Objective: To determine the number of RA cases and to evaluate the demographic patterns in all 4 Rheumatology Referral Centers under the Ministry of Health Malaysia. Materials and methods: One thousand and eighty-four rheumatoid arthritis patients from all 4 centers i.e. Hospital Selayang, Putra Jaya, Seremban and Taiping which are situated in the west coast of West Malaysia, using rheumatoid arthritis database comprising of basic clinical and patient questionnaire, until the end of year 2004 were analysed. Results: At the time of documentation, 88.6% were female at all range of ages especially between age of 25 and 54 years (77.6%) with female to male ratio 8 :1. 52.1% were housewives. Mean age of onset of RA was 49.6 ± 11.8 SD with female 49.3 ± 11.7 SD and male 52.0 ± 12.0 SD (p < 0.05). Indian was the predominant ethnic group (54.5%), followed by Malay (31.4%), Chinese (11.6%) and others (27%). Majority had their education up to secondary level (50.8%), followed by primary (32.6%), and tertiary (6.3%) levels while 10.3% of cases had not received any formal education in their lives. 74.4% were seropositive and 87.3% fulfilled at least 4 out of 7 American College of Rheumatology (ACR) revised criteria for rheumatoid arthritis. 74% were diagnosed RA within 2 years after the onset of arthritis. Seropositivity was not significantly related to gender. Positive rheumatoid factor was dominated by Indian followed by Malay and Chinese. 83.3% were married. 23.3% female and 33.9% male between age group 25-54 were employed. 7.4% had achieved their retirement at time of entry whilst 8.9% were unemployed. Employment status was statistically significant across gender (p < 0.001). The cases differed between rheumatology centers as well as individual practices. Conclusion: There are increasing numbers of RA cases in Malaysia. Results from this study did not reflect the true prevalence of RA in Malaysia. Hence, a larger and more comprehensive database on RA with collaboration of all Government and Private Hospitals in the whole nation will provide better information about the patient case mix in different healthcare settings, treatment practice as well as disease complications. The implementation of rheumatology centers with better regional cooperation, will lead to better treatment and outcome in terms of identification of early as well as established RA cases. Early referral to the centers will be made possible for proper treatment institution and rehabilitation. Hence, improve quality of life including socio-economic status especially among those within the productive age.
MeSH terms: Arthritis, Rheumatoid; Employment; Female; Hospitals; Malaysia; Male; Quality of Life; Rehabilitation; Rheumatoid Factor; Prevalence; Age of Onset
Background: Rheumatoid arthritis (RA) is an inflammatory disease. Predictors of disease activity include presence of joint inflammation, blood investigations such as erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP). ESR is said to be imprecise as it is affected by aging, female sex, obesity, pregnancy, anaemia and polycythaemia. But it is inexpensive and easy to perform. CRP is produced as an acute phase reactant by the liver in response to interleukin 6 and other cytokines. CRP is more specific but costs more than ESR. Both tests are done in the rheumatology clinic of Hospital Seremban. Objective: To compare the usefulness of ESR and CRP as a predictor of disease activity in rheumatoid arthritis (RA) patients. Method: This was a retrospective study. The medical records of 248 RA patients who attended the rheumatology clinic, Hospital Seremban between 1 January 2004 and 31 Dec 2004 were reviewed. The following data were obtained: joint swelling and tenderness, other clinical features which indicate inflammation secondary to infection or trauma and inflammation of soft tissue, ESR, CRP, FBC and UFEME. Results: Data was analysed and the results showed that a total number of 248 patients were seen. There were 13 defaulters. Of the 248 patients there were 929 patients' visits. Of the total number of patients' visits where patients clinically had active disease, 80.2% had raised ESR while 88.8% had raised CRP. As for visits where patients had quiescent disease clinically, 57.3% had normal ESR and 36.5% had normal CRP. Conclusion: CRP is more sensitive but less specific than ESR. This suggests that we still should use both tests as they complement each other. ESR can serve as a countercheck for CRP and vice versa.
