IMR Bulletin Jan Apr 2004

IMRISmMR(46.04 (BUL)

Jaa/Apr. 2004 No. 57/58

CONTENTS From the Editor-in-Chief.. ........................................................................................ 1

Notice to contributors.. ............................................................................................ 1

ARTICLES

A randomized comparative study of oral levofloxacin versus Augmentin0 for the treatment of community-acquired pneumonia Jurina H., Mariarn M., Roslan H., Roslinn M., and Jeflri AH.. ............................................ 2

Sugar intake amongst a sample of staff of the Institute for Medical Research (IMR), Kuala Lumpur ............... Ng TKW., Suresh R. . Nur Suffia S., Zawiah A., Norhafizah AW. and Noorkaslinda S. 15

Traction Immobiliser as Opposed to Traditional Traction Methods in the Initial Management of Fractured Femur in Adults Thirurnal M.. Surendra M., and Vijayachandran V.. ......................................................... 20

Racun Perosak di dalam Makanm- Padi dan Hasilannya Wan Roslina, W.A.., Nurul Izzah, A. and, Aminah, A. ...................................................... 26

Pembangunan dan Peranan Perpustakaan IMR: Selaku Penyelaras Perpustakaan Kementerian Kesihatan Malaysia Siti Rodziah Othman.. ............................................................................................ 34

Implementation of MS IS0 9000 in IMR: Achievement & Challenges Jawatan Kuasa Pasukan Pelaksana MS IS0 9001 IMR ............................................................. 39

PUBLISHED ABSTRACTS

A Study on Malaysian's Practice Towards Waste Disposal Wan Rozita WM., Hanjeet K., Sumarni MG. and Lirn KH. ................................................. 43

Tissue Engineering of Ear and Trachea Aminuddin BS., Chua, KH.. Mazlyzam, AL., Fauzina H., Lokman, BS., Munirah BS. and Ruszymak BHI.. ............................................................................................................ 43

Space Spraying of Bacterial and Chemical Insecticides against ~no~he1e . s Balabacensis Baisas for the control of Malaria in Sabah, East Malaysia Krishnasamy, M., Lee, H.L., Jeffery J. and Ambu, S ....................................................... 44

Effect of ten chlorophytes on larval survival, development and adult body size of the mosquito Aedes Aegypti 44 Rohani Ahmad, Wan-Loy Chu, Zamree Ismail, Hun-Lim Lee and Siew-Moi Phang. .....................

Molecular subtyping of Salmonella Enterica Serovar Tshiongwe recently isolated in Malaysia during 2001 - 2002 Kwai Lin Thong, Shamsilawani Ahmad Baker, Kin Seng Lai, YinTee Koh, Mohd Zainuldin Taib, Lim 45 VKE and Rohani Md. Yasin.. ......................................................................................

Susceptibility of laboratory and field animals to experimental infection by Schistosoma spindale cercaria Krishnasamy M., Chong NL., Ambu S., Inder SK., Jeffery J., Edariah AB. and Oothuman P. ............ 45

Notes on the ectoparasites of rodents from the Ulu Gombak Forest reserve, Selangor Salleh Ismail, Baharudin Omar, Sallehudin Sulaiman, Juraihan Sulaiman and Zuraidawati ZolkaJee 46

Collection of domiciliary cockroaches and their parasites from the Faculty of Medicine, University of Malaya, Kuala Lumpur John Jefeiy, Sulaiman Abdullah, Khairul Anuar, Baharudin Omar, N~rha~yati Moktar, Sallehudin Sulaiman, Hidahatulfathi 0. and Krishnasamy M. ............................................................ 46

Domiciliary cockroaches and house lizards and their parasites from Kg. Tebengau, a rice-growing village in Kedah John Jeffeq, Nor Afandy H , Sulaiman Abdullah, Sallehudin Sulaiman, Norhayati Moktar, Baharudin Omar, HidayatuZfathi O., Ismail MG., Ahmad Firdaus MS. and Krishnasamy M.. ....................... 47

REPORTS

National Surveillance on Antibiotic Resistance Report for 2003 Institut Penyelidikan Perubatan .................................................................................. 48

EDITORIAL BOARD 5 8

IMR Quarterly Bulletin No. 57/58: JadApril2004

From the Editor-in-Chief

The Editorial Committee wishes to express its sincere apologies for the inadvertent delay in publishing Issues 57 and 58. We are extremely grateful to the many contributors who have waited patiently for the release of these two issues. As in our past issues, the contents will continue to include original research articles and reports, abstracts of published scientific papers as well as calendar of events of research interests.

Yet another year is coming to pass, and soon the year 2005 will be born. As we look back at the events of the past 10 months, we see the world to be still grappling with newly emerging diseases such as SARS and the Avian Flu. Some of our neighbours are facing the brunt of the avian flu. We also see international cooperation as the means to deal with these new human pathogens and Malaysia has done well in controlling and limiting the spread of these new pathogens. The Ministry of Health and other relevant organizations in Malaysia have been in the forefront to put in place appropriate measures to control these emerging public health problems efficiently and effectively.

Our health programmers are successful due to the close collaboration between the different agencies and the spirit of camaraderie displayed by them in working on emergency response plans. We should be proud of this culture and continue to build on these virtues to put in place our future health programmes. The data we gather in our routine work can be translated into useful information and disseminated to health programme managers for planning programmes. The IMR Quaterly Bulletin is a portal for dissemination of such information, and it has taken on the role as an 'Information Clearing House' to assist researchers disseminate their findings.

On this note, I once again request public health researchers, clinicians and policy makers to use the IMR Quarterly Bulletin to publish their research findings.

Notice to Contributors

The article should have the following sections: Brief Abstract, Introduction; Materials and methods; Results; Discussion; Acknowledgements and References. Illustrations should be drawn clearly and not photocopied. Care should be taken that illustrations do not exceed a maximum size of 12.0 x 18.5cm. The Editorial Board reserves the right to arrange drawings and photographs in a manner so as to make a composite plate to avoid undue wastage of space. References should be given in alphabetical order with the full title of the journal.

The articles can be written in Bahasa Malaysia or in English with double spacing and submitted as a typescript, on size A4 paper to Pn. Siti Rodziah, Unit Perpustakaan dan Sumber Maklumat, Institute Penyelidikan Pembatan or transmitted electronically to the following e-mail address: [email protected]. Also please attached your e-mail address for easy contact.

It is assumed that all articles submitted for publication have the prior approval of their respective Directors. The Editorial Board takes no responsibility for the accuracy of statements made by the author(s) and the views expressed in the articles are not to be taken as that of the Institute for Medical Research or the Ministry of Health Malaysia.

ARTICLES

IMR Quarterly Bulletin No. 57158: JadApril2004

A randomized comparative study of oral levofloxacin versus ~ u ~ m e n t i n @ for the treatment of community-acquired pneumonia

Jurina H. ', Mariam M. ', Roslan H . ~ , Roslina M. 3, Jeffri AH.^

1 General Hospital, Kuala Lumpur, isea ease Control Division, Ministry of Health, 3~espiratory Unit, Department of Medicine, HUKM, Malaysia

