This paper describes the culture of Traditional Malays, in particular the use of sustainable furniture inside a Traditional Malay House (TMH). The sample houses for this study were retrieved from archived reports, from the Centre for Built Environment in the Malay World (KALAM), Universiti Teknologi Malaysia (UTM). Data collected were analysed using Componential Analysis for the presence of components (based on drawings of archival reports as well as photographic evidence from site visits). The findings showed that the Malays used a variety ofsustainable furniture in their houses. Additionally, their homes had built-in furniture, which indicated the houses were pre-designed based on its user.
Rapid urbanisation and industrialisation have had an adverse and deep impact on the environment contributing to global warming and climate change. These thermal environmental problems can be even more challenging to people living in regions with warm and humid climatic conditions throughout the year, such as Malaysia. This paper analyses wind characteristics and outdoor thermal comfort index at the hottest temperatures based on data recorded hourly between 2012 and 2014 for two cities in East Malaysia, namely Kuching (Sarawak) and Kota Kinabalu (Sabah). Wind characteristics were analysed using only wind velocity and direction, while the level of outdoor thermal comfort was measured using Universal Thermal Climate Index (UTCI). The results showed that hourly average wind velocities for Kuching and Kota Kinabalu were 1.84 m/s and 2.15 m/s respectively while the highest average wind velocities was 10.1 m/s and 12.4 m/s respectively. No wind movement (i.e. 0 m/s) was recorded for both locations. The prevailing annual wind flow is generally from South-Southeast (150°) in Sarawak and from East-Southeast (110°) in Sabah. It was also found that both Kuching and Kota Kinabalu experienced strong and extreme heat stress conditions with UTCI levels of 44.8°C and 49.8°C respectively. Thus, it can be concluded that, East Malaysia faces strong and extreme heat stress conditions. This study is an original contribution on the subject of outdoor thermal environment in Malaysia, Further research to better understand outdoor thermal environmental problems is recommended.
Sungai Sarawak is the most important river in Sarawak. This study was aimed at assessing water quality in the selected stations from Satok bridge to the downstream, Muara Tebas, located along Sungai Sarawak. Water quality trend analysis was conducted to determine the correlation between the water quality parameters. Trend analysis was carried out using Mann-Kendall Test because data collected was non-parametric. Next, Spearman rank was used in order to determine the correlation between parameters. The results obtained and the observation made in this study reveals that the trend exists only for Chemical Oxygen Value (COD). But there are trends for Biochemical Oxygen Demand, (BOD), Dissolved Oxygen (DO), Total Suspended Solid (TSS), Ammoniacal Nitrogen (NH4N) and Turbidity to decrease or increase with no trends between 2007 and 2011. The correlation between parameters is not very strong because there are many determinants of water quality parameters. The result from this study would provide useful information for water quality management in order to maintain and improve the water quality of Sungai Sarawak.
MeSH terms: Environmental Monitoring; Maintenance; Malaysia; Nitrogen; Oxygen; Water Pollution, Chemical; Rivers; Water Quality
In the area of sustainable development, construction waste is an important issue that must be tackled responsibly. It is an assortment of waste, at the stage of construction. This paper assesses waste minimisation or reduction measures and such practices in the Kuala Lumpur construction industry. A structured questionnaire survey was conducted to obtain contractors’ views on 25 waste minimisation measures discussed in literature. Data was analysed using frequency analysis method and average index analysis method. The results showed that adoption of proper site management techniques is widely practised. The adoption of these waste minimisation measures could lead cost savings to the construction industry and prevent environmental degradation.
Sustainability is an important factor in designing vernacular architecture, including vernacular palace architecture; the latter refers to low-rise buildings similar to Traditional Malay Houses (TMH). However, the Istana Lama Seri Menanti is a 4-storey mid-rise vernacular palace which was designed with sustainability in mind. This mid-rise element of the palace communicates the vernacular architecture of TMH in Negeri Sembilan whereas sustainable designs are factored in environmentally friendly materials, construction methods, and the environmental impact of the building culturally and economically. This research was aimed at examining the sustainability approach of Istana Lama Seri Menanti as a mid-rise vernacular palace in the early 20th Century, and its impact on the current generation after 109 years. The research methodologies include case and precedent studies of vernacular palaces in Malaysia as well as interviews with experts in the field. In conclusion, the architectural sustainability of Istana Lama Seri Menanti had taken into account timber availability, consumption of naturally available resources, designs with minimal environmental impact and high cultural importance in the building design with the ultimate aim of conserving it for future generations.
