Pyruvate dehydrogenase deficiency is an important cause of primary lactic acidosis. Most cases occur as a result of mutations in the gene for the E1 alpha subunit of the complex, with a small number resulting from mutations in genes for other components, most commonly the E3 and E3-binding protein subunits. We describe pyruvate dehydrogenase E3-binding protein deficiency in two siblings in each of two unrelated families from Kuwait. The index patient in each family had reduced pyruvate dehydrogenase activity in cultured fibroblasts and no detectable immunoreactive E3-binding protein. Both were homozygous for nonsense mutations in the E3-binding protein gene, one involving the codon for glutamine 266, the other the codon for tryptophan 5.
We present a case of a middle-aged woman with a mass in the posterior third of the tongue which was diagnosed as a tongue haemangioma. The tumour was successfully excised via a midline mandibular osteotomy and tongue splitting approach. The histopathology examination, however, revealed the 5x4 cms mass to be a lingual thyroid. The salient features of this unusual presentation of a thyroid enlargement will be discussed.
Comment in: Ng CS, Mohd MS. Lingual thyroid--a lesson to learn. Med J Malaysia. 2005
Backgrounds and aims: The Asian Young Diabetes (ASDIAB) project is a five-year prospective study on the clinical and immunological characterisation of diabetes in newly diagnosed young Asians. This paper aims at evaluating the aetiological classification of diabetes in these patients based on presence/absence of islet autoantibodies and beta cell function at disease presentation and one year.
Materials and methods: A total of 919 patients (from Beijing, Shanghai, Hong Kong, India, Malaysia and Singapore) with age at diagnosis 12-40 years and diabetes duration <12 months were recruited between 1997 and 1999. Complete information on autoantibodies to glutamic acid decarboxylase (GAD) and IA-2 and fasting C-peptide at baseline and 1 year were available in 633 patients. Antibody positivity (Ab+) was defined by presence of GADab and/or IA-2 abo Poor beta-cell function was defined with fasting C-peptide <0.3nM at one year. TlDM was identified in patients Ab+ at diagnosis (irregardless of p cell function status) and in those Ab- at diagnosis and I-year, but demonstrated poor beta-cell function at I-year. Patients who were Ab- at diagnosis and I-year but had good beta cell function (fasting C-peptide >=0.3nM) at I-year were classified as having type 2 diabetes (T2DM).
Results: 139 patients (22%) were classified as having T1DM. Of these, 90 were Ab+ and 49 were Ab- and had poor beta cell function. The remainder 494 patients (78%) were classified as having T2DM. The ethnic distribution of T1DM patients (73% Chinese, 16% Indians and 11 % Malays) was similar to the T2DM. Compared to T2DM, T1DM patients were significantly younger at diagnosis (mean age 28.0 vs 32.9 yrs), leaner (mean BMI 21.5 kg/m' vs 25.9 kg/m' at diagnosis, 22.0 kg/m2 vs 26.1 kg/m2 at 1 year), and had significantly higher HbA1 , (11.8% vs 9.7% at diagnosis; 8.9% vs 8.0% at 1 year) . Median fasting C-peptides were significantly lower in T1DM than T2DM patients (0.2 vs 0.7 nM at diagnosis; 0.2 vs 0.8 nM at 1 year). T2DM were more insulin resistant than T1DM patients as assessed by HOMA index (median 5.8 vs 4.4 at diagnosis, 4.9 vs 3.4 at 1 year).
Conclusions: In Asians with young onset diabetes, assessment at diagnosis and one year for islet autoantibodies (GADab and lor IA-2Aab), together with estimation of p-cell function with fasting serum C-peptide levels, were useful for classifying patients as having T1DM and T2DM .
Grant from Novo Nordisk Asia Pacific, Singapore
40th EASD Annual Meeting of the European Association for the Study of Diabetes : Munich, Germany, 5-9 September 2004
MeSH terms: Beijing; Adult; Autoantibodies; C-Peptide; China; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Fasting; Germany; Glutamate Decarboxylase; Hong Kong; Humans; India; Insulin; Malaysia; Prospective Studies; Singapore; Thinness; Body Mass Index; Asian Continental Ancestry Group
There are disturbing trends of emerging and re-emerging infectious diseases, globally and locally thus giving it a real cause of concern. These include diseases by agents hitherto unknown in human such as Severe Acute Respiratory Syndrome (SARS) and Ebola; those that were purely zoonoses but had now affected man such as bovine spongioform encephalitis (BSE) in United Kingdom and avian influenza in Vietnam and Thailand; those that were thought to be eliminated but reappeared such as plague in India and those that begun to show reverse trends such as tuberculosis (TB) and malaria. Malaysia is no exception. Viral fever EV71, Chinkugunya, Conjunctivitis C24 variant or Nipah encephalitis were local examples of unknown or exotic infectious diseases occurring in recent years. In this age of globalization with expanding air travel and industrial trade, Malaysia is vulnerable to a wide array of new and resurgent infectious diseases. Apart from the direct health consequences on morbidity, mortality and its staggering cost, these infections also have far reaching implications upon sustainable development, psychosocial, economic, political and global security.
