Hypophosphatemic osteomalacia is a rare form of metabolic bone disorder in neurofibromatosis type 1 (NF1). The exact disease mechanism of this disorder in NF1 is yet to be established. We present a 44-year-old female known to have NF1, who presents with debilitating bone pain, weakness and multiple fractures. Laboratory investigations showed persistent hypophosphatemia with renal phosphate wasting suggestive of hypophosphatemic osteomalacia. She also had concomitant vitamin D deficiency which contributed to the disease severity. Medical therapy with oral phosphate and vitamin D improved her symptoms without significant changes in fracture healing or phosphate levels.
The life table developmental attributes of laboratory colonies of wild strains of Aedes albopictus and Aedes aegypti were analyzed and compared based on the age-stage, two-sex life table. Findings inclusive in this study are: adult preoviposition periods, total preoviposition period, mean intrinsic rate of increase (r), mean finite rate of increase (λ), net reproductive rates (R0), and mean generation time (T). The total preadult development time was 9.47 days for Ae. albopictus and 8.76 days for Ae. aegypti. The life expectancy was 19.01 days for Ae. albopictus and 19.94 days for Ae. aegypti. Mortality occurred mostly during the adult stage. The mean development time for each stage insignificantly correlated with temperature for Ae. albopictus (r = -0.208, P > 0.05) and (r = -0.312, P > 0.05) for Ae. aegypti. The population parameters suggest that Ae. albopictus and Ae. aegypti populations are r-strategists characterized by a high r, a large R0, and short T. This present study provides the first report to compare the life parameters of Ae. albopictus and Ae. aegypti strains from Penang island, Malaysia.
Piper betle (sirih) is a medicinal plant that has been reported for various pharmacological activities such as antifungal, antibacterial, antioxidant, anticarcinogenic and, anti-inflammatory. The researchwas carried out to study the antifungal activity of ethanolic extract from P. betle leaves. Matured leaves of P. betle were collected and processed to a fine powder before being extracted using ethanol. The first part of the research involved evaluation of antifungal activity of the ethanolic extracts using disk diffusion method at four different concentrations (5, 25, 50, 100 mg/mL) against 3 types of fungi isolated from laboratory surfaces. The sensitivities of the fungal towards the ethanolic extracts were determined by measuring the size of inhibitory zones. Results showed that highest concentration of the extract (100 mg/mL) inhibited fungal growth for all three types of isolated fungi with 0.97, 0.83, and 0.77 cm zone of inhibition for yeast, Aspergillus sp. and Penicillium sp., respectively. Low concentrations (5, 25 and 50 mg/mL) did not inhibit the fungal growth except for Penicillium sp. that showed zone of inhibition, 0.53 cm at concentration of 50 mg/mL. The second part of the research involved evaluation of fungal count utilizing effective dose of betel leaves ethanolic extract obtained from the first part of this research which is 100 mg/mL. This study found that no fungal growth on the microscope wire that has been sprayed with betel leaves ethanolic extract on Day 1, Day 4 and Day 7. For wire that been sprayed with ethanol 70%, the average of fungal count was same on Day 1 and Day 4 (5.6 x 102 cfu/mL) but increased to 9.2 x 102 cfu/mL on Day 7. In conclusion, betel leaves extract exhibit fungicidal properties that support their use as antifungal agents from natural products which are safe, easily available with no adverse effects.
Teaching, learning and reseach activities in chemical laboratory usually involves a variety of hazardous chemicals. All chemicals stored in the laboratories should be accompanied by a safety data sheet which contains information such as chemical composition, safety precautions for handling and storing chemicals and emergency measures in case of accident. Ineffective management of chemical safety data sheet makes it difficult to access and resulting in slow action taken in the event of accident. To overcome this problem, Quisy-SDS was introduced to ensure a more effective chemical safety information management. Quisy-SDS provides a convenient method for all lab users and emergency respondents to acess the chemical safety information. This method uses a Quick Response (QR) code and website that allow users to acess the information in no time, anytime and anywhere. The use of Quisy-SDS has successfully reduced the search time of chemical safety information by 98% compared to the previous method.
Detection of Plasmodium spp. is sometimes inconvenient especially in rural areas that are distant from a laboratory. In this study a portable diagnostic test of Plasmodium spp. was developed using insulated isothermal polymerase chain reaction (iiPCR) as an alternative approach to improve this situation.
