We describe the results of serology for parasitic infection of 250 foreign workers who were seen at the University of Malaya Medical Centre, UMMC during 7-months period. The 250 foreign workers participated included 114 from Indonesia, 142 from Bangladesh, two from Myanmar and two from Pakistan. Blood samples were taken from these workers and eight tests (amoebiasis, echinococcosis, filariasis, leishmaniasis, malaria, schistosomiasis, toxoplasmosis, and trypanosomiasis) were performed on serum. Among the 250 sera tested, 92 (36.8%) were found to be positive for at least one parasitic infection. There was one case where the serum was found positive for 5 tests. The most common antibody detected in those positive sera was antibody for toxoplasma (80.%), followed by filaria (32.8%) and amoeba (30%). Other tests showed low percentage of infection with schistosomiasias, 10%; echinococcosis, 6% and malaria, 3.6%. None of the foreign workers were found positive for leishmaniasis or trypanosomiasias.
A pilot study on 250 foreign workers was undertaken during a 7-month period beginning December 1996. The sample of subjects mainly males (88.8%) was selected on a non-probability basis from two sources i.e. from University of Malaya (72.8%) and PEREMBA group (27.2%). The study was a clinic-based and a face-to-face interview was carried out to elicit information on social, demographic, environmental, medical and recent illness using a structured questionnaire. Physical examinations were also performed on the same day of the interview. Subjects were also required to give their stool, venous blood, and urine specimens for microbiological, parasitological and clinical laboratory investigations. Chest X-Rays was done on ail subjects. The other investigators had already reported findings on the various specific areas of the study. In this part of the report attempt was made to relate the infectious diseases to some of the socio-environtnental variables on the 112 Indonesian, 133 Bangladeshi workers. Some aspects of health seeking behaviour of these foreign workers were also presented. Most of the Indonesian workers (84%) were from Jawa Timua and Jambi, Sumatra, while majority of the Bangladeshis (67.7%) were from two neighboring administrative districts of Dhaka and Chittagong. Majorities of the Indonesians (50.0%) were working in service industry, while 53.5% Bangladeshis were in the manufacturing. One-fifth of the workers lived in squatter areas, and nearly half of them were working for the service industry. About 70% of the workers had at least one infection. The proportion was slightly higher among the Indonesians (72.3%) compared to the Bangladeshis (67.7%). It is of interest to point out that 40.0% had multiple infections. Thirteen had five or more infections (details for the two of the 13 cases are presented as case studies). However, the findings did not indicate any association between sanitation and infections. Risk for transmission was developed based on the number of infections in the person. The Indonesian workers carried a higher risk of transmitting the diseases (33.9%) compared to 19.5% among the Bangladeshi workers. Those working in the construction industry were at a higher risk of transmitting the diseases compared to other industries. Slightly more than half of the workers experienced some form of minor illness or injury during the two-week period preceding the interview. Majority sought private care (43.1%), while 42.3% either self-medicate or did nothing al all. Nearly two-thirds paid out of their own pocket. Among the employers, construction sector made negligible contribution (2.9%) to the payment. It is interesting to find that 41.0% of the workers took some form of health suppletnents, and majority (48.4%) got it from the phartnacy or traditional sources. Nearly all (88.5%) paid on their own for the health supplements. The findings from this pilot project need to be interpreted with solne caution. However, it appears that the foreign workers carry sizeable anlount of health problems. If these are not addressed quickly it may eudanger the health of a nation, while we readily acknowledge their contribution towards our national development.