MeSH terms: Animals; Cattle; Communicable Diseases; Conjunctivitis; Conservation of Natural Resources; Encephalitis; Fever; Influenza in Birds; Great Britain; Humans; India; Malaria; Malaysia; Plague; Thailand; Tuberculosis; Vietnam; Zoonoses; Hemorrhagic Fever, Ebola; Communicable Diseases, Emerging; Internationality; Severe Acute Respiratory Syndrome; Air Travel
Workers in the health care industry and related occupations are at risk of occupational exposure to blood borne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and other potentially infectious agents. The primary route of occupational exposure to blood borne pathogens is accidental percutaneous (through the skin) injury. Health care workers handle sharp devices and equipment such as hypodermic and suture needles, intravenous blood collection devices, phlebotomy devices, and scalpels. Health care workers with the most involvement in direct patient care e.g., nursing staff, sustain the highest proportion of reported NSIs (needle stick injuries).
MeSH terms: Breast Feeding; Patient Care; Health Personnel; Hepatitis B virus; Humans; Malaysia; Needles; Nursing Staff; Occupations; Sutures; HIV Infections; Hepacivirus; Occupational Exposure; Needlestick Injuries; Blood-Borne Pathogens; Phlebotomy; Health Care Sector
A road safety audit is a formal examination of an existing or future road or traffic project, or any project that interacts with road users, in which independent, qualified examiners look at the projects crash potential and safety performance. The objectives of road safety audit are to identify potential safety risks for road users and to ensure that measures to eliminate or reduce the risks are fully considered. Road safety audit works in two ways to ensure that safety is improved, namely by removing preventable crash producing elements at the design stage and by mitigating the effects of any remaining risks by the inclusion of suitable crash-reducing elements. The present paper focuses on providing a preliminary or basic understanding of the Road safety Audit. Later the discussion is preceded further to the important elements and the various stages in the Road Safety Audit. Finally, the conclusion focuses briefly on the implementation of the Road Safety Audit, which can only be successful if the members of the Audit Team possess sufficient specialized professional knowledge and other virtues.
Stress is on one of the important hazards faced by nursing staff. Although various intervention methods to reduce stress have been developed, its effectiveness among Malaysian nurses has yet to be established. This study involved 185 health nursing staff working at health districts Kemaman and Dungun in Terengganu. Health nursing staff from Kemaman (n=94) was selected as intervention group whereas those from Dungun (n=91) were chosen as controls. Members of the intervention group were given stress awareness education. They were taught how to reduce stress by relaxation methods. Teaching was conducted through lectures, practical training and providing a stress guidebook. A stress reliever card and letter reminding respondents to practice stress reduction methods were sent every two weeks. The total intervention period was 6 weeks. The control did not receive any education on stress reduction or encouragement to practice any stress reduction techniques throughout this period. The effectiveness of the intervention programme was measured by comparing changes in stress symptoms scores. Stress symptoms were measured using a modified Personal Stress Inventory questionnaire. The study found significant reduction of stress symptoms (42.66 ± 20.36 to 35.51 ± 22.60) in the intervention group after intervention compared to before intervention. However there was no significant difference in change of mean score of stress symptoms between both groups. Further studies need to be conducted to establish an intervention programme, which is suitable and effective in reducing stress among health nursing staff.
Psychology has been well-accepted for application in virtually all aspects of human activities, including making a living. Thus, the objective of this paper is to introduce the application of psychology at workplaces. Specifically this paper addresses the importance of the profession of Industrial and Organizational Psychologist in the increasingly advanced and industrious society of Malaysia. It highlights the areas that the professional cares for, as well as its roles and positions in the view of the nation’s needs. Besides that, this paper also stresses the essential issues that Industrial and Organizational Psychologist practicing in Malaysia should consider. In short, this paper advocates the need of having professionals to look into the well-being of individuals contributing towards making Malaysia a developed nation.
