMLAH

Bil I Jenis Penvelidik I Jumlah I Jumlah

2 6

1 . 2 .

Penyelidik IMR

I luar)

Penyelidik luar IMR (Hospital, UKM, UM & institusi

I JUMLAH

Penyelidik 6

1 1 1 119

Sampel 82

5 37

EDITORIAL BOARD


EDITORIAL BOARD

Advisor Dr. Lye Mum Sann

Editor-in-Chief Dr. Stephen Ambu

Editors Dr. Ng. Kok Han Dr. Azizah Radhi Dr. Fuzina Noor Hussein Dr. Sumitra Sithamparam Dr. Raden Shamila Hisan Cik Nur Ain Meskam En Salleh Ismail

Secretary Pn. Siti Rodziah Othman

Editorial Assistant Cik Zyafjrdah Mohamad Zin

Published by Institute for Medical Research Jalan Pahang 50588 KUALA LUMPUR

Tel: 03-26986033 Fax: 03-26937367

IMR Quarterly Bulletin Apr 2003

Documents

Transcript of IMR Quarterly Bulletin Apr 2003