MeSH terms: Natural Resources; Environment; Malaysia; Research Design; Social Responsibility
Sarawak has experienced several earthquakes of local origin and was also affected by long-distance earthquake that originated from Southern Philippine and the Straits of Macassar, Sulu Sea and Celebes Sea. The objectives for this study were to conduct site specific ground response analysis and develop design response spectra for Bakun area by using 1-D equivalent linear ground response analysis. The site characterisation was carried out utilising the soil profile and soil property data of the selected site. Local surface fault ruptures were investigated for possible hazards due to intraplate earthquakes. Earthquake ground motion records were selected based on characteristics of the controlling earthquakes for an area and the maximum magnitude faults were considered for risk assessment. The site-specific response spectra represent the predicted surface ground motions that reflect the levels of strong motion amplitude and frequency content at a particular site. The site-specific ground response analysis for Bakun site found that the peak ground acceleration at bedrock was amplified from 0.16 g to 0.33 g at the ground surface.
Remanufacturing of used-products is becoming an important activity in many production companies. This paper reviews key remanufacturing process, highlights eight unique characteristics of remanufacturing process environment and proposes a generic conceptual remanufacturing process model that considers the presence and interactions of these eight features. The generic conceptual model could be modified to suit remanufacturing process of any given used products to be remanufactured. Future research can modify the generic remanufacturing model to suit used automotive parts remanufacturing with unique characteristics and apply simulation technique to model and analyse the corresponding remanufacturing process.
This paper is aimed at examining the use of blended learning and how it affects students’ score in examination. Basic Movement Therapy (BMT) Digital Learning was constructed and developed based on multimedia design guidelines. A quasi-experimental design using two groups with pre-test post-test approach was used. A total of 103 students from the Universiti Kuala Lumpur, RCMP (Royal College Medical, Perak) were divided in two groups. The Control group received standard teaching sessions (N=51). The Treatment group received the same standard sessions but additionally used BMT Digital Learning application (N=52). Written test on basic movement therapy was done by students before and after intervention. Statistically significant better scores for the treatment group were noted. The results suggest that the use of BMT Digital Learning application was suitable for practical procedure purposes.
Efforts to reduce manufacturing cost and negative environmental impacts have seen the mixture of natural fibre with synthetic fibre in composite structures. However, there are limited studies on the notch effect and fibre orientation on mechanical properties of hybrid fibre metal laminate (FML). In this study, tensile properties of FML with notch and different fibre orientation were investigated. The hybrid FML incorporated with kenaf fibre at the middle layer was compared with FML with three layers of E-glass fibre. Kenaf fibre and E-glass fibre used were in plain woven form. The FML in 2/1 configuration was manufactured through hot press manufacturing method to bond layers of annealed aluminium 5052 to the composite. Tensile test was conducted in a quasi-static manner according to ASTM E8. The results showed FML with three layers of glass fibre exhibited higher tensile strength compared with hybrid FML. However, the introduction of kenaf fibre in hybrid FML reduces the notch and fibre orientation sensitivity compared with glass fibre reinforced FML.
Optic neuritis, which may be a precursor to multiple sclerosis (MS), is an uncommon disease in
Asian patients. The Asian Collaborative Longitudinal Optic Neuritis Epidemiology (ACLONE) is
an observational cohort study that assessed the risk of recurrent optic neuritis and/or progression
of further neurologic events, either MS or neuromyelitis optica (NMO) in Asian patients with firstever
optic neuritis. Secondary aims were to study the presenting characteristics and visual outcome,
and to identify risk factors for development of either MS or NMO. A total of 112 patients (25 men
and 87 women) aged from 12 to 61 years were recruited from Singapore, Taiwan, South Korea and
Malaysia. Of these, 94 (84%) had unilateral optic neuritis, with the right eye involved in 45 patients
and the left eye in 49 patients and the remaining 18 (16%) had bilateral optic neuritis. Follow up
data was available for 104 patients, and patients were followed for a median duration of 25.9 months.
Of these patients, 6 patients were adjudicated to have reached the primary endpoint (composite of
MS/NMO and optic neuritis): 3 patients with recurrent optic neuritis also subsequently experienced
neurologic symptoms, and 3 patients without recurrent eye involvement had neurologic symptoms.
Only one patient was considered to have prototypical MS, the other 5 were diagnosed with NMO,
all with subsequent antibody confirmation. Optic neuritis in Asian patients has significantly different
presenting characteristics from the classic description. However, in the majority of the patients it is
usually a benign disease, with good visual outcome and no further events.
