Several types of water treatment technologies including adsorption are now being used to treat polluted water. In this paper the removal of phenol by adsorption will be discussed. Activated carbons are successfully applied for purification of potable water and the removal of organic pollutants in wastwater. This paper is concerned with a low cost approach to treating waste water that is significant especially for those countries where oil palm is an available agricultural product like Malaysia, Ivory Coast, Nigeria, Thailand, Papua New Guinea. In the coastal region coconut is an available agricultural product and activated carbon prepared using coconut shell is also an economical method of water treatment. The materials used in this study were Commercial Activated Carbon (CAC), prepared from coconut shell and Modified Oil Palm Shell (MOPAS) of 1 to 2 mm diameters. The surface area of CAC and MOPAS was 38.5 m2/g and 38.2 m2/g respectively and the iodine number was determined as 674 and 454 for CAC and MOPAS, respectively. From the study the result shows above 70% removal efficiency for 5 mg/L and 40% removal efficiency for 20 mg/L of phenol solution. The performance efficiency will be discussed based on batch test, following Freundlich adsorption isotherm. The results indicate that CAC exhibits a higher adsorptive capacity (Kf of 0.079) as compared to MOPAS (Kf of 0.048). Hence a better removal efficiency for CAC at lower concentration of phenol. Results from column tests show a better adsorptive capacity for CAC (2.73) as compared to MOPAS (2.48).
Breast Surgery International (BSI) was formed in 1999 as an integrated society within the International Surgical Society ISS/SIC. One goal is to promote breast surgery world wide and focus on the situation in the developing countries. An edited summary of a symposium on locally advanced breast cancer (LABC) and the current situation in two African countries and in Malaysia is reported. Diagnosis, management and treatment options differ from recommendations that prevail due to lack of resources, lack of access to facilities and cultural and socioeconomic barriers. Younger age at onset, more men are affected and locally advanced breast cancer dominates the clinical panorama. A rational treatment plan for LABC should have chemotherapy, surgery, radiotherapy and hormonal therapy as armaments. A unique opportunity exists for international interchange within a professional organization such as BSI, for providing training opportunities, for clinical and experimental studies of the world' s most common female malignancy.
MeSH terms: Breast Neoplasms/epidemiology; Breast Neoplasms/surgery*; Breast Neoplasms/therapy; Developing Countries/statistics & numerical data*; Female; Humans; International Agencies*; Malaysia/epidemiology; Mastectomy/statistics & numerical data*; South Africa/epidemiology
Glove wearing during patient treatment has been central to dental surgery infection control for over 15 years. However, little is known about the cutaneous effects of glove wearing on the hands of dental healthcare workers (DHCWs). The objective of this project was to assess the hand skin health of DHCWs before and after wearing gloves of two types and to compare this with a control group of non-DHCWs.
MeSH terms: Analysis of Variance; Dental Auxiliaries*; Dentists*; Dermatologic Agents/therapeutic use; Equipment Design; Female; Follow-Up Studies; Hand/pathology*; Hand Dermatoses/classification; Hand Disinfection; Humans; Latex/chemistry; Male; Nitriles/chemistry; Dermatitis, Occupational/classification; Statistics as Topic; Surface Properties; Time Factors; Water Loss, Insensible/physiology; Chi-Square Distribution; Case-Control Studies; Gloves, Protective; Skin Care
We report on a retrospective study of maternal deaths in Malaysia that occurred within 24 hours of delivery, abortion or operative termination of the pregnancy (defined as sudden deaths) in the years 1995-1996. There were 131 sudden maternal deaths (20.6% of all maternal deaths); postpartum hemorrhage, obstetric embolisms, trauma and hypertensive disorders of pregnancy were the main causes. There was a disproportionately increased risk of sudden maternal deaths in the Chinese and the 'other bumiputra' racial groups. The proportion of mothers who had no obstetric risk factors in the pregnancy that led to death was 16.8%. Fourteen mothers died in transit Twenty mothers died after a cesarean section. The findings of this review emphasize the fact that caregivers in obstetrics need to be forever vigilant. All maternity staff need to be well trained in emergency care and there needs to be quick referral to centers that can provide expertise in handling these emergencies.