Introduction: Gout is a clinical syndrome resulting from the deposition of monosodium urate monohydrate crystals. Recent studies have shown gout to be a significant metabolic disorder. However, there has been insufficient information on the clinical spectrum in the Malaysian population.
Objective: This study is conducted to review the clinical characteristics of patients with gout.
Study methods: In this cross-sectional study 52 patients with gout were recruited. The records of 13 patients from National University of Malaysia Hospital and 39 patients from Putrajaya Hospital, attending the rheumatology clinic between October and December 2005 were reviewed. Results: Gout was found predominantly among ethnic Malays 83%, and Chinese 17% in these centers. The male to female ratio was 12 :1. The peak age of onset of the disease was less than 40 years in 46% of the subjects. Primary gout in females was seen after menopause. 37% cases had a definitive hereditary incidence. At the first presentation 83% had acute monoarthritis and 17% acute polyarticular arthritis. Podagra was seen in 62%. Peripheral joints involvement was seen in 81% patients. Tophaceous gout was seen in 42%. In 85% cases the disease had a chronic polyarticular course, whereas in 15% the disease remained only at a single joint. In 10% cases, there was associated sero-negative arthritis. Associated disorders included hypertension (65%), diabetes mellitus (33%), dyslipidemia (56%), ischemic heart disease (23%), urate nephropathy (39%), uric acid nephrolithiasis (2%). In 88% of cases, there was associated hyperuricaemia. Most of the patients were overweight with body mass index 25-29 (39%) and obese with body mass index 30-70 (36%). Conclusions: Gout is not an unusual disorder in our centre. The age of onset of gout occurred much earlier with forty-six per cent of patients having their first attack of gout before the age of 40. Primary gout in females was seen after menopause. Majority of patients first presented with acute monoarthritis, of which sixty-two per cent presented with podagra. The incidence of tophi was high. Patients with gout should be screened for other associated disorders like diabetes mellitus, hypertension, dyslipidemia and obesity.
Objective: To determine the epidemiological, clinical and laboratory features of the patients with gout, on follow up in Rheumatology Outpatient Clinic, Hospital Seremban.
Methods: This was a retrospective study. Case notes of all our existing gout patients were reviewed, and data on demography, clinical features, associated conditions, and laboratory findings were noted.
Results: 54 patients were studied, 48 (89%) were male and 6 (11%) were female at the ratio of M : F = 8:1, 30 (57%) of them had the onset of symptoms at their 3rd and 4th decades of life. The majority were the Malays 39 (72%), followed by the Indians 11 (20%) and the Chinese 4 (8%). Commonly associated conditions were hypertension in 37 (68.5%), obesity (BMI of 30 and above) in 36 (66.7%) and hyperlipidaemia in 36 (66.7%) of them. Mixed hyperlipidaemia (High TG and LDL cholesterol) were found in 19 (53%). Underlying history of diabetes mellitus 7 (13%), alcohol consumption 8 (15%), smoking habits 22 (40%) and family history of gout 18 (33%). Half of our patients 27 (50%) had at least 2 or more joints involvement. 28 (52%) of them had tophaceous gout. Among those with tophaceous gout, 18 (64%) had renal impairment with serum creatinine of .150mmol/l. 6 (31.5%) of the patients with renal impairment found to have renal calculi on ultrasonography.
Conclusion: There was male predominance in our group of patients which was consistent with other reported epidemiological studies. Hypertension, mixed hyperlipidaemia and obesity were common associated conditions while diabetes mellitus, smoking and family history of gout were not. The majority of gout patients in our clinic were Malays and due to religious reasons, alcohol was not a common associated factor. Half of our patients had multiple joints involvement and more than half also had tophaceous gout. There was high incidence of renal impairment seen in patients with tophaceous gout. These could be due to delay in seeking medical treatment, present of renal calculi and possibly contributed by associated hypertension and diabetes mellitus.