Abstract

Objectives: To compare the efficacy and safety of oral levofloxacin 300 mg once daily dose with amoxicillin/clavulanate potassium 375 mg thrice daily dose for the treatment of community-acquired pneumonia in adults. Methodology: Sixty patients with confirmed diagnosis of mild to moderate community-acquired pneumonia were enrolled in this randomised, open comparative trial. Patients were evaluated before, during (days 3, 7, 10 and 14 of taking the antibiotics), and 4 to 5 weeks post-therapy. Results: The patients were randomised into levofloxacin treatment arm (n=31) and amoxicillin/clavulanate potassium treatment arm (n=29). Both treatment arms were similar in the demographic characteristics, clinical presentations at baseline and duration of antibiotics given. Clinical efficacy, severity score, safety of the drugs and aetiological organisms were the study end- points. Clinical response was rated as a success (patient was cured or had improved) for 90.3% (28131) and 93.1% (27129) of clinically evaluable levofloxacin and amoxicillin/clavulanate potassium-treated patients. No relapses were seen within 4 weeks of the study population. The evaluation of severity score for cough and sputum demonstrated significant difference in clinical response on day 3 of taking the antibiotics; the levofloxacin-treated group achieved better and faster improvement as compared to the. amoxicillidclavulanate potassium-treated group. Dmg-related adverse events were described in 16.1% and 27.6% .of levofloxacin and amoxicillin/clavulanate potassium-treated groups respectively. The adverse effects were mild in both the treated groups and there was no need to stop treatment in any of the patients. Laboratory results did not show any changes in any of the patients while they were on treatment. Both treatments were generally well tolerated; the most common adverse events in both the groups affected the gastrointestinal tract. The common isolates were Klebsiella species (8.4%), beta- haemolytic Streptococcus (3.4%), Enterobacter species (3.3%), Acinetobacter species (1.7%), Branhamella species (1.7%) and Stenotrophomas maltophilia (1.7%). No resistance was found with levofloxacin group. Conclusions: When given orally, a once daily 300 mg dose of levofloxacin was as effective and well tolerated as amoxicillin/clavulanate potassium 375 mg thrice daily dose for mild to moderate community-acquired pneumonia but with levofloxacin, a better and faster improvement may be seen by day 3 of antibiotics.

1.0 INTRODUCTION developing world (3). The true incidence of CAP is not available (4,5). The incidence rate

Community-acquired pneumonia (CAP) is the of pneumonia in Malaysia was in the range of sixth leading cause of death in the United 10.28 to 1 1.33 per 10 000 population during States (1,2) and a major cause of death and the year 1995 to 1998 (Table 1) with fatality a increased health budget in the developed and rate of 4.83 to 5.50% (6).

Table 1: Incidence and fatality rate of reported pneumonia (ICD 9) in Malaysia

Year No. of cases Incidence Rate Fatality Rate (per 10,000 population) (%)

1998 2606 1 11.33 5.50

Source: Report of morbidity and mortality for inpatients, IDS Unit, MOH, 1999

IMR Quarterly Bulletin No. 57/58: JadApril 2004

Diagnosis of CAP depends on a history of fever with sputum production, which is supported by a physical examination, chest radiograph, sputum Gram-stains and cultures, blood cultures and serology, if atypical pathogens are suspected. The commonest microorganism is Streptococcus pneunzonine encountered by about 40 - 80% of the cases; nevertheless about 30 - 50% cultures reveal no organisms or normal oral flora (2,7,8,9,10).

The discovery of nalidixic acid in 1962 led to worldwide recognition of quinolones as antimicrobial agents. In 1978, fluoroquinolone (new quinolones) were developed. Levofloxacin is one of the newest fluoroquinolones antimicrobial that has been approved by the US Food and Drug Administration and has been available since 1996. It is the active isomer of ofloxacin and is available for either oral or parenteral use. It inhibits bacterial replication and transcription by blocking DNA gyrase (1 1). It has enhanced activity against Streptococczls pneumoniae that is susceptible, intermediately susceptible or resistant to penicillin (12) and is considered as the first of the "anti-pnecmococcal" fluoroquinolones (1 3,14) based on eight successful trials involving more than 3900 patients with CAP and the isolated organisms resistant to beta-lactam antibiotics (1 5,16).

Levofloxacin is well absorbed after oral administration, reaching peak concentrations in one to two hours (1 1,17) and has an oral bioavailability approaching 100% (1 8). Serum concentrations of levofloxacin rapidly increase dose dependency after administration, and is not accumulated in tissues after multiple-dose administration (5,19). In the United States and United Kingdom, the usual dose of levofloxacin 500 mg taken orally or given intravenously once daily for 7 to 14 days is used to treat CAP (12). Many clinical trials demonstrate levofloxacin as safe and well tolerated with low incidence of gastrointestinal and central nervous system adverse events, very little photo toxicity, and no cardio toxicity (1 8,2O).

Amoxicillin-clavulanate potassium or augmentin has been used to treat CAP and other respiratory tract infections for many years and was found to be effective and safe (21,22). It is a potent inhibitor of bacterial beta-lactamases (23) with broad coverage for both Gram-positive and negative strain (22). Many published clinical trials have shown excellent efficacy of levofloxacin for lower respiratory tract infections (1 8,19,24,25,26). So far there are no published local data on the usage of a lower dosage of levofloxacin 300

mg daily in the treatment of CAP. The aim of this comparative trial between levofloxacin 300 mg once daily and amoxicillinlclavulanate 2501125 mg thrice daily is to evaluate the efficacy and safety between these two antimicrobials in treating mild to moderate CAP in our local population.

OBJECTIVES

Primary objective To determine the efficacy of oral levofloxacin when compared to oral amoxicillinlclavulanate (augmentin) in the treatment of mild to moderate CAP.

Secondary objectives To compare the safety and tolerance of levofloxacin to augmentin. To identify the aetiology of CAP.

Hypothesis Levofloxacin is as effective in treating CAP when compared to augmentin. Levofloxacin is as safe in treating CAP when compared to augmentin.

METHODOLOGY

This was a randomized, open comparative trial carried out at Hospital Universiti Kebangsaan Malaysia (HUKM) from lSt January 1999 to 3 1" January 2001. HUKM Ethical committee approved the protocol and patients were provided written informed consent forms to sign.

3.1 Patient Selection Subjects were recruited from the emergency department, respiratory clinic and medical wards. A total of 60 patients were enrolled in the trial. Eligible patients were randomized using Fisher random numbers to receive either levofloxacin 300 mg daily or augmentin 375 mg thrice daily doses. This trial was designed as a single blinded where the investigator involved in assessing and following up the patients, did not know the patients' treatment until the study ended. Eligibility of patients included into the trial depend on the inclusion and exclusion criteria below:

Inclusion criteria Age 18 years or more Informed consent obtained Clinical diagnosis of CAP was based on: a. Fever (temperature > 37.0" C) b. Have at least of the following

signs and symptoms:

IMR Quarterly Bulletin No. 57/58: JanlApril2004

Chills, dyspnoea, cough, pleuritic chest pain, mucopurulent or purulent sputum, focal crepitations or evidence of consolidation on chest auscultation

c. Presence of consolidation on chest radiograph

3.1.2 1.

11.

... 111.

iv. v.

vi. vii.

Exclusion criteria Atypical presentation such as myalgias, joint pains, headache, anorexia and diarrhoea History of hypersensitivity to fluoroquinolones or penicillin History of seizure or major psychiatric disorder Patients with HIV infection Evidence of renal impairment (serum creatinine > 133 umolll) Pregnant or nursing women Patient who required a second systemic antimicrobial regimen

viii. Effective systemic antimicrobial therapy within 48 hours prior to admission

ix. Patients with severe CAP requiring parented antibiotic therapy:

a. Abnormal vital signs: Heart rate > 140lmin Respiratory rate >30/min Systolic blood pressure <9OmmHg

b. Abnormal investigations: White cell count <4,0001mm3 and >30,000/mm3 Haematocrit < 30%

Table 2: Evaluation criteria of symptoms and signs

Elevated blood urea or creatinine

c. Suppurative or metastatic infections:

Empyema, meningitis, endocarditis, etc.

d. Coexisting illness: Diabetic ketoacidosis Severe renal/liver/cardiac failure Terminal malignant disease

3.2 Dosage and duration of antibiotic therapy

The duration of antibiotic therapy may be extended up to 14 days according to their clinical response. The dosage given were as below: -

i. Levofloxacin: 300 mg per oral q24 ii. Amoxicillin/clavulanate potassium:

2501125 mg per oral q8h

3.3 Progress monitoring The relevant symptoms, signs and occurrence of adverse reactions were documented.

3.4 Clinical evaluation Clinical evaluations were undertaken at baseline, during therapy (day 3, 7, 10 and 14 of treatment) and at 4 - 5 weeks post-therapy as shown in the Table 2. The severity of their presentations was scored at each visit. Duration of treatment was determined by clinical improvement documented on day 7, 10 or 14 of treatment.