MeSH terms: Humans; Human Activities; Industry; Malaysia; Psychology, Industrial; Societies; Workplace; Developed Countries; Life
A cross sectional study to determine the exposure of heat and its biological effects on the workers in a plastic factory located in the Shah Alam Industrial Estate, Selangor, Malaysia. Forty five respondents from the polymer section in the factory were selected as the respondents. Variables measured were the environmental temperature (WBGTin), air velocity, relative humidity, body temperature, average heart and recovery heart rate. QUESTEMP°34 Area Heat Stress Monitor was used to measure the environmental temperature in °C (WBGTin) and relative humidity (%). Velocicheck Model TSI 8830 was used to measure the air velocity in meter per second (m/s) while the OMRON Blood Pressure Monitor Model T3, was used to measure average heart rate and recovery heart rate. Body temperature (°C) was measured by the Instant Ear Thermometer-OMRON Gentle Temperature Model MC509. Interviews using questionnaires were used to determine respondents’ socioeconomic background, previous risk factors on heat exposure and other information related to heat stress. Results showed that the mean environmental temperature for the exposed group was 28.75°C, the mean air velocity was 0.15 m/s and the mean relative humidity was 58.1%. These production workers were exposed occasionally to heat when loading plastic powder into the molds as well as demolding the finished plastic products from the molds. The average time of monitoring was 2 hours for intermittent exposure and 8 hours duration for overall exposure. Maximum demand for work load was measured 1 minute after work activities were stopped at the demolding section. There was a significant difference between body temperature and average heart rate before work, after 2 hours of work and after 8 hours of work ( p < 0.001). The mean recovery heart rate after 1 min was 88.0 ± 12.0 beat per min. (bpm), indicating that there is no excessive physiological demand. Body temperature (36.8 ± 0.40°C) and average heart rate after 8 hours (78 ± 12 bpm) indicated a good body control of heat exposure. Five out of six workplaces monitored had temperatures of greater than 28°C (ACGIH TLV). The workers were exposed to moderate heat stress during the study period, however, body temperature and average heart rate measurement did not reach unacceptable level of physiologic strain.
A cross-sectional study was conducted on 83 female electronics factory workers. The respondents comprised 50 exposed workers who use lead alloy solder and 33 unexposed workers. The objective of this study was to assess the lead exposure of these workers. Breathing zone were sampled using air sampling pumps. Dust samples were collected by wipe method. Venous blood collected and blood pressure were measured. All lead analyses were carried out with Graphite Furnace Atomic Absorption Spectrophotometer. The mean air lead for exposed workers (57 0. ± 0.93 μg/m³) was significantly higher than the unexposed workers (0.0067 ± 0.0045μg/m³) (p
This paper presents the use of factorial experiments and response surface methodology to determine the best workstation design configuration of an existing electronic industry. The aim is to find the value of physical dimensions that gives the best performance for the workstation. Four performance measures are selected; the cycle time, the metabolic energy expenditure, worker’s posture during the task and lifting limitations. The methodology used in this study consists of two parts. The first part is based on factorial experiments and handles discrete search over combinations of factor-levels for improving the initial solution. In the second part, the solution that was obtained earlier is further refined by changing the continuous factors by using response surface methodology. The result of this optimization study shows that the optimum value of physical dimensions gives a significant improvement for the performance measures of the workstation.
MeSH terms: Energy Metabolism; Industry; Posture; Solutions; Lifting; Pharmaceutical Solutions
Exposure to organic solvent during work activities has been known to be associated with significant clinical conditions such as peripheral neuropathy and neurobehavioral changes. Three reported cases of peripheral neuropathy most likely due to exposure to chronic organic solvent were reported recently in Bentong Malaysia. These cases showed a compatible clinical history, occupational history, examination and neurological study that link with peripheral neuropathy due to organic solvent poisoning. Proper education and training with review of engineering control measures are among preventive and corrective measures recommended. More comprehensive study in order to establish significant causal-effect relationship as documented evidence is recommended.
MeSH terms: Malaysia; Organic Chemicals; Peripheral Nervous System Diseases; Solvents; Work
This retrospective study was conducted at the audiology clinic of UKM in the year 2000. It was intended to detect the effect of walkman on the hearing system of its users and to investigate whether distortion product otoacoustic emission test can provide an early and reliable sign of cochlear damage or not. Distortion product otoacoustic emission test helps to determine the function of outer hair cell. Outer hair cells get damaged with exposure to loud sound, drugs and aging. Thirty subjects (20 in the study group and 10 in the control group), between the ages of 19-25 years, who fulfilled all the criteria of selection, were investigated. There were two sets of criteria (general and specific). Anyone, in the control or study group, failing in any of these criteria was excluded from the study. According to the general criteria, it was essential for all the subjects to have clean ear canals, normal hearing at all the frequencies (250Hz- 8000Hz), normal middle ear function (Type A tympanogram), no middle ear problem, not used/using any ototoxic medicine, no family history of hearing loss, no history of ear surgery, not exposed to any form of loud noise like disco, concert, F1 racing or gun shooting. According to the special criteria it was essential for the subjects in the control group to have never used a walkman and those in the study group must have been using a walkman for at least 6 months.