Citation: Mohd Ghazali RJ. A study on the adequacy of outpatient management of essential hypertension in MOH hospitals and health centres. Kuala Lumpur: Institute of Health Management, Ministry of Health, Malaysia; 2006
MeSH terms: Ambulatory Care Facilities; Hospitals; Humans; Hypertension; Malaysia; Medical Audit; Outpatients; Quality Assurance, Health Care; Prevalence
Dosimeter pendarcahaya terma (TLD) telah mula digunakan untuk tujuan perlindungan sinaran. Peratus kepudaran yang rendah untuk satu jangka panjang merupakan salah satu kelebihannya. Harshaw sebagai salah satu pembekal telah mendokumenkan kepudaran TLD mereka iaitu kurang dari 2% untuk masa penyimpanan tidak melebihi tiga bulan. Kajian yang dijalankan di MINT ini menguji kepudaran TLD-100H Harshaw untuk tempoh 30 hari. Disamping mengesahkan apa yang telah didokumenkan, kajian ini mengesyorkan TLD dibaca setelah empat hari masa penyimpanan.
The insulator-metal transition temperature, Tim of La1-xSrxMnO3(x = 0.0, 0.05, 0.15 and 0.3) was studied during warming and cooling between 50 K to 300 K. The results showed that Tim of La1-xSrxMnO3 shifted to a higher temperature as Sr was substituted for La. Scanning electron micrographs showed that the average grain size is in the range of 0.6 µm - 1.4 µm. Grain boundaries are almost completely revealed for x = 0.3. X-Ray powder diffraction patterns showed cubic structure (space group Pm-3m) and contain no secondary phases.
In this paper, a direct integration implicit variable step size method in the form of Adams Moulton Method is developed for solving directly the second order system of ordinary differential equations (ODEs) using variable step size. The existing multistep method involves the computations of the divided differences and integration coefficients in the code when using the variable step size or variable step size and order. The idea of developing this method is to store all the coefficients involved in the code. Thus, this strategy can avoid the lengthy computation of the coefficients during the implementation of the code as well as to improve the execution time. Numerical results are given to compare the efficiency of the developed method with the 1-point method of variable step size and order code (1PDVSO) in Omar (1999).
Thirty-three surface sediment samples were collected around the Clyde Sea and were analyzed for fatty acids, fatty alcohols and sterols by the GC-MS detection. Cluster analysis (Ward’s method with correlation coefficient) performed separately on fatty acids, fatty alcohols and sterols showed that they were grouped according to their geochemical sources. However, terrestrial derived compounds can be seen grouping with marine and bacterial derived compounds in every analysis. Bacterial derived compounds can be found in all clusters in the mixed compound cluster analysis showing that bacterial inputs occurred together with marine and terrestrial inputs.
During fermentation cells are subjected to various kinds of stress. One of the stresses concerned is high osmotic environment, which cells need to encounter in order to continue growing. To understand how cells adapt to this stress condition, information from genome, proteome and metabolome levels are crucial. In yeast cells, it was report that they produce glycerol to avoid depletion of water in the cell that could lead to cell shrinkage and eventually death. Thus, investigation of physiological responses were executed by shake flask method using three different Saccharomyces cerevisiae strains namely s288c, IFO2347 and FY834 which were grown in yeast potato dextrose (YPD) medium under the treatment of sodium chloride (NaCl) and sorbitol at 1M concentration to create the osmotic condition. These agents were added into the medium after 5 hours of fermentation when the cells reached exponential phase and carbon source is still available. The results proved that addition of both NaCl and sorbitol created the osmotic condition during growth resulted in higher accumulation of glycerol and trehalose when compared to the control in all strains. Among these strains, production of glycerol (g glycerol/g cell dry weight) was found highest in IFO2347, followed by s288c and FY834.
