Head injury is a significant economic, social and medical problem all over the world. Road accidents are the most frequent cause of head injury in Malaysia with highest risk in the young (15 to 24 years old). The associated outcomes include good recovery, possibility of death for the severely injured, which may cause disruption of the lives of their family members. It is important to predict the outcome as it will provide sound information to assist clinicians in Malaysia in providing prognostic information to patients and their families, to assess the effectiveness of different modes of treatment in promoting recovery and to document the significance of head injury as a public health problem.
RESULTS: A total of 103 cases with intracranial haemorrhage i.e. intracerebral haemorrhage, extradural haemorrhage, subdural haemorrhage, intraventricular haemorrhage, haemorrhagic contusion and subarachnoid haemorrhage, following motor vehicle accidents was undertaken to study factors contributing to either good or poor outcome according to the Glasgow Outcome Scale. Patients below 12 years of age were excluded. The end point of the study was taken at 24 months post injury. The selected variables were incorporated into models generated by logistic regression techniques of multivariate analysis to see the significant predictors of outcome as well as the correlation between the CT findings with GCS.
CONCLUSION: Significant predictors of outcome were GCS on arrival in the accident emergency department, pupillary reflex and the CT scan findings. The CT predictors of outcome include ICH, EDH, IVH, present of SAH, site of ICH, volumes of EDH and SDH as well as midline shift.
This study was conducted to evaluate the effect of an eminent decay fungus, Phanerocheate chrysosporium of organic residues on wastewater sludge for its improvement through decomposition and separation of waste particles by Liquid State Bioconversion (LSB). The effect of fungal treatment was compared to uninoculated (Control) at three different harvests 7, 14 and 21 days after inoculation (DAI). The observed results showed that the weight loss and solid content of wastewater sludge were significantly influenced by Phanerocheate chrysosporium. Both parameters were highly influenced at 7 DAI. The COD and pH of wastewater sludge were also highly influenced by fungal treatment.
To determine the frequency of complex features in febrile convulsion, association of complex febrile convulsion with neurological findings and risk factors associated with complex febrile convulsion.
Geographically, Turkey is situated in an area where malaria is very risky. The climatic conditions in the region are suitable for the malaria vector to proliferate. Due to agricultural infrastructural changes, GAP and other similar projects, insufficient environmental conditions, urbanization, national and international population moves, are a key to manage malaria control activities. It is estimated that malaria will be a potential danger for Turkey in the forthcoming years. The disease is located largely in south-eastern Anatolia. The Diyarbakir, Batman, Sanliurfa, Siirt, and Mardin districts are the most affected areas. In western districts, like Aydin and Manisa, an increase in the number of indigenous cases can be observed from time to time. This is due to workers moving from malaria districts to western parts to final work. Since these workers cannot be controlled, the population living in these regions get infected from indigenous cases. There were 84,345 malaria cases in 1994 and 82,096 in 1995, they decreased to 60,884 in 1996 and numbered 35,456 in 1997. They accounted for 36,842 and 20,963 in 1998 and 1999, respectively. In Turkey there are almost all cases of P. vivax malaria. There are also P. vivax and P. falciparum malaria cases coming from other countries: There were 321 P. vivax cases, including 2 P. falciparum ones, arriving to Turkey from Iraq in 1995. The P. vivax malaria cases accounted for 229 in 1996, and 67, cases P. vivax including 12 P. falciparum cases, in 1997, and 4 P. vivax cases in 1998 that came from that country. One P. vivax case entered Turkey from Georgia in 1998. The cause of higher incidence of P. vivax cases in 1995, it decreasing in 1999, is the lack of border controls over workers coming to Turkey. The other internationally imported cases are from Syria, Sudan, Pakistan, Afghanistan, Nigeria, India, Azerbaijan, Malaysia, Ghana, Indonesia, Yemen. Our examinations have shown that none of these internationally imported cases are important in transmitting the diseases. The districts where malaria cases occur are the places where population moves are rapid, agriculture is the main occupation, the increase in the population is high and the education/cultural level is low. Within years, the districts with high malaria cases also differ. Before 1990 Cucurova and Amikova were the places that showed the highest incidence of malaria. Since 1990, the number of cases from south-eastern Anatolia has started to rise. The main reasons for this change are a comprehensive malaria prevention programme, regional development, developed agricultural systems, and lower population movements. The 1999 statistical data indicate that 83 and 17% of all malaria cases are observed in the GAP and other districts, respectively. The distribution of malaria cases in Turkey differs by months and climatic conditions. The incidence of malaria starts to rise in March, reaching its peak in July, August and September, begins to fall in October. In other words, the number of malaria cases is lowest in winter and reaches its peak in summer and autumn. This is not due to the parasite itself, but a climatic change is a main reason. In the past years the comprehensive malaria prevention programme has started bearing its fruits. Within the WHO Roll Back Malaria strategies, Turkey has started to implement its national malaria control projects, the meeting held on March 22, 2000, coordinated the country's international cooperation for this purpose. The meeting considered the aim of the project to be introduced into other organizations. In this regards, the target for 2002 is to halve the incidence of malaria as compared to 1999. The middle--and long-term incidence of malaria will be lowered to even smaller figures. The objectives of this project are as follows: to integrate malaria services with primary health care services to prove more effective studies; to develop early diagnosis and treatment systems, to provide better diagnostic services, and to develop mobile diagnostic ones; to make radical treatment and monitoring patients; to conduct regular active case surveillance studies; to conduct regular vector control studies; to monitor the sensitivity of vectors to insecticides and to provide their alternatives; to design malaria control studies for the specialists of districts; to implement educational programmes among the population and attract it in controlling malaria.