In this review, tuberculosis of the genital tract was diagnosed retrospectively in 11 females over 15 years. The presentations of nine cases are described. Seven of the nine cases presented with ascites, vague abdominal distension, weight loss and were misdiagnosed as ovarian carcinoma. Eight women had no relevant past history. A review on clinical presentations and diagnosis of pelvic tuberculosis is presented. We conclude that although the incidence of tuberculosis is uncommon in developed countries, its prevalence appears to be increasing worldwide. Therefore, clinicians should consider tuberculosis as a differential diagnosis when encountering clinical presentations of pelvic mass and ascites.
OBJECTIVE: Bimodality in blood glucose (BG) distribution has been demonstrated in several populations with a high prevalence of diabetes and obesity. However, other population studies had not found bimodality, thus casting doubt on its universality. We address this question in four ethnic populations-namely Malay, Chinese, Indian, and the indigenous people of Borneo.
RESEARCH DESIGN AND METHODS: A national health survey was conducted in Malaysia in 1996. A total of 18,397 subjects aged > or =30 years had post-challenge BG measurements taken. To test whether BG was consistent with a bimodal distribution, we fitted unimodal normal and skewed distribution as well a mixture of two normal distributions to the data by age and ethnic groups.
RESULTS: Age-specific prevalence of diabetes varied from 1.3 to 26.3%. In all ethnic/age groups, the bimodal model fitted the log BG data better (likelihood ratio tests, all P values <0.001).
CONCLUSIONS: Bimodality in BG distribution is demonstrable even in populations with a very low prevalence of diabetes and obesity. Previous studies that found unimodality had failed to detect the second mode because of inadequate sample size, bias due to treatment of subjects with known diabetes, and inclusion of subjects with type 1 diabetes in the sample. Bimodality implies that diabetes is a distinct entity rather than an arbitrarily defined extreme end of a continuously distributed measurement.
MeSH terms: Adult; Blood Glucose/metabolism*; Diabetes Mellitus/blood; Diabetes Mellitus/epidemiology*; Ethnic Groups; Female; Health Surveys; Humans; Malaysia; Male; Middle Aged; Obesity/blood; Obesity/epidemiology; Reference Values; Sex Characteristics; Body Mass Index; Incidence; Glucose Intolerance/epidemiology*
In this study, recombinant proteins that encompassed the AD I-AD III regions of 56 kDa immunodominant gene of 2 Orientia tsutsugamushi (OT) serotypes; Gilliam and TA763 were expressed in Escherichia coli. Both recombinant proteins exhibited serologic cross-reactivity with the rabbit antisera against various OT serotypes, as evaluated by enzyme-linked immunosorbent assay (ELISA), but not against other rickettsial species, including Rickettsia typhi, R. prowazekii and TT118 SFG rickettsiae. The feasibility of using the recombinant proteins as a diagnostic reagent was further evaluated by ELISA using sera from blood donors and scrub typhus patients. The results suggested a higher affinity of the antihuman IgM than IgG with both recombinant proteins. The IgM ELISA findings were agreeable with the results of indirect immunoperoxidase (IIP) assay especially with sera of high antibody (1:1600). However, more than one antigen are probably needed for development of an effective assay for serodiagnosis of scrub typhus in endemic areas.
In 1998, an outbreak of acute encephalitis with high mortality rates among pig handlers in Malaysia led to the discovery of a novel paramyxovirus named Nipah virus. A multidisciplinary investigation that included epidemiology, microbiology, molecular biology, and pathology was pivotal in the discovery of this new human infection. Clinical and autopsy findings were derived from a series of 32 fatal human cases of Nipah virus infection. Diagnosis was established in all cases by a combination of immunohistochemistry (IHC) and serology. Routine histological stains, IHC, and electron microscopy were used to examine autopsy tissues. The main histopathological findings included a systemic vasculitis with extensive thrombosis and parenchymal necrosis, particularly in the central nervous system. Endothelial cell damage, necrosis, and syncytial giant cell formation were seen in affected vessels. Characteristic viral inclusions were seen by light and electron microscopy. IHC analysis showed widespread presence of Nipah virus antigens in endothelial and smooth muscle cells of blood vessels. Abundant viral antigens were also seen in various parenchymal cells, particularly in neurons. Infection of endothelial cells and neurons as well as vasculitis and thrombosis seem to be critical to the pathogenesis of this new human disease.