An equation modeling on Sembulan river, Sabah, Malaysia, has been undertaken using a backward stepwise multiple linear regression. A good performance has been obtained using a log transformation on water quality data designated as predictors and dependent variable. The regression model is in accordance with the ANOVA result. The temperature, biochemical oxygen demand (BOD), Echerichia Coli, Pb and nitrate were described as continuous predictors, while the river location (downstream, municipal and upstream) was designated as independent string grouping variable, and the chemical oxygen demand (COD) was set up as the dependent variable. The string grouping variable was converted to its dummy variable, which in turn led to design of a three-equation model with respect to river location. The results show that BOD has a strong effect on COD, while Pb and nitrate show less effect on COD. The temperature gives little negative effect on COD, while other variables such as pH, salinity and Cd are excluded from the river modeling since they induce insignificant effects based on backward criterion probability of F-value ≥ 0.100. Using the general linear model with LSD mode, it is revealed that predictor(s) show a remarkable discriminant effect between upstream and municipal/downstream on the 0.05 level. The most effect came from salinity indicated by the canonical discriminant function based on Wilks’ lambda.
This paper analyzes the asymmetric long memory volatility dependency of the interday prices of Composite Index (CI) at Bursa Malaysia by using GARCH family models. The GARCH type models are used with the assumption that the innovations series follow either one of the following distributions: Gaussian, Student -t and skewed Student -t. The stock returns' long memory dependency is determined using the Hurst parameter. The long memory and asymmetric volatility are modelled by fractionally integrated GARCH models. It is found that the asymmetric and long memory GARCH models with skewed student-t distribution give better predictive ability on the volatility of the Kuala Lumpur Composite Index (KLCI).
MeSH terms: Commerce; Malaysia; Memory; Students; Volatilization; Statistical Distributions; Normal Distribution
In Sarawak, pig farm operators are required to treat the wastewater containing pig waste and spilt food in oxidation ponds before discharge. However, information on the impact of this industry on surface water quality is lacking. Therefore, the objective of this study is to determine the impact of pig farm effluent on the water quality of Serin River and its tributaries. Results of analysis show that the tributary that received pond effluent has significantly higher mean of total suspended solids (TSS), biochemical oxygen demand (BOD5) chemical oxygen demand (COD), ammonia-nitrogen (NH3 -N), reactive phosphorus (SRP) and Escherichia coli (E. coli) concentrations when compared to those of the tributary that did not receive pond effluent. Comparisons between the stations upstream and downstream of the discharge point indicated that BOD5 and COD were significantly higher at the downstream station that received pond effluent. Dissolved oxygen (DO) was the lowest at the tributary receiving effluent from pig farms with a mean of 2.40 mg/l. According to the Interim Water Quality Standard of the Department of Environment, water quality at the tributary that received pig farm effluent falls into Class III whereas that of the other stations falls into Class II. It is recommended that further studies be conducted on the management of waste to explore the possibility of turning the waste into a resource so that water quality of rivers can remain pristine for drinking and recreation.
A survey on coastal vegetation of Pahang in some localities from Sg. Balok in Kuantan southwards to Kuala Endau in Rompin was conducted from middle 2004 to early 2005. A total of 88 species of plants were recorded and identified mostly to the generic or species level. The usual vegetation types were sand and mudflat beach vegetations like Pandanus odoratissimus, Ipomoea pes capre and Casuarina equisetifolia and mangrove vegetation like Sonneratia caseolaris, Rhizophora mucronata and Avicennia marina. This paper also reports some unique heath-type forest vegetation like Hopea spp. in Menchali area.
The behaviour of many financial time series cannot be modeled solely by linear time series model. Phenomena such as mean reversion, volatility of stock markets and structural breaks cannot be modelled implicitly using simple linear time series model. Thus, to overcome this problem, nonlinear time series models are typically designed to accommodate these nonlinear features in the data. In this paper, we use portmanteau test and structural change test to detect nonlinear feature in three ASEAN countries exchange rates (Malaysia, Singapore and Thailand). It is found that the null hypothesis of linearity is rejected and there is evidence of structural breaks in the exchange rates series. Therefore, the decision of using regime switching model in this study is justified. Using model selection criteria (AIC, SBC, HQC), we compare the in-sample fitting between two types of regime switching model. The two regime switching models we considered were the Self-Exciting Threshold Autoregressive (SETAR) model and the Markov switching Autoregressive (MS-AR) model where these models can explain the abrupt changes in a time series but differ as how they model the movement between regimes. From the AIC, SBC and HQC values, it is found that the MS -AR model is the best fitted model for all the return series. In addition, the regime switching model also found to perform better than simple autoregressive model in in-sample fitting. This result justified that nonlinear model give better in-sample fitting than linear model.