Traceback systems in most countries of Asia are not well developed, as indicated by responses to a questionnaire by veterinary officials in thirteen countries. Marking of animals for traceback is practised only in a limited number of countries in specific areas or zones and for specific purposes only. In Malaysia, traceback has been undertaken by marking farm code tattoos on pigs. This enables the identification of the farm of origin of pigs found to be infected by Nipah virus in sero-surveillance programmes. The origin of the foot and mouth disease (FMD) virus that surfaced in the Republic of Korea in March 2000 was investigated through several epidemiological studies of suspected sources of contamination such as imported hay, yellow sand, milk collection trucks and feed delivery trucks. None of these studies gave results that indicated the origin of the FMD virus. The origin of the FMD virus that was recorded in Japan in March 2000 was also investigated in epidemiological studies; in this case, imported wheat straw was incriminated as the most likely source of infection. Comparative studies of the pathogenicities of FMD (type O) viruses isolated in Taipei China, the Republic of Korea and Japan, suggest that these viruses might have originated as vaccine strains used in a third country.
This present study was undertaken to validate the English version of the General Health Questionnaire (GHQ-12) in urological patients. Validity and reliability were studied in patients with lower urinary tract symptoms (LUTS) and patients without LUTS. Reliability was evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Sensitivity to change was expressed as the effect size in the pre-intervention versus post-intervention score in additional patients with benign prostatic hyperplasia (BPH) who underwent transurethral resection of the prostate (TURP). Internal consistency was excellent. A high degree of internal consistency was observed for each of the 12 items with Cronbach's alpha value of 0.37-0.79, while total scores was 0.79 in the population study. Test-retest correlation coefficient for the 12 items score were highly significant. Intraclass correlation coefficient was high (0.35-0.79). It showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significant level between baseline and post-treatment scores were observed across all 12 items in the treatment cohort but not in the control group. The GHQ-12 is suitable, reliable, valid and sensitive to clinical change in urological disorders.
The aim of this prospective study was to determine the prevalence of Cryptosporidium parvum in hospitalized children in Kota Bharu, Malaysia. Over a 19 month study period, 258 stool samples were examined from 159 children; 109 with diarrhea and 50 controls without diarrhea. Modified Ziehl-Neelsen staining method and a polymerase chain reaction (PCR) assay were used to detect C. parvum and the samples were also examined for the presence of other intestinal parasites. Only 1 of the 109 (0.9%) children with acute diarrhea was positive for C. parvum by microscopy and PCR. Thirty-one percent of children were infested with other intestinal parasites, the most common being Ascaris lumbricoides and Trichuris trichiura. In conclusion, we found C. parvum to be an uncommon infective agent in hospitalized children with or without diarrhea in Kota Bharu, Malaysia.
