马来西亚大学医学中心角膜溃疡的回顾分析

目的：分析角膜溃疡的病例分布、危险因素、临床特点、微生物检查及预后结果。方法：对2003-07／2006-04就诊于马来西亚大学医学中心的84例（87眼）患者进行研究，其中1例双眼发病，另1例曾因疱疹性角膜炎复发3次就诊。选入标准包括角膜上皮缺损、角膜基质浸润及炎症。结果：患者84例中有男46例，女38例。主要是马来人（52％）。3个主要的危险因素是角膜接触镜的配戴（47％），眼外伤（25％）及眼表疾病（24％）。在老年患者中，糖尿病（8％）及高血压（9％）是重要的系统性疾病。阳性为25％，而微生物培养阳性为73％。在各危险因素组中，绿脓杆菌是最常见的致病菌，在角膜接触镜配戴者中最高。耐庆大霉素革兰染色阴性菌有2例，耐青霉素表皮葡萄球菌有1例。75％的患者溃疡愈合，遗留角膜混浊。2mo后，54％的患眼最佳矫正视力〉6／18，14％〈3／60。3例患者需要行眼球摘除或剜除术。结论：角膜接触镜配戴和眼外伤是青年人群中主要的可预防性危险因素，相反，眼疾是老年人中不可预防的危险因素。超过60％的培养阳性病例为革兰染色阴性菌。     

Development of emergency food assistance design: a nutritionally balanced,culturally tailored and cost-effective strategy for flood mitigation

Emergency food assistance forms an integral component of flood mitigation in Malaysia. A cross-sectional survey investigating emergency food assistance among 202 flood victims was conducted and alternative food assistance plan was developed using linear programming targeting post-disaster food requirement scenarios. From the study, the receipt of food aid was significantly associated with ethnicity, household income, residential area and evacuation into temporary shelters. Linear programming analysis identified nutritionally appropriate food assistance targeting mass feeding, emergency food basket, and immediate food requirement for as low as MYR 6.07 (1.55 USD), MYR 7.14 (1.82 USD), and MYR 8.00 (2.04 USD), respectively. This study provides nutritional guidelines for disaster food assistance policy.     

Risk assessment: Foodhandling practices and food-contact surfaces of hawkers in Malaysia

Risk assessment, as a supplement to epidemiological data, provides invaluable food safety assurance information to help prevent foodborne illnesses. A study of foodhandling practices (FHP) and food-contact surfaces (FCS) by methods of risk assessments was carried out in spring 1998. Aimed at determining the extent of risk concerns in FHP and FCS, 36 samples of three ethnic origins (Malay, Chinese and Indian) and in three designated hawker sites in Kuala Lumpur were pre-defined. The FHP were assessed based on 13 main constructs in three distinct areas of cleaning and cleanliness, personal hygiene and training and time/temperature control and cross-contamination. The FCS were assessed based on the contamination levels of work surfaces (WS), chopping boards (CB) and dishcloths (DC). The findings showed high concerns for FHP in general. FCS findings for the ethnic hawker foods showed high concern for Nasi Lemak , and moderate to high concerns for Char Koay Teow and Roti Canai . The FCS results were used in an attempt to validate the findings of the FHP. Pearson bivariate correlations, however, showed no association between FHP and FCS scores. Findings of this study provide: (1) useful risk indicators for three popular and traditionally ethnic hawker foods; (2) a yardstick for monitoring the hawkers using standardised risk assessment; and (3) useful feedback for the government/control authority on the need for intervention in the surveillance of hawkers and hawker foods.     

Cervical cancer screening in Malaysia: Are targeted interventions necessary?

This study examines the determinants of Papanicolaou Smear Test (PST) screening for cervical cancer among women in Malaysia. Attention is focused on the reasons different population subgroups give for non-screening. We find that Indian women are the least likely to have had a PST and also the least likely to know the reasons why one is screened. Malay women are less likely than Chinese women to have received a PST and are more likely to report embarrassment as the reason for not being tested. Urban women are less likely than rural women to have been tested and more likely to state lack of time as the reason. These results suggest targeted interventions may be necessary to increase screening rates in Malaysia.     