MeSH terms: Adolescent; Adult; Aged; Animals; Asia, Southeastern/epidemiology; Blood Vessels/pathology; Blood Vessels/virology; Central Nervous System/pathology; Central Nervous System/virology; Disease Outbreaks; Female; Humans; Male; Middle Aged; Neurons/ultrastructure; Neurons/virology; Swine; Zoonoses*; Paramyxovirinae/isolation & purification*; Paramyxovirinae/physiology; Paramyxoviridae Infections/diagnosis; Paramyxoviridae Infections/epidemiology; Paramyxoviridae Infections/pathology*; Paramyxoviridae Infections/virology; Central Nervous System Viral Diseases/diagnosis; Central Nervous System Viral Diseases/epidemiology; Central Nervous System Viral Diseases/pathology; Central Nervous System Viral Diseases/virology; Communicable Diseases, Emerging/diagnosis; Communicable Diseases, Emerging/epidemiology; Communicable Diseases, Emerging/pathology*; Communicable Diseases, Emerging/virology
The emergence and spread of multiresistant methicillin-resistant Staphylococcus aureus (MRSA) strains, especially those resistant to fusidic acid and rifampicin, in Malaysian hospitals is of concern. In this study DNA fingerprinting by PFGE was performed on fusidic acid- and rifampicin-resistant isolates from Malaysian hospitals to determine the genetic relatedness of these isolates and their relationship with the endemic MRSA strains. In all, 32 of 640 MRSA isolates from 9 Malaysian hospitals were resistant to fusidic acid and rifampicin. Seven PFGE types (A, ZC, ZI, ZJ, ZK, ZL and ZM) were observed. The commonest type was type ZC, seen in 72% of isolates followed by type A, seen in 13%. Each of the other types (ZI, ZJ, ZK, ZL and ZM) was observed in a single isolate. Each type, even the commonest, was found in only one hospital. This suggests that the resistant strains had arisen from individual MRSA strains in each hospital and not as a result of the transmission of a common clone.
The title molecule, C(13)H(13)N(3)O(3).H(2)O, is in the form of a monohydrated zwitterion. The tetrahydropyridinium ring adopts an envelope conformation and is nearly coplanar with the plane of the imidazoline ring. The water solvate molecule plays an important role as a bridge between zwitterions, forming molecular chains running along the c direction, which are interconnected by N-H.O hydrogen bonds into molecular ribbons. The crystal packing is further stabilized by another N-H.O and one O-H.N hydrogen bond, which interconnect the molecular ribbons.
The long surface antigen (L-HBsAg) of hepatitis B virus (HBV) plays a central role in the production of infectious virions. During HBV morphogenesis, both the PreS and S domains of L-HBsAg form docking sites for the viral nucleocapsids. Thus, a compound that disrupts the interaction between the L-HBsAg and nucleocapsids could serve as a therapeutic agent against the virus based upon inhibition of morphogenesis. Synthetic peptides correspond to the binding sites in L-HBsAg inhibited the association of L-HBsAg with core antigen (HBcAg). A synthetic peptide carrying the epitope for a monoclonal antibody to the PreS1 domain competed weakly with L-HBsAg for HBcAg, but peptides corresponding to a linear sequence at the tip of the nucleocapsid spike did not, showing that the competing peptide does not resemble the tip of the spike.