Compliance to delivery of orthodontic appliances within specified times and factors which influenced compliance by dental technicians in Selangor was evaluated. This is a prospective 8-month study of 18 trainee/ trained technicians from 4 main government dental laboratories in Kajang, Klang, Tanjong Karang and Shah Alam. Delivery times specified by orthodontists were 1 day for plastic retainer, 3 days acrylic retainer, 5 days active plates (URA), 10 days functional appliances (FA), 10 days transpalatal arch (TPA) and 10 days for quadhelix. Punctual delivery was recorded as ‘compliant’. Compliance was compared between appliances, clinics, technicians, orthodontists and seniority of technicians. The sample comprised appliances from 365 patients; 38 (10.4%) Tanjong.Karang, 114 (31.2%) Kajang, 191 (52.3%) Klang and 22 (6.0%) Shah Alam. The majority of appliances were retainers (66.3%), followed by URA (13.4%), functionals (9.3%), TPA (9.0%) and quadhelix (1.9%). Mean compliance for all appliances in Selangor was 55%. Plastic retainers had highest compliance (77.8%), followed by acrylic retainers (59.9%), quadhelix (57.1%), FA (47.1%), TPA (45.5%) and URA (24.5%). Senior technicians (>3 years in service) were more compliant than juniors (
Background : The implementation of Occupational Safety and Health Management System (OSHMS) requires a level of measurement. The effectiveness of OSHMS implementation was influenced by inhibiting and supporting factors. The objective of this study was to determine the inhibiting and supporting factors towards the implementation of OSHMS in medical laboratories.
Methodology : The implementation of Occupational Safety and Health Management System (OSHMS) requires a level of measurement. The effectiveness of OSHMS implementation was influenced by inhibiting and supporting factors. The objective of this study was to determine the inhibiting and supporting factors towards the implementation of OSHMS in medical laboratories.
Result : This study showed the level of compliance to the OSHMS MS1722 guideline among medical laboratories who are MS ISO 15189 accredited & have a higher scores in overall measurement indicators OSHMS compared to those do not have SAMM accreditation. Private medical laboratories services have higher scores in overall measurement indicators OSHMS, compared to government medical laboratories. However, there was no significant difference (p>0.05) between medical laboratories which have ISO 9000 quality management system certification, compared to level of compliance to the OSHMS MS 1722 guideline among medical laboratories. There was also no significant difference (p>0.05) between the laboratories who had been operating for more than 10 years compared to those with less than 10 years, towards implementing the OSHMS. Results showed that majority of medical laboratories management perceived that difficulty and complexities of OSH legislation are the most important factor that prevent them from implementing OSHMS in their organization. The most important supporting factor, that medical laboratories management perceived as the most important to comply to the OSHMS were their moral responsibilities towards the community.
Conclusion : In conclusion, the study shows there were many inhibiting and supporting factors that contribute towards effective implementation of OSHMS elements in workplace.
Introduction: Increased monocyte percentage and monocyte anisocytosis were suggested as new markers for den- gue fever detection. This study aims to investigate and evaluate monocyte volume standard deviation (MoV-SD) and monocyte percentage (Mono %) parameters using Coulter automated haematology analyser as screening parameters in discriminating between dengue infection and other febrile illness. Methods: A cross-sectional laboratory analysis using suspected dengue fever patients were included in this study. The study was conducted in the Department of Pathology, Hospital Tuanku Jaafar Seremban from June 2016 until June 2017. Patients were classified into dengue positive and dengue negative based on dengue IgM and NS1 result. The diagnostic performance of MoV-SD and Mono % was analysed by receiver operating characteristic (ROC) curve analysis. The cut-off value of the MoV-SD and Mono % was determined and evaluated with the validation group. Chi-square test was used to assess the as- sociation between the parameters. Results: 88 (48.4%) from 182 samples were confirmed to have dengue infection. ROC curve analysis showed Mono % at cut off value of 10.5 % with area under the curve (AUC) of 0.869 with 84.1% sensitivity and 84% specificity (95% CI: 0.812-0.925) and MoV-SD cut off value at 22.2 (AUC 0.776, 80.7% sensitivity, 61.7% specificity, 95% CI: 0.709-0.843) are an excellent parameters in separating dengue positive and dengue-negative patients. A cut-off value of 10.5 of Mono % and 22.2 of MoV-SD were applied to the validation group showed 83.1%, 66.4% sensitivity and 84.9%, 77.3% specificity respectively. Conclusion: MoV-SD and Mono
% parameters are a potential parameter for the screening of dengue infection in acute febrile illness patients with good specificity and sensitivity.