With the increasing ease of travel and the passage of peoples between counkies there is a need to ensure that the recipient country is not burdened by the need for care of ilniiiigrant with health problems as well as the increased risk posed to the local population froni exposure to conun~unicabled isease. To assess the chest radiographs of a selected group of inun~igrantsto ascertain the presence of abnormalities especially the presence of tuberculosis. A total of 250 imniigrants were prospectively evaluated by a PA chest radiograph. The chest radiograph was evaluated by two radiologists for the presence of abnormalities of the heart, lungs, mediastinum and bony rib cage. There were 112 Indonesians, 133 Bangladeshis, one Myanmar, three Pakistanis and one others. Males made-up 222 while there were 28 females. The chest radiograph was diagnostic in all cases. There were 13 cases with enlarged hearts but with no evidence of heart failure. There was only a single inlmigrant who had evidence of active TB though there were 6 others who had evidence of old disease. There was evidence of other infections in five. With regard to the mediastinuni there was a single case with enlarged hila probably secondary to increased cardiac output. There were 21 patients with scoliosis of the spine and two with abnormaIities of the ribs. Even though there was a single case with evidence of TB from this pilot study, from unreported data from the UMMC, there were 15,16 and 23 immigrants treated for TB for 1994,1995 and 1996 respectively. This was mainly seen in the Indonesians followed by the Bangladeshis and Myanmar. We attribute this discrepancy to the biased salnpie in this study where probably only the healthy were seen while those who were not well did not want to participate in this study. In addition, this may also be due to the small sample used in this study. We feel that screening of the immigrants out in the field may be able to detect cases of active TB. As for the large hearts we feel that in the absence of any cardiac symptoms and other radiological changes these are probably due to the increased workload on the heart from physical activities. This is a recognised presentation. The changes in the mediastinum and bony rib cage are probably not very significant.
Lymphatic filariasis is endemic in Asia. The infections persist as a major cause of clinical morbidity and a significant impediment to socioeconomic development. Its prevalence is increasing world wide, largely because of rapid unplanned urbanization in many endemic areas. It is estimated that at least 120 million people are infected. In our study on foreign workers, a total of 241 day time blood samples were collected. The countries represented were Bangladesh (134), Indonesia (103), Pakistan (3) and Myanmar(1). The tests conducted on blood samples were thick blood film for microfilaria and thin blood film for malaria and quantitation of eosinophiles using the Giemsa stain. Out of the 241 blood samples tested, one was positive for Wuchereria bancrofti and one other was positive for malaria (Plasmodium falciparum) each from Bangladesh and Indonesia respectively. As for the blood eosinophiles, 39 (16.18%) blood samples showed high eosinophilia. Fifteen (6.22%) were from Banglandesh and 24 (9.96%) were from Indonesia. The Bangladeshi male who was positive for Witcherrria bamuofti also showed eosinophilia of 22%. We believe that some of these cases with high eosinophilia, may be positive for microfilaria. We may have missed some cases because of the methodology we chose. Lymphatic filariasis is endemic in Bangladesh and Indonesia. In Malaysia W. brancrofti, especially in the cities have been eliminated. However their vectors for the transmission of W. bancrofti is rampant in the cities. With the influx of immigrants with W. bancrofti and in relation to their occupational nature, W. bancrofti may eventually be introduced into the community and change the whole facet of the disease in Malaysia.
During the study period, a total of 241 foreign workers were examined. The countries represented were Indonesia (103), Bangladesh (133), Myanmar (I), Pakistan (3) and others (1). The specimens collected were blood (238) and stool samples (173). The tests conducted on blood samples were for syphilis by RPR and TPHA, HIV, Hepatitis B, and from stool samples, enteric pathogens such as Salirzoirella spp, Shigelln spp. and Vibrio clrolerne. Table I shows the type of tests performed on the various nationalities and Table 2 the results of testing. Of the 230 blood samples tested by RPWPHA, five were positive, one from Indonesia (1.09%) and four from Bangladesh (3.79%). There was only one sample of blood out of 238 tested which was HIV positive (0.42%) and this was in an Indonesian. Twenty three workers were found to be Hepatitis B antigen positive (9.66%), 10 out of 102 (9.80%) from Indonesia and 13 out of 131 from Bangladesh (9.92%). As for the entric bacterial pathogens, only six out of 173 stool samples tested were positive, five for Saliizoilella Spp. and one for Slligdla sp. Of the five positives for Salmonella, one was from Indonesia and four from Bangladesh. The single isolate of Shigella was from Pakistan. From this pretiniinary study, it is obvious that hepatitis B is the most important problem among the workers from Indonesia and Bangladesh. The second of importance is venereal disease and enteric bacteria among Bangladesh workers. The other three national groups are too small to be analyzed. It is interesting to note that although these workers are supposed to have been screened for venereal diseases, a number of them were still found to be positive. However, we are not certain that these might not have been acquired locally. There was only one case of HIV detected but if the foreign workers continue with their pronliscuous lifestyle they are likely to pick up other sexually transmitted diseases including HIV and chlamydia1 infections. For those who were found to be stool positive for enteric pathogens, it is important to determine whether they are food-handlers as they will prove a significant risk for the spread of infections. Originally, it was intended to test blood samples for hepatitis C and E markers since the incidence in foreign countries from which the workers come are higher. However, due to the shortage of the samples, this had to be deferred. In the light that hepatitis carriage rate is the highest for the microbes tested, it is important to include these two markers in future studies.
Familial amyloid polyneuropathy is most commonly associated with variant plasma transthyretin (TTR) although it has been described in association with variant apolipoprotein A1 and gelsolin. More than 40 TTR variants, all consisting of single amino acid substitutions diskibuted widely along the length of the 127 residue TTR subunit have now been described. We report here a novel TTR variant, Glu18, in a Colombian woman with TTR amyloidosis.
The majority of migrant workers studied in this pilot survey were male, from Bangladesh and Muslim. The mean age was 30 years and the majority were aged between 21-30 years. Although almost half of them had 7-13 years of schooling, or an equivalent to secondary education, the majority were work- ing in the Service industry, predominantly in cleaning services. It is noted that this enlployment trend varied from the national situation, whereby majority of legal migrant workers (Indonesian and Thai) are found in the agricultural sector. More than two thirds of the migrant workers were provided with various forms of housing by the employer. However, it is not known if such acconunodation was adequate or not, as there were no questions about housing structures aod extent of overcrowding. Majority of them stated that they had better amenities, such as piped drinking water and sanitaly toilets, here in Malaysia compared to those in their home countries. Yet, the real extent of better sani- tation is difficult to assess since verification of such amenities could not be done. From their self- reports, it appears that the majority did not engage in risk behaviours, such as smoking, alcohol and drug abuse. It is pertinent, however, to include other risk behaviours in the study, particularly the area of sexual behaviour. The pilot study yielded 28 female Indonesian migrant workers. More than two thirds of them were married. Although none of the married women reported that they were pregnant at the time of the survey, more than two thirds of then1 had betweenl-3 children in Malaysia. Since the age range of these children would be an important indicator of the need for preventive health care, it is proposed that age range of the accompanying children and their immunisation status be included in the questionnaire. Just below half of them were currently practising family planning, and more than two thirds were using modern methods, such as, pill, Norplant and IUD. It is recotnmended that in addition to pregnancy and family planning information, the study could also collect data on gynaeco- logical health and the health seeking behaviour for these problems.
This section only examines the clinical findings and some blood chemistly in these workers. A total of 222 men and 28 women were studied. Their ages ranged from 12 to 57 years, the mean being 30.1 (±7.4). Generally most of the physical examination was normal and no external features of infectious diseases were seen. The mean systolic and diastolic blood pressure was 120 (±13) and 76(±8.7) nun Hg respectively. About 8.4% of the population had elevated blood pressure of 140/90 mmHg or greater. About 12.4% of these man and women were underweight (Body mass index (EMI) less than 19 kg/m2) while 11.2% were either overweight or obese (BMI>25) with the mean being 21.8 (±2.7). Only 3 had BMI greater than 30. Three subjects had a lnitral regurgitation murmur thought to be due to mitral valve prolapse. Four others had tinea cruris, six had insignificant axillary lymph-nodes, five had cervical lymph-nodes of which one was due to carcinoma of the tonsil 30 with shotty inguinal lymph-nodes which was thought to of no pathological significance. Four subjects had crepitations and five had rhonchi in their lungs. A full blood count revealed that 16.65% of the man and 32.1°/o of the women had haemoglobin levels of less than 14gm/dl and 12gm/dl respectively. The most striking abnormality was the high prevalence of eosinophilia. 37% of the subjects had eosinophilia counts of greater than 450/dl. About 19.4% of this study population had fasting blood glucose of greater than 6mmol/l but only 1.3% with fasting blood glucose of greater than 7.8 mmo/l. About 22% of the urine examined revealed pro- teinuria but were otherwise unremarkable for the other parameters. This group of foreign workers was made up of a presumably fairly healthy young population. Attempts to look for infectious disease on physical examination, not surprisingly did not reveal any remarkable findings. It could be that the majority of these subjects already had a examination prior to coming into the country and another one soon after arrival. However an indirect measurement of infectious diseases via the eosinophilic count revealed a high prevalence of parasitic infestations. Attempts to examine the end results of social hardship, be it intrinsic before or appearing after arrival indirectly shoved some degree of suffering. There was a fairly high prevalence of anaemia, especially amongst the women. The body mass index also revealed this population to be generally less obese than other populations. The value of medical check-ups has been debated, especially if it were done as a pre-employment procedure. This pilot study has shown that it is not cost-effective to do physical examination or blood chem- istry and urine analysis in hying to identify infectious diseases in the migrant workers. In the light of the paucity of clinical findings in this pilot study, it would be prudent to review the strategy for examining the health status of migrant workers. Perhaps the physical examination can be dispensed with, and blood andurine analysis beveryfocused and directedin order to maximise the cost- effectiveness of this programme. Certainly the high prevalence of eosinophilia needs further evalua- tion.
