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I quarterly 6uCCetin Disember 1993 No. 30

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Bulletin Dec 1993

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  • I quarterly 6uCCetin

    Disember 1993

    No. 30

  • ISSN : 0127 . 0265

    f l KANDUNGAN . Maklumat perubatan dan kesihatan di tahun 2020 ............................................. 1

    Tinjauan ke atas perubahan-perubahan ekologi ............................................................. di kawasan projek hidro-letrik Pergau 3

    ....................................................... Ringkasan Penerhitan-Penerbi tan IMR 4

    Tesis-tesis Sarjana Sains ................................................................................ 6 Kursus dm Bengkel ........................................................................ 8 ..............

    .................................... Projek Penyelidikan dalam Penyakit Tropika IMR-JICA 11

    / CONTENTS - Medical and Health Information for the year 2020 ........................................... Deoxyribonucleic acid (DNA) analysis by flow cytometry .................................

    ............... Medico-ecological studies in the Pergau Hydroelectric Project area Abstracts of IMR Publications ...................................................................... M . Sc . Theses ....................................................................................................

    Courses and Workshops ..................................................................................

    IMR-JICA Collaborative Project .................................................................... Visiting Scientist ..............................................................................................

    ........................................................................................................... Obituary

    - .. .

    GAMBAR KULIT COVER PHOTOS

    PROJEK EMPANGAN PERGAU PERGAU DAM PROJECT

    1 . Meratakan tanah . I . Clearing of land . 2.' Penempatan sementara pekerja.pekerja . 2 . 'I emporary quarters for workers . 3 . Pembinaan terowong . 3 . Construction of underground tunnel .

  • Artikel Utama

    ( J.L. F~I-nnnrkr - Irelr~nd

    K i t a kini berada di era Teknologi Maklumal (IT). Setiap individu bercakap tentang IT. Mak- lumat memberi kelebihan tambahan kepada seseorang. Setiap negaradan bidang perniagaan serius tentang IT. Maklumat mengenai produk baru/barangan keluaran terbaru, pasaran, te- knologi terbaru, dll. telah memberi kelebihan pada sesebuah negara, perniagaan atau untuk menangdalam persaingannya. Begilu juga halnya dalam bidang perubatan dan kesihatan.

    Sudah tiba masanya para profesional di bidang perubatan di Malaysia memberi perhatian ter- hadap IT dan mengambil peluang ini hagi memenuhi keperluan bidang masing-masing. Para klinisian, pentadbir, penyelidik, dll. akan nlendapati bahawa ban yak maklumat dalam bi- dang mereka dengan hanya meluangkan beberapa rninit untuk mendapatkannya. Terdapat maklu- mat dalam setiap topik dan maklumat ini adalah sangat bernilai kepada setiap individu dan tugas mereka samada dal am bidang diagnosa, pengendalian penyakit, pentadbiran atau penyelidikan.

    Di sektor perubatan, yang berkaitan dengan kesihatan dan kesejahteraan hidup setiap individu, membuat keputusan berdasarkan fakta adalah amat penting dan keputusan ini dibuat herdasarkan maklumat yang sedia ada. Maklu- mat tersebut mungkin sempit, terhad dan ketinggalan zaman atau juga has, menyeluruh dan terkini. Bidang kesihatan merupakan aset

    yarlg arna~yenli~~g dan pasGnya seliap keputusan yang dibuat harus berdasarkan kepada maklu- mat yang terkini.

    Tiada perlu dipertikaikan bahawa setiap profesional di bidang kesihatan mempunyai pengetahuan masing-masing dalam menangani masalah klinikal, pentadbiran atau penyelidikan yang di hadapi. Bagaimmapun, tidak harus dilupakan bahawa program pendidikan adalah dirancang untuk memenuhi keperluan asas bagi pelajar untuk berfungsi sebagai seorang profesional dm pengetahuan begini, merupakan permnlaan kepada proses pembelajaran yang berterusan ke arah kehidupan seorang profesional.

    Sejak Perang Dunia ke-2, penulisan di bidang sains, termasuk perubatan telah berkembang dengan pesatnya. Fenomenaini sering dirujukkan sebagai 'ledakan maklumat' . Justeru itu individu tidak mampu untuk mengemaskini pengetahuan seiring dengan kepesatan penulisan. IT berkembang untuk memenuhi keperluan ini, iaitu pengumpulan dan penyebaran maklumat. Satu daripada keluaran terkini IT di pasaran ialah dalam bentuk cakerapadat iaitu CD-ROM (Com- pact Disc - Read Only Memory). Media ini berkeupayaan menyimpan maklumat sehingga 270,000 mukasurat teks dalam cakera yang berukuran 4.7 inci. Kelebihan cakera padat adalah berkeupay aan membuat pencarian se- cara cepat, tepat, akses rawak, menggunakan pelbagai terminologi dan medan.

  • Artikel Utama

    Pengumpulan maklumat di bidang yang khusus, membina pangkalan data dan menyimpan mak- lumat dalam satu format yang sama merupakan satu projek besar dan pihak swasta, juga badan kerajaan telah pun mengambil peluang ini. Pel- bagai pangkalan data boleh diperolehi dalam bentukcakerapadat (CD-ROM), dari yangkhusus dalam satu bidang sahaja kepada yang meliputi seluruh bidang perubatan.

    Antara pangkalan data yang popular adalah sep- erti berikut :-

    MEDLINE - keluaran National Library of Medicine, USA, yang mengindeks artikel daripada lebih 3,300 jernal terpilih di bidang bioperubatan (biomedical). Versi cetak MEDLINE ialah 'Index Medicus'. Pangkalan data ini merangkumi penulisan bioperubatan, termasuk klinikal amali, penyelidikan, pentadbiran, isu-isu men- genai dasar dan perkhidmatan penjagaan kesihatan.

    2. EMBASE - keluaran Excerpta Medica, anak syarikat Elsevier Science Publish- ing, Amsterdam, The Netherlands. Ia mempakan pangkalan data bioperubatan dan farmakologi, meliputi bahan yang diterbitkan dalam 3,500 jernal daripada 1 10 negara.

    3. Health Planning & Administration - kelua- ran National Library of Medicine, USA. Pangkalan data ini memberikan akses ke- pada lebih dari 350,000 rekod dalam as- pek penjagaan kesihatan.. . . bukan klinikal, perancangan dan pentadbiran kemudahan kesihatan, pentadbirdn kewangan, insuran kesihatan, perlesenan dm pertauliahan,

    pentadbiran personel, kawalan kualiti, peraturan, perkhidmatan dan tenaga manu- sia.

    4. Drug Information Source - yang meng- gabungkan kandungan tigapenerbitan oleh American Society of Hospital Phm-macists, iaitu AHFS Drug Information, Handbook of Injectible Drugs dan International Phar- maceutical Abstracts (indeks kepada 700 jernal). Iajuga meliputi tandadan penggu- naan ubat, kontraindikasi dan kesan mudarat, dos dan regimen, kimia dan kestabilan, penyelidikan ubat, dll.

    CANCERLIT - pangkalan data menye- luruh mengenai maklumat penyelidikan kanser, disusun oleh US National Cancer Research Institute. Ia menyediakan maklu- mat terperinci mengenai prosedur diag- nostik dan rawatan, epidemiologi (risiko dan pencegahan), biologi molekul dan sel, virologi dan irnmunologi kanser, karsinogen dan karsinogenesis dan perkembangan ubat anti-kanser.

    6. PDQ(Physician DataQuery) - disusun oleh US National Cancer Institute. PDQ me- liputi setiaprawatan yang diperolehi untuk pesalut kanser. Pangkalan data ini men- gandungi Fail Maklumat Kanser dengan maklumat prognostik dan rawatan, untuk pesakit dan juga klinisian, Fail Protokol yang menerangkan lebih dari 1,000 ujian klinikal yang aktif dan diperakui dan sejnmlah standard rawatan regimen yang terhad dan File Direktori yang menye- naraikan alarnat dan nombor telefon lebih dari 17,000 doktor dan pakar bedah yang tugas mereka terlibat dengan kanser.

  • selepas penyiapan empangan. Pada tahun 1992, pasukan EIA dari IMR beralih ke fasa lain dalarn projek hidro-letrik dengan mengawasi penyakit- penyakit clan kesihatan mereka yang terlibat dalam fasa pembinaan empangan tersebut.

    Projek EIA ini telah di jalankan di kawasan Projek Hidro-letrik Pergau dengan bantuan dari TenagaNasional Berhad. Tujuan kajian ini adalah untuk menentukan jangkitan biasa yang berhubungkait dengan perubahan alam sekitar di kalangan pekerja binaan, menentu perubahan vektor pen yakit, dan memperolehi maklumat atau pendapat penduduk-penduduk kampung bag- aimana pembangunan baru memberi kesan pada penghidupan mereka.