MeSH terms: Amino Acid Sequence; Animals; Binding Sites; Electrophoresis, Polyacrylamide Gel; Hepatitis B Core Antigens/metabolism; Hepatitis B Core Antigens/pharmacology*; Hepatitis B Surface Antigens/metabolism; Hepatitis B Surface Antigens/pharmacology*; Hepatitis B virus/drug effects*; Hepatitis B virus/physiology; Microscopy, Electron; Molecular Sequence Data; Peptide Fragments/chemical synthesis; Peptide Fragments/pharmacology*; Protein Binding; Rabbits; Virion/physiology; Virus Assembly/drug effects; Virus Assembly/physiology
BACKGROUND: A retrospective study was undertaken to examine the hypothesis that esophoria is associated with higher amounts of myopia. METHODS: One hundred and forty-four subjects were selected from the files of optometry clinics at the Department of Optometry, National University of Malaysia, from the years 1995 to 1998 inclusive. These subjects were matched in terms of age group, sex, race and near phoria group. Near phorias were determined by Maddox wing technique and were classified into three groups: more than six prism dioptres exophoria, zero to six prism dioptres exophoria and any esophorias. RESULTS: One way analysis of variance revealed that there were significant differences in mean myopias between the three phoria groups (ANOVA, F(2,141) = 5.34, p < 0.01). Further analysis with the Student-Newman-Keuls test showed that the amount of myopia is significantly higher in the esophoric group than in the other two groups. CONCLUSIONS: The results support the hypothesis that near esophoria is associated with high myopia. This study suggests that near phoria might be an important factor in myopia development.
Worldwide population studies have generally agreed that rheumatoid arthritis (RA) is associated with a group of HLA-DRB1 alleles which share a common amino acid sequence at residues 70-74. This represents the first study to investigate the association of HLA-DRB1 genes with susceptibility to RA amongst Malay, Chinese and Indian ethnic groups in Malaysia. One hundred and thirty three RA patients and one hundred and sixty seven healthy controls were recruited. The HLA-DRB1 alleles were studied using the Phototyping method. The subtypes of HLA-DR4 were detected by "high resolution" PCR-SSP DRB1*04 typing techniques. The prevalence of HLA-DRB1*0405 was significantly higher in Malay patients with RA than in healthy controls (28.9 vs. 8.3%, p = 0.0016, OR = 4.48, 95% CI = 1.26-16.69). Similarly, DRB1*0405 was more common in Chinese RA patients than in controls (30.0 vs. 6.7%, p = 0.0029, OR = 6.00, 95% CI = 1.67-23.48). In addition, DRB1*0901 was a predisposing factor (32.0 vs. 6.7%,p = 0.0015, OR = 6.59, 95% CI = 1.85-25.64) and *0301/04 had a protective role (4.0vs. 25.0%, p = 0.00562, OR = 0.13, 95% CI = 0.02-0.62) in Malaysian Chinese RA. RA in Indians was associated with DRB1*1001 (51.1 vs. 8.5%,p = 0.00002, OR = 11.24, 95% CI = 3.13-44.18). DRB1*0701 (13.3 vs. 42.6%,p = 0.0022, OR = 2.73, 95% CI = 1.40-5.37) may have a protective effect. Therefore, in the Malaysian population, RA is primarily associated with the QRRAA motif, and we suggest that genetic factors play a crucial role in the pathogenesis of RA, compared to environmental factors.
BACKGROUND: The purposes of this study are to determine the viewing distance with minimum heterophoria and its relationship with refractive error and the resting position of accommodation. METHODS: The heterophoria and the accommodation responses of 36 optometry students (25 emmetropes and 11 myopes) were tested. Heterophoria was measured with the Free-Space Heterophoria Card at five different viewing distances (25 cm, 33 cm, 50 cm, 100 cm and 300 cm). The dioptric viewing distance with minimum heterophoria for each individual was estimated from the graph, where heterophoria in prism dioptres was plotted against viewing distance in centimetres. The Canon R-1 autore-fractor was used to determine the accommodation response at six different viewing distances (25 cm, 33 cm, 50 cm, 100 cm, 300 cm and 600 cm). The resting position of accommodation for each individual was estimated from the graph where the accommodative stimulus in dioptres was plotted against the accommodative response in dioptres. RESULTS: The dioptric viewing distance with minimum heterophoria ranges from 0.003 D to 0.65 D in emmetropes and ranges from 0.03 D to 2.36 D in myopes. There is no difference in the dioptric viewing distance with minimum heterophoria between myopes and emmetropes. Our results show a possible but not significant correlation between the dioptric viewing distance with minimum heterophoria and the resting position of accommodation. CONCLUSIONS: The viewing distance with minimum heterophoria is not affected by refractive error (stable early-onset myopia) and is poorly correlated with the resting position of accommodation.