Degree1 Score

Items 0 1 2 3

Cough Absent + ++ +++ Sputum Absent Mild Moderate Severe Amount (ml) (< 1 Olday) (1 0 - 5O/day) (> 501day) Property of sputum Absent Mucoid Mucopumlent Purulent

Dyspnoea Absent + ++ ++i

Pleuritic chest pain Absent + ++ ++t

Crepitations Absent + ++ +++ Adapted from Kvung et al., 1996

3.5 Laboratory examinations completion of antibiotics therapy were chest Sputum samples for culture and sensitivity radiographs, full blood counts, renal profiles, were taken within the 24 hours before starting liver profiles and random blood sugars. An the treatment, during treatment (on day 3) and increase in creatinine level to twice the upper upon completion of treatment. Other limit of normal was considered as abnormal. investigations that were done before and upon Moderate or marked liver functions


abnormality were defined as alanine transaminase > 66U/L and >I32 U/L and total bilirubin >34.5 umol/l and >46 umolll.

3.6 Clinical efficacy Clinical efficacy was determined by the overall clinical, microbiological and radiological responses, and clinical outcomes were determined at the end of study (day 30). The definition of the responses above were as follow:

3.6.1 Clinical response Clinical response was evaluated at the end of therapy (day 7 to 14). It was divided into four categories:

Cure Resolution of signs and symptoms of pneumonia to baseline level that existed prior to the occurrence of pneumonia. For a subject to be considered clinically cured there must be improvement or lack of progression of acute lung infiltrates on the chest radiograph at the end of therapy. Improvement Resolution of fever; if present at baseline, but incomplete resolution of the other signs and symptoms of pneumonia and no requirement for additional antibiotic. Failure Lack of resolution of any signs and symptoms and a need for additional antibiotic. For subjects who were previously assessed as failures, the outcome would always be failure at subsequent time points.

Microbiological response Microbiological response was evaluated by sputum culture and sensitivity after completion of the course of antibiotics (7 to 14 days). It was divided into five categories:

Eradication1 presumed eradication Admission pathogens were absent or no material available for culture because of a favorable clinical response. Persistence Admission pathogens present at the end of therapy or presumed to persist due to antibiotic failure. Relapse Reappearance of the original causative organism from the original site of infection within 5 days of discontinuation of treatment or during treatment after a post-baseline culture has been negative. Indeterminate

No evaluation was possible such as no baseline causative pathogen was isolated.

3.6.3 Radiological response: Consecutive chest radiographs were done after completion of antibiotics and 4 weeks post treatment if no complete resolution occurred at the end of antibiotic. The radiological responses were categorized as follows:

a. Disappearance Disappearance of all radiological signs of infection

b. Improvement Significant improvement in the radiological signs of infection compared to baseline

c. Failure No change or worsening in the radiological signs of infection compared to baseline

d. Unable to evaluate No consecutive chest radiograph due to failure of treatment

3.7 Outcomes Clinical outcomes were evaluated at four weeks after completion of antibiotics for the signs, symptoms and microbiological response. It was divided into three categories:

a. Success Curelimprovement with no relapse at end of study

b. Failure Failure at the end of therapy as previously defined.

c. Relapse Curelimproved at the end of therapy but requiring additional antibiotic therapy for pneumonia prior to the end of study

3.8 In vitro antibiotic susceptibility test National Committee Clinical Laboratory Standards (NCCLS) disc methods were used to perform bacterial isolates in vitro antibiotic susceptibility tests (27).

3.9 Adverse reactions monitoring Any serious adverse events occurring during or after 4 weeks of completion of the antibiotic were documented in the format given and prompt action was taken.

3.10 Discontinuation (withdrawal) from study

Discontinuation from this clinical trial was documented in the study format. Reasons for discontinuation were stated, such as: -

Severe adverse effects Worsening of clinical evaluation requiring change in antibiotic therapy


Failure to come for follow up and fh-ther evaluation

All patients discontinued from the study due to severe adverse reaction or failure of response requiring change of therapy were given appropriate alternative treatment and were followed up.

3.11 Statistical analysis Sample size was determined to provide 80% power to detect a difference of 30% clinical response between both treatment groups at 5% level of significant using sample size table by World Health Organization (WHO) (Lwanga and Lemeshow, 1991). The sample size for each treatment group with the above consideration was 30. Significance test for comparison of efficacy and safety between levofloxacin and amoxicillin/clavulanate potassium was done by chi-square test and student t-test. Paired t-test was used to determine any significance difference in symptoms between antibiotics during the course of treatment. Ninety-five percent confidence intervals were used to assess treatment effect. SPSS 10.01 was the statistical software used.

4.0 RESULTS

4.1 Study population A total of 70 patients were screened and 62 patients with mild to moderate pneumonia

were randomised. Only 60 patients completed the study (n = 31 levofloxacin and n = 29 amoxicillidclavulanate potassium) while 2 patients (n = 1 levofloxacin and n = 1 amoxicilliniclavulanate potassium) had their therapy prematurely discontinued due to protocol deviation.

There was no significant difference between the two treatment groups in demographic characteristics and duration of signs and symptoms prior to treatment and the baseline investigations (Table 3). The mean duration of levofloxacin and amoxicillidclavulanate potassium in the treatment groups were 9.7 days and 9.6 days, respectively. Clinical signs and symptoms at presentation were comparable between both treatment groups, with mean duration of symptoms before levofloxacin and amoxicillidclavulanate potassium were 7.1 f 5.5 days and 6.9 f 3.4 days, respectively (p value = 0.91).

About 5 1.6% in levofloxacin-treated patients and 37.9% in amoxicillin/clavulanate potassium-treated patients had one or more co- morbid illness (Table 4). Diabetes mellitus patients have good control of blood sugar before and after completion of antibiotics with no significant difference seen in diabetes or non-diabetes patients (Table 3).

Table 3: Baseline characteristics of subjects according to assigned study treatment

Levofloxacin ~ u ~ m e n t i n @ (N= 31) (N = 29)

Characteristic No. (94) No. (%) Sex

Male 13 (41.9) 11 (37.9) Female 18 (58.1) 18 (62.1)

Race Malay 18 (58.1) 17 (58.6) Chinese 8 (25.8) 6 (20.7) Indian 5 (16.1) 6 (20.7)

Mean f SD Mean f SD Age (year) 55.5 k 13.9 53.0 f 16.1 Haemoglobin (g%) 13.59 f 1.98 12.95 f 1.70 White cell count (X 1 0 ~ 1 ~ ) 11.83 + 5.04 12.7 f 3.64 Platelet count (X 1 0 ~ 1 ~ ) 270.1 + 108.9 263.5 f 98.9 Random blood sugar (mmol/l) 8.65 f 4.71 8.44 + 5.23 Duration of symptoms prior to antibiotic (days) 7.1 + 5.5 6.9 f 3.4 Duration of antibiotic (days) 9.7 f 3.1 9.6 + 3.2

N.B.: Demographic data of study population at the time of randomisation into the study. None of the differences between the treatment groups were statistically significant.

IMR Quarterly Bulletin No. 57/58: JaniApril2004

Table 4: Co-morbid illness in evaluable study population

Levofloxacin ~ u ~ m e n t i n ' N = 3 1 N = 2 9

Co-morbid illness No. (%) No. (%)

Diabetes mellitus 7 (22.6) 4 (13.8)

Congestive cardiac failure 0 (0.0) 1 (3.4)

Coronary artery disease

Congenital heart disease

Hypertension

Chronic airways disease

Previous tuberculosis

Chronic asthma

Onelmore co morbid illness 16 (51.6) 12 (41.4)

None 15 (48.4) 17 (58.6)

N.B.: None of the differences between the treatment groups were statistically significant

4.2 Clinical evaluations

At presentation, all subjects from both the treatment groups presented with cough, sputum production and crepitations (100%). On day 10, resolution of symptoms occurred in Ievofloxacin and amoxicillin/clavulanate potassium treated groups with cough reduction of 71% versus 79.3%, sputum production of 87.1 % versus 89.5% and crepitations 67.7% versus 79.3% respectively. At day 30, complete resolution for patients in levofloxacin-treated group but 3.4% amoxicillin/clavulanate potassium-treated group continue having dry cough and crepitations. However, there was no significant difference seen in both treatment groups for resolution of all signs and symptoms at the end of therapy at day 14 and on follow up at day 30. Refer to Figure 1 to 3.