    Kesirnpulan dari kajian ini menunjukkan pertam- bahan potensi ke atas transrnisi malariadi kawasan pembinaan disebabkan oleh bertambahnya kawasan pembiakan nyamuk vektor. Juga terdapat risiko yang berpotensidalam pembawaan denggi ke situ kerana terdapat takungan air yang mengandungi jentik-jentik nyamuk bawaan vektordi kawasan tersebut. Cacing-cacing tularan tanah yang biasa terdapat di kalangan pekerja binaan dan jangkitan cacing kerawit lebih kerap di dapati di kalangan pekerja yang membina jalan kerana ketiadaan tandas untuk digunakan pada masa kerja. Kebanyakan penduduk-penduduk kampung bersikap berkecuali terhadap empangan itu dan gembira kerana bertambahnya peluang perkerjaan dan merekaj uga menjangka mendapat bekalan air paip dan letnk selepas empangan dibina.

    Ringkasan Penerbitan-Penerbitan IMR

    Seroprevalen antibodi terhadap Toxocara cnnis di kalangan orang asli di Semenanjrmg Malaysia

    Lokman Hakim S, Mak JW, Lam PLW, Nazma S and Normaznah Y .

    Southeast Asian J Trop Med Pub Hlth 1992; 493-496

    Assai imunosorben enzim-terungkai meng- gunakan antigen kemunah-rembes dari pengkulturan in vitro larva peringkat kedua di-

    gunakan untuk menentukan seroprevalen antibndi Toxocara dikalangan Orang Asli di Semenanjung Malaysia. Min + 3DS dari 30 subjek sihat digunakan sebagai titik perbedaan. Prevalen keseluruhan adalah 31.9%. Tidak terdapat perhubungan bermakna d i antara kadar positif dengan jantina dan kumpulan umur, wa- laupun kanak-kanak berumur antara 0 -9 tahun mencatatkan kadar positif tertinggi.

    Didapati bilangan eosinofil berhubung rapat dengan proporsi positiviti jangkitan toxocara dan min densiti optik. Terdapat jugareaktiviti- silang dengan sera positif dariTrichuris trichuria.

  • Penerbitan

    Mutasi Gen Ras di pesakit leukemia Malaysia

    Chin YM, Koh CL & Bosco JJ

    Acta Haematol1992; 87: 107 - 108

    Kajian mutasi gen ras dijalankan secara sembarangan terhadap 30 pesakit leukemia mieloid akut (AML) di Hospital Universiti, Kuala Lumpur, dari Julai 1988 hingga Oktober 1989. Asid deoksiribonukleik (DNA) dari sumsum tulang dan darah perifera1 pesakit diamplifikasikan secara invitro dengan tindakbalas rantai polimerase pada kawasan kodon 12, 13, dan 61 ketiga-tiga gen ras; H-ras, K-ras dan N- ras. Hasil yang diamplifikasikan kemudian dipenghibridan dengan perob-perob oligonukleotid untuk mengesan mutasi titik pada kodon 12,13, dan 6 1 ketiga-tiga gen ras; H-ras, K-ras dan N-ras.

    Mutasi gen ras dikesan dalam 4 (13.3%) dari 30 pesakit AML. Kekerapan mutasi gen ras dalam kumpulan kecil AML M3 dan M4adalah 37.5% dm 8.3%. Keempat-empatpesakitdengan mutasi ras adalah di bawah 35 tahun. Dalam kajian tersebut, mutasi gen ras ditemui dalam pesakit AML M3 dan kumpulan umur yang muda. Penemuan ini belum dilapurkan di negara barat.

    Menggunakan pendekatan penjagaan kesihatan awal dalam pengawalan malaria di Malaysia: Pelajaran dalam penyertaan komuniti.

    Haliza Mohd Riji

    Southeast Asia JTrop Med Public Health 1992; 23 Suppl 1 : 18-22

    Pendekataan penjagaan kesihatan awal di Ma- laysia mula-mula dijalankan di Sarawak, Malay-

    sia Timur pada tahun 1982. Pada tahun 1984, program pengawalan penyakit bervektor, Kelantan bersetuju menggunakan pendekatan penjagaan kesihatan awal sebagai strategi penambahan dalam usaha-usaha pengawalan malaria dalam negeri itu, yang kemudiannya mengalami penambahan kes-kes malaria. Berbagai-bagai usaha dijalankan untuk membentukkan kesedaran dan mem- berangsangkan minat kakitangan kesihatan dan komuniti untuk menggunakan strategi h i . Kelantan digunakan sebagai model. Tulisan ini membentangkan rangka proses yang terbabit dan ciri-ciri pekerja penjagaan kesihatan awal. Satu kajian dijalankan di kalangan pekerja- pekerja kesihatan, ahli-ahli komuniti dan kakitangan kesihatan di atas pengetahuan dan pembabitan penjagaan kesihatan awal dalam tiga negeri, termasuk Kelantan. Dari pandangan kejayaan keseluruhan pendekatan ini, dan kelemahan yang dikesan, beberapa kemun&- nan cara penyelesaian telah dicadangkan dan sepatutnya diberi tindakan.

    Kejadian kes rabies manusia di Semenanjung Malaysia

    Ganesan J & Sinniah M.

    Med J Malaysia 1993,48: 194-199

    Kejadian kes rabies manusia di Semenanjung Malaysia ditinlbulkan. Walaupurl berbagai-bagai cara kawalan diadakan, kes-kes rabies yang sporadik masih berlaku di Semenanjung Malay- sia terutama di negeri-negeri utara. Tujuan ini adalah untuk menimbulkan kesedaran dan kepekaan mengenai penyakit ini supaya profilaksi yang berkesan selepas jangkitan dapat diambil secepat mungkin untuk mengelakkan jangkitannya.

    Ujian makrnal postmortem dari seorang kes ra- bies dari Hospital Besar Alor Setar dilapurkan.

  • Tesis Sarjana

    Seorang budak lelaki berbangsa India, berumur 7 tahun telah dimasukkan ke Hospi t d tersebut kerana gigitan 'anjing gila' yang berkeliaran sebulan sebelum itu. Pada waktu itu, pesakit menunjukkan sawan, sentakan otot-otot mukanya, hidrofobia dan lumpuh flaksid menaik. Tahap kesedarannya bertukar kepada koma dan meninggal dunia 10 hari selepas itu. Ujian post- mortem dijalankan di Hospital tersebut dan otaknya dihantar ke Institut Penyelidikan Perubatan (IPP). Di makmal Virologi IPP, smear irnpresi dibuat dari otak itu dan didapati positif kepada antigen rabies yang spesifik melalui ujian floresen antibodi rabies. Otak itu juga diperiksa secara histologi.

    Potongan darinya menunjukkan gambaran se- perti meningoencephalitis viral. Juga, potongan yang diwarna dengan cam Sellers' menunjukkan intrasitoplasmik asidofilik badan-badan rangkuman yang besar serta bujur seperti badan Negri. Ini dapat memastikan bahawa meningoencephalitis itu berpunca dari rabies.

    Laporan ini diikuti dengan rumusan kaedah pencegahan terkini dan cara diagnosis rabies.

    Ekstrasi Delta-9-THC karbosilik asid dari urin terkumpul positif kannabis bagi penye- diaan piawai

    Mohd Isa Wasiman, Mohd Zaini Abd Rahman, Badrul Amini Abd Rashid & Zakiah Ismail

    Malaysian J Med Lab Sci 1992; 9(1) : 26-28

    Kaedah ekstraksi delta-9-THC karboksilik asid dari urin terkumpul positifkannabis untukpenye- diaan piawai dibincangkan. Sarnpel urin dijalankan penyaringan terhadap kannabis menggunakan "fluoresence polarization immunossay PPIA)". [Trine terkumpul dilakukan hidrolisis dalam keadaan alkali pada 50 C untuk 30 rninit, selepas itu urine diselaraskan kepadapH 2-3 dan diekstrak menggunakan pelarut sikloheksana : etilasetate. Karni memperolehi 185ug delta-9-THC-COOH dari 2 liter urine. Penulenan ekstrak dijalankan menerusi HPLC persediaan menggunakan turus fasa terbalik C18 22mm X 25cm. Fraksi mengandungidelta-9-THC-COOH dikumpulkan dan dipekatkan dengan pemeruapan di bawah aliran udara pada 50 C. Jurnlah delta-9-THC- COOH tulen yang diperolehi adalah 98ug.

    ... ... ... .... . . .