BACKGROUND: Causes of low vision and types of low vision devices (LVDs) prescribed in other low vision clinics have been studied extensively. Similar studies have not been conducted in Malaysia. This paper reports the results of a retrospective study of 573 patients seen at the Universiti Kebangsaan Malaysia-Malaysian Association for the Blind (UKM-MAB) low vision clinic in Kuala Lumpur. METHODS: The record cards of 573 patients seen at the UKM-MAB clinic over 10 years were examined and the following information extracted: date of first consultation, age, sex, cause of visual impairment as diagnosed by an ophthalmologist and types of low vision devices (LVDs) prescribed. RESULTS: The majority of patients were from the younger age groups with 423 (73.8 per cent) less than 50 years of age. Three hundred and ninety-five (68.9 per cent) of the subjects were males and 178 (31.1 per cent) female. The main causes of low vision were congenital structural defects including nystagmus among patients in the zero to 29 years age group, retinitis pigmentosa among the 30 to 59 years age group and age-related macular degeneration (ARM) among those over 60 years of age. CONCLUSIONS: Since the majority of the patients were from the younger age group the main causes of low vision were congenital and hereditary diseases. Three hundred and forty-one (59.5 per cent) patients seen at the low vision clinic accepted the use of LVDs.
We report the prevalence and ethnic differences of autosomal-dominant cerebellar ataxia (ADCA) in Singapore. Amongst 204 patients with ataxia who underwent genetic testing for dentatorubral-pallidoluysian atrophy (DRPLA) and for spinocerebellar ataxias (SCA) 1, 2, 3, 6, 7, 8, 10 and 12, 58 (28.4%) patients from 36 families tested positive. SCA 3 was identified in 31 (53.4%) patients from 15 families, SCA 2 in 17 (29.3%) patients from 12 families and SCA 1 in four (6.9%) patients from four families. Other SCA subtypes were rare. SCA 2 was the only subtype identified amongst ethnic Malay and ethnic Indian families. The estimated prevalence of ADCA in Singaporean families was at least 1 : 27,000. Based on the history and ancestry of Singaporeans, our study supported a founder effect for specific SCA subtypes and the association of ethnicity-specific SCA subtypes. Our findings suggest that SCA 2 is relatively common amongst the Malay race and that priority testing for SCA 3 and SCA 2 for ethnic Chinese, and SCA 2 for ethnic Malay, may be cost effective and relevant for the region.
BACKGROUND: Identification and preservation of the recurrent laryngeal nerve (RLN) is of major concern in surgery of the thyroid gland. The purpose of this study was to review the surgical anatomy of the nerve and to describe its relationship to other important structures.
METHODS: A total of 325 patients were accrued in this prospective non-randomized study from January 1999 to December 2000. All patients who had total, subtotal and hemithyroidectomies were included in this study. Each side of the thyroid gland was considered as a separate unit in the analysis of the results.
RESULTS: Two hundred and seventy-six patients had thyroidectomies as their primary operation, while 49 patients had them as a reoperative procedure. There were 276 women and 46 men (6:1 female to male ratio) with a mean age of 43.1 years (range: 10-84 years). The total number of dissections was 502. The RLN was clearly identified in 491 (97.8%) dissections: single trunk in 323 dissections (65.8%), two extralaryngeal branches in 164 dissections (33.4%), and three extralaryngeal branches in three dissections (0.6%). One non-recurrent laryngeal nerve was encountered (0.2%) in the series. The proximity of the RLN to the inferior thyroid artery (ITA) was noted in 444 (90.4%) dissections: 372 (83.8%) nerves were described to be posterior and intertwined between the branches of the ITA, and in 72 (16.2%) RLNs, they were observed to be anterior to the ITA. The close association of RLN to an enlarged tubercle of Zuckerkandl was documented in 381 dissections (73.7%). A total of 231 RLNs (60.8%) was seen in the tracheoesophageal groove, 18 (4.9%) nerves were observed to be lateral to the trachea, and in 109 (28.3%), they were posterior in location. Of concern in 23 (6.0%) dissections the RLN was on the anterior surface of the thyroid gland, which is at highest risk of injury before curving down to pass behind the tubercle of Zuckerkandl. It appears that the anterior course of the RLN was seen more often in the reoperative procedures to the thyroid gland (20%).