Comparison of distortion product emission levels between control and study groups revealed that emissions were significantly lower in the study group, across all the frequencies, suggesting outer hair cell damage in the walkman users. These differences reached level of statistical significance (p
A study was undertaken to determine the effect of polyethylene and polystyrene used in the manufacture of plastic items on colour perception. Colour vision was assessed using the Ishihara plates, panel 015 test and the Farnsworth Munsell 100-Hue test. Two factories were chosen at random. One factory (referred here as factory A) used virgin resin in pellet form (polyethylene) in the manufacturing of plastic containers to store consumer edible oil. The other factory (referred as factory B) used polystyrene to make plastic bags. A total of 39 healthy employees from factory A (mean age 26.4 :t 8.2 years) and 40 healthy employees from factory B (mean age 26.8 :t 9.6 years) were recruited in this study. A control group of 27 normal healthy subjects (mean age 27.4 :t 4.3 years) who were employees of UKM with no occupational involvement with petroleum derivatives were also recruited in this study and they performed the same colour vision tests. All subjects passed the Ishihara plates test showing that none of the subjects (employees of factory A and B, and control subjects) had a congenital red-green defect. All control subjects passed all of the colour vision tests whilst some employees of factories A and B failed the 015 and FM100 Hue tests. For employees from factory A results from the 015 test showed that 7 (17.9%) had a tritan (blue-yellow) type of defect and 1 (2.6%) had a complex type of defect. The FM 100 Hue results of factory A employees showed that 51.3% (n=20) had a complex type of defect. Total error scores (TES) calculated from the FM 100 Hue test revealed that employees from factory A had a statistically significant higher mean TES of 65.13:!: 48.31 compared to that of control subjects with a mean TES of 31.26:!: 14.93. For employees in factory B, 10 employees (25.0%) had a tritan (blue-yellow) type of defect and 2 (5.0%) had a complex type of defect. Results of the FM 100 Hue test showed that 4 employees (1.0%) had a tritan type of defect whereas 22 (55.0%) had a complex type of defect. Mean total error scores (TES) calculated from the FM 100 Hue test revealed that employees from factory B had a statistically significant higher mean TES of 71.54 :t 54.63 compared with that of control subjects with a mean TES of 31.26 :t. 14.93
The above results show that employees of the plastic factories studies are associated with a higher risk of acquiring colour vision defects as compared to normal subjects who are not engaged in the plastic manufacturing industry. This may have an implication towards the future retinal health of employees in petrod1emical-based industries.
MeSH terms: Color Vision Defects; Color Perception; Color Perception Tests; Petroleum; Plant Extracts; Plastics; Polystyrenes; Resins, Plant; Polyethylene; Control Groups; Color Vision; Healthy Volunteers; Manufacturing Industry
Malaysia is blessed with oil and gas resources, which form raw materials for the petrochemical industry. The petrochemical industry creates added value to this resource and is an important contributor to the national economy. The petrochemical industry however also creates hazards of which fire or explosions and chemical release are of special concern. These hazards pose a risk not only to workers but also to the surrounding population and environment. To ensure industry is prepared to cope with emergencies, a comprehensive emergency response programme is necessary. This is inline with both the Malaysian Occupational Safety and Health (Control of Industrial Major Accident Hazards) Regulations 1996 and the Responsible Care initiative of the chemical industry. This paper describes elements to be considered in an emergency response programme for industry such as the concept of emergency management, organisation, duties and responsibilities, emergency system, training and mutual aid plans and agreements. We shall provide related examples based on a multinational petrochemical company practice.
