The risk behavior in malaria has been identified as one of the factors contributing to malaria in Malaysia. The occurrence of malaria among illegal immigrants and indigenous groups, staying in risk prone areas where conditions are favorable for transmission, highlights the behavior pattern of these groups. In these areas the usual anti-malarial activities are less effective and thus there is a need to identify control measures suited to that particular condition and environment and to community groups. Some of the determinants contributing to the increase in malaria cases like man-vector contact, non-compliance to drugs, complications of the disease, and factors interfering with malaria control measures, factors favoring transmission and proposals to modify risk behavior, which can be applied in an endeavor to control the diseases, have been discussed.
Melioidosis is endemic in Malaysia. Cutaneous melioidosis is one manifestation and it may progress to necrotizing fasciitis. The case highlights a 46-year-old male, a chicken-seller who presented with scalp cellulitis which later progressed to necrotizing fasciitis and pneumonia are presented here. It illustrates several key features of the presentation, prompt laboratory diagnosis and early treatment of melioidosis which saved the patient's life.
Pneumocystis pneumonia (PCP) has become the most common opportunistic infection in HIV/AIDS patients with a CD4 count < or = 200. The incidence of PCP has declined as a result of prophylaxis and better highly active antiretroviral therapy (HAART). The objective of this study was to review the demographic data of HIV patients diagnosed clinically as having PCP at the Hospital Raja Perempuan Zainab II (HRPZ II) in Malaysia. This was a prospective study. All HIV patients admitted to HRPZ II with respiratory symptoms were enrolled in this study after giving informed consent. Their demographic data were collected. The total number of HIV patients reviewed in this study was 107. Nearly 60% of patients were clinically diagnosed as having pneumocystis pneumonia based on their signs, symptoms and chest x-ray findings. A CD4 count was available in 83 out of 107 patients. The fifty-three percent of patients(44) had a CD4 < 200 and were clinically diagnosed as having pneumocystis pneumonia. Thirty percent had a CD4 < 200 but did not have clinical pneumocystis pneumonia. Sixteen point nine percent had a CD4 > 200 and had clinical pneumocystis pneumonia, three of whom had received HAART, four patients had received prophylaxis. Overall, 94 patients (87.8%) received prophylaxis for pneumocystis pneumonia. Thirty-three patients (30.8%) received HAART. The occurrence of pneumocystis pneumonia was common before full implementation of HAART. Pneumocystis pneumonia can occur in patients with a CD4 >200.
Illness and injury have a significant impact on employees, their families and employers. The consequences faced by an injured worker could lead to disability, which could then lead to inability to work. This study examined the patterns of the Return to Work (RTW) using data from The Social Security Organisation (SOCSO) of Malaysia RTW database from 2010 to 2013. Factors of successful return to work, employees' salary upon returning to formal employment were also investigated. Gender, age, year of injury, industry, and job hierarchy were found to be significant predictors of employees' salary upon returning to work. Although there are other costs involved on the part of employers and employees, themselves, in the long term the financial returns that can be brought back by injured workers who have successfully returned to work combined with the qualitative benefits substantially outweighs the costs of RTW program.
Three hundred thirty-one consecutive patients presenting with hypertension to the outpatient medical clinic of Tengku Ampuan Afzan Hospital, Kuantan, Malaysia were screened and 150 patients with concurrent diabetes were enrolled into a cross-sectional study. The majority of patients were male (60.6%) with a mean age of 60.0 +/- 11.0 years. The mean systolic blood pressure (SBP) was 140.9 +/- 20.1 mmHg and the mean diastolic blood pressure (DBP) was 81.7 +/- 9.8 mmHg. Only 38.0% (57/150) of patients had blood pressures within recommended guidelines (130/80 mmHg). The mean blood pressure in this group was 123.7 +/- 8.5/76.4 +/- 5.6 mmHg. The majority of patients were on either 2 (41.3%) or 3 (31.3%) anti-hypertensives. Females had a significantly higher SBP 145.4 +/- 22.7 vs. 138.0 +/- 17.8 mmHg in males (p = 0.026). The level of blood pressure control in diabetics was unsatisfactory, especially in females and the elderly. A reassessment of priorities in the management of patients with concurrent hypertension and diabetes is therefore, urgently needed.