Severity assessments of clinical presentation were done at each visit using the severity score (Table 2). Patients who received levofloxacin had faster resolution of cough and sputum volume on day 3 when compared to amoxicillin/clavulanate potassium patients despite having higher cough score at day 0 for levofloxacin group. However, when both treatment groups were compared for cough and sputum volume score on subsequent visits, there were no differences seen (Table 5). Other parameters such as chest pain, dyspnoea and crepitations showed significant reduction on each visit within the treatment groups and severity score did not show any statistical difference when compared between both groups (p value > 0.05).

Table 5: Severity scores for cough and sputum volume at each visit.

Levofloxacin Augmentin @

Parameters p value (Mean f SD) (Mean + SD)

Cough Day 0 2.58 + 0.81 2.34 + 0.48 0.001 Day 3 1.52 + 0.73 2.21 f 0.62 0.01 Day 7 0.84 + 0.67 0.90 f 0.86 0.78

Sputum volume Day 0 2.68 + 0.48 2.31 f 0.47 0.004 Day 3 1.23 f 0.88 1.76 f 0.87 0.022 Day 7 0.42 +_ 0.56 0.52 f 0.87 0.61


daily was effective and safe for treating lower respiratory tract infections, both in patients with normal lung function as well as those with underlying lung diseases with overall response rate of 92.3% (n = 22) (30).

In our trial, the dose of levofloxacin was 300 mg daily, yet the clinical efficacy was comparable to other board-spectrum antibiotic used in CAP (32,33).

"Pneumonia of unknown aetiology" is one of the leading causes of CAP (34). In our study, mainly gram-negative bacilli were isolated even though our patients had no risk factors such as recent hospitalisation or home nursing. Other studies also report increased trend of gram-negative bacilli isolates (34), namely the elderly and the chronically ill who are believed to be predisposed to oropharyngeal colonization with enteric gram-negative bacilli, which are especially virulent pathogens causing CAP (35).

Many published clinical trials recommend levofloxacin as a first line outpatient therapy for mild to moderate CAP because of its 100% bioavailability after oral administration, its activity against a broad range of gram-positive and gram-negative organisms, including multi- resistant Streptococcus pneumoniae, with its mild and tolerable side effects (12,36,37,38,39).

In 1998, Infectious Disease Society of American (IDSA) came up with a guideline recommending levofloxacin as a single agent for outpatient cases, suspected penicillin- resistant pneumococci, and for hospitalised patient either as a single agent or in combination with other agents (40).

A report from a neighbouring country, shows excellent review of levofloxacin with more that 95% susceptibility against methicillin- sensitive Staph,vlococcus aweus, Streptococcus pneumonia, Klebsiella pneumoniae and Proteus mirabilis in 400 isolated pathogens (41). Furthermore, the occurrence of multidrug-resistant Streptococcus in this part of the world including Malaysia has not as yet reached to a critical level.

In levofloxacin treated group, the adverse events were transient and no discontinuation of dmgs were needed. The cost of levofloxacin and amoxicillin/clavulanate potassium is similar but with levofloxacin once daily dose, milder and well tolerated side effects and a faster resolution makes it preferable when compared to amoxicillidclavulanate potassium.

5.1 Limitations of study Our study has had limitations. This study was carried out at a University Hospital which is a tertiary referral centre in this country, where cases referred were often of a more severe form and the outpatient department accepted cases of mild degree; this resulted in difficulty in recruiting patients.

In order to reduce selection bias, randomisation was done before starting the trial. One of our limitations was also on the single-blinded design where measurement bias might occur. Another reason that contributed to the limitations is the recruitment pattern that was not uniform across the centre because the University Hospital covers the city population and this may not reflect the spectrum of the disease in Malaysia. We believe that a longer study period and more centres should be involved in recruiting patients so as to get better results.

5.2 Conclusions In selecting an antimicrobial agent for the treatment of CAP, the practitioner must consider not only documented efficacy but also the adverse events profile of the agent and the cost of therapy.

Levofloxacin has good in-vitro activity against nearly all-treatable pathogens except some anaerobes. Clinical trials have shown equivalent or superior activity compared to other standard agents. The results of this comparative study indicate that levofloxacin 300mg daily dose is a safe and effective alternative to amoxicillin/clavulanate potassium 250/125 mg thrice daily in the treatment of mild to moderate CAP. Moreover, levofloxacin has been proven to be both clinically and bacteriologically effective inpatients with CAP. Its once daily dosing regimen will contribute to high patient compliance and successful therapeutic outcomes. Although many studies of levofloxacin clinical trials in CAP have been published in the United States, Europe and Japan, we believe this to be the first reported trial of levofloxacin 300 mg daily dose in mild to moderate CAP in Malaysia and it showed excellent clinical response with minimal adverse events, good compliance and encouraging for the use in outpatients.

In conclusion, given its demonstrated efficacy, once-daily dosing, excellent pharmacokinetics and low incidence of adverse event, levofloxacin should be usehl for the treatment of CAP. More importantly, this study demonstrated that levofloxacin at 300 mg daily dose is sufficient for mild to moderate CAP


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18. Davis R, Bryson HM. Levofloxacin: a review of its antibacterial activity, pharmacokinetics and therapeutics ejjcacy. Drugs 1994,47(4); 677-700.

19. Nakashima M, Uematsu T, Kanamaru M, Okazaki 0, Hakusui H. Phase I studv of levojloxacin, (S)-(-) ofloxacin. Japanese J Clin Pharmacol and Therapeutics 1992,23; 5 15 -20.

20. Benjamin AL, Catherine AB. Fluoroquinolone toxicity profiles; a review focusing on newer agents. Clin Infect Dis 1999,28; 352 - 64.

2 1. Oh HM, Ng AW, Lee SK. Cefuroxime compared to amoxicillin-clavulanic acid in the treatment of community-acquired pneumonia. Singapore Med J 1996, 37(3); 255 - 7.

22. Brook I., S. Lolekha. The clinical management of upper respiratory tract infection (URTI) pathogens - broad- spectrum strategies and their justification. Research and Clinical Forums Vol. 17 No. 2; 19 - 29.

23. Ernest J. Penicillins & cephalosporins. In: Katzung BG, Basic and clinical Pharmacology. Fourth edition. U.S.A. Lanne 1989.562.

with better and faster resolution of cough and therapeutics 1997, publisher Parkins CJ. reduction of sputum on the third day of 39(999); 41 - 3. treatment with antibiotics. 12. Langtry HD, Lamb HM. Levofloxacin:

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24. File TM, Segreti J, Lala D, et al. A nzulticentre, randomised study coniparing the ef$cacy and safety of intravenous and/ or oral levojloxacin versus ceftriaxone and/or cefifitroxime axetil in treatment of adults with comnzunity-acquired pneunzonia. Antimicrobiol Agents Chemother, 1997, 41(9); 1965 - 1972.

25. Michael PH, Layne OG, Guillermo RG, et al. Multicenter, randomised stzdv comparing eficacy and safety of oral levofloxacin and cefaclor in treatment of acute bacterial exacerbatiom of chronic bronclzitis. Infect Dis Clin Pract 1998, 7; 101- 9.

26. Shi-Rong H. Levojloxacin versus augmentin in treatment of lower respiratory tract infection. 5th Western Pacific Congress of Chemotherapy and Infectious Diseases, Singapore, Dec 1 - 4. Free Paper, 1996.

27. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing; Fourth Information Supplement. NCCLS Document M100-S4, NCCLS, Villanove, Pennsylvania, 1992.

28. Soejima R, Kawane H, Okimoto N et al. Comparative study of levofloxacin and ofloxacin in chronic respiratory tract infections by double-blind method (Abstract) Chemother 1992, 40 (3); 97 - 120.

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30. Aziah AM. Clinical evaluation of levojloxacin 200 nlg twice dailv in the treatment of lower respiratory tract infection. 5th Western Pacific Congress of Chemotherapy and Infectious Diseases, Singapore, Dec 1 - 4. Free Paper, 1996.