    .>:.:. Kajian Reseptor Molekul Virus Epstein Barr 1 .:- (Abstrak tesis yang diserahkan kepada University of London oleh

    Vijayamalar Balasubramaniam bagi Ijazah Sarjana Sains)

    Virus s stein ~ a r r (EBV) adalah puncapenyakit Infectious Mononucleosis dan berkait rapat den- gan Limfoma Burkitt's (BL) dan karsinoma nasopharangeal. Ia menjangkiti sel-sel B yang matang (secaraterpendam) dan sel-sel epitelial di mana ia melalui proses replikasi ymg aktif. Reseptor virus EB di dalam sel B telah dikesan sebagai molekul CD21lCR2. Lirnfoma Burkitt's

    wujud dalam bentuk epidemik dan sporadik. Bentuk sporadik selalunya virus EB yang tidak mempunyai genom (Virus EB genom negatlf). Virus EB genom negatif dari keturunan sejurai kanser ini tidak mempunyai atau mempunyai kadarekspirasi CD21 yang terlalurendah. Walau bagaimana pun, sel-sel ini boleh dijangkiti den- gan virus EB. Tujuan kajian ini adalah :

  • Tesis Sarjana

    1) Untuk melihat hubungan tahap infeksi EBV dari EBV negatif sel dari keturunan sejurai

    2) Untuk cuba menghalang infeksi EBV dari negatif sel dari keturunan sejurai dengan menggunakan antihodi monoklonal terhadap CD21.

    Kami berjaya menj angkitkan BL2 dari keturunan sejurai walaupun, tahap ekspresi CD21 < 2%. BL30 sel dari keturunan sejurai juga telah berjaya dijangluti. (20% ekspresiCD21). Kamijugadapat membuktikan bahawaantibodi monoklonal OKB7 menghalang infeksi EBV sel keturunan sejurai secara separa dan pcnyatuan B2 dapat menggalakkan penyerapan dan infeksi EBV.

    Dari hasilnya, kami percaya bahawa kemungki- nan wujudnya reseptor alternatif di EBV negatif BL sel keturunan sejurai : BL02 dan BL30. Ia juga telah menunjukkan B2. berkemunglunan mempunyai penggalak penyerapan EBV dan EBNA protin sintesis. Dari awal1970penyelidik- pen ye1 idi k percaya bahawa wujudnya reseptor alternatif kerana sel-sel epitelial (semasa itu) tidak mempunyai kadar reseptor seperti mana reseptor CD21 yang dapat dikesani.

    Maka hasilnya yang diperolehi dapat menimbulkan rninat dalam reseptor alternatif ini. Tangpng- jawab B2 dalam sebagai penggalak penyerapan virus haruslah disiasati kerana ia mungkin dapat mcnunjukkan jalan cara penyerapan dan pengambilan EBV di samping mengesanreseptor alternatif ini.

    Penghasilan antibodi monoklonal terhadap Haemophilus ducreyi

    (Abstrak tesis yang diserahkan kepada Universiti Malaya oleh Rohani Md Yasin bagi Ijazah Sarjana Pathologi)

    Chancroid adalah penyakit jangkitan sex yang disebabkan oleh bacteria Haemophilus decreyi yang menyebabkan luka atau ulser. Penyakit ini sering terjadi di negara-negara yang sedang membangun di rnana herpes genital jarang ditemui. Ia juga hendaklah dibezakan dari penyakit sifilis dm 'lymphogranuloma venereum'. Diagnosis boleh dibuat berdasarkan salah satu dari yang berikut : Pengasingan bacteria penyebab; Pengesanan bacteria penyebab di dalam nanah dari bisul atau biopsi tisu; Gambaran klinikal. Diagnosis biasanya dibuat berdasarkan persembahan klinikal dan disahkan dengan demonstrasi H. ducreyi melalui palitan dan

    pengasingan organisma itu dari ulser atau nanah bisul.

    Interpritasi palitan ulser agak sukar dibuat wa- laupun oleh orang yang telah mahir kerana mofologi yang khusus 'school of fish' yang dlbentuk oleh H. ducreyi tidak selalu ditemui dan bacteria lain yang sering terdapat di dalam ulser itu sering memberikan gambaran yang serupa. Beberapa penyelidlk yang terdahulu mendapati kepekaan pencelupan Gram berbeza-beza dari 27 - 50% dengan ketepatan dan 'positive predic- tive value' yang rendah. Pengasingan bacteria ini mahal dan sukar kerana ia memerlukan media

  • Kursus & Bengkel

    yangkhusus. Kejayaan pengasingan tidakpernah melebihi 60 %. Deny s dan rakan-rakan telah mem- bentuk asai imunofloresen tak langsung untuk mengesan chancroid tetapi penggunaan serum polivalen memberikan reaktiviti bersilang yang tinggi. h i dapat diatasi dengan penggunaan antibodi monoclonal (MAB).

    MAB telah dibentuk terhadap H. ducreyi 'ibu' menggunakan teknik Kohler dan Milstein (1975). Saringan telah dilakukan menggunakan teknik imunofloresen dan kelas imunoglobulin dite,ntuka menggunakan asai 'captures enzyme- linkedimmunoabsorbance'. MAB yang dihasilkan telah diuji terhadap beberapa H. ducreyi strain dan lain-lain spesis hacmophilus juga lain-lain organisma untuk menentukan ketepatan dan reaktiviti bersilang mereka.

    Kejayaan percanturnan adalah dalam lingkungan 75% dan hanya 8 klon telahdipelihara seterusnya. Dari 8 MABs itu, 5 adaldh IgG, 2 adalah IgM sementara satu bertindak balas dengan kedua- dua IgM dan IgG. MABs dari klon-klon F62, F41 dan D3 1 tidak memberikan reaktiviti bersilang dengan H. injluenzae, H. parainfluenzae, H. aphrophilus, N. gonorrheae, E. coli and P. aeruginosa. MAB dari klon D31 bertindak balas dengan kesemua 21 H. ducreyi strain yang diuji tetapi memberikan reaktiviti bersilang yang

    tertinggi dengan lain-lain spesis haemophilus dan lain-lain organisma (7125). MAB dari klon F42 tidak dapat mengesan 2 dari 21 H. ducreyi strain tetapi mengesan 2 dari 19 lain-lain spesis haemophilus dan 2 dari 25 organisma lain.

    Penentuan awal ciri-ciri MABS yang dihasilkan menunjukkan hibridF42 adalah klon yang terbaik. Apabila MAB dari klon ini digunakan dalam ujian irnunofloresen tak langsung ia memberikan pera- tus ketepatan sebanyak 88.6% dan kepekaan sebanyak 90.5%. Ini masih tidak memuaskan kerana peratus kepekaan adalah di bahagian yang rendah dan ketepatannya adalah amat rendah. Satu MAB yang baik mestilah spesifik di mana ia mempunyai ketepatan yang tinggi walaupun kepekaannya tidak begitu tinggi. Sebagai contoh MAB terhadap Chlamydia trachomatis yang dihasilkan oleh Kallestad Diagnostic untuk pengesanan antigen C. trachomatis mempunyai kepekaan setinggi 86% dan ketepatan setinggi 98 - 100%. Untuk r~ierirlayatkarl MAB yang spesifik lebih banyak klon hendaklah dievaluasi dan MABs yang terpilih hendaklah disaring lebih lanjut untuk menentukan Liridak balas merekaterhadap fokus penentu antigen yang spesifik seperti sebahagian dari protin membran luar dari H. ducreyi, sebelum evaluasi bagi me- nentukan kepekaan dan ketepatan diteruskan.

    Kursus dan Bengkel

    Perayaan Ulangtahun ke 90 IPP Seminar tersebut ialah 'Penyelidikan Kesihatan: Pencapaian, Cabaran dan Arah Tujuan Masa

    IPP telah ditubuhkan dalam tahun 1900, telah Depan'. Objektif Seminar adalah untuk menilai menyambut ulangtahunnya yang ke 90 dalam semula hasil kerja Institut selama 90 tahun, dan tahm 1992 dengan mengadakan Seminar mencadangkan arah tujuan masa depan. Seminar Saintifik, Hari Terbuka dan Hari Keluarga. tersebut telah dibuka dengan rasminya oleh Kemuncak dari perayaan tersebut ialah Seminar Yang Berhormat Dato' Lee Kim Sai, Menteri Saintifik yang diadakan pada 23-25 Jun. Tema Kesihatan.