Study site: outpatient medical clinic of Tengku Ampuan Afzan Hospital,
A cross-sectional study was conducted to determine the risk factors of job-related depression in laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) Hospitals in Kelantan, between September 2001 and February 2002. One hundred and two laboratory technicians from HUSM and 79 from KKM Hospitals were selected and 84 (82.4%) from HUSM and 71 (89.9%) from KKM Hospitals were recruited as study subjects. Data were collected by self-administered questionnaire using the validated Malay version of the Job Content Questionnaire (JCQ), originally developed by Robert Karasek. The results indicated significant associations between the risk factors of job-related depression, and low social support, and high psychological demands (OR 3.0, 95% CI 1.1-8.8) in laboratory technicians in HUSM. However, for laboratory technicians in KKM Hospitals, the significant association was between job-related depression, and low social support and low decision authority (OR 9.7, 95% CI 1.1-91.1). Low social support was highly associated with job-related depression in laboratory technicians in HUSM and KKM Hospitals. We, therefore, conclude that low social support positively predicted depression in laboratory technicians in HUSM and KKM Hospitals. In addition, high psychological demands also significantly predicted depression in laboratory technicians in HUSM; however, for laboratory technicians in KKM Hospitals, low decision authority was the significant predictor of depression.
A study was conducted to determine the helminthes in dog's feces and soil samples from urban and rural areas. Six species of nematodes (Toxocara sp, an undetermined nematode larvae, Strongyloides sp larvae, Ascaris sp ova, hookworm ova, Trichuris sp ova) and one species of Cestode (Taenia sp) were found in 175 stool samples. Seventy-eight point nine percent of stool samples were positive for helminthes. Mixed infection with at least one parasite was found in 32.6% of the samples. The prevalence of helminth infection ranged from 1.1% to 45.1%. The prevalence of hookworm sp was the highest with 45.1%. The highest prevalence in urban dogs was hookworm sp in 76.7% and in rural areas was Ascaris sp in 48.7%. Soil samples were also examined to determine contamination of the environment, especially due to Toxocara canis, as a potential source of infection. Urban soil samples showed a higher contamination rate with 26.7% compared to rural areas with 4.9%. Toxocara ova were the most prevalent helminthes contaminating the soil with 12.1%. This study showed that humans from both urban and rural areas are at risk of acquiring helminth infection from contaminated soil.
We performed a case control study to examine protective and risk factors for acute respiratory infections (ARI) in hospitalized children in Kuala Lumpur. Consecutive children between the ages of one month and five years hospitalized for pneumonia (n = 143), acute bronchiolitis (n = 92), acute laryngotracheobronchitis (n = 32) and empyema (n = 4) were included as cases and were compared with 322 children hospitalized during the same 24 hour period for non-respiratory causes. Potential risk and protective factors were initially analysed by univariate analysis. Logistic regression analysis confirmed that several home environmental factors were significantly associated with ARI. The presence of a coughing sibling (OR = 3.76, 95%CI 2.09, 6.77), a household with more than five members (OR = 1.52, 95%CI 1.03, 2.19) and sleeping with three other persons (OR = 1.45, 95%CI 1.00, 2.08) were independent risk factors. Significant host factors were history of allergy (OR = 2.50, 95%CI 1.74, 3.61) and ethnicity (Malay race) (OR = 2.07 95%CI, 1.27, 3.37). Breast feeding for at least one month was confirmed as an independent protective factor (OR = 0.58, 95%CI 0.38, 0.86). However, the study was not able to demonstrate that domestic air pollution had an adverse effect. This study provides further evidence that home environmental factors, particularly those associated with crowding, may predispose to ARI and that breast feeding is an important protective factor.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the commonest causes of neonatal jaundice in Malaysia. Screening of cord blood for G6PD deficiency by the semiquantitative fluorescent spot test (FST) is performed in Malaysia but this test can miss cases of partial G6PD deficiency. The OSMMR-D kit assay measures G6PD activity and hemoglobin (Hb) concentration, allowing direct expression of results in U/gHb. We evaluated this method and established the normal range for G6PD activity in normal term neonates and adults. EDTA blood from 94 neonates and 295 adults (age 15-59 years old) with normal Hb and FST were selected. The normal means for G6PD activity for neonates and adults were 12.43 +/- 2.28 U/gHb and 9.21 +/- 2.6 U/gHb, respectively; the reference ranges for normal G6PD activity in neonates and adults were 10.15-14.71 U/gHb and 6.61-11.81 U/gHb respectively. There were no significant differences in mean normal G6PD activity between the Malays and Chinese racial groups or between genders. The upper and lower limit cut-off points for partial deficiency in neonates were 7.4 U/gHb (60% of the normal mean) and 2.5 U/gHb (20% of the normal mean), respectively. For adults, the upper and lower limit cut-off points for partial deficiency in adults were 5.52 U/gHb (60% of the normal mean) and 1.84 U/gHb (20% of the normal mean), respectively. The quantitation of G6PD enzymes using this OSMMR-D kit with Hb normalization was simple since the Hb was analyzed simultaneously and the results were reproducible with a CV of less than 5%.