Tuberculosis (TB) has made a comeback. It has become a resurgent public health problem in developing countries in the tropics and is the leading cause of death from any single infectious agent. Non-compliance to anti-tuberculosis treatment is the most serious problem in TB control. A cross-sectional study was conducted to investigate the determinants of poor compliance with anti-tuberculosis treatment among tuberculosis patients in Kota Bharu, Kelantan, Malaysia in 1999. A total of 390 patients were included in the study of which 130 were tuberculosis patients who defaulted treatment and 260 were those compliant to treatment. Data collection was done by interviewing the patients and collecting clinical and laboratory data from their medical records. Using multiple logistic regression analysis, patients who were not on direct observed therapy (DOT) lived distant to the health facility, were non-intravenous drug users (IVDU) and were HIV positive had statistically significant higher odds of being non-compliant. Patients should be given treatment under direct supervision with special attention to IVDU and HIV positive groups. Anti-TB treatment should be accessible to patients at the nearest health center from their residence. Interventions with health education programs emphasizing the benefits of treatment compliance should be implemented by further large-scale multicentered studies.
Study site: Chest clinic, Hospital Kota Bharu, Kelantan, Malaysia
Mycoplasma pneumoniae is increasingly recognized as an important cause of community acquired pneumonia (CAP) in children. We determined the importance of M. pneumoniae as a causative agent in 170 children aged 1 month to 15 years who were hospitalized with CAP over a 6-month period. The diagnosis of M. pneumoniae infection was based on serological evidence obtained by a particle agglutination test (SERODIA-MYCO II). A positive serological diagnosis was made if the acute phase serum titer was more than 1:160 or paired samples taken 2-4 weeks apart showed a four-fold or greater rise in the serum titer. M. pneumoniae was identified as the causative agent in 40 (23.5%) children. Children with M. pneumoniae infection were more likely to be older than 3 years (OR 4.0 95%CI 1.8-9.1, p<0.001), Chinese (OR 4.3 95%CI 2.0-8.9, p<0.001), have a duration of illness longer than 7 days prior to admission (OR 6.0 95%CI 2.7-13.5, p<0.001) and have perihilar interstitial changes on chest X-ray (OR 4.6 95%CI 2.2-9.9, p<0.001). A significant number of hospital admissions for CAP in Malaysian children can be attributed to M. pneumoniae. It is important to identify these children so as to administer the most appropriate antibiotic treatment.
Fermented fish and meat samples were purchased from supermarket and wet market for microbiological analysis of Listeria species and Listeria monocytogenes contamination. Listeria species were isolated from 17 (73.9%) of 23 samples of imported frozen beef, 10 (43.5%) of the 23 samples of local beef and 14 (56%) of the 25 samples of fermented fish from wet market. Listeria monocytogenes occurred in 15 (75%) of the frozen beef samples, 6 (30.4%) of the 23 samples of local meat and 3 (12%) of the 25 samples from fermented fish. Listeria species was not isolated from any of the 23 samples of imported frozen beef from supermarket and from the 5 samples of buffalo meat examined. This highlights the possibility of Listeria spp or L. monocytogenes to persist in meat and fermented fish in wet market and raises the problem of illness due to the handling and consumption of Listeria-contaminated meat or fermented fish are likely as evidence by the high contamination rates of samples sold at the wet market.
MeSH terms: Fish Products/microbiology*; Food Microbiology; Listeria/classification; Listeria/growth & development; Listeria/isolation & purification*; Malaysia; Meat Products/microbiology*; Species Specificity
A cross-sectional study was conducted to identify the factors related to smoking habits of secondary school teachers in Kelantan, Malaysia. A total of 180 male teachers and trainee teachers from four secondary schools in Kelantan and a Teachers' Training College were interviewed by using a structured questionnaire. Cluster sampling was applied. The significant findings found were current smokers were found as high as 40.56%. Mean duration of smoking was 6.8 years and mean initiation age was 16.5 years. Trainee teachers had a significantly higher proportion of current smokers. There was a significant association between smoking status of teachers and their fathers' and perception of the hazards of smoking on health. Peer influence was found to be the major reason for smoking among smokers. Religious belief and care for health attitude prevented non-smokers from smoking. About 3/5 of smokers thought of quitting smoking and of these 1/4 had tried at least once. There was a significant difference of proportion of attempted quitting between regular and occasional smokers. Mass media was the best source of information on knowledge about smoking hazards. Anti-smoking campaigns should start as early as possible in schools. Lectures and talks on smoking should be included in the curriculum of teachers' training courses.