  • Kursus & Bengkel

    Gambaran keseluruhan penyelidikan yang telah dijalankan di IPP telah diberikan oleh Dato' (Dr) M. Jegathesan, Pengarah IPP dan ini dituruti oleh Ucapan Dasar bertajuk ' Arah Tujuan Masa Depan Penyelidikan Kesihatan di Malaysia' yang disampaikan oleh Ketua Pengarah Kesihatan, Tan Sri Dato' @r) Abu Bakar Suleiman. Be- berapa orang penyelidik-penyelidik kanan IPP telah diberi tanggungjawab untuk menilai pencapaian-pencapaian penyelidikan dalarn bi- dang-bidang tertentu dan menjelaskan bagaimana ia telah menyumbang ke arah penjagaan dan perawatan pesakit serta pengawalan penyakit. Tajuk-tajuk yang telah diliputi ialah penyakit berjanglut, penyakit tidak berjangkit, pemakanan manusia, d a m sekitar dan kesihatan. Berapa orang saintis tempatan dan luar yang terkenal telah juga dijemput untuk membentangkan kertas kerja mengenai perkembangan semasa isu-isu tropika seperti biologi molekular dan bioteknologi, alam sekitar dan kesihatan, penyelidikan dalam penyakit parasitik dan pemakanan manusia.

    Komponen penting dari Seminar tersebut ialah sessi dialog di antara pengarah-pengarah Pro- gram Kementerian Kesihatan dan penyelidik- penyelidik dari IMR, di mana pihak terdahulu mengemukakan pemasalahan yang a a d a p i

    dalam perlaksanaan program masing-masing yang memerlukan penyelesaian. Beberapa isu yang sangat penting telah dibangkitkan dan beberapa projek penyelidikan telah dikenalpasti untuk perhatian segera. Kedua-kedua belah pihak ber-yendayal sessi tersebut sangat berfaedah dan cadangan supaya ianya diadakan secara tetap dan lebih kerap disuarakan. Prosiding serni- nartersebut telah diterbitkan dan boleh dipmulehi dari IMR.

    Sutnbangan Mak Joon Wah

    Seminar SEAMEO-TROPMED mengenai filariasis

    Seminar SEAMEO-TROPMED ke 34 mengenai

    'Status S e m a w Filariasis di Asia Tenggera7 telah diadakan diInstitut Penyelidikan Perubatan, Kuala Lumpur dari 26-27 Jun 1992. Seminar tersebut telah dibuka secara rasrni oleh Ketua Pengarah Kesihatan, Tan Sri Dato' @r) Abu Bakar Suleiman dan telah dihadiri oleh peserta dari Indonesia, Filipina. Thailand, Malaysia, Jerman, U.S.A. dan Pertubuhan Kesihatan Sedunia. Objektif Seminar tersebut ialah untuk membincangkan keadaan semasa filariasis di negara-negara dari rantau ini, membentangkan penemuan semasa penyelidikan dan menilai se- mula kemajuan dalam filariasis. Tajuk-tajuk yang dikaji semula ialah kemajuan dalam teknik epidemilogi dan diagnostik, kemoterapi, biologi molekular dan imunologi, genetik, biologi dan ekologi nyamuk, kawalan vektor dan aspek sosial penyakitfilariasis. Perbincangan am juga telah diadakan tentang perkaitan kemajuan-kema- juan ini dengan perawatan pesakit dan pengawalan filariasis limfatik. Adalah dicadangkan bagi negara-negara di rantau ini supaya mengambillangkah segera untuk mening- katkan bilangan kakitangan yang dilatih dalam penyelidikan dan kawalan filariasis lirnfatik. SEAMEO-TROPMED boleh memainkan per- anan positif dalam aspek ini melalui seminar- seminar seperti yang diadakan, dan bertindak sebagai satu forum bagi penyebaran maklumat mengenai perkembangan semasa. Prosiding serni- nar akan diterbitkan sebagai terbitan tarnbahan dari jurnal 'Southeast Asian Journal of Tropical Medicine and Public Health'.

    Sumbangan Mak Joon Wah

    Kursus asas mikroskupi eleklron trans~nisi

    Unit Mlkroskopi Elektron di Institut Penyelidkin Perubatui idah rritmgcridalikiui "Kcll.sus Asas Mikroskopi Elektron Transmisi" untukpegawai- pegawai yang menjalankan penyelidikan dihstitut ini. Dr Dcborah J. Stcnzcl dari Queensland University of Technology adalah pakar perunding anjuran WHO. Lapan orang peserta dan tiga

  • Kursus & Bengkel

    orang pemerhati menghadiri ktwsus ini yang dijalankan pada 12 - 28 Oktober 1992. Syarahan-syarahan dan latihan amali dijalankan bagi memenuhi keperluan pegawai-pegawai yang tidak mempunyai pengalaman dalam bidang rnikroskopi elektron. Peserta-peserta diajar men- genai mikroskop elektron transmisi, teknik imuno- label, sitokimia, dan pengendalian peralatan- peralatan seperti penyejat vakum, pembuatpisau- gelas dan ultramikrotom. Kemahiran lain yang diajar termasuk pemeriksaan contoh-contoh ultrakeratan di bawah mikroskop elektron transmisi, fotomikrografi, memperoses filem dan mencetak cetakan lekap. Perhatian lebih ditumpukan kepada pemeriksaan fotomikrograf bagi mengenal pasti ultrastruktur-ultrastruktur sel dan membezakannya dari artifak-artifak yang rnengelirukan, juga beberapakelemahan teknikal pemprosesan contoh dan kualiti foto mikrograf. Pakar perunding menggunakan pengalamannya sendiri dalam setiap langkah dari peringkat awal pemprosesan hingga ke produk terakhir, iaitu fotornikrograf. Peserta-peserta telah diberi penerangan tentang kegunaan mikroskopi elektron transmisi dalam bidangpatologi, virologi, bakteriologi, parasitologi dan entomologi. Dalam kursus ini, peserta juga telah membincangkan kemungkinan penggunaan mikroskopi elektron transrnisi dalam penyelidikan mereka.

    Sumbangan Karen Lai Peng Foon

    Pemastian kualiti bagi perkhidmatan makmal palulugi

    Program Kepastian mutu (QAP) KKM bertujuan untuk mempastikan kualiti dalam rriernberikan khidmat rawatan kesihatan. Ia merupakan satu dari enam jawatankuasa bagi pelbagai bahagian Kcmcn tcrian. Jawatankuasa Perkhidmatan Makmal Patologi telah ditubuhkan pada akhir 1990. Ia dianggoti oleh Jawatankuasa Kecil Patologi Kimin, Mikrobiologi Perubatan, Haematologi & Penabungan darah dan Histopatologi & Sitopatologi yang akan ber-

    tanggungjawah ke atas tugas mengenalkan penunjuk QA yang sesuai untuk pelbagai disiplin makmal patologi dan penerapan penggunaannya. QAP Perkhidmatan Makmal Patologi telah dilancarkan dengan rasminya pada 12 Februari 1993 dan ia telah diikuti dengan bengkel yang ke 2 dimana penemuan dan kajian perintis yang dijalankan pada tahun lalu dibincangkan. Ia bertujuan bagi membincangkan kebolihlaksa- naan pelbagaipenunjuk dan penetapan piawaian.

    Pengawasan penunjuk kualiti perkhidmatan rnakrnal sedang dijalankan. Ini termasuklah penunjuk 'pencapaian' dalam Skim Penilaian Mum Luaran Kebangsaan (EQAS) yang mesti dij alankan bersesuaian dengan prinsip dan kaedah EQAS Antarabangsa WHO, dan 'turn around times' bagi pelbagai khidrnat yang diberikan. Disamping itu kadar penolakan spesimen dan peratus ujian segera, adalah sebagai penunjuk kesesuaian penggunaan makmal. Kesemua penunjuk ini cukup merangkurni aspek-aspek penting yang mempengaruhi hasil dari perkhid- matan makmal.

    Perkhidmatan makmal patologi adalah sebaha- gian dari khidmat dalam rawatan pesakit. Keputusan makmal selalu penting bagi menen- tukan diagnosis dan pengurusan pesakit. Pengawasan berkala menggunakan penunjuk membolihkan makmal yang gagal mencapai piawaian dikenalpasti. Satu proses bertujuan memperbaikinya rnelibatkan pencarian sebab bagi kegagalan tersebut dan diikuti dengan langkah susulan yang sesuai dan seterusnya pengawasan semula dibuat bagi melihat perubahan kedudukannya. Berdasarkan matlamat QA yang bertujuan pembaikan berterusan satu piawaian baru (yang berdasarkan kriteria minima dapat diterima dan bukan yang ideal) akan diambil. Ini bcrlcpalan dengarr pcrubahan rnasa yarlg mengakibatkan kualiti yang semakin tinggi dapat dicapai dirnasa akan datang.

    Sumbangan Lim How Hin

  • Usahasama

    Projek Penyelidikan dalam Penyakit Tropika IMR - JICA

    Sejarah penyelidlkan perubatan kolaboratif antara Malaysia dan Jepun terhasil apabila satu perjanjian dicapai di antara Institut Penyelidikan Perubatan, Kuala Lumpur dengan Agensi Kerjasama Antarabangsa Jepun (JICA) pada 23 Jun 1992, dalam kerjasama teknikal penyelidikan mengenai penyakit-penyakit tropika tertentu. Projek penyelidikan dalam penyakit-penyakit tropikaIMR-JICA bermula secararasminyaden- gan ketibaan Professor Hiroshi 'I'anaka sebagai ketua penasihat dan Cik Izumi Ota sebagai penyelaras, pada 13 Januari 1993 di IMR.

    Objektif projek tennasuklah pemindahan ke- pakaran dalarn bidang bioteknologi dari pakar- pakar Jepun kepada rakan sejawat dari Malaysia

    dan membangunkan asai-asai diagnostik yang lebih sensitif d m cepat bagi ppenjagaari pesakit serta pengawalan penyakit malaria, denggi, demam denggi berdarah dan ensefalitis Japanese. Selain daripada pakar-pakar perunding jangka- panjang yang ditempatkan d i Bahagian Entnmologi Peruhatan, Virologi dan Pusat Bio- teknologi, beberapaorangpakar-pakarperunding jangka-pendek akan dltempatkan di IMR. Rakan sejawatdariBahagian-bahagian yang terlibat &an diberi latihan di Jepun. Peralatan bioteknologi bagi meningkatkan kemudahan akan chsediakan oleh JICA.

    Sumbangan Mak Joon Wah

  • Leading Article

    ( Medical and Health Information for the year 2020 1 ... ... ... I

    J.L. Fernandez - Irelan

    I t is the Information Technology (IT) Age. Everyone is tallcing about IT. It is information that gives one the added advantage. Every country and every business is serious about IT. Information on new products, new technology, new markets, etc. is what gives a country or business, advantage or the winning edge over its competitors. This should also be the case in medicine and health.

    Itis time that the medical professionalin Malaysia pay more attention to IT, and take advantage of i t to meet his own needs. Clinicians, administrators, researchers, etc will find that there is a vast amount of untappedinformation in their own individual fields only if they care to spend a few minutes searching for it. There is information on every topic, and information can be very valuable in each and everyone's work, be it in the diagnosis, management of diseases, administration or research.

    In the medical sector which deals with the health and well-being of the individual, informed decision-making is of dire importance, and informed decision-making is the making of decisions based on information available. Available information can be narrow, limited and out-dated or can be wide, detailed and current. In dealing with health, which is our greatest asset, it goes without saying that decisions should be based on the latter.

    No doubt it can be argued that each health professional has his own individual store of knowledge upon which he draws to solve the clinical, administrative or research problems that

    face him. However it must not be forgotten that educational programmes are designed to provide the basic knowledge with which the student can start functioning as a professional, and this knowledge is meant to be the beginning of a continuous process of life-long professional learning.

    Since World WarU, scientific literature, including medical literature, has been growing exponentially. This phenomenon is often referred to as the information explosion. Thus the individual is faced with an ever increasing body of literature that he can never hope to keep up with. ITgrew out of this need to organize the vast amount of information that one is faced with. One of the most recent IT products in the market to meet this need is the CD-ROM, Compact Disc - ReadOnly Memory. This mass storage medium allows up to 275,000 pages of text to be stored on a single 4.7 inch silver disc. The advantages of the CD are almostinstantaneous direct, random access and multi-term, multi-field searching capability.

    Gathering together information in a specific field andcreating databases by putting this information into a common format is big business, andprivate firms as well as government departments have taken advantage of this. A whole range of databases are available on CD-ROM, and some of these are specialised databases covering only one subject while others span the whole field of medicine.

    Some of the better known databases are as follows:

  • Leading Article

    i. MEDLINE, produced by the National Library of Medicine, USA. It indexes articles from more than 3,300 selected leading biomedical journals. The printed version of MEDLINE is Index Medicus. This database covers biomedical literature, including clinical practice, research, administration, policy issues and health care services.

    ii. EMBASE, produced Excerpta Medica, a subsidary of Elsevier Science Publishing, Amsterdam, TheNetherlands. This is a biomedical and pharmacological database covering material published in 3,500 journals from 110 countries. The printed version is called Excerpta Medica and is divided into 52 separate sections, e.g. Excerpta Medica - Immunology and Excerpta Medica - Radiology and Nuclear Medicine.

    iii. Health Planning & Administration, produced by the National Library of Medicine, USA. This datahase provides access to more than 350,000 records on the non-clinical aspects of health care delivery, planning and administration of health facilities, financialmanagement, healthinsurance, licensure and accreditation, personnel administration, quality assurance, regulations, and services and manpower.

    iv. Drug Information Source, which incorporates the contents of three publications by the American Society of HospitalPharmacists, i.e. AHFS Drug Information, Handbook on Injectable Drugs, and InternationalPharrnaceutical Abstracts (ildexing some 700 journals). Its coverage includes indications and uses, contraindications and adverse ellecls, dosages andregimens, chemistry and stability, investigational drugs, etc.

    v. CANCERLIT, a comprehensive database of cancer research information compiled by the US National Cancer Research Institute. It presents detailed information on diagnostic and treatment procedures, epidemiology (risk and prevention), molecular and cell biology, cancer virology and

    immunology, carcinogens and carcinogenesis, andanti-cancer drug development.

    vi. PDQ (Physician Data Query) compiled by the US National Cancer Institute. PDQ covers every therapeutic option available to cancer patients. This database includes a Cancer Information File with prognostic and treatment information for patients as well as clinicians, a Protocol File describing over 1,000 active or approved clinical trials and a limited number of standard treatment regimens, and a Directory File listing addresses and telephone numbers of over 17,OOOphysicians and surgeons who work with cancer.

    vii. AIDS Compact Library, produced by Macmillan New Media, USA. It includes treatment databases such as AIDSTRIALS and AIDSDRUGS, full-text articles from 10 leading medical journals such as JAMA and BMJ, AIDSLINE from the US National Library of Medicine, International AIDS Database from the Bureau of Hygiene and Tropical Diseases in London, and clinical newsletters such as AIDS Clinical Care and AIDS Newsletter.

    viii. Life Sciences Collection, produced by Cambridge Scientific Abstracts, USA. This contains abstracts from journals, books, monographs, conference papers, US patents and reports, covering a whole range of subjects incuding animal behaviour, biochemistry, biotechnology, calcified tissue, chemoreception, ecology, entomolugy, genetics,'human genome, immunology, microbiology, neurosciences, oncogenes, toxicology, virology, and AIDS.

    CD-ROM technology has, no doubt, brought information to our door-step. Every medical and health personnel who is vested with the care of individual or groups of people or the nation as a whole must attempt to keep abreast with the latest developmentsin this field. How can anyone hope to choose the best available option if helshe does not know what the options themselves are?

  • Tecltnique

    It goes without saying that medicalprofessionals, particularly clinicians, are extremely busy people. However, with the heavy responsibility thrust upon them, it is all the more necessary that they spare a few minutes a week updating themselves. Sitting in front of a computer and browsing through articles of interest to them will not only be a form of relaxation to the doctors' busy

    schedule, and it will also add zest to their work, and even serve as a force propelling them to write case reports and undertake research in their own fields. After allif Malaysians are looking towards being a fully industrialized nation by the year 2020, the health and medical professionals must not be left behind by their counterparts in the advanced nations.

    Deoxyribonucleic acid (DNA) analysis by flow cytometry [I .... ....

    .... ....

    .... .... ( Chin Yuer Meng

    T h e study of cell kinetics has been facilitated by the use of flow cytometry to determine cellular DNA content. A single-cell suspension is prepared andcells are stained with afluorescent dye whose binding is proportional to the DNA content of the cell. Cells are then directed in single file through a laser beam to excite the DNA-specific dye, and the fluorescence emission is collected and displayed as a fluorescence distribution as shown in Fig. 1. By integrating the areas under the curve (Fig. 1) the percentage of cells in each phase of the cell cycle, GOIG1, S, and G2+M can be determined.

    Cell cycle analysis by flow cytometry can be used to study the biochemistry of cell growth, kinetic properties of cell population and the proliferative activity of a tumour. During the S-phase of the cell cycle, DNA synthesis occurs. The prolifera- livt: activity of a turrivur is indicated by the S- phase fraction.

    1 x 2 x

    DNA Content

    Fig. 1 : DNA distribution of a population of singk cells produced byjlo w cytometry.

  • Technique

    DNAploidy analysis is usedin clinical research to predict the outcome of certain malignancies. For the solid tumours, an aneuploid neuroblastoma is associated with a favourahle prognosis while an aneuploid colon carcinoma is associated with an unfavourableprognosis. In acutelymphoblastic leukemia (ALL) hyperdiploidy shows a good prognosis while hypodiploidy indicates a bad prognosis. To determine the ploidy status of a tumour, the DNA index is calculated by dividing the GO/Gl DNA peak channel of the tumour cell by the GO/G1 DNA peak channel of a normal population of cells. A diploid tumour will givc a DNA index of one. A hyperdiploid population will have a DNA index greater than one while that of a hypodiploid population will be less than one.

    The disadvantage of flo w cylu~nclric measurement is that it requires cells to be in a single cell suspension. Single cells can be prepared from fresh solid tissues by solubilization in detergent, enzymatic digestion and mechanical dsaggregation. Flow cytometric analysis of a tissue should always beinterpreted in conjunction with Wright-Giemsa andlor Haematoxylin-eosin- stained cytocentrifuge preparation of the cell suspension for morphological studies. Morphologic correlation must be made to confirm that the cellular population of interest was present in the cell suspension studied.

    Flow cytometry can be applied to the study of fixed tissue that is stored in paraffin blocks. A technique fordissolving the paraffin, followed by dispersion and 'staining of the cells has been developed (1). This technique is useful for relat- ing kinetic parameters of human tumours to

    Several fluorescent dyes have been used to stain DNA, including ethidium bromide, propidium iodide, acridine orange, mithramycin and Hoechst 33312. Acridine orange can be used to separate and sort cells on the basis of both DNA content (green fluorescence, from staining double- straricled DNA) and RNA content (red fluoresence, from staining single-stranded RNA), and has been used to discriminate between G1 cells and non-proliferating subpopulations.

    In solid tumours such as breast, ovarian, colorectal, pulmonary, and cervical carcinoma, the frequency of aneuploidy increases with the advancement of the tumour stage. The survival rate of these patients with aneuploid tumours are worse than those with diploid tumours. Tumours with a low S-phase fraction (less than 5%) have a better prognosis than those with a high S-phase fraction. Aneuploid tumours have a higher S- phase fraction than diploid tumours, thus indicating a higher proliferative rate than diploid tumours (2, 3).

    At the Institute for Medical Research, DNA ploidy studies by flow cytometry is being carried out in acute myeloid leukemia (AML), ALL and breast cancer. Of the 50 ALLpatients, 10% were hyperdiploid. All the 50 AML patients studied were diploid. In our preliminary studies of breast cancer patients, aneuploidy was detected in 40% of the patients. There is also an association of aneuploidy with the histopathological staging of the breast cancer. Followup studies are being done on the prognosis of the ALL and breast cancer patients with and without aneuploidy.

    subsequent outcome of treatment of the patients, Using DNA analysis by flow cytometry cell cycle

    since it can be applied retrospectively to tumours from patients where complete followup is avail- distribution and ploidy status of a tumour can be able. Compared to fresh tissue, DNA analysis by determined. Flow cytometry plays an important flow cytometry using paraffin blocks is very time role in the diagnosis, prognosis and histological consuming and gives histograms which show classification of the tumour. wider coefficient of variation.

  • References

    1. Hedley DW. Flow cytometry using paraffin- embedded tissue: five years on. Cytometry 1987; 8: 377-385.

    2. Seckinger D, Sugarbaker E & Frankfurt 0. DNA content in human cancer. Arch Path01 Lab Med 1989; 113: 619-626.

    3. Hatfty BG, Tith M, Flynn S, Fischer D & Carter D. Prognostic value of DNA flow cytometry in the locally recurrent, conserva- tively treated breast cancer patient. J Clin Oncol 1992; 10: 1839-1847.

    Medico-ecological studies in the Pergau Hydroelectric Project area 11 .... .... .... .... ...

    T h e Institute for Medical Research (IMR) has for some years been involved in the medico- ecological environmental impact assessment (EIA) of hydroell=c~ic projects. Mrasl of the studies were aim at obtaining base-line informa- tion and assessing potential disease hazards which may be brought about by ecological changes. Two studies have been on completed hydro- electric projecls. In 1992, the EIA team of the IMR began monitoring the health of people at the site of the dam during its construction.

    The last mentioned study was conducted in the Pergau Hydroelectric Project area. The objec- tives were to determine the common infections related to environmental changes among con- struction workers and to study presence of vec- tors of diseases, as well as to obtain information

    from the villagers on how the project affected their lives.

    The findings showed that there was a potential increase in transmission of malaria in the con- struction area owing to the increase in suitable breeding sites for the mosquito vectors. There was the potential risk of introduction of dengue into the area as many containers were found to have larvae of the dengue vectors. Soil-transmit- ted helrninth infections were common among the workers, and it appeared that hookworm infec- tion was more common among roadconstruction workers who had no access to toilets during working hours. Most villagers were neutral in their feelings towards the construction of the dam though they were pleased with the increase in job opportunities and anticipated being supplied with electricity once the dam became operational.

  • ZMR Publicutions

    Abstracts of IMR Publications

    Seroprevalence of Toxocara canis antibodies among Orang Asli (aborigines) in Peninsular Malaysia

    Lokman Hakim S , Mak JW, Lam PLW, Nazma S and Normaznah Y .

    Southeast Asian J Trop Med Public Health 1992; 23: 493-496.

    A n enzyme-linked immunosorbent assay using excretory-secretory antigens of the second stage larvae maintained in vitro was used to determine the seroprevalence of Toxocara antibodies in Orang Asli (aborigines) of Peninsular Malaysia. The mean + 3SD optical density of 30 healthy subjects was used as the cutoff point. Overall prevalence was foundto be 3 1.9%. No significant relationship was found between positive rates with sex and age groups, though children between 0 and 9 years recorded the highest positive rate. Eosinophil counts were found to beclosely related to the proportion of positivity to Toxocora infection and mean optical densities. There was some degree of cross-reaction with Trichuris trichuria positive sera.

    Ras Gene Mutations in Malaysian leukemia patients

    Chin Y M , Koh CL & Bosco JJ

    R a s gene mutation studies was performed at random on 30 acute myeloid leukemia (AML) patients, admitted to the University Hospital,

    Kuala Lumpur, from July 1988 to October 1989. The deoxyribonucleic acid (DNA) isolated from the bone marrow or peripheral blood of the leukemia patients were subjected to in vitro amplification at regions around codons 12, 13, and 61 of the three ras genes; the H-ras, K- m s , and N-)-as by thepolyn~erase chain reaction. The amplified products were then hybridized with oligonucleotide probes to detect point ~r~ulalions at codons 12, 13, and 61 of the three ras genes; the H-ras, K-ras, and N-ras.

    Ras gene mutations were detected in 4 (13.3%) of the 30 AML patients. The incidence of ras gene mutations in the M3 and M4 subgroups of AML were 37.5% and 8.3% respectively. All the four patients with ras mutations were below 35 years. In the present study, ras gene mutations was mainly found in M3 AML patients and a young age group. These findings have not been reported in Western countries before.

    Adopting the primary health care approach in Malaria control in Malaysia: Lessons in community participation

    Haliza Mohd Riji

    Southeast Asian J Trop Med Public Health 1992; 23 Suppl. 1: 18 - 22

    T h e Primary Health Care (PHC) approach in Malaysia was first tried out in Sarawak, East Malaysia in 1982. In 1984, the Vector Borne Disease Control Programme in Kelantan decided to adopt the PHC approach as an additional strategy in its effort to control malaria in the state,

  • ZMR Publications

    which then experienced an increase in malaria cases. Effort was directed at creating awareness and stimulating the interest of health staff and communities to adopt the strategy. Kelantan was made the model state. The paper gives an outline of the process involved and some characteristics of PHC workers. A study was carried out among health workers, community members and health staff on their knowledge and involvement in PHC in three states, including Kelantan. Tn view of the overall success of this approach, and the weaknesses which have been identified, possible solutions have been suggested and should be acted upon.

    Occurence of human rabies in Peninsular Malaysia

    Ganesan J & Sinniah M.

    Med. J . Malaysia 1993; 48: 194-199

    T h e occurence of a case of human rabies in Peninsular Malaysia is highlighted. Despite the various control measures taken sporadic cases of rabies have continued to occur in Peninsular Malaysia especially in the northern states. The purpose of this paper is to create awareness of the occurence ofrabies so that effective post-exposure prophylaxis will be instituted as soon as possible to prevent the possible occurence of this dreaded disease.

    The postmortem laboratory findings from a hu- man case of rabies from the Alor Setar Hospital are reported. A.7-year old Indian boy had been admitted to the Alor Setar Hospital with a history of having been bitten by a stray 'mad dog'one month prior to admission. On admission the patient had fits, twitching of facial muscles, hydrophobia and ascending flaccid paralysis. Consciousness deteriorated into coma and the patient died 10 days after admission. A postmortem was performed at the Alor Setar Hospital and the brain sent to the IMR. At the

    Virology laboratory of the IMR impression smears were made from the brain and these were positive for specific rabies antigen by the fluorescent rabies antibody technique. The brain was also examined histologically. The sections showed features consistent with those of viral meningoencephalitis. In addition sections stained by the Sellers' method showed largely oval intracytoplasmic acidophilic inclusion bodies having features consistent with Negri bodies and hence further confirming that the meningoen- cephalitis was caused by rabies.

    The case report is followed by a summary of currently available preventive measures and diagnostic methods for rabies.

    Extraction of Delta-9-THC Carboxylic Acid from pooled cannabis positive urine for preparation of standard.

    Mohd Isa Wasiman, Mohd Zaini Abd Rahman, Badrul Amini Abd Rashid and Zakiah Ismail.

    Malaysian J Med Lab Sci 1992; 9(1): 26-28 r 1 1 he procedure for extraction of delta-9-THC Carboxylic acid from pooled cannabis positive urine for preparation of standard is discussed. The urine samples were screened for cannabis using fluorescence polarization irnrnunoassay (FPIA). The pooled urine was subjected to alkaline hydrolysis at 50C for 30 min, after which the urine were adjusted to pH 2-3 and extracted with cyc1ohexane:ethylacetate solvent. 185 ug of delta- 9-THC-COOH was recovered from 2 liters of urine. Purification of the extract was carried out by preparative HPLC using a reverse phase 22mm x 25 cm C18 column. The fraction containing delta-9-THC-COOH was pooled, and concentrated by evaporation under an air stream at 50C. The amount of pure delta-9-THC- COOH recovered was 98 ug.

  • M. Sc. Theses

    f Study of the Epstein Barr virus

    receptor molecules i

    (Abstract of thesis submitted to the University of London by Vijayamalar Balasubramaniam for the degree of Masters of Science)

    T h e Epstein Barr virus (EBV) is the causative agent of infectious mononucleosis and is closely associated with Burkitt's lymphoma (BL) and nasopharyngeal carcinoma. It primarily infects matureB cells (latently) andepithelial cells where it undergoes active replication. The receptor for EBV in theB cell has been identified as the CD211 CR2 molecule. BL exists as an epidemic and sporadic form. The sporadic form is usually EBV genome negative. EBV negative cell lines raised from this tumour have no or very low levels of expression of CD21. However these cells can be infected withEBV. The aims of this project were:

    1) To correlate the level of EBV infection in EBV negative cell lines

    (20% expression of CD21). We also showed that monoclonal antibody OKB7 partially blocked EBV infection of these ccll lines and that I32 binding appeared to enhance the uptake and infection of EBV.

    The results of this small project has led us to believe that there is a likely possibility of the existence of anotherlalternative receptor present in EBV negative BL cell lines: BL2 and BL3O. It has also showed that B2 probably has an enhanc- ing EBV uptake andEBNA protein synthesis. As early as the 1970's researchers had believed in the existence of an alternative receptor especially since epithelial cells (at that time) did not have detectable levels of CD21-like receptors.

    2) To attempt to block EBV infection of Thus the results obtained should stimulate a EBV negative cell lines with monoclonal modicum of interest in the quest for an alternative antibodies to CD21. receptor. The role of B2 in enhancing virus

    uptake should be investigated too as it may throw We were successful in infecting the BL2 cell line some light on the mode of uptake and although the level of expression of CD21 was less internalisation of the EBV as well as the identifi- than 2%. BL30 cell line was successfully infected cation of alternative receptor.

  • Courses and Workshops

    Courses and Workshops

    IMR celebrates its 90th Anniversary

    T h e IMR, founded in 1901, celebrated its 90th anniversary in 1992 with a Scientific Seminar, Open Day and a Family Day. The theme of the Scientific Seminar, held from 23 to 25 June, was Health Research: Achievements, Challenges and Future Directions. The objectives of the Seminar were to review the 90 years of work of the Institute, with special emphasis on the last 15 years, and to consider its future direction. The Seminar was opened by the Minister of Health, the Honourable Dato' Lee Kim Sai.

    An overview of research carried out in the IMR was given by Dato' (Dr) M. Jegathesan, Director, IMR, andthis was followed by aKeynote Address on Future Directions on Health Research in Malaysia by the Director-General of Health, Tan Sri Dato' (Dr) Abu Bakar Suleiman. Some senior IMRresearchers were given the task of reviewing the research achievements on selected topics and relating these to patient care and management and control of diseases. The topics covered were infectious diseases, non-communicable diseases, human nutrition; environment and health. Some prominent local and foreign scientists were also invited to present papers on recent developments in topics such as molecular biology, biotechnology, environment and health, research in parasitic diseases, and human nutrition.

    An important component of the Seminar was a dialogue session between programme directors of the Ministry of Health and IMR researchers,

    where the former identified problems encoun- tered in the implementation of their respective programmes. Some extremely important issues were raised and a number of research projects were identified for urgent action. Both sides found the exercise extremely useful and it was suggested that the dialogue sessions be held frequently. The proceedings of the Seminar has been published and is available from the IMR.

    Contributed by Mak Joon Wah

    Workshop on Flow Cytometry in Clinical Medicine

    T h e first flow cytometer (Facscan system) in Malaysia was installed at the Institute for Medical Rescarch in 1988. Since then interest has been shown by staff members in using the flow cytometer for research projects. The Flow Cytometry Workshop in Clinical Medicine was therefore organised by the Division of Haematology, IMR with the help of the Division of I~ii~nunology and sponsorcd by the Training Division of the Ministry of Health.

    Prior to the workshop, pi-e-workshop lectures were conducted from 10 to 21 August 1993 by lecturers from University Hospital, Universiti Kebangsaan Malaysia, National University of Singapore and IMR. The lectures included basics of immunology, experiences with the flow cylorneler and cell cycle kinetics. These lectures were useful adjuncts to the workshop proper.

  • Courses and Workshops

    Purtic~ipanis and or~iniz ing c~otnrniliec~ ofihr workshop

    Participa at one of the lec

    The workshop proper which was held from 6 to 15 September 1993 was officially opened by the Director of IMR, Dato' Dr M. Jegathesan. The consultant for the workshop, Ms Melinda Leong was from Singapore, and the 10 participants included officers and medical laboratory technologists from the IMR and a specialist from Hospital Kuala Lumpur. The objectives of the workshop were to provide an overview of the Facscan system and how it works, and familiarize the participants with system operation, main- tenance and quality control. Techniques for

    sample preparation, irnrnunophenotyping and DNA content analysis of cells from leukemias and cancers were taught. The workshop also gave the participants information on the usefulness of the Facscan system in routine diagnostic work and its potential in the field of research. It is hoped that the participants will utilise this newly gained knowledge to improve on their research. Participants were given certificates of attendance by the Ministry of Health, Malaysia.

    Contributed by Rahimah Ahmad

  • Courses and Workshops

    Quality Assurance for the Pathology Laboratory Services

    Thc Ministry of Health Quality Assurance (QA) Programme is aimed at ensuring quality in the provision of the health care services. One of six committees of the Ministry, the Laboratory Com- mittee was set up in late 1990. It comprises the Chemical Pathology, Medical Microbiology, Haematology, & Blood Banking and Histopathology & Cytopathology sub-commit- tees which arc given the task of developing practical QA indicators for the respective medi- cal laboratory disciplines and implementing them. The laboratory QA Programme was officially launched on 12 February 1993. In the second workshop the findings of pilot studies, con- ducted the previous year to determine feasibility of using the various indicators and standards established, were discussed.

    The monitoring of nine laboratory qualityindica- tors is in progress, These include the perfor- mance indicators from existing national external quality assessment schemes (EQAS), turnaround times, specimen rejection rate and the percentage of urgent laboratory tests. These indicators cover key aspects of the laboratory process which affect outcome of the services.

    The pathology laboratory services are an integral component of the overall patient-care services as laboratory results are often necessary for diagno- sis of disease and patient management. Periohc monitoring of the quality indicators is to identify laboratories which fail to comply with desired standards. Improvement involves identifying the reasons for failure to comply with desired stan- dards and instituting proper remedial actions. In accordance with QA7s goal of continuous im-

    provement, realistic standards (based on mini- mum acceptable criteria rather than the ideal) are adopted, and these will be raised in future to improve quality.