Objective: To determine prevalence and factors associated with neuropathic pain symptoms in a multiethnic cohort of Malaysian adult diabetic patients.
Methods: This was aprospective cross-sectional observational study of hospital-based diabetic outpatients in Malaysia. Subjects were interviewed for their demographic data and medical history. The painDETECT questionnaire was used to screen for neuropathic pain symptoms and pain intensity was assessed using the numeric pain rating scale (NPRS). Neuropathy symptoms and signs were assessed using the Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS).
Results:Of 242 patients,140 (58%) were women, with a mean age of 61 + 11.4 years (range 21 to 81). Ninety nine(40.9%) were Malay, 64 (26.4%) Chinese, 76 (31.4%) Indian and three (1.2%) were Eurasian. Mean duration of diabetes was 15.9+ 9.8 years (range 1 to 53) and 232 (95.9%) patients had Type II diabetes. Peripheral neuropathy,based on NSS and NDS criteria, was found in 83 (34.3%). Thirteen (5.4%) patients were found to likely have neuropathic pain symptoms and this was independently associated with peripheral neuropathy ((OR) = 3.40, 95% confidence interval (CI): 1.04, 11.14) and Indian ethnicity (OR = 5.44, 95% CI: 1.50,
19.57)). Patients with neuropathic pain had higher average pain intensity scores.
Conclusions: The prevalence of neuropathic pain symptoms in a Malaysian DM patient cohort was low and was associated with the severity of neuropathy symptoms and Indian ethnicity. The causes for ethnic differences are unknown and could be due socio-cultural or physiological differences in neuropathic pain perception.
Study site: Diabetic clinic, University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
MeSH terms: Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Female; Hospitals, University; Humans; Malaysia; Middle Aged; Neuralgia; Outpatient Clinics, Hospital; Outpatients; Surveys and Questionnaires; Cohort Studies; Prevalence; Confidence Intervals; Young Adult
Background: Tuberculous disease of spine (spinal TB) is under-recognized in tuberculous (TB) meningitis.
The objective of the study was to evaluate the frequency, clinical and neuroimaging changes, and
outcome in the patients with spinal TB.
Methods: All the patients with spinal TB admitted in the two
largest tertiary hospitals in Kuala Lumpur from 2009 to 2017 were recruited, the clinical features were
documented, the magnetic resonance imaging (MRI) of the spine was performed. Clinical outcome was
assessed with Modified Rankin scale (MRS).
Results: Twenty two patients were recruited. This was
out of 70 TB meningitis patients (31.4%) seen over the same period. Eighteen (81.8%) patients had
concomitant TB meningitis. The clinical features consisted of systemic symptoms with fever (63.6%),
meningitis symptoms with altered sensorium (45.5%), myelopathy with paraparesis (36.4%). The
findings on spinal MRI were discitis (36.4%), spinal meningeal enhancement (31.8%), spinal cord
compression (31.8%), psoas abscess (27.3%), osteomyelitis (22.7%), and cord oedema (22.7%). All
except two patients (90.9%) had involvement in psoas muscle, bone or leptomeningeal enhancement,
features that can be used to differentiate from myelopathy that affect the parenchyma only, such as
demyelination. Unusual manifestations were syringomyelia and paradoxical manifestations seen in 3
patients each. The outcome were overall poor, with 68% having MRS 3 or more.
Conclusion: Spinal TB is common in TB meningitis. The outcome is overall poor. A heightened
awareness is crucial to enable early diagnosis and treatment.
MeSH terms: Demyelinating Diseases; Edema; Humans; Magnetic Resonance Imaging; Osteomyelitis; Syringomyelia; Tuberculosis, Meningeal; Tuberculosis, Spinal; Discitis; Psoas Muscles; Psoas Abscess; Paraparesis; Early Diagnosis; Neuroimaging; Tertiary Care Centers
Background and Objective: There is a great challenge to establish a level 4 epilepsy care offering
complete evaluation for epilepsy surgery including invasive monitoring in a resource-limited country.
This study aimed to report the setup of a level 4 comprehensive epilepsy program in Malaysia and the
outcome of epilepsy surgery over the past 4 years.
Methods: This is a retrospective study analyzing
cases with intractable epilepsy in a comprehensive epilepsy program in University Malaya Medical
Center (UMMC), Kuala Lumpur, from January 2012 to August 2016.