Laboratory workers exposed to diverse occupational exposures to accidents. Evidently, extant, yet very limited em- pirical underpinnings suggest that knowledge, practices and awareness of safety precautions are uncharacteristically poor among laboratory workers. As such, their demonstration of safety-related attitudes and practices have remained questionable. This paper, thus presents a systematic search of the literature on laboratory workers’ safety-related knowledge, attitudes, and practices. Specifically, literature published between 2007 and 2017 that characteristically attempted to evaluate knowledge, attitudes and practices among laboratory workers on Occupational Safety and Health were reviewed. Evidently, results from the review indicate poor knowledge, attitude and practice among the laboratory workers. It is critical that strategies be put in place by the management of the health facilities to institute and undertake activities in the form of training, improved safety management practices, organizational commitment and improved safety culture.
Interpretation of thyroid function test (TFT) is often straightforward but in certain scenarios, discordance between the clinical impression and the laboratory results exists. A 50-year-old woman with a ten years history of hypothyroidism on levothyroxine presented with a recent notable change in TFT [elevated free thyroxine (FT4) and thyroid-stimulat- ing hormone (TSH)], in an otherwise clinically euthyroid and previously stable TFT, leading to levothyroxine being withheld. This case report highlights the possibility of assay interference as a cause of discordant TFT. It also draws the importance of close collaboration between clinicians and the laboratory to avoid unnecessary investigations and inappropriate management of such a case.
Rhinocerebral mucormycosis is a potentially fatal and progressive angioinvasive fungal infection. It is classically described in patients with uncontrolled diabetes mellitus and hematological malignancies. This report describes a case of progressive rhinocerebral mucormycosis in a patient with poorly controlled diabetes who was on prolonged prednisolone therapy for autoimmune kidney disease. The patient, who was a female, presented to hospital with headache, orbital pain and nasal bridge swelling. Black eschar on nasal mucosae was present on admission. Later, she was started on intravenous fluconazole for the diagnosis of fungal sinusitis. Subsequently, she developed intra- cerebral haemorrhage complicated with transtentorial herniation. Diagnosis of rhinocerebral mucormycosis was later observed by a laboratory finding and the treatment was changed to intravenous amphotericin B. However, the patient succumbed to her illness on the 6th day of hospitalisation. This report discusses the risk factors associated with rhinocerebral mucormycosis as well as the underlying pathogenesis. This report will also highlight the importance of early diagnosis and appropriate treatment for mucormycosis to improve prognosis in patients.
Haemophilia A is an inherited bleeding disorder, commonly involve soft tissues and joints. Gastrointestinal tract
bleeding, are not uncommon but seldom highlighted. A 23-year-old male with underlying severe haemophilia A was
presented with a generalised abdominal pain for 2 days, abdominal distension, diarrhoea and vomiting. He did not
have any trauma to the abdomen. Abdominal examination revealed generalized tenderness with sign of guarding
on palpation. Laboratory investigations revealed isolated, prolonged activated partial thromboplastin time (APTT)
with normal total white blood cell count and haemoglobin level. In view of acute abdomen, which was not resolved
by conservative treatment, an emergency laparotomy was done with FVIII concentrate and recombinant factor VII
(rFVII) coverage. Intraoperative findings noted patchy gangrenous spots of about 30 cm in length in the small bowel.
Histopathology examination revealed an evidence of haemorrhage within the submucosal and intramuscularis layer
from the resected specimen. This case highlighted the possibility of gastrointestinal bleeding without prior trauma,
which can be presented as acute abdomen in severe haemophilia patient.