    Contributed by Lim How Hin

    SEAMEO-TROPMED Seminar on Filariasis

    T h e 34th SEAMEO-TROPMED Seminar on Current Status of Filariasis in Southeast Asia was held at the Institute for Medical Research, Kuala Lumpur, from 26 to 27 June 1992. The Seminar was officially opened by the Director-General of Health, Tan Sri Dato' (Dr) Abu Bakar Suleiman and attended by delegates from Indonesia, Phil- ippines, Thailand, Malaysia, Germany, U.S.A. and the World Health Organization. The objec- tives of the Seminar were to discuss the current situation of filariasis in countries of the region, present recent findings, and review advances in the study of filariasis. The topics reviewed were advances in epidemiological and diagnostic tech- niques, chemotherapy, molecular biology and immunology, genetics, biology and ecology of mosquitoes, vector control, socio-behavioural aspects of filariasis. General discussions were held on how these advances relate to patient management and the control of lymphatic filariasis. It was recommended that countries in the Region should take urgent steps to increase the pool of personnel trained in research and control of lymphatic filariasis, and that SEAMEO- TROPMED play a positive role in this respect through Seminars such as the present one, to serve as forums to disseminate recent advances. The proceedings of the Seminar will be published as a supplementary issue of the Southeast Asian Journal of Tropical Medicine and Public Health.

    Contributed by Mak Joon Wah

  • Collaboration

    Basic Course on Transmission Electron Microscopy

    T h e IMR Electron Microscopy Unit conducted a Basic Course on Transmission Electron Mi- croscopy for researchers of the Institute. Dr. Deborah J. Stenzel from Qutxnslarid University of Technology was the WHO consultant for the course. Eight participants and 3 observers at- tended the course which was held from 12 to 28 October 1992.

    The lectures and practicals were designed for those without any previous experience in elec- tron microscopy. The participants were taught the mechanics of the transmission electron mi- croscope (TEM), processing of biological speci-

    mens, immuno-labelling and cytochemistry, and use of support equipment such as vacuumevapo- rator, knife maker and ultra-microtome, exarni- nation of ultra-sections under the TEM, taking of photo-micrographs, development of film and making of contact prints. Emphasis was placed on the examinatinn nf photo-micrographs tn identify ultra structures and artifacts, defects in the processed specimens and quality of photo- micrographs. The group was briefed on the applications of transmission electron microscopy inpathology, virology, bacteriology, parasitology, and entomology. During the course, the participants also discussedthepossibility of using transmission electron microscopy in their re- search work.

    Contributed by Karen P.F. Lai

    IMR- JICA Collaborative Project

    A milestone in collaborative medical research between Malaysia and Japan was reached when an agreement was signed between the Institute for Medical Research, Kuala Lumpur and the Japan International Cooperation Agency (JICA) on 22 June 1992, on technical cooperation in research of selected tropical diseases. The IMR- JICA research project on tropical diseases officially began with the arrival in the IMR of Professor Hiroshi Tanaka, Chief Advisor andMs Izurni Ota, Coordinator, on 13 January 1993.

    The objectives of the project include the transfer of expertise in biotechnology from Japanese experts to their Malaysian counterparts and the

    development of more rapid and sensitive diag- nostic assays for patient care and control of malaria, dengue, dengue haemorrhagic fever and Japanese encephalitis. In addition to long term consultants being attached to the Divisions of Medical Entomology, Virology and the Biotechnology Centre, a number of short-term consultants are also posted in the M R . The counterparts from the Divisions concerned will receive further training in Japan. In addition, equipment for upgrading facilities will be sup- plied by JICA.

    Contributed by Mak Joon Wah

  • Visiting Scientist

    Rama

    Professor Rama Chandran Nair, Director of Epidemiology and Community Medicine at the University of Ottawa (U of 0 ) , Canada has spent part of his sabbatical leave from January to June 1993 at theInstitute for Medical Research (IMR).

    Professor Nair is a biostatiscian and epidemiolo- gist, with primary interests in epidemiologic re- search methods. He has over 40 publications in refeered journals and numerous presentations to learned societies. Apart from his regular teaching activities at the Faculty of Medicine at U of 0, he has conducted several workshops on Research Methodology for students of various disciplines. He has assisted severall-esearchers in Carlaclaand abroad in developing research proposals and carrying out research.

    His visit to the IMR was sponsored partly by the SEAMEO-TROPMED institutional linkage agreement, which he was instrumental in negoti- ating, between IMR and U of 0. Under this activity, Professor Nair held a workshop on Research Methodology at the IMR in March 1993, and this was attended by more than 50 researchers. Dr. Amal Nasir b, Mustaffa of the Division of Epidemiology and Biostatistics at IMR is currently doing research for his M.Sc. degree, under the guidance of Professor Nair. Several researchers from IMR and HKL have taken advantage of his presence in Malaysia to obtain statistical advice on their research. He has

    C. Nair

    also initiated and helped in setting up an elec- tronic linkage (E-mail) between IMR and U of 0 as well as other national and international agen- cies.

    As part of his research activities, Professor Nair has collaborated with Dr. Lye Munn Sann of the Division of Epidemiology and Biostatistics on various research projects. This resulted in the submission of several articles for publications (one of which has already been accepted).

    In addition to the above, Professor Nair has organized the National Workshop on Clinical Epidemiology, sponsored by the World Health Organisation and IMR (held in May 1993). He has also been the joint coordinator for the Na- tional Workshop on Research Methodology in Vietnam, held under the sponsorship of WHO and the Government of Vietnam. He conducted a one-week workshop in April 1993 on Ad- vanced Statistical Methods for the Faculty of the Department of Community Medicine at Universiti Sains Malaysia, Kubang Kerian, and is planning a two day workshop on Clinical Trials forphysi- cians in Kuching, Sarawak in June 1993.

    Professor Nair's visit to IMR has been a catalyst in promoting better linkage between IMR and U of 0 and it is anticipated that similar collaboration between other staff memhers of both instit~~tions will take place during the coming years for the mutual benefit of the two institutions.

  • Obituary

    [ Obituary . . . . . . Arthur Anantharaj Sandosham

    L.M.S., Ph.D., M.D., A.M. 9 June 1905 - 28 November 1992

    Professor Sandosham was born in Karur, India on 9 June 1905. He came to Malaya with his family in 19 13. He married Emily in 193 1 and they had three children, two sons and a daughter. Professor Sandosham passed away at the age of 87 on 28 November 1992 in Trichur, India.

    Professor Sandosham completed his secondary education at the Penang Free School and was awarded an Entrancc Scholarship to King Ed- ward VII College of Medicine, Singapore. He graduated in 1930 with prizes in Medicine and Public Health. Tn 1948, he was awarderlaQue~n's Scholarship to pursue a Ph. D. degree at the London School of Tropical Medicine and Hy- giene.

    Upon graduation, Professor S andos ham joined the Department of Biology at his alma mater. He was appointed to the chair of parasitology. In 1959, he was appointed Vice-Chancellor of both &visions (Singapore and Kuala Lumpur) of the University of Malaya. Professor Sandosham left the University in 1960 to work at the WHO Western Pacific Regional Office in Manila as the coordinator of malaria studies. He joined the Institute for Medical Research in 1961 as a senior research officer in malaria and filariasis. In 1963, he was appointed Director of IMR and served in the post until 1965. He remained in the IMR as research consultant and advisor to the Division of Malaria and Filariasis and was the first Dean of the Dipluma in Applied Parasitology and Ento- mology course in 196811969. He retired from the IMR in 1970.

    Although Professor Sandosham's early work was in classical parasitology, his major and

    enduring interest was malaria. He wrote his first book on malaria entitled 'Malaria in Malai' dur- ing the war when he was headof the Anti-Malaria Laboratory in Singapore. When he joined the IMR he collaborated with Dr. J. W. Field and Yap Loy Fong in producing a new edition of the book on the microscopical diagnosis of malaria. While at the IMR, Professor Sandosham's work was focused on two problems, the transmission of simian malaria to man and on the emergence of drug resistant Plasmodium falciparum strains. The simian malaria work led to the discovery of many new species of malaria parasites. One of these, Plasmodium sandoshimi, found in the flying lemur, was named after Professor Sandosham.

    Professor Sandosham was a very active member of society. He served on many committees and organizations. It was Prufessur Sandusham whu suggested the formation of the 'Malaysian Soci- ety of Parasitology' and later became its first president. In addition, he was editor of the Medi- cal Journal of Malaysia and the SEA Journal of Tropical Medicine and Public Health. Through- out his working life, this kind and approachable man, used his good offices to encourage and help the younger members of the scientific commu- nity. Sandy, as he was affectionately known, was famous for his special brand of humour which laced his after-dinner speeches and the 'Sandy's Spices' column which he wrote for the MMA newsletter.

    With Professor Sandosham's demise, the scien- tific and medical community has lost a leader, a mentor and a very dear friend.

    Contributed by Harvinder Kaur Gill

  • Pengerusi : Dr. lsmail Mohd. Nor Penasihat : J.L. Fernandez - Ireland Penyunting : Chin Yuet Meng

    Azizah Mohd. Radzi Penolong : Mohd. Fo'ad b. Kastamam

  • Bangunan IMR - 1977

    Bangunan IMR - 1901

    lnstitut Penyelidikan Peru batan (Institute for Medical Research) Jalan Pahang 50588 Kuala Lumpur Malaysia