Combining iterative methods with appropriate preconditioners is a worthwhile effort in improving the performances of the methods since the reliability of these methods have been shown to improve by the use of appropriate preconditioning techniques. However, the hardest issue is to find the suitable preconditioners which are computationally inexpensive and easy to solve for the group methods. The aim of this paper is to study the performance of the Explicit Group (EG) method (Evans & Yousif 1986) preconditioned by a specific ‘splitting’ approach in solving the two dimensional elliptic partial differential equation. Our goal in this work is to investigate whether the performance of this group method is affected by this preconditioner. The experimental work performed is reported and discussed.
Pengukuran keberintangan secara menegak dan secara 2D telah dilakukan di Sungai Kelambu, Banting untuk memetakan lapisan dan jenis air yang terdapat dalam akuifer pasir serta endapan yang berada di sekitarnya. Pengukuran keberintangan menegak dilakukan di sebanyak 29 stesen manakala pengukuran keberintangan 2D dilakukan di sebanyak 8 profil. Keberintangan sebenar yang diperolehi menerusi permodelan songsang telah dikorelasikan dengan data lubang gerudi yang berhampiran untuk memudahkan pentafsiran. Berdasarkan pentafsiran, lapisan lempung didapati berkerintangan 8-180m dan tebal purata 15m berada di atas lapisan akuifer pasir berkeberintangan 40-800m dan tebal 35-87m. Lapisan pasir ini terendap di atas metasedimen yang berjulat keberintangan 600-800 m. Selain daripada fakta keberintangan dan ketebalan, taburan stesen kajian telah memungkinkan pembinaan peta kontur untuk melihat taburan ketebalan dan keberintangan lapisan akuifer. Peta kontur ketebalan menunjukkan bahagian akuifer yang paling tebal terletak di bahagian tengah dan tenggara kawasan kajian. Oleh sebab julat keberintangan akuifer ini berkisar di antara 40-800m, ini bermakna akuifer tersebut mengandungi air segar hingga payau.
Satu kajian kualiti air di Tasik Chini telah dijalankan pada bulan Julai, Ogos dan September 2004. Sebanyak 15 stesen persampelan telah dipilih dan sebanyak 14 parameter kualiti air telah ditentukan dalam kajian ini. Keputusan yang diperolehi menunjukkan nilai purata keseluruhan tasik bagi tiga bulan persampelan bagi parameter suhu, oksigen terlarut, konduktiviti, jumlah pepejal terlarut, turbiditi, ph, ammonia-N, nitrat, fosfat, permintaan oksigen kimia, sulfat, permintaan oksigen biokimia dan jumlah pepejal terampai masing-masing adalah 29.73 ± 0.44 °C, 6.08 ± 0.88 mg/L, 21.35 ± 4.32 mS/cm, 13.66 ± 2.76 mg/L, 2.84 ± 3.77 NTU, 6.63 ± 0.24, 0.11 ± 0.04 mg/L, 0.02 ± 0.02 mg/L, 0.05 ± 0.02 mg/L, 0.23 ± 0.36 mg/L, 16.69 ± 4.31 mg/L, 1.97 ± 1.32 mg/L dan 5.17 ± 3.67 mg/L. Perbandingan dengan nilai Piawaian Interim Kualiti Air Kebangsaan (INWQS) menunjukkan secara amnya parameter yang dikaji berada dalam kelas I-IV. Kepekatan klorofil-a adalah rendah pada bulan Julai dan September dengan purata 1.4 µg/L, tetapi meningkat pada bulan Ogos dengan purata 21.91 µg/L dan meletakkan Tasik Chini dalam status eutrofik pada bulan tersebut. Faktor-faktor yang menyumbang ke arah fenomena in dibincang lanjut dalam kertas ini.