3 1. Hoepelman IM, Mollers MJ, Greefhorst AP, et al. A short (3 days) course of azithromycin tablets versus a 10 days course of amoxicillin/clavulanate in the treatment of adults with lower respiratory tract infections and effects on long-term outcome. Int J Antimicrob Agents 1997, 9(3); 141 -6.

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once daily and amoxicillin/clavulanate three times daily in the treatment of acute exacerbation of chronic bronchitis. Clin Therapeutic 1998, 20(1); 88 - 100.

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IMR Quarterly Bulletin No. 57/58: JanIApril 2004

Sugar intake amongst a sample of staff of the Institute for Medical Research (IMR), Kuala Lumpur

Ng TKW', Suresh R', Nur Suffia s', Zawiah A ~ , Norhafizah A W ~ , Noorhaslinda s4 I Cardiovascular Disease Unit (CVD), Institute for Medical Research (IMR), ' ~e~a r tmen t of Nutrition

& Health Sciences, Universiti Putra Malaysia (UPM), 3~utrition Unit, IMR, 4~aculty of Food Technology, Universiti Sains Penang (USM)

Abstract

A sugar database compiled by the Cardiovascular Disease Unit of the Cardiovascular, Diabetes and Nutrition Research Centre (CDNRC), Institute for Medical Research (IMR), was used in combination with the 24-hr food recall method to determine the daily sugar intake in a group of 25 apparently healthy, non-obese individuals (1 1 males, 14 females, aged 23-55 years). The results showed that daily sugar intakes of the subjects ranged from a low 16 g to a high 185 g, with a mean of 52.6 g (11.0 energy %) for females and 89.6 g (15.2 energy %) for males. These mean intakes are substantially lower than the 110 glpersonlday indicated by the Food Balance Sheets (FBS) 2000 for Malaysia. Males appear to consume on the average, 37.0 g more per head compared with the females (a <0.05), but this difference disappears when sugar intakes for gender are expressed as "% kcal". To the authors' knowledge, this report represents the first local study on sugar intake using a sugar database on common Malaysian foods and drinks consumed.

Introduction

The term "free sugars" refers to all monosaccharides (e.g. glucose and fmctose) and disaccharides (e.g. sucrose and maltose) added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices (FAOIWHO, 2003). Therefore, in the determination of daily sugar intake, both the "added sugar" in the foods consumed, as well as the intrinsic sugar found naturally in fruit juices and honey, are taken into account. Sugar intake amongst Malaysians has often been estimated from the nation's FBS compiled by the Food and Agricultural Organisation (FAO) of the United Nations for the region. For example, the FBS for Malaysia 1999 and 2000 shows that the supply of sugar (raw equivalent) as 109 glcaputiday and 112 glcaputlday, respectively. These amounts are equivalent to a high 7% tablespoons of sugar per person per day!

Although a causal effect of high sugar consumption and diabetes has not been established, there is concern that excessive use of Gee sugars would provide energy without associated nutrients and hence displace nutrient-containing foods. Besides, the frequent ingestion of sucrose contributes to the formation of dental caries (WHOIFAO, 1990).

The rise of chronic diseases such as obesity and diabetes amongst Malaysians, the majority of which do not lead an active lifestyle, has prompted the Ministry of Health Malaysia (MOH) to initiate two major plans of action to

cut sugar intake in the local population. Firstly, manufacturers of softdrinks and ready-to-drink beverages are persuaded to lower substantially, the sugar content in these products. Secondly, new labelling laws, which were gazetted at the end of March 2003, make it mandatory for these products to carry labels declaring the total sugar content.

FBS figures for a population often over- estimate sugar intake (Gibney et al., 1995). As such, the value of ll0glcaputlday from FBS data for Malaysia, which is twice the 10% kcal WHOIFAO upper limit, should be interpreted with caution.

The lack of sugar consumption data for the local population is largely because present food databases do not facilitate for this determination. The NutriCal Programme for nutrient intake developed by the Institute for' Medical Research (IMR). Kuala Lumpur has help to revolutionize determination of food consumption in the local context. Unfortunately, the programme does not cater for sugar consumption.

The present study utilises analytical data compiled earlier by the IMR on total sugar content of softdrinks and ready-to-drink beverages, as well as additional information provided on the product label of such products. For cakes and other popular Malaysian snacks, the amount of sugar consumed per serving is calculated from the recipes of the foods concerned. It is hoped that the preliminary model for sugar intake provided in this article would provide the catalyst for future studies in


this area. The authors understand that the preliminary data reported for daily sugar intake utilising a sugar database, represents the first of its kind in the Malaysian context.

Materials and Methods

The app.arently healthy subjects comprised 14 females and 11 males, aged 22-55 years, who are staff of the IMR. The number of subjects, although small, was considered adequate as the primary purpose of the study was to test the usefulness and appropriateness of the sugar database on Malaysian foods, softdrinks, and beverages compiled.

The amount of sugar per serving was obtained from the product labels of softdrinkshotanical beverages and from popular recipes of snackslcakes which provided information on amount of sugar to be added and the number of persons the recipes concerned were meant for.

Daily food intake of the subjects was recorded by 24-hour food recall using a structured questionnaire. This was performed twice for each subject, where the days for interview selected were Tuesday to Saturday; in order to avoid food where the intake of food may differ from that of work-days.

Nutrient intake (energy, protein, fat, and carbohydrate) was determined by the NutriCal programme. Any energy intake value above 4,000 kcallday or under 1,000 kcallday were considered as outliers and the subject concerned was interviewed a third time for confirmation. In the present study, there were two cases of outlier values (>4,000 kcallday) for male subjects. These values were rejected and the respective "repeated" values were included in the analysis instead.

Energy, protein, fat and carbohydrate intakes were analysed by the NutriCal software programme developed by the IMR. Sugar intake was then calculated "manually" using the 24-hour food intake records and the sugar database compiled by the Cardiovascular Disease Unit of the IMR.

Statistical analysis:

Differences in sugar intake between the male and female subjects were analysed by the Student t test using a level of significance of -= 0.05.

Results and Discussion

The results of the nutrient and sugar intakes of the subjects are shown in the table below:

Table 1: Nutrient and sugar intakes of the male and female subjects in the study

Energy Protein Fat CHO Sugar Sugar Subjects (kcallday) (glday) w a y ) (glday) (glday) (% kcal)

WOMEN (n=14) RO 223 1 108 19 413 76 13.6 YSI 2207 115 84 246 23 4.2 ZO 2160 64 64 331 28 5.2 JN 1867 52 66 266 29 6.2 RE 1748 43 74 228 102 23.3 RI 1937 76 5 8 276 27 5.6 SLK 2018 79 70 266 54 10.7 SHY 2076 62 54 335 50 9.6 ZA 1612 80 62 184 70 17.4 FM 1643 5 7 52 239 7 1 17.3 NY 2280 83 90 285 41 7.2 RR 1741 71 64 222 46 10.4 YYH 1389 6 8 48 173 16 4.6 MD 2279 76 68 34 1 103 18.0 Mean 1942 73.9 62.3 2 72 52.6 11.0 Std Dev. 283 19.6 17.0 66 28.3 6.1

IMR Quarterly Bulletin No. 57158: JanlApril2004

MEN (n=ll) ZH 1793 62 45 283 96 21.4 KH 1999 56 5 6 319 17 3.4 TN 2354 68 68 367 107 18.2 LKK 2342 8 1 72 343 63 10.8 AAR 2793 79 67 468 120 17.2 RA 2811 79 121 35 1 98 13.7 NMM 2090 79 74 2 77 91 17.4 HMY 1310 42 40 196 65 20.0 RT 2214 83 73 309 60 10.8 PM 2379 76 72 359 84 14.1 MI 3628 11 1 148 463 185 20.4 Mean 2338 74.2 76.0 339 89.6 15.3 Std Dev. 603 17.6 31.7 79 42.3 5.4

The results indicate that daily total sugar consumption of the subjects ranged from 16 g to 185 g, with the male subjects generally consuming more sugar daily (mean ISD= 89.6 +42.3) than the female subjects (52.6 *28.3), [a = <0.05]. The means for both the male and female subjects are substantially lower than the 110 glday reflected in the FBS data for Malaysia.