MeSH terms: Adult; Cross-Sectional Studies; Data Collection; Humans; Malaysia; Malaysia/epidemiology; Male; Peer Group; Smoking/epidemiology*; Health Behavior; Prevalence; School Teachers
Using the reverse transcription-polymerase chain reaction (RT-PCR) and direct sequencing, capsid protein and non-structural protein 1 (nsP1) regions of Sagiyama virus and eight Getah virus strains were analysed. The viruses were isolated from Malaysia and various areas of Japan over a period of 30 years. Based on the available published sequence data, oligonucleotide primers were designed for RT-PCR and the sequences were determined. Our findings showed that though there were differences in the nucleotide sequences in the nsP1 region, there was 100% amino acid homology. On the other hand, in the capsid region, the nucleotide differences caused a major difference in the amino acid sequence. Therefore, the difference in the capsid region is one of the useful markers in the genetic classification between Sagiyama virus and strains of Getah virus, and might be responsible for the serological difference in complement fixation test. The genomic differences among the Getah virus strains are due to time factor rather than geographical distribution.
AIMS: Rhodovulum sulfidophilum was grown in sardine processing wastewater to assess growth characteristics for the production of bacterial biomass with simultaneous reduction of chemical oxygen demand.
METHODS AND RESULTS: Growth characteristics were compared in diluted and undiluted, settled and non-settled wastewater growing in anaerobic light and aerobic dark conditions; and also at different agitation speeds. The highest biomass (8.75 g l(-1)) and a reduction in chemical oxygen demand of 71% were obtained in unsettled, undiluted wastewater after 120 h culture with 15% inoculum. In settled wastewater, highest biomass (7.64 g l(-1)) and a COD reduction of 77% was also obtained after 120 h. Total biomass was higher (4.34 g l(-1)) after 120 h culture in anaerobic light compared to (3.23 g l(-1)) in aerobic dark growth.
CONCLUSIONS, SIGNIFICANCE AND IMPACT OF THE STUDY: Better performance, mean of total biomass (6.97 g l(-1) after 96 h), total carotenoids (4.24 mg g(-1) dry cell from 24 h) and soluble protein (431 microg ml(-1) after 96 h) were obtained from aerobic dark culture at 300 rev min(-1). The COD reduction, however, was lower (69%) after 96 h culture. Thus, the benefits in the production of bacterial biomass in non-sterilized sardine processing wastewater with the reduction of chemical oxygen demand could be achieved.
Nipah virus is a newly discovered paramyxovirus transmitted directly from pigs to humans. During a large encephalitis outbreak in Malaysia and Singapore in 1998-9, most patients presented acutely. A 12 year old child is described who developed encephalitis 4 months after exposure to the virus. She was diagnosed by a new indirect IgG enzyme linked immunosorbent assay (ELISA), which is also described. The late presentation and IgG subclass responses had similarities to subacute sclerosing panencephalitis. Nipah virus should be considered in patients with encephalitis even months after their possible exposure.
The aphrodisiac effect of Eurycoma longifolia Jack (0.5 g/kg) was evaluated in noncopulator male rats using an electrical cage. Fractions of E. longifolia Jack decreased the hesitation time of noncopulator male rats, throughout the investigation period. Furthermore, it possessed a transient increase in the percentage of the male rats responding to the right choice, more than 50% of the male rats scored "right choice" after 3 weeks post-treatment and the effect became more prominent after 8 weeks post-treatment (only 40-50% of the control male rats responded to the right choice) using the electrical copulation cage. Hence, this study lends further support to the use of the plant by indigenous populations as a traditional medicine for its aphrodisiac property.
Laryngeal foreign bodies, especially in children, mostly present as an acute emergency. Few cases of long-standing laryngeal foreign bodies have been reported in the literature. This case illustrates one of the sequelae of a neglected laryngeal foreign body, resulting in significant granulation tissue formation in the larynx, and its management.
MeSH terms: Animals; Bone and Bones; Child, Preschool; Diagnostic Errors; Foreign Bodies/surgery; Humans; Laryngoscopy; Male; Radiography; Time Factors
The bioavailability of beta- and gamma-cyclodextrin artemisinin complexes was evaluated in comparison with a normal commercially available preparation, Artemisinin 250. Twelve healthy male volunteers participated in the study conducted according to a three-way crossover design. The bioavailability was compared using the parameters, total area under the plasma level-time curve (AUC(0-infinity)), peak plasma concentration (C(max)), and time to reach peak plasma concentration (T(max)). A statistically significant difference was observed between the values of the complexes and Artemisinin 250 for the three parameters. However, no statistically significant difference was observed between the values of the beta- and gamma-cyclodextrin complexes. Moreover, the 90% confidence interval for the ratio of the AUC(0-infinity) values of the beta-cyclodextrin complex over those of Artemisinin 250 was estimated to be between 1.51-2.04, while that of C(max) was between 1.73-2.93. For the gamma-cyclodextrin complex, the respective intervals were 1.30-1.76 and 1.43-2.43. These findings indicated that the beta- and gamma-cyclodextrin complexes had a much higher rate and extent of bioavailability compared to Artemisinin 250. In addition, the absorption of artemisinin was observed to be poor and negligible when the preparations started to arrive in the colon. This could be attributed to poor dissolution of artemisinin in the semi-solid faecal matter in the lower part of the gastrointestinal tract.