Results: A total of 92 cases
had comprehensive epilepsy evaluation from January 2012 till August 2016. The mean age was 35.57
years old (range 15-59) and 54 (58.7%) were male. There were 17 cases having epilepsy surgery
after stage-1 evaluation. Eleven cases had mesial temporal sclerosis and 81% achieved Engel class
I surgical outcome. Six cases had lesionectomy and 60% had Engel class I outcome. A total of 16
surgeries were performed after stage-2 evaluation, including invasive EEG monitoring in 9 cases.
Among those with surgery performed more than 12 months from the time of data collection, 5/10
(50%) achieved Engel I outcome, whereas 2 (20%) had worthwhile improvement (Engel class III)
with 75% and 90% seizure reduction.
Conclusion: Level 4 epilepsy care has an important role and is possible with joint multidisciplinary
effort in a middle-income country like Malaysia despite resource limitation.
Genetic predisposition to carbamazepine (CBZ)-induced Stevens-Johnson syndrome (SJS) and toxic
epidermal necrolysis (TEN) had been reported in several Southeast Asian populations, but not in
Myanmar. Previous studies had so far reported more than 70% of CBZ-induced SJS/TEN cases
positive for HLA-B*15:02 allele.1-4 Myanmar, as the second largest country in Southeast Asia with a
population of 54.5 million, has high HLA-B*15:02 carrier frequency in its general population (27.3-
49.1%).5,6 We investigated the association of HLA-B alleles and CBZ-induced SJS/TEN in Myanmar
population. HLA-B*15:02 was detected in 3/3 (100%) of cases and 6/53 (11.3%) of tolerant controls,
and HLA-B*15:02 is significantly associated with CBZ-SJS/TEN in Myanmar population (OR 51.2,
95% CI 2.36-1106.95, p=0.003). (Copied from article)
MeSH terms: Alleles; Myanmar; Carbamazepine; Genes, MHC Class I; Humans; Stevens-Johnson Syndrome; HLA-B Antigens; Genetic Predisposition to Disease; Asian Continental Ancestry Group; HLA-B15 Antigen
Objective: We aim to study the prevalence and predictive factors for hip displacement, in order to
justify a hip surveillance programme for children with cerebral palsy (CP) in Malaysia.
Methods:
Children aged 2 to18 years old with CP were recruited from September 2013 till June 2014. The hip
joint migration percentage (MP) and acetabular index (AI) were measured on all hip radiographs.
The CP subtype was determined and gross motor function was classified according to the gross motor
function classification system (GMFCS).
Results: Seventy-five children were recruited. Fifty-five percent of them had marked hip displacement
with MP > 30% and 15% developed hip dislocation (MP=100%). Marked hip displacement occurred
as early as age of 2 years and most hip dislocations were detected by age of 10 years. The risk of
marked hip displacement was directly related to the GMFCS level, from none in GMFCS I to 75% in
GMFCS V. There was a moderate positive correlation between the initial AI and initial MP.
Conclusions: One in every two children with CP was at risk of hip displacement, with GMFCS level
and initial AI as significant predictive factors. We recommend a hip surveillance programme for
Malaysian children with CP, based on the child’s age and GMFCS level, with both MP and AI as
indicators for hip surveillance.
Background: Tuberculous meningitis is a life-threatening manifestation resulting from infection
by Mycobacterium tuberculosis, especially in the developing countries. The molecular aspects of
pathogenesis of tuberculous meningitis remain poorly understood. We evaluated the correlation of
cerebrospinal fluid (CSF) and serum cytokine levels with the clinical outcome of 15 HIV-negative
patients with tuberculous meningitis. We also assessed the association of CSF and serum cytokines
with neuroimaging of brain findings in the patients.
Methods: The prospective longitudinal study was
conducted at the University Malaya Medical Centre between 2012 and 2014. Neuroimaging of the
brain was performed and the findings of leptomeningeal enhancement, hydrocephalus, tuberculoma,
infarcts and vasculopathy were recorded. The CSF and serum specimens were analyzed for IL-1ß,
IL-8, IL-10, IL-18, IP-10, IFN-γ, MCP-1, TGF-ß, VEGF, TNF- α, IL-18BPa and MMP-9. The clinical
outcome was graded at 3 months based on Modified Rankin scale (mRS).