The records of 141 consecutive patients with proven tuberculosis (TB) were reviewed to examine for changes in their serum proteins, erythrocyte sedimentation rate (ESR) and tuberculin skin test reactivity. Hypoalbuminaemia was present in 73% of patients and hyperglobulinaemia was seen in 92% of patients. ESR showed a negative correlation with the serum albumin level but a positive correlation with the serum globulin level. In the case of pulmonary TB, ESR was higher in patients with radiologically more extensive disease. Tuberculin reactivity was reduced in patients who were older, those with more severe hypoalbuminaemia and those with disseminated TB. KEYWORDS: Albumin, erythrocyte sedimentation rate, globulin, tuberculin reactivity, tuberculosis
Screening for drugs of abused were conducted by using Gas chromatography-Mass spectrometry (GCMS) fitted with capillary column. Urine samples supplied by Centre of Inmigrant Studies, University of Malaya were processed upon arrival and screened for the following drugs. Amphetamines, methamphetamines, aphedrine, hydroxy-amphetamines, ecstasy, benzamphetamines, codeine, morphine, heroine, cocaine and diazepam. The analysis was done using Shimadzu QP5000 Gas chromatograph-mass spectrometer by selected ion monitoring with BPX35 column, 15 m length, 0.32 ID, helium gas as carrier and quadropole mass detector at 1.60 kV electron gain. Analysis were performed using selected ion monitoring (SIM) mode and quantitations were based on area under the curve of individual standards at various concentrations. The method is sensitive to nanogram levels and are able to detect the presence of these drugs in both urine and plasma. From this study (n-100), none of the urine were found positive for the drugs screened. The major problem encountered were adulterated with water based on the clearness and the colour of the urine. Based on this suspicion we would like to suggest that the testing be done on blood samples as this would be more confirmative and quantitative.
One hundred seventy three stool samples were obtained from workers from Indonesia, Bangladesh, Myanmar, Pakistan and others. The stool samples were examined for Ascaris, Trichuris, Hookworm, Schistosomes, trematodes and cestodes. The protozaon parasites included Bnlantidiirrir coli, Blastocystis honlinis, Cyclospora cryptosporidium, Microsporidiirin, Entamoeeba histolytica, Giardia lamblia, lodamoeba butschilli. Of these 21.9%, 17% and 1% of the population studied had hookworm, Trichuris trichiura and Ascaris lumbricoides infections respectively. There was only one Indonesian reported to have Hymenolepis nana infections. The most common protozoan seen in the faecal sample is Blastocystis hominis (36%) followed by Giardia lamblia (4%). Most of the stools positive with these faecal pathogens were semisolid especially the ones positive for the protozoan. We have also shown Blastocystis from the Indonesian workers show very small forms almost 3-5 in size compared to the normal size of 10-15 pm in the other nationalities. These forms show a distinct growth profile in cultures and appears to be more resistant to temperature changes than Blastocystis seen in the other two nationalities. The high incidence of Hookworm and Trichuris infections is suggestive that if these workers are left unheated their productivity will be hampered by other possible serious complications such as anaemia, weight loss, abdominal pain with diarrhoea1 stools and nausea. There are increasing reports that Blastocystis hominis is pathogenic. Flatulence, abdominal discomfort and the increase in the frequency of the passing watery stool has been noted in patients infected with the parasite. Since most of the workers are generally housed in crowded rooms it is highly likely that this will facilitate transmission through the faecal-oral route of both Giardia and Blastocystis possibly increasing the incidences of these infections among workers.