MeSH terms: Adult; Antimalarials/pharmacokinetics*; Biological Availability; Cyclodextrins/pharmacology*; Drug Interactions; Gastrointestinal Transit; Half-Life; Humans; Male; Metabolic Clearance Rate; Sesquiterpenes/pharmacokinetics*; Cross-Over Studies; Area Under Curve; Artemisinins*
Landfills are sources of groundwater and soil pollution due to the production of leachate and its migration through refuse. This study was conducted in order to determine the extent of groundwater and soil pollution within and around the landfill of Seri Petaling located in the State of Selangor, Malaysia. The condition of nearby surface water was also determined. An electrical resistivity imaging survey was used to investigate the leachate production within the landfill. Groundwater geochemistry was carried out and chemical analysis of water samples was conducted upstream and downstream of the landfill. Surface water was also analyzed in order to determine its quality. Soil chemical analysis was performed on soil samples taken from different locations within and around the landfill in the vadose zone (unsaturated zone) and below the water table (in the soil saturated zone). The resistivity image along line L-L1 indicated the presence of large zones of decomposed waste bodies saturated with highly conducting leachate. Analysis of trace elements indicated their presence in very low concentrations and did not reflect any sign of heavy metal pollution of ground and surface water or of soil. Major ions represented by Na, K, and Cl were found in anomalous concentrations in the groundwater of the downstream bore hole, where they are 99.1%, 99.2%, and 99.4%, respectively, higher compared to the upstream bore hole. Electrical conductivity (EC) was also found in anomalous concentration downstream. Ca and Mg ions represent the water hardness (which is comparatively high downstream). There is a general trend of pollution towards the downstream area. Sulfates (SO4) and nitrates (NO3) are found in the area in low concentrations, even below the WHO standards for drinking water, but are significantly higher in the surface water compared to the groundwater. Phosphate (PO4) and nitrite (NO2), although present in low levels, are significantly higher at the downstream. There is no significant difference in the amount of fluoride (F) in the different locations. In the soil vadose zone, heavy metals were found to be in their typical normal ranges and within the background concentrations. Soil exchangeable bases were significantly higher in the soil saturated zone compared to the vadose zone, and no significant difference was obtained in the levels of inorganic pollutants. With the exception of Cd, the concentration ranges of all trace elements (Cu, Zn, Cr, Pb, and Ni) of Seri Petaling landfill soils were below the upper limits of baseline concentrations published from different sources.
MeSH terms: Aluminum Silicates/analysis; Data Collection; Electric Conductivity; Electrodes; Fresh Water/analysis*; Fresh Water/chemistry; Hydrogen-Ion Concentration; Image Processing, Computer-Assisted; Malaysia; Metals, Alkali/analysis; Metals, Alkaline Earth/analysis; Refuse Disposal; Soil Pollutants/analysis*; Water Pollutants, Chemical/analysis*; Water Pollution, Chemical/analysis*; Phosphorus Compounds; Nitrogen Compounds; Metals, Heavy/analysis*
In this study, the genome of the Plasmodium falciparum Gombak A strain was examined for the presence of a gene encoding falcipain-2, a cysteine protease, using homology-based polymerase chain reaction cloning. The nucleotide sequence obtained from the gene cloned (designated pFG1) is approximately 99% homologous to other falcipain-2 genes from different strains. Comparatively, it is 69% homologous to falcipain-3 genes. Direct cloning of the falcipain-2 gene and its resemblance to the reported corresponding mRNA transcript suggests the absence of introns in this gene. Sequence alignment and comparison revealed four amino acid differences at positions 15, 51, 59 and 414 in the falcipain-2 from P. falciparum Gombak A as compared to other falcipain-2 proteins from different strains.