Results: On admission and
at one month of anti-tuberculosis treatment, the CSF levels of IL-8, IL-1β, IP-10, IFN-γ and VEGF
were elevated in all of the patients. Serum IP-10, MCP-1, IL-1β and IL-8 levels were increased on
admission and at one month of anti-tuberculosis treatment. There were statistically significant differences
between good and poor outcome (mRS at 3 months) for CSF IFN-γ (p=0.033), CSF IL-10 (p=0.033)
and serum VEGF (p=0.033) at one month of treatment. None of the patients showed any association
between CSF and serum cytokines on admission and at one month of anti-tuberculosis treatment with
neuro-radiological findings.
Conclusion: The CSF cytokine levels were not related to TBM disease severity on admission, and
changes on MRI/CT scans. CSF levels of IFN-γ and IL-10 at one month of anti-tuberculosis treatment
were associated with clinical outcome at 3 months. CSF cytokine levels on admission were not
associated with the clinical outcome.
Medulloblastoma is the most common form of childhood primary brain tumour arising from the
cerebellar vermis. It is classified as WHO grade IV embryonal tumours and currently at least four
histological variants have been established. Only few case reports been published on the imaging
features of the medulloblastoma with excessive nodularity variant. We report the MRI features of a rare
case of medulloblastoma with excessive nodularity in a child which is confirmed by histopathology.
MeSH terms: Brain Neoplasms; Cerebellar Neoplasms; Child; Humans; Magnetic Resonance Imaging; Medulloblastoma; Neoplasms, Germ Cell and Embryonal; World Health Organization; Cerebellar Vermis
We report the first known ethnic Malay patient with laminin alpha-2 (merosin) deficiency (MDC1A),
a subtype of congenital muscular dystrophy (CMD)as a result of novel LAMA2 gene mutations. The
21-month-old female presented with hypotonia at birth and gross motor delay of her distal lower
limbs. Physical examination showed generalised hypotonia, hyporeflexia and myopathic facies but
good cognitive functions. Serum creatine kinase was elevated and white matter changes were detected
in the brain MRI. Muscle biopsy showed dystrophic changes with complete laminin α2 deficiency
by immunohistochemistry. Mutation analysis of LAMA2 showed compound heterozygote at exon 21,
c.2888delG(p.Gly963Alafs*111) and exon 34, c.4886dupC(p.Pro1629Profs*40) leading to premature
stop codon for each of the frameshift mutations. Patient review at seven years of age showed satisfactory
cognitive functions despite having contractures and weakness. Genetic testing of LAMA2 related
muscular dystrophy facilitated the earlier diagnosis of MDC1A and genetic counselling for this family.
A 42-year-old Chinese man, known case of renal cell carcinoma with lung metastasis, was referred to Universiti
Kebangsaan Malaysia Medical Centre for left eye blurring of vision for one month duration, which was worse upon
waking up in the morning and cleared up after 1-2 hours. On examination, visual acuities were 6/6 in both eyes. No
relative afferent pupillary defect. Left fundus showed inferonasal retinal detachment without macular involvement.
No retina break, no retinitis and no choroidal lesion seen. Right eye examination was normal. Optical coherence
tomography (OCT) of left eye showed subretinal fluid temporal and inferior to optic disc. Fundus fluorescein
angiography (FFA) left eye showed hypofluoresence in early phase but hyperfluorescence with pin point leakage in
late phase over inferonasal quadrant. Indocyanine green (ICG) showed early hypofluoresence with late pin point
hyperfluoresence in the same quadrant. A clinical diagnosis of exudative retinal detachment due to choroidal
metastasis secondary to renal cell carcinoma was made. The patient was planned for cyber-knife radiotherapy of his
left eye but unfortunately we lost the follow up. High index of suspicion and relevant investigation are needed for
patients with visual complaints and history of renal cell carcinoma to diagnose choroidal metastasis.
A 47-year-old healthy Indonesian gentleman, presented with blurring of vision on the left eye associated with pain
and redness after history of foreign body entering the eye. A general practitioner prescribed him some eye drops;
however, his symptoms worsened. A corneal laceration wound measuring 0.5 x 3.5mm with a large stromal abscess
measuring 9.0 x 5.0mm with flat anterior chamber was seen on the left eye. Emergency corneal T&S revealed a large
descemetocele and cyanoacrylate corneal glue was applied on the area. C&S showed Pseudomonas aeruginosa.
Patient was subsequently undergone penetrating keratoplasty as a definitive measure. This case highlights the rapid
progression of pseudomonas keratitis, presented with a large descemetocele, which can be mistaken as an infected
corneal laceration wound. Corneal cyanoacrylate glueing together with corneal suturing is a viable temporary method
for large descemetoceles awaiting definitive surgery.