The WHOIFAO (1 990,2003) has set an upper limit for sugar intake as 10% kcal, which is equivalent to 50-60giday based on a 2000- 2400 kcal diet. Of interest, 1011 1 of the males and 7114 of the females in the study exceeded this WHO upper limit. In view of this, and the fact that the upper limit for sugar intake set by the Institute of Medicine (IOM) , Food and Nutrition Board, United States (2000) is 20% kcal, the National Technical Committee on Dietary Recommended Intakes (DM) Allowances has tentatively proposed an upper limit of 15% kcal for daily sugar intake for Malaysians (Chairman, National DRI Committee, personal communication).

A closer examination of the 24-hour dietary recall records of the subjects showed that the main source of sugars in their diet comes from soft-drinks, cordials/syrups and beverages such as milo and coffee. Therefore, a reduction in the consumption of these "food" items and their replacement by plain water or "Chinese" tea, goes a long way to cut daily sugar intake.

It is recognised that the sample size in the present study is small and is not representative of the national scenario. However, this report serves to provide preliminary data on sugar intake among Malaysian adults which is lacking in the local context. In addition, the sugar database compiled is by no means exhaustive and further work at the CDNRC shall contribute towards extending and refining the database.

Conclusion

A simple sugar database developed by the CVD Unit of the CDNRC at the Institute for Medical Research, Kuala Lumpur, was used to estimate daily sugar intake from food intake records of 25 adult men and women obtained by the 24-hour recall method. The results showed that mean intake of the 11 men (89.6 g or 15.3% kcal) were significantly higher (a=0.05) than that of the 14 females (52.6 g or 11.0% kcal), with half or more of the subjects consuming more than the 10% kcal upper limit for sugar intake set by WHOIFAO.

Acknowledgement

The authors wish to thank Ruzana Othman and Young Swee Ing of the CDNRC Centre for assistance rendered in the present study. Thanks also go to the many subjects in the study for their cooperation.

References

1. FAOIWHO (1990) Diet, nutrition and the prevention of chronic diseases. Report of a WHO Study Group, WHO Technical Report Series 797, WHO, Geneva.

2. FAOIWHO ( 1997) Carbohydrates in human nutrition. Report of a Joint FAOIWHO Expert Consultation, Rome. F A 0 Food and Nutrition Paper. No. 66.

3. FAOIWHO (2003) Diet, nutrition and the prevention of chronic diseases. Report of a Joint WHOFA0 Expert Consultation, WHO Technical Report Series 916, WHO, Geneva.

4. Gibney M, Sigman-Grant M, Stanton J et al. (1995) Consumption of sugars. Am J Clin Niitr, 62:178S-1948.


5. 1nstikte of Medicine (IOM), Food and United States, 2000. Nutrition Board, Academy of Sciences,

Appendix:

Sugar database compiled by the CDNRC, IMR

Food item Serving size Amount sugarlserving (g)

SoftlbotanicaYfruit drinks

Diluted fmit syruplsquash [Based on 1:5 dilution with water]

Fruit drinkslfruit juices (n=72)

Botanical drinks (11=26)

Coffee/Tea Coffee/Tea with milk*

Coffee/tea "3 in 1 "

Ice creamlshakes, flavoured yogurtlmilk

Vanilla shake/"Fruitopian

Fruit-flavoured yogurtlmilk

Ice-cream

Cendol

Biscuits Plain biscuit (2in x 2in)

Biscuit with cream (approx. 1.5 in diameter)lsugar coating

Chocolates (fruitlmilk)

Cakeslsnacks Snack bar Pudding Cream-puff Doughnut Chocolate/sponge cake

200 ml 250 ml

325 ml ("mug")

200 ml 250 ml 325 ml

1 pack (20g)

560 g

227 g

1 scoop (35g) l /q cup (65 g)

% cup (130 g)

1 cup (250 ml) 1 bowl (680 ml)

2 pcs

2 pcs

60 g


Traditional "kuih-muih" Bubur kacang merahhijau 1 bowl 50 Pengat keledek 200 g 45 Onde-onde keledek 125 g 40 Kuih apam 120 g (5 pcs) 20 Kuih apam balik 115 20 Pengat pisang 200 g 16 Kuih talam 80 g 15 Kuih binga beraslj agung 50 g 12 Kuih koci pulut putihhitam 82 (2 pcs) 10 Kuih lapis 87 g 10 Puteri mandi 120 g 10 Pulut seri muka 99 g 10 Angku keledek 65 g 9 Kesari 35 g 6 Kuih keria 38 g 5 Fried banana (pisang goreng) 65 g 5

Sweet Sauces 30 g (2 tbsp)


Traction Immobiliser as Opposed to Traditional Traction Methods in the Initial Management of Fracture Femur in Adults

Thirumal M.; Consultant orthopedic surgeon Surendra M.; Orthopedic surgeon

Vijayachandran V; Medical officer

Orthopedic Department, Hospital Tengku Ampuan Rahimah, Klang

Abstract

In government hospitals of Malaysia, patients with fracture femur are initially managed with skeletal traction using Steinmann pin or skin traction before definitive surgery is carried out at a later date. This is due to inadequate operating time and under staffing. This traditional method of management has several disadvantages. Hence, we carried out this study to see whether, with existing constraints, an alternative method like the traction immobiliser could be used instead.

This is a prospective study involving 124 consecutive patients with fracture femur who were admitted to Hospital Tengku Ampuan Rahimah, Klang between January 2002 and May 2002. In the initial two months the traditional methods were adopted and for the remainder, the traction immobiliser was applied. 41 Patients were managed with skeletal traction; 32 patients with skin traction and 5 1 patients with traction immobilizer.

We monitored the complications i.e.; infections, skin problems iatrogenic fracture and foot drop. Other factors that were monitored were time of application, pain, loosening of traction, patients comfort and nursing problems.

We found that the traction immobilizer was superior compared to the other methods. This device can be applied immediately in casualty and there is virtually no waiting time. There was no infection, iatrogenic fractures or neurological complications encountered. Initially, we encountered some skin problems due to the straps. This was easily rectified with appropriate padding. There was no burden on the nursing staff and the patients were comfortable.

This study clearly shows the initial management with traction immobilizer is simple, efficient, safe and cost effective. We recommend that all closed fractures of femur in adults be managed in this way. Children and the elderly may be better managed with skin traction. Steinmann pin should only be reserved for patients undergoing general anaesthesia for other concurrent injuries and for fractures, which require conservative treatment with prolonged traction.

Introduction To be able to give an equivalent standard of care to these patients like that in developed

In this country especially in Government countries, these fractures should be fixed hospitals, the Steinmann pin insertion followed within twenty- four hours. by skeletal traction or skin traction has been We are unable to do so due to the tremendous the initial modality of treatment until definitive volume and lack of adequate staffing and surgery is carried out for fractures of the femur operating time. and fracture dislocations of the hip.

Background

Until the advent of implants in the early 40s, skeletal traction using the Steinmann pin insertion in the Tibia used to be the standard of treatment for fractures of the femur in the West.

This method is no longer practiced there but it continues to be practiced in third world countries including Malaysia.

Objective

We decided to carry out this study to see if an alternative method, i.e., the traction immobiliser could be applied instead of the Stienmanann pin or skin traction.

We felt that the traditional methods of traction, especially the Steinmann pin traction was not ideal as it had several short comings and limitations. This will be elaborated in our discussion.

BfR QuarCe?.ly Bulletin No. 37/58: JadApril2004

Materials And Methods

This was a prospective study of 124 consecutive patients who were seen at the accident and emergency ward of Hospital Tengku Ampuan Rahimah Klang between January and May 2002. Patients who at the emergency ward requested further treatment elsewhere were excluded from this study.

The distribution of male to female patients is shown in figure 1. In our study, the majority of casualties were young men involved in motor vehicle accidents as opposed to the majority of female patients belonging to the elderly age group who sustained their injuries as a result of a fall at home.