We have analysed DNA fingerprinting patterns by pulsed-field gel electrophoresis (PFGE) of 52 unrelated Burkholderia pseudomallei strains isolated from septicemic and localized infections from Malaysian subjects. A total of 38 PFGE types were observed among 36 septicemic and 16 localized strains with no predominant pattern. Type 25 was seen in 2 epidemiologically related strains, suggesting human to human transmission. Twelve PFGE types were shared among 26 strains (21 septicemic and 5 localized) showing close genetic relatedness with coefficient of similarity of 0.81 to 1.0. The other 26 strains (15 septicemic and 11 localized) were unrelated as shown by the similarity coefficient of < 0.8. This study showed that our B. pseudomallei strains in Malaysia were mainly heterogenous with no predominant type both in septicemic or localized strains.
Head lice infestation contributes a significant morbidity among schoolchildren in Malaysia. A cross-sectional study was designed to determine the prevalence and associated factors of head lice infestation among primary schoolchildren in Kelantan, Malaysia. Six schools were randomly selected from three sub-districts of Kuala Krai, Kelantan. A total of 463 eleven-year-old pupils were screened by visual scalp examination and fine-toothed combing. Self-administered questionnaire was used to collect data on socio-demography and associated factors of head lice infestation. The prevalence of head lice infestation was 35.0% (95% Cl: 30.6, 39.3) with 11.9% inactive, 23.1% active, 18.2% light and 16.8% heavy infestations. The associated factors were girls; family income of RM247 or less; head lice infestation of family member and having four or more siblings. The high prevalence of head lice infestation in this study indicates the need for regular school health program that emphasis on the eradication of head lice. The significant associated factors identified in this study reconfirm the importance of controlling the transmissibility of head lice. Pupils and parents should be informed regarding factors that may facilitate the transmission of head lice.
Recent studies on cytogenetics, behavioral, geographical and distinct morphological characters on adult, pupal and larval stages have revealed that "balabacensis" is a species complex. Anopheles dirus the mainland species, is distributed widely in Thailand and is renowned for its role as primary vector of human malarial parasites. Further, evidence from cytogenetic and taxonomic studies suggests that "An. dirus" is a species complex comprising at least four distinct species provisionally designated: dirus A, B, C and D. These cryptic species are distinguishable only partially morphologically, but can be separated on the basis of metaphase chromosomes using the Giemsa and Hoechst 33258 staining techniques. Apparently, these siblings show distinct patterns of geographic distribution in Thailand and Peninsular Malaysia. The recognition of dirus as a complex of species in Thailand and Peninsular Malaysia requires a re-evaluation of the role that the individual members of this complex have in the transmission of malaria parasites in this region. Cytological analysis of gene rearrangements in ovarian polytene chromosomes has shown that An. maculatus is a sibling-species complex consisting of at least four species in Thailand provisionally designated: maculatus A, B, C and G. These siblings are sympatric in some populations. Furthermore, species B is so highly polymorphic for chromosome rearrangements that four geographic forms can be recognized. It is not known whether these four forms are subspecies or yet further species within the species B complex. These sibling-species must be differentiated in order to understand any differential capabilities in their transmission of human malaria parasites. Anopheles nivipes was elevated from synonymy under An. philippinensis to full species status by Reid, a decision recently confirmed by cross mating experiments. The Thailand Malaria Division does not differentiate these two species and only identifies An. philippinensis, yet, An. nivipes is by far the most common of the two species in Thailand. Furthermore, preliminary surveys of the ovarian polytene chromosomes of several widely separated populations of An. nivipes in Thailand have revealed at least two distinct chromosomal types of nivipes based on fixed inversions on the X chromosomes.
Until recently, very little was known of Anopheles species complexes and their relationships to epidemiology and malaria transmission in Southeast Asia. During the past eight years, extensive studies on the genetics of natural populations of anopheline mosquitoes in this region, involving the interdisciplinary efforts of taxonomists, operational entomologists and biologists, have revealed groups of cryptic species of Anopheles vectors, particularly the An. leucos phyrus group. This species group comprise seventeen species and two subspecies widely distributed in the forested areas of Southeast Asia. Among these species. An. dirus Peyton and Harrison, has been shown by cytogenetic and morphological studies to be a complex of at least seven isomorphic species, provisionally designated species A, B, C, D, E, F and takasagoensis, on the Southeast Asian mainland. Cytological identification of these species is based on distinct banding patterns of salivary gland polytene chromosomes as well as heterochromatin differences in mitotic karyotypes. The five species found in Thailand (A-D, F) exhibit distinct geographic distributions. Species A is widespread throughout Thailand except in the south. Species B had been found in sympatry with species C in southern Thailand and both seem to show north-south clinal geographic variation. Species D is common on the west side of southern Thailand and along the Thai-Burmese border in sympatry with species A. Species F, An. nemophilous Peyton and Ramalingam, has been found in a population at the Thai-Malaysian border in this study although it was known to be common in southern and western Thailand and Peninsular Malaysia. Species E is known only from western India. The five species found in Thailand also exhibit seasonal variation in relative abundance and different nocturnal biting cycles. Chromosomal polymorphisms have been observed in mitotic and polytene chromosomes of An. dirus A and D. Species B and C also show heterochromatin variation in the sex chromosomes, but are monomorphic for the standard sequence in polytene chromosomes. These biological characteristics of the An. dirus complex may have implications for understanding the epidemiology of malaria in Southeast Asia. Recent cytogenetic studies of wild-caught samples of An. leucosphyrus from Sumatra, Kalimantan and southern Thailand have revealed the presence of two distinct species within this taxon. Species A is widely distributed in southern Thailand, East Malaysia and Kalimantan, while species B is confined to Sumatra. The two isomorphic species are vectors of human malaria within their range of distribution.(ABSTRACT TRUNCATED AT 400 WORDS)
The efficacy of the larvicidal and pupicidal agent (Agnique) MMF was evaluated against larvae of An. arabiensis and Culex (Diptera: Culicidae) under field conditions in Bahary Locality, Khartoum, Sudan. At an applied dosage of 0.25 ml/m2, MMF resulted in 89.4, 79.8 and 88.2% reductions in L3-L4 instars An. arabiensis and 63.5% in Culex larvae (all stages) 24 to 72 hours post-treatment. Pupae were completely eliminated (100%) within 24 hours posttreatment. The earlier instars (L1-L2) of An. arabiensis were more tolerant with a 62.5% reduction at 72 hours post-treatment compared to (L3-L4) instars and pupae. At 7-days post-treatment Agnique gave a 57.5% reduction in L1-L2 and 92.6% in L3-L4 instar larvae of An. arabiensis and 57.3% and 86.4% in Culex larvae and pupae, respectively. We conclude that Agnique can perform effectively against L3-L4 instars and pupae of An. arabiensis for only 1 week, and 3 to 4 days against L1-L2 instars of Culex spp.
A description of sensory receptors of Trichobilharzia brevis is given. They are compared with the five Schistosomatidae described by Richard (1971), namely, Trichobilharzia ocellata, schistosoma mansoni, S. bovis, S; haematobium and S. rodhaini. All these species display very similar chaetotaxic characters. In the study of the cercaria of Haplorchis pumilio, comparison with the few Opisthorchioidea cercarial sensory organs already known has enabled the authors to characterise the chaetotaxy for this superfamily.
VectoBac DT, a tablet formulation of Bacillus thuringiensis israelensis (Bti) was evaluated for the potential control of dengue vectors in various types of potable water containers. On introduction to containers, the tablet sinks to the bottom and the Bti toxins are found concentrated at the sides and the base, while the treated water column is free of Bti toxins within 24 hours after tablet introduction. In a simulated study, earthen, HDPE and plastic containers were kept covered and laboratory-bred larvae were introduced to determine the control by the tablet. The efficacy and persistence of the tablet, with a control of > 90%, was significantly longer in earthen containers in comparison to the HDPE and plastic containers. Efficacy and persistence were observed in earthen containers for a minimum period of 5.5 months (166 days) both without water replenishment and with weekly, 50% water volume, replenishment, and for a maximum period of 2.2 months (66 days) with daily, 50% water volume, replenishment. In plastic and HDPE containers, the tablet activity had a persistence of 2.1 months (63 days) without water replenishment and 1.8 months (54 days) with weekly water replenishment. The efficacy and persistence of the VectoBac DT was significantly longer in the earthen containers, with or without regularly treated water exchange, due to the Bti toxins being embedded in the porous earthen container surfaces, which protects them from rapid degradation. Lesser toxin amounts are removed from the water column during water exchange. The efficacy of VectoBac DT was also evaluated for the control of natural infestation of Aedes larvae which were resistant to temephos at the WHO diagnostic dosage of 0.012 mg/l. The tablet significantly reduced the pupal density by 8 fold in earthen containers for 67 days and 5 fold in HDPE containers for 55 days in comparison to untreated containers (p < 0.05). However, the tablet was effective for a shorter period of 25 days post-tablet-introduction due to fungal infestation in the treated plastic containers. There is a need to determine the capacity of the VectoBac DT to reduce the dengue vector population to a threshold which will prevent dengue outbreaks in dengue endemic areas.
Neodiplostomum (Conodiplostomum) Brachylaima, Ectosiphonus and Euparadistomum are reported for the first time from small mammals in Malaysia. New host and locality records are given for Echinostoma, Achillurbainia, Beaveria, Odeningotrema, Leipertrema, Athesmia, Skrjabinus and Zonorchis. Possible-life-cycles of the parasites are discussed in relation to the ecology and feeding habits of the hosts.