Smoking is associated with an increased risk of developing ACPA-positive but not ACPA-negative rheumatoid arthritis in Asian populations: evidence from the Malaysian MyEIRA case–control study

Abstract

We investigated the association between cigarette smoking and the risk of developing rheumatoid arthritis (RA) in the Malaysian population. A total of 1,056 RA patients and 1,416 matched controls aged 18–70 years within a defined area of Peninsular Malaysia were evaluated in a case–control study between August 2005 and December 2009. A case was defined as a person with early diagnosed RA using the 1987 American College of Rheumatology criteria for RA. Controls were randomly selected matched for sex, age, and residential area. Cases and controls answered a questionnaire on a broad range of issues, including lifestyle factors and smoking habits wherein current and former smoking was classified as ever-smoking. The presence of anti-citrullinated peptide antibodies (ACPA) was determined for cases and controls. We found that ever-smokers had an increased risk of developing ACPA-positive RA [odds ratio (OR) = 4.1, 95% confidence interval (CI) 1.9–9.2] but not ACPA-negative RA (OR = 0.7, 95% CI 0.3–2.0), compared with never-smokers. A significant dose–response relationship between cumulative dose of smoking and risk of ACPA-positive RA was observed (<20 pack-years OR = 3.3, 95% CI 1.1–9.8; at least 20 pack-years OR = 5.2, 95% CI 1.6–17.6). Hence, smoking is associated with an increased risk of ACPA-positive RA in the Malaysian population, in which the genetic context is similar to several other Asian countries.     

Association between Landscape Factors and Spatial Patterns of Plasmodium knowlesi Infections in Sabah,Malaysia

The zoonotic malaria species Plasmodium knowlesi has become the main cause of human malaria in Malaysian Borneo. Deforestation and associated environmental and population changes have been hypothesized as main drivers of this apparent emergence. We gathered village-level data for P. knowlesi incidence for the districts of Kudat and Kota Marudu in Sabah state, Malaysia, for 2008–2012. We adjusted malaria records from routine reporting systems to reflect the diagnostic uncertainty of microscopy for P. knowlesi. We also developed negative binomial spatial autoregressive models to assess potential associations between P. knowlesi incidence and environmental variables derived from satellite-based remote-sensing data. Marked spatial heterogeneity in P. knowlesi incidence was observed, and village-level numbers of P. knowlesi cases were positively associated with forest cover and historical forest loss in surrounding areas. These results suggest the likelihood that deforestation and associated environmental changes are key drivers in P. knowlesi transmission in these areas.     

Reemergence of endemic Chikungunya, Malaysia

Chikungunya virus infection recently reemerged in Malaysia after 7 years of nondetection. Genomic sequences of recovered isolates were highly similar to those of Malaysian isolates from the 1998 outbreak. The reemergence of the infection is not part of the epidemics in other Indian Ocean countries but raises the possibility that chikungunya virus is endemic in Malaysia.     

Thoughts about populations with unexpected low prevalences of Helicobacter pylori infection

Helicobacter pylori is one of the few remaining major pathogens that accompanied humans on their travels from Africa. A recently published study reports the unexpected finding of a low H. pylori prevalence among pregnant women in Zanzibar (Farag, T.H., Stolzfus, R.J., Khalfan, S.S., Tielsch, J.M., 2007. Unexpectedly low prevalence of Helicobacter pylori infection among pregnant women on Pemba Island, Zanzibar. Trans. R. Soc. Trop. Med. Hyg. 101). The apparent epidemiology of higher prevalence with higher socioeconomic status and decrease with age are unprecedented. As with many 'unexpected' events, a search of the literature reveals evidence of low prevalence populations in Java and Malaysia, with clues dating back to the mid-twentieth century. Why some populations apparently lost H. pylori infection remains an open question. However, the tools needed to resolve the dilemma are readily available and we hope investigators will soon rise to the challenge.     

Adult community-acquired pneumonia in Malaysia: prediction of mortality from severity assessment on admission

OBJECTIVES: Prediction of mortality in patients with community-acquired pneumonia (CAP) can be assessed using clinical severity scores on admission to hospital. The clinical benefit of such tools is untested in Asian countries. The aim of this study was to determine the early adverse prognostic factors in patients hospitalized with CAP in Malaysia and to assess the usefulness of the British Thoracic Society (BTS) severity criteria. METHODOLOGY: A prospective study was undertaken of all adult patients admitted between August 2002 and March 2003 in an urban-based university teaching hospital. RESULTS: One hundred and eight patients (mean +/- SD age 55 +/- 20 years; 58% men) were eligible for the study. Thirteen patients (12%) died in hospital and 95 (88%) survived to hospital discharge. Older age, the presence of chronic illness, severity of comorbidity, reduced oxygen saturation and higher blood urea were associated with mortality during admission. Multivariate logistic regression of these variables identified reduced oxygen saturation as the only independently associated variable. BTS criteria fared poorly in predicting mortality compared with clinical assessment by attending clinicians (36-fold increased risk of death by 'clinical assessment' vs two-threefold by 'BTS criteria'). CONCLUSIONS: In hospitalized patients with CAP, certain factors are adversely associated with mortality during admission. Severity criteria validated in specific countries might not be universally applicable.