Introduction: Laboratory turnaround time (LTAT) is considered a reliable indicator of the quality and efficiency of a laboratory’s service. LTAT achievement, particularly of urgent tests, remains unsatisfactory and challenging in many clinical laboratories especially in tertiary health care centres with high workload and restricted resources. The unresolved issue of unsatisfactory urgent renal profile (RP) LTAT below the standard performance goal prompted our interest to improve laboratory’s handling of urgent test request. We thus implemented the Lean principle in the management of urgent test requests using urgent RP as the test model. Methods: The implementation of laboratory Lean involved 4 steps process; (1) Development of burning platform for change (2) Identification of waste (3) Plan- ning and implementation of control measures (4) Measuring, monitoring, and sustaining the improvement. Urgent RP LTAT and the percentage of the request met the time requirement determined based on the data extracted from laboratory information system (LIS) before and after the implementation of Lean was compared to assess the effec- tiveness. Results: Urgent RP LTAT after the implementation of Lean was reduced i.e 35 min (before) vs 31 min (after), with the percentage of LTAT met the time requirement was significantly increased above the set target i.e 82.8% (before) to 93.5% (after) with P-value = 0.001. Conclusion: Implementation of innovation using Lean management has significantly improved urgent RP LTAT achievement, thus optimised urgent test management in our Chemical Pathology laboratory. Lean is a strongly recommended strategy to improve urgent test LTAT especially in laboratories with restricted resources.
Introduction: The study is introducing a laboratory technique to sustain the longevity of Heterotrigona itama sting- less bees collected from the farm in order to facilitate future health research on Kelulut honey. Methods: The worker bees were held in laboratory at 26 ± 2 oC, 57 ± 8 % relative humidity (RH) and 12:12 hours (light:dark period) in a cup covered with meshed cloth and installed with an inverted-wick system consists of a drinking straw with the bottom end loosely plugged with cotton wool. The artificial diet was pipetted into the straw to wet the cotton wool. The bees were divided into five diet groups, namely a) unfed - control, b) distilled water, c) purified tap water, d) non-carbonated isotonic drink or e) 5% honey solution. Feeding activity and survival of worker bees were observed daily. Results: The worker bees are seen to frequent and lick the cotton wool wetted with artificial diets. Comparison between the artificial diets, Kaplan-Meier statistical analysis showed that the 5% honey solution and non-carbonated isotonic drink have significantly (P < 0.05) extended the longevity of the worker bees with 50% survival probability at least 8 days. When the similar holding and feeding technique used for the bees from commercial farms, the 50% survival probability was extended to 14 days. Conclusion: The inverted-wick system with the use of 5% honey solu- tion or isotonic drink as the artificial diet is capable to hold the H. itama worker bees at least for a week with survival above 50% for laboratory experiments.
Introduction: This study reported the concentration of bacterial and fungal bioaerosol at an animal house and hospi- tal laboratories with the aim to compare the concentration levels at library and administrative offices. The bioaerosol levels between mid-shift (afternoon) were also compared to the concentration measured during pre-shift (morning). Methods: The NIOSH 0800 method utilising microbiological air sampler collecting airborne bacterial and fungal samples via impaction technique on Nutrient agar (NA) and Sabouraud Dextrouse agar (SDA) as culture medium, respectively. Sampling was done twice daily; before (pre-shift) and during working (mid-shift) hour. Results: The highest bacteria and fungi concentration was recorded at the animal house with median concentration of 2477 CFU/ m3 (IQR=121-2477) and 791 CFU/m3 (IQR = 379-2081), respectively. Higher-risked workplaces such as animal house and hospital laboratories have significantly higher bioaerosol concentrations compared to control workplaces such as library and administrative offices (p
Presently, there is no specific federal legislation governing articular cartilage tissue engineering (ACTE) experimenta- tion practices in Malaysia. However, there are related regulations and guidelines provided by government agencies to oversee and guide such practices. The rules and regulations provided in the documents have the essential aim of safeguarding public health through ensuring that non-clinical studies reach a certain quality, efficient and safe for hu- man use. There are themes identified when scrutinising relevant documents which includes, the need for authorised personnel and the establishment of facilities in conducting such experiments, the aspect of cell-scaffold construct development, the use of human materials, the aspect of biosafety, animal care and use during the experiments, and considerations on the impact on the environment. The individual laboratory or facility shall adopt and adapt these standards as deemed appropriate by the ACTE researchers to ensure that non-clinical studies are conducted in a proper and ethical manner.