A review of the questionnaire was carried out basically to assess the relevance of the questions to the objectives of the study, to identify weaknesses of the questions particularly in terms of the wording in order to make them as clear as possible to the respondents and to minimize ambiguity and thus the problems of getting the questions across to the respondents. Based on the review a new set of questionnaire would be proposed. The review thus focuses on two major aspects namely the structure and the content of the questionnaire. From the structural aspects each question was reviewed in terms of the language, wording, sequencing and continuity between one another. Basically, not much problems have been identified except in certain cases of ambiguity largely due to language and words used and some cases lack of continuity due to improper sequencing of the questions In terms of the content, for each questions, the purpose of asking, and what is expected of the questions was thoroughly examined and then the relevance assessed. Based on the analysis, three group of questions were identified i.e., the irrelevant questions, the partially relevant and most inlportant non-existence of many relevant questions. It is recommended that the irrelevant questions be omitted, those partially relevant to be modified and new questions added.
Bisphosphonates are synthetic analogues of pyrophosphate. Their main pharmacological effect is to iuhibit bone resorption by a variety of mechanisms, not all of which are clearly understood. The activity of the bisphosphonates varies depending on the compound. In clinical trials, they have been shown to stop postmenopausal bone loss and increase bone density, with a concomitant reduction in fracture rate with some agents. This article reviews the currently known mechanisms of action of the bisphosphonates and the evidence that they are useful in the treatment of osteoporosis.
We report a case of visceral leishmaniasis (kala azar) in a 28 year old Bangladeshi migrant. The patient had migrated to Malaysia 9 months prior to admission to our hospital. He was employed in a glove factory. His illness began one week prior to presentation with high swinging fever, chest pain and substantial weight loss. On examination, he was found to be cachetic, with cervical and inguinal lymphadenopathy and niassive hepatosplenomegaly. Investigations revealed a pancytopaenia with a Hb of 9.9 g/L, WBC 3.10 x 10^9/L and a platelet count of 29 x 10g/L. Liver function test revealed an elevated alkaline phosphatase 380 I.U./L and transanlinases AST 169 I.U/L and ALT 95 I.U./L. The serum albumin was 19 g/L. Blood for malaria parasite was negative. A bone marrow examination was performed to look for LD bodies and to exclude haematological malignancies. The bone marrow examination revealed multiple LD bodies. Serology for leishmania was strongly positive. The patient was heated with atnphotericin B to a total dose of 0.6 g. There was resolution of his fever and reduction in the size of the liver and spleen at the end of therapy. There was also a steady gain in his weight. The patient unfortunately failed to return for subsequent follow-ups
Senescent-decliue in the nervous-system functions is very frequently atbibuted to age-related neurone-loss. Processes and mechanisms involved in neuro- degeneration form part of the structural frame-work for interpreting the functional consequences. The literature concerning this matter are confusing and contradicting. The behaviour of cranial nerve ganglia was studied using neuro-histological techniques. On the evidence available in the present study, the dark cells are considered as active ones; the light cells are considered as those which have failed to establish functional projections, inactive, dying, dead or degenerating ones. Probably it is during the me- dium-sized stage of cell growth, the peripheral and central processes (of axons) begin to grow from the cell body and attempt to get established in their projection fields. The light cells have appeared among the very-small cells just on the day of hatching. This probably signifies the possible attempt to elinlinate the growing cells since they are no longer needed to replace larger categories of cells which have already well- developed neuronat connections at this stage. It is assumed that the time of appear- ance of light cells might be indirectly related to the onset of establishment of active functional connections of neurones and to the functional importance of the organs which it supplies. KEYWORDS: Neurone-Loss and Ageing, Dark and Light Neurones, Sensory and Autonomic Ganglia
A survey of malnutrition and helminth infections among 268 pre-school children living in the Kuala Betis Orang Asli resttlement villages in Kelantan. The prevalence of helminth infections was 47.4% with Ascaris lumbricoides being the most common helminth (43.9%), followed by Trichuris trichiura (29.7%) and hookworm (6.3%). The prevalence of Ascaris lumbricoides and Trichuris trichiura infections increased with age, with the highest prevalence found in the 6-7 years age group. The overall prevalence of stunting, underweight and wasting were 61.7%, 60.4% and 17.5% respectively. Both stunting and underweight were significantly higher among the infected children. Factors associated with helminth infections in the pre-school children were older age group, poor water supply and households with more than 5 members. Rountine regular deworming is recommended based on the World Health Organisation recommendations for school children.