Figure 1: Sex distribution of patieats with fracture femur.

There was an almost equal &s.h.ibution in the affected side with 64 fractures involving the right limb as opposed to 60 involving the left. Interestingly, majority of the male patients had fractures involving the right limb (49 out of 88 or 56%) and the majority of the female patients had fractures involving the left limb (21 out of 36 or 58%).

Most of the fractures in our study were closed with the exception of eight cases that were open grade 1 and 2 fractures by Gwtillo's dassification. These; open fktures wen: primarily debrided and then put on skeletal traction with antibiotic cover until defkitive internal fixation at a later date.

This is illustrated in figure 2.

Figure 2: Distribution of open and c W d fractures of the femur.

We found that the raajority of males belonged to the younger age group of less than 20 (42 out of 88 or 48%) while mjority of the f e d e patients were above 60 (19 out of 36 or 53% ) . This is illustrated in the table below.

Table 1: Age and sex dfs?ributSen of fracture femur

Age (years) Male Female TOW 12 to 20 42 8 50 21 to 40 29 4 33 41 to 60 10 5 15 Above 60 7 19 26 Total 88 36 124

F h r e 3: Age to sex diarMbation of fracture femur.

Age distribution to sex.

I II Male 'II Female


Skin problems were mainly blisters that healed with dressing. There was one case of allergic reaction to the plaster used in the skin traction.

Loosening of the skin traction was seen in 5 patients all of whom were on this method of traction for more than a week.

Discussion

Skeletal traction.

In our set-up, this procedure is usually done under local anesthesia if there is no other procedure planned for the patient. This is certainly an unpleasant experience for the patient both emotionally and physically to say the very least! Neither is it free from complications. Also , it is usually performed by a junior doctor. To make matters worse, it is given the lowest priority in the operating list resulting in patients having to wait from 12 to even 36 hours for this procedure.

Such a long waiting time for such a simple procedure does not reflect well on the services provided by the hospital. To overcome this problem, this procedure is carried out in the wards in certain local hospitals though not appropriate.

This relatively 'simple' procedure involves the use of manpower and resources, which is not apparent unless one analyses all the steps involved.

First the doctor has to fill in the operating form and this has to be sent to the operating theatre either by the attendant or nurse.

The patient needs to be sent to the operating theatre, which requires one staff nurse and one attendant.

An operating theatre facility is required with one scrub nurse and one 'runner'. The doctor

and nurse require to scrub-up for the procedure which requires use of povidone, brush, a set of sterile gowns and 2 to 4 pairs of sterile disposable gloves.

The affected limb needs to be cleaned and draped. This again requires povidone -and sterile drapes. 1% or 2% lignocaine is usually administered. This requires the use of a syringe, 2 hypodermic needles and the ampoule of lignocaine.

A power driver is used to pass the Steinmann pin after a small skin nick is made with a size I I blade and tissues spread using an artery forcep.

After the procedure, the pin site needs to be dressed with gauze and bandage or plaster. This entire procedure usually takes about 30 minutes.

All instruments used need to be washed, packed and autoclaved. All drapes and gowns similarly need to be washed, packed and sterilised.

When the procedure is completed, the ward staff need to come and take the patient back to the ward.

The appropriate weights need to be secured for the skeletal traction. This is done by the staff nurse. Pin site dressing needs to be carried out daily by the ward staff.

The steps illustrated above clearly demonstrate the amount of time, work, resources and cost involved which is not appreciated by most people who routinely use this method in their daily practice.

All the above-mentioned factors clearly illustrates why we felt that this method has several shortcomings and limitations.

IMR Quarterly Bulletin No. 57/58: JanJApril2004

Racun Perosak di dalam Makanan:- Padi dan Hasilannya

Wan Roslina, W.A., Nurul Izzah, A., Aminah, A.

Pengenalan

Malaysia mempunyai tanah yang subur serta iklim panas dan lembap sepanjang tahun yang sesuai untuk aktiviti pertanian. Faktor ini menjadikan industri pertanian sebagai salah satu sektor penting yang menyumbang kepada pendapatan negara. Antara tanaman utama yang terdapat di Malaysia ialah tanaman padi yang merupakan makanan ruji bagi penduduk negara ini.

Beras adalah bahan makanan kategori bijirin yang penting dalam diet manusia kerana mempunyai nilai pemakanan yang tinggi. Ia merupakan bijirin terpenting di dunia di mana sebahagian besarnya dihasilkan untuk makanan manusia (Louis & Nickerson 1992). Beras membekalkan sumber kalori yang utama dalam bentuk kanji. Ia juga menyediakan protein yang tinggi kualiti pemakanannya berbanding bijirin lain. Beras bersifat hipoalergenik, mudah dihadam di samping mempunyai pelbagai nilai kefungsian serba guna (Moldenhauer et al. 1998). Negara-negara Asia termasuk Malaysia juga merupakan negara pengguna beras yang utama untuk mendapatkan sumber tenaga. Adalah dianggarkan bahawa 80% - 90% peratus pengambilan kalori harian bagi penduduk Asia diperoleh daripada beras (Luh 1999).

Statistik daripada "Food and Agriculture Organization" yang disiarkan dalam Perangkaan Padi Malaysia 1999 (Jabatan Pertanian 200 1 ) menunjukkan bahawa pada tahun 1999, kawasan penanaman padi di dunia meliputi kawasan seluas 153.1 juta hektar. Jumlah pengeluaran padi dunia pada tahun tersebut ialah 586.8 juta tan metrik manakala jumlah penggunaan beras ialah 391 juta tan metrik. Antara negara pengeluar utama padi dunia termasuklah China (200.7 juta tan metrik), India (127.6 juta t.m.), Indonesia (49.5 juta t.m.), Bangladesh (29.9 juta t.m.), Vietnam (28.1 juta t.m.), Thailand (23.0 juta t.m.) dan Myanmar (17.8 juta t.m.) (Jabatan Pertanian 2001).

Thailand merupakan negara pengeksport beras yang utama di dunia dengan jumlah 6.7 juta tan metrik pada tahun 1999. Ini diikuti Vietnam, China, India, Amerika Syarikat dan Pakistan yang mengeksport beras melebihi 1.0 juta tan metrik. Negara-negara pengimport utama beras pula ialah Indonesia (3.8 juta tan metrik), Bangladesh (1.8 juta t.m.), Brazil, Iran dan Filipina (masing-masing 1.0 juta t.m.), Arab Saudi (0.8 juta t.m.), Jepun, Malaysia dan Senegal (masing-masing 0.7 juta t.m.), Amerika Utara (0.6 juta t.m.) dan China (0.5 juta t.m.) (Jabatan Pertanian 2001).

Pengeluaran Beras di Malaysia hektar. Pada masa sekarang, terdapat dua kawasan penanaman padi utama di Malaysia

Perusahaan padi merupakan salah satu industri iaitu di Kedah yang diletakkan di bawah warisan yang penting dalam ekonomi negara bidang kuasa "Muda Agricultural Malaysia sejak sebelum merdeka. Penanaman Development Authority" (MADA) dan di padi telah bermula sejak beberapa abad dahulu Kelantan (Cheah & Lum 1998a). hi beberapa ka~asanje la~ang di negeri Kedah dan Perlis. Pada masa tersebut, perancangan aktiviti penanaman padi sangat bergantung kepada perubahan alam sekitar. Penanaman padi pada awalnya dilakukan menggunakan kaedah tradisional dan hanya ditanam sekali dalam masa setahun. Namun begitu, perkembangan dan penggunaan teknologi moden pada hari ini telah membolehkan penanaman padi dua kali setahun dijalankan (Supaad & Suhaimi 1995).