CONCLUSIONS: Although various methods of localizing the RLN have been described, surgeons should be aware of the variations and have a thorough knowledge of normal anatomy in order to achieve a high standard of care. This will ensure the integrity and safety of the RLN in thyroid surgery. The anatomical variation may be minor in degree, but is of great importance as it may affect the outcome of the surgery and the patient's quality of life.
Presently, globalization and the world economy maintain power relations that hamper the economic integrity and the political autonomy of the developing world. My paper addresses specific economic conditions that perpetuate poverty and poor health. I examine multinational corporations and their effects on women's health, particularly in Mexico and parts of Asia. The advent of multinational corporate business in Mexico, Malaysia, Philippines, India, and Indonesia has led to increased poverty and human rights abuses. Women bear the brunt of this because of specific international economic arrangements and their low social status, both locally and globally. As a result, their physical, mental, and emotional health is suffering. Solutions to these health problems have been proposed on multiple levels: international top-down approaches (i.e., employing international protectionist regulatory standards, exposing multinationals who infringe on their workers' human rights), as well as local grassroots organizational campaigns (i.e., conducting informational human rights workshops for factory workers). Ultimately, the answers lie in holding corporations accountable to their laborers while developing countries maintain their comparative advantage; this is the only way women's health will improve and the developing world can entice corporate investment.
MeSH terms: Asia; Economics*; Female; Health Status; Humans; Human Rights; Industry*; International Cooperation; Mexico; Politics; Poverty; Social Class; Women, Working*; Women's Health*
Nine cynomolgus monkeys were rotated randomly through four dietary treatments with each treatment lasting 6 weeks. A wash-out period of 4 weeks was maintained between each dietary rotation. The animals were fed diets containing 32% energy fat derived from palm olein (POL), lauric-myristic-rich oil blend (LM), American Heart Association (AHA) rich oil blend and hydrogenated soybean oil blend (trans). Diets were fed with (phase 1) or without (phase 2) the addition of dietary cholesterol (0.1%). In phase 1, when animals were fed without dietary cholesterol, plasma total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) was significantly raised and high-density lipoprotein cholesterol (HDL-C) was significantly depressed by the trans diets relative to all other dietary treatments. The resulting LDL-C/HDL-C ratio was also significantly increased. The LM diet increased TC significantly relative to the AHA diet while LDL-C was significantly increased compared to both POL and AHA. Apolipoprotein (apo) B was not affected significantly by these dietary treatments. Apo A1 was significantly increased by POL relative to all other dietary treatments. The trans diet reduced apo A1 and the resulting apo B/A1 ratio was increased significantly by trans relative to all other dietary treatments. Addition of 0.1% dietary cholesterol to these diets almost doubled the plasma TC and LDL-C in all dietary treatments. However, HDL-C was only marginally higher with the addition of dietary cholesterol. The LM + C (cholesterol added) diet resulted in the highest TC and LDL-C that was significant compared to all other dietary treatments. Trans + C increased TC compared to POL + C and AHA + C diets while increases in the LDL-C did not attain significance. The addition of dietary cholesterol did not affect HDL-C between treatments whereas plasma triglycerides were significantly increased by the trans + C diet relative to all other treatments. Both the trans + C and LM + C diets increased apo B and decreased apo A1 relative to the POL + C and AHA + C diets. The resulting apo B/A1 ratio was similarly altered. These results affirm that the lauric + myristic acid combination, along with trans fatty acids, increased lipoprotein-associated coronary heart disease risk factors compared to either POL or AHA.