Radiotherapy causes various complications including low immunity. Past research has shown that the low immunity is due to the low amount of lymphocytes and consumption of citrullus vulgaris will alleviate this problem. Based on this a study was conducted to identify how citrullus vulgaris was able to produce radioprotection on the lymphocyte membrane. A total of 30 adult male Sprague-Dawley rats were used and divided into three equals groups of positive control, negative control and treatment. For seven days, positive control and negative control were force fed with normal saline of 40 ml/kg animal weight while the treatment group received 40 g/kg animal weight fresh juice of citrullus vulgaris daily. After a week positive control and treatment group were irradiated with 0.9 Gy gamma ray. Viable lymphocyte were determined using propidium iodine and acridine orange stain. Results clearly shows that positive control, negative and treatment group were significantly different at 34 3% , 80 2% and 71 2% respectively. SEM results shows that pores were present on the membrane of the positive control while the negative control had none. Similar results were also found on the treatment group. Based on the result it had shown that citrullus vulgaris had radioprotection properties and lymphocytes were destroyed by the formation of pores on their membrane. It is very likely that the radioprotection properties could be due to the presence of antioxidants particularly vitamin A, C and lycopene. In conclusion, citrullus vulgaris could be used as a safe radioprotection agent.
Various palm oil (RBD Palm Olein) based urethane acrylate prepolymers (UPs) having different structures and molecular weights were synthesised from palm oil based polyols, diisocyanate compounds and hydroxyl terminated acrylate monomers by following established synthesis procedures described elsewhere. The products (UPs) were compared with each other in terms of their molecular weights (MW), viscosities and UV curing performances of pressure sensitive adhesives (PSA) UP based formulations. The molecular structure of diisocyanate compounds and hydroxyl acrylate monomers tend to determine the molecular weights and hence viscosities of the final products of urethane acrylate prepolymers (UP), whereas, the MW of the UP has no direct effects on the coatings and adhesive properties of UV curable UP based PSA.
A laboratory scale test rig to treat simulated flue gas using electron beam technology was installed at the Alurtron EB-Irradiation Center, MINT. The experiment test rig was proposed as a result of feasibility studies conducted jointly by IAEA, MINT and TNB Research in 1997. The test rig system consists of several components, among others, diesel generator sets, pipe ducts, spray cooler, ammonia dosage system, irradiation vessel, bag filter and gas analyzers. The installation was completed and commissioned in October 2001. Results from the commissioning test runs and subsequent experimental work showed that the efficiency of flue gas treatment is high. It was proven that electron beam technology might be applied in the treatment of air pollutants. This paper describes the design and work function of the individual major components as well as the full system function. Results from the initial experimental works are also presented.
MeSH terms: Air Pollutants; Air Pollution; Ammonia; Electrons; Feasibility Studies; Laboratories; Research; Technology
The studies of ¹³⁷Cs content in the seawater surrounding Peninsular Malaysia had been carried out as part of the Malaysia Marine Radioactivity Database Project. The results of the measurement will serve as the baseline data and reference level to Malaysia. A numbers of sampling locations, including coastal and offshore at the East Coast (South China Sea) and West Coast (Straits of Malacca) of Peninsular Malaysia had been selected for the study. From each location at the coastal area, water samples were collected from the surface of the seawater. Meanwhile, for the offshore area, water samples have been collected at three different depths. Due to usual low concentration of ¹³⁷Cs in the marine environment, large volumes of seawater were collected and the co precipitation technique was employed to concentrate the ¹³⁷Cs. The activity of ¹³⁷Cs was determined by measuring the peak area under photo peak of the gamma spectrum at 661 keV, which is equivalent to the gamma intensity corrected to the HpGe detection efficiency and percentage of gamma ray abundance of the ¹³⁴Cs. At each study location, there were no significant differences for ¹³⁷Cs activities at 95% confidence interval. The activities of ¹³⁷Cs found to be quite uniformly distributed in the range of 2.33 to 5.00 Bq/m3and 1.76 to 4.76 Bq/m3for the South China Sea and the Straits of Malacca, respectively.
The main component of most building materials in Malaysia is rocks. These rocks have been found to naturally contain U-238, Th-232 and K-40. In order to estimate the radiological impact to the dweller, the level of radionuclides present in various building materials available in Malaysia were analyzed using gamma spectrometry. The radiation hazard indexes were calculated based on the above results. The results showed that the activity concentration of natural radionuclides U-238, Th-232, K-40 were between 19.0 Bq/kg – 42.2 Bq/kg, 16.5 Bq/kg –28.8 Bq/kg and 243.3 Bq/kg – 614.2 Bq/kg respectively. On the whole the radionuclides concentrations were still below the global average of 50 Bq/kg, 50 Bq/kg and 500 Bq/kg for U-238, Th-232 and K-40 respectively. The radiation hazard indexes of the building materials were also lower than the maximum value suggested.
MeSH terms: Construction Materials; Malaysia; Radioisotopes; Spectrometry, Gamma