Antara agensi utama yang terlibat dalam industri padi di negara ini ialah Padiberas Nasional Berhad (BERNAS). BERNAS telah diperbadankan pada 14 April 1994 berperanan mengambil alih Lembaga Padiberas Nasional (LPN) terutama untuk aktiviti-aktiviti komersil dan sosial. Peranan BERNAS adalah untuk memelihara, mengekal dan menguruskan Simpanan Stok Padi/Beras Kebangsaan serta menanggung pembelian padi daripada para ~e tan i sebagaimana yang ditentukan oleh - -

Tanaman padi adalah yang ketiga terbesar dari kerajaan darimasa ke semasa. BERNAS juga segi penggunaan tanah pertanian di Malaysia berperanan dalam pengurusan perbelanjaan selepas kelapa sawit dan getah (Jabatan subsidi kepada para petani di samping Pertanian 2001). Pada tahun 1999, penanaman bertanggungjawab dalam pengurusan Skim padi di negara ini meliputi kawasan seluas Pengilang Padi Bumiputera. Selain itu, 692,389 hektar manakala kawasan jelapang BERNAS juga memperoleh hak untuk padi yang digazetkan adalah seluas 394,076 mengimport beras ke Malaysia bagi tempoh

IMR Quarterly Bulletin No. 57\58: JadApril2004

lima belas tahun bermula 12 Januari 1996 (BERNAS 2003).

Penyelidikan yang dijalankan oleh agensi seperti Institut Penyelidikan dan Pembangunan Pertanian Malaysia (MARDI) telah berjaya memajukan teknologi yang boleh meningkatkan daya pengeluaran padi. Penghasilan varieti moden juga telah memberikan sumbangan yang ketara terhadap industri padi negara di mana bagi tempoh 1964- 1990, sebanyak 24 varieti padi telah diisytiharkan. Antara varieti padi tersebut termasuklah MR 106, MR 103, MR 81, MR 84, Setanjung, Sri Malaysia I & I1 dan lain-lain (Supaad & Suhaimi 1991 ). Daya pengeluaran tanaman padi di Malaysia telah dipertingkatkan melalui pembangunan infiastruktur serta pengenalan varieti moden yang membolehkan penanaman padi dua kali setahun diamalkan. Namun begitu, bagi tempoh 1980 hingga 1990, ketidakstabilan pengeharan melanda industri penanaman padi di mana terdapat arah alir turun naik dari aspek keluasan penanaman, hasil pengeluaran dan juga purata hasil bagi setiap hektar kawasan tanaman (Supaad & Suhaimi 1995).

Berdasarkan laporan yang dikeharkan oleh BERNAS (2003), pengeluaran beras oleh pengusaha tempatan pada tahun 2002 ialah sebanyak 956,000 tan metrik berbanding 903,000 tan metrik pada tahun sebelumnya. Walaupun berlaku pengurangan dari segi keluasan kawasan tanaman padi, faktor-faktor seperti keadaan cuaca yang baik dan infrastruktur serta teknologi moden yang diamalkan dapat meningkatkan hasil tanaman beras tempatan. Jumlah pengeluaran beras di Malaysia perlu dipertingkatkan dari masa ke semasa bagi memenuhi keperluan pertumbuhan penduduk negara yang semakin meningkat. Ini sejajar dengan sasaran kerajaan untuk memenuhi 65 peratus keperluan beras negara seperti yang digariskan dalam Dasar Pertanian Negara (1992 - 2010) (Mohd Yusof 1995).

Malaysia masih mengimport beras daripada beberapa negara pengimport untuk memenuhi keperluannya. Negara-negara tersebut ialah Thailand, China, Vietnam, Pakistan, Amerika Syarikat, India, Australia dan Myanmar. Jumlah import pada tahun 2002 ialah sebanyak 478,000 tan metrik, lebih rendah berbanding 535,000 tan metrik pada tahun sebelumnya. Permintaan atau penggunaan beras di kalangan penduduk pula meningkat kepada 1,899,000 tan metrik pada tahun 2002 daripada 1,848,000 tan metrik pada tahun 2001. Secara puratanya, penggunaan beras oleh penduduk Malaysia pada tahun 2002 ialah pada kadar 8 1 kilogram

per individu per tahun bersamaan 22 1 gram per jndividu per hari (BERNAS 2003).

Penggunaan Racun Perosak di Sawah Padi

Penggunaan racun perosak semasa penanaman padi merupakan salah satu komponen dalam pengurusan dan pengawalan makhluk perosak yang bertujuan melindungi tanaman padi dan beras. Ini kerana musuh dan makhluk perosak adalah merupakan ancaman utama tanaman padi yang menyebabkan pengurangan hasil. Beberapa langkah kawalan telah diperkenalkan bagi membendung masalah ini. Teknologi kawalan rumpai, tikus, serangga dan penyakit meliputi aspek kawalan kimia dan biologi serta kawalan bersepadu ("Integrated Pest Management - IPM") (Supaad & Suhaimi 199 1 ). Makhluk perosak yang menjadi sasaran racun perosak termasuklah serangga, tumbuhan atau rumpai, kulat, tikus, siput, bumng dan sebagainya. Racun perosak didatangkan dalam beberapa bentuk seperti aerosol, semburan, butiran, serbuk atau sebagai umpan (Vincent & Miley 1993).

Pada amnya, kadar penggunaan racun perosak di negara ini semakin meningkat dari tahun ke tahun. "Malaysian Agricultural Chemicals Association" (MACA) dalam laporan tahunan 1997 telah mencatatkan bahawa nilai penggunaan racun perosak di Malaysia untuk tempoh tiga tahun sebelumnya telah menjangkau RM 300 juta bagi sektor pertanian dan RM 190 juta bagi sektor kesihatan awam. Penggunaan racun perosak di sektor pertanian ini merangkumi racun mmpai sebanyak 75%, racun serangga 1696, racun kulat 5% dan racun tikus 4% (MACA 1997). Purata kos input bagi tujuan kawalan rumpai semasa penanaman padi di kawasan jelapang padi Malaysia pada musim utama penanaman tahun 199811999 adalah berjumlah RM 122.77 per hektar kawasan tanaman manakala kos kawalan serangga dan penyakit pula berjumlah RM 103.78 per hektar (Jabatan Pertanian 2001).

Antara racun perosak yang biasa digunakan di kawasan sawah padi termasuklah karbofuran, endosulfan, butil fenil metil karbamat (BPMC), isoprokarb (MIPC), parakuat, tiobenkarb, molinat, propanil, pretilaklor, glifosat, metsulfuron, 'quinclorac' dan fenoprop-etil (Ho et al. 1991). Penggunaan racun perosak mmpai adalah berbeza mengikut peringkat penanainan padi. Pada asasnya, racun perosak mnlpai ini digunakan sebagai pra-cambah atau lepas-cambah dalam penanaman padi sawah. Racun kimia juga digunakan di peringkat sebelum atau semasa penyediaan tanah. Pada peringkat awal iaitu

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sebelum atau semasa penyediaan tanah, racun perosak mmpai yang biasa digunakan ialah parakuat pada kadar 1.0 kg bahan aktifhektar. Satu lagi jenis racun perosak ialah glifosat yang telah terbukti potensinya dalam pengawalan rumpai. Tanah sawah yang disembur racun perosak tersebut perlu dibiarkan bagi tempoh sekurang-kurangnya 7 hingga 10 hari sebelum masa membajak (Ismail & Man 1986).

Racun perosak mmpai pra-cambah seperti butaklor, pretilaklor, bendiokarb, piperofos, molinat dan oksadiazon pula disembur antara 5 hingga 7 hari sebelum benih ditabur. Bagi pengawalan rumpai selepas tabur atau pada peringkat mengubah, racun kimia fenoksi (isobutil ester (2,4-D IBE), metil kloro fenoksi asetik (MCPA), 2,4-D Amine) dalam beberapa fonnulasi telah digunakan dengan meluas di mana racun ini disembur dalam tempoh 14 hingga 2 1 hari bagi kaedah mengubah atau 2 1 hingga 28 hari bagi kaedah penanaman tabur tems. Selain daripada racun fenoksi, racun perosak lain yang digunakan ialah bensulfuron dan molinat. Racun perosak molinat disembur di kawasan yang mempunyai masalah rumput sambau pada 7 hingga 14 hari selepas padi ditabur (Ismail & Man 1986). Sisa bahan- bahan kimia racun perosak yang digunakan semasa penanaman padi ini biasanya akan disingkirkan ke dalam ