The objectives of this study are to determine the prevalence of hand-arm vibration (HAVS) among the automobile assembly workers and the associated risks. A cross sectional study was conducted to determine the prevalence of HAVS and also ascertain the association between HAVS and reduction in VPT among workers using vibration hand held tool in automobile industry. Aim of this study was to determine the prevalence Hand Arm Vibration Syndrome (HAVS) among vibrating hand held tool exposed workers. A cross sectional study design using structured questionnaire and invasive measurement of vibrotactile perception threshold (VPT) at the fingertips was conducted in one of the automobile company in Klang Valley. All the respondents were hand arm vibration exposed workers. A total 109 assembly line workers with at least one year job tenure participated in this study. The finding revealed that 27.5% of workers reported HAVS through questionnaire. This study consisted of 109 respondents. All of them were male. The mean age was 32.9 years. The mean daily vibration exposure for 8-hours was 1.41m/s2. There was 11% of the tools measured were above the Action Level recommended by European Union Directive 2002. The overall prevalence of HAVS based on reported symptom through questionnaire was 27.5%. None of the respondent reported any whiteness at their fingers due to exposure to vibration. However, 36.7% of the respondent reported tingling sensation and 57.8 % reported the feeling of numbness in their hands. Only 10.1% claim that the pain was persistence. Since this study was done among exposed workers without control group, the thresholds were measured by comparing the observed VPT with the VPT of healthy population provided by ISO 13091-2. The result showed that 98.2% of the respondent in this study having positive threshold which indicate the percentage of respondent that having deterioration in finger tactile perception. The positive threshold from comparison above showed that the respondent of this study was affected with the vibration exposure. The value proven that the exposure has caused the deterioration of tactile sensitivity in 98.2% of respondent in this study which showed by having positive threshold compared to healthy population. The result also showed that there was a significant correlation between daily vibration exposure A (8) and VPT at both frequency tested which was 31.5Hz (r = 0.417, p = 0.002) and 125Hz (r = 0.480, p = 0.001). Even though the mean daily vibration exposure for 8-hours was low and below the recommended level, the workers still exposed to the effect of hand arm vibration

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is relatively a rare tumour of head and neck region. Without histopathological confirmation, it appears and behaved as like malignant epithelial tumor of the head and neck region as will be illustrated in the present case. Cutaneous involvement of the tumor with distant metastasis has made the prognosis unfavorable. This isolated case of head and neck PC-ALCL was highlighted as it has a tendency to behave aggressively and early diagnosis and treatment is crucial to avoid poor survival outcome.

Pheochromocytoma during pregnancy is potentially disastrous to the mother and fetus. Its ambiguous presentation is often mistaken for pre-eclampsia, although it may imitate other problems during pregnancy. Early diagnosis and timely, appropriate management reduces possible maternal and fetal complications. We identified a case of pheochromocytoma during pregnancy; the condition was initially diagnosed as pre-eclampsia complicated with gestational diabetes. Surgical intervention via left adrenalectomy was successfully performed in the second trimester. After surgery, all of the patient’s medical problems nearly subsided and she did not require further treatment. However, her fetus displayed restricted intrauterine growth, and the patient eventually had premature delivery via a caesarean section. A multidisciplinary team to identify and treat pheochromocytoma is mandatory to ensure optimal conditions for tumour removal and to anticipate any possible catastrophic events.

To investigate some morphological and molecular characteristics of fungal parasites isolated from wild tropical bed bug, Cimex hemipterus. Methods: A series of culture methods were used to obtain fungal isolates from field-collected bed bugs. Characteristics of the isolates such as colony appearance, mycelial texture and pigmentation were studied to explore their morphology. Isolates were also subjected to a PCR-based genotyping test. Results: There were noticeable differences in morphological characteristics among the four isolates. Conidial areas of one isolate were dark green, whereas those of the remaining colonies were olive-green, black or dark brown. Conidia of the dark green isolate were globose, while those of olive-green, black and dark brown isolates were globose to subglobose, globose to spherical and globose to subglobose/finely roughened, respectively. These morphological specificities and the molecular analyses showed that the fungal internal transcribed spacer ribosomal region and β-tubulin gene sequences of the isolates shared clade with Trichoderma and Aspergillus sequences. Conclusions: Overall, the new discovery of common pathogens in agricultural field developed in live bed bugs storage tank may initiate the use of biological agents in later years.

Patients with Benign Prostatic Hyperplasia (BPH) commonly presents with lower urinary tract symptoms (LUTS), which can be of obstructive symptoms such as hesitancy, incomplete voiding, post void dribbling or of irritative symptoms such as urgency, frequency and nocturia. Various recent studies indicate that nocturia is a very important and bothersome lower urinary tract symptom especially among patients with Benign Prostatic Hyperplasia (BPH). The aim of the study was to determine the frequency of common urinary symptoms among patients with BPH in HUSM as well as to evaluate the extent of bothersomeness of each and every symptom to these patients. This study too was aimed at evaluating the success of TURP in resolving pre operative LUTS. This was a questionnaire-based survey using a validated ICSBPH model whereby patients with BPH were selected and quizzed personally by an investigator. A subset of patients who had undergone TURP was further questioned regarding their satisfaction with the procedure. When nocturia is defined as waking up at night once or more to pass urine, the prevalence of nocturia was about 90%, but only 1 in 6 patients considered this is a very serious symptom. Even if the definition was changed to waking up twice or more, the prevalence is still quite high at over 80%. Urgency was noted in half of the patients, but only a quarter of them consider it a serious problem. 1 in 5 patients experienced significant leak and almost all consider it serious. About one third of the studied population had to be catheterized due to urinary obstruction and interestingly only about half of them considered it as a very serious event. Overall, a great majority of these patients considered suffering from these urinary symptoms for the rest of their life as very devastating. This study concludes that although the prevalence of nocturia was high among BPH patients, but it was not considered serious by majority of them. In fact, LUTS in our BPH patients did not differ much from BPH patients elsewhere. On the whole, TURP resolved most of the LUTS effectively.
symptoms <1> ; Prostatic Hypertrophy, Benign ; Nycturia ; Benign ; Urinary Tract

Mucopolysaccharidoses (MPS) are a group of inherited disorders caused by the defi ciency of specifi c lysosomal enzymes involved in glycosaminoglycans (GAGs) degradation. Currently, there are 11 enzyme defi ciencies resulting in seven distinct MPS clinical syndromes and their subtypes. Different MPS syndromes cannot be clearly distinguished clinically due to overlapping signs and symptoms. Measurement of GAGs content in urine and separation of GAGs using high-resolution electrophoresis (HRE) are very useful initial screening tests for isotyping of MPS before specifi c enzyme diagnostics. In this study, we measured total urinary GAGs by a method using dimethylmethylene blue (DMB), and followed by isolation and separation of GAGs using high resolution electrophoresis (HRE) technique. Of 760 urine samples analyzed, 40 have abnormal GAGs HRE patterns. Thirty-fi ve of these 40 cases have elevated urinary GAGs levels as well. These abnormal HRE patterns could be classifi ed into 4 patterns: Pattern A (elevated DS and HS; suggestive of MPS I, II or VII; 16 cases), Pattern B (elevated HS and CS; suggestive of MPS III; 17 cases), and Pattern C (elevated KS and CS; suggestive of MPS IV, 5 cases), and Pattern D (elevated DS; suggestive of MPS VI; 2 cases). Based on the GAGs HRE pattern and a few discriminating clinical signs, we performed selective enzymatic investigation in 16 cases. In all except one case with MPS VII, the enzymatic diagnosis correlated well with the provisional MPS type as suggested by the abnormal HRE pattern. Our results showed that GAGs HRE is a useful, inexpensive and practical fi rst-line screening test when MPS is suspected clinically, and it provides an important guide to further enzymatic studies on a selective basis.

Introduction: Automotive workers are exposed to high level of noise as part of their daily work routine. Determining the predictors of knowledge, attitude and practice of noise induced hearing loss (NIHL) among automotive is important because it may help prevent a serious irreversible disease known as noise induced hearing loss. Methods: A cross sectional study in an automotive plant in Shah Alam, Selangor was conducted from January 2015 to May 2015 among 550 workers with response rate of 83%. Respondents were workers from the operational divisions, selected based on simple random sampling using validated, published (1) and reliable self-administered questionnaire that focused on knowledge, attitude and practice towards NIHL. Results: Logistic Regression was used to determine predictors and the predictors for satisfactory knowledge on noise induced hearing loss were perceived noise exposure as harmful noise (AOR=0.54, 95%CI = 1.02 - 3.41), years in service for more than 10 years (AOR=2.79, 95%CI = 1.71 – 4.56) and had received training on safety (AOR=1.94, 95%CI = 1.12 – 3.36). For satisfactory attitude the predictors were perceived noise exposure as harmful noise (AOR=3.79, 95%CI = 2.36 – 6.10), years in service for more than 10 years (AOR=0.56, 95%CI = 0.34 – 0.83) and tertiary level of education (AOR=3.61, 95%CI = 1.67 - 7.81). As for satisfactory practice the predictors were more than 10 years in service (AOR=2.16, 95%CI = 1.24 – 3.75) and had received training on safety (AOR=1.94, 95%CI = 1.26 – 2.99). Conclusions: The results from this study may be used to set appropriate measures and identify workers who are at risk of developing noise induced hearing loss.
Hearing Loss ; Noise, Occupational

Prolonged work with highly repetitious flexion and extension of the wrist and forceful grip task were shown to increase the risk of developing carpal tunnel syndrome (CTS) among dental personnel. The present study was carried out to determine the prevalence, risk factors and coping strategies of probable CTS among clinical dental support staff in Hospital Universiti Sains Malaysia (HUSM). A cross-sectional study was conducted and a set of questionnaire consisting of socio-demographic status, work-related and psychosocial risk factors and coping strategies was distributed. Ninety-five clinical dental support staff completed and returned the questionnaire with a response rate of 80.5%. The prevalence of probable CTS was 38.9%, with the highest prevalence was found among dental surgery assistants (40.5%) followed by dental technologists (29.7%). There was no significant association between work-related or psychosocial risk factors with probable CTS (p>0.05). Most of the respondents with symptoms of CTS chose religion as the coping mechanism; mean 7.11 (SD 1.13). Awareness training should be emphasized among clinical dental support staff on the prevention of CTS.
Carpal Tunnel Syndrome

Balance and motor skills are essential prerequisites for physical development of a child. The aims of this study were to measure anthropometrics, postural balance and motor skills; and examine their correlation among healthy preschool children. Forty nine healthy preschool children aged between 3 to 4 years old participated from PERMATA preschool organization. Pediatric Balance Scale and Peabody Development Motor Scale-2nd Edition (PDMS-2) were administered to measure balance skills for both fine and gross motor skills respectively. Mann-Whitney U test demonstrated that there was no significant difference in balance (p=0.72) and motor skill (p=0.33) between boys and girls. Spearman correlation coefficient demonstrated that there was significant correlation between balance skills with height (r=0.45, p=0.001) and body mass index(r=0.47, p=0.001). No significant correlation was found between balance skills and motor skills (r=0.11, p=0.44). The present study suggests that balance skills in healthy preschool children aged 3-4 years old are correlated with their physical growth such as height and weight but not motor skills.

In 2005, Ministry of Health introduced the Needle Syringe Exchange Program (NSEP) and Methadone Maintenance Therapy (MMT) program as a part of Harm Reduction program to combat HIV infection in Malaysia among people who inject drug (PWIDs). Expenditures were estimated approximately RM10 millions per year to establish and sustain the NSEP and MMT centres. This study examined the impact of MMT program on preventing HIV seroconversion among registered MMT clients that are people who inject drug (PWIDs), and to identify other predictors of HIV seroconversion among this group. This was a retrospective cohort study done in the state of Perak involving a total of 212 randomly selected MMT clients registered between 2008-2017 in 6 clinics. This study looks at data collected from the last ten-year cohort from baseline to follow-up. A questionnaire was used to obtain socio-demographic data, sexual and drugs abuse history. Test results for HIV were obtained from medical records. Cox regression analysis was performed to examine factors associated with seroconversion and Kaplan-Meier analysis to estimate HIV survival time. This study displayed that both Methadone take home supply (HR 10.4, 95% CI: 1.6 – 68.8) and unprotected sexual practice (HR 5.9, 95%CI: 1.1 – 31.5) shown higher risks of HIV seroconversion compared to DOTS and condom practice among MMT clients respectively. Mean survival for HIV seroconversion among MMT clients was 104.44 (95%CI: 101.85 – 107.04) months. This study provides reliable evidence that MMT program markedly reduces incidence of HIV infection among people who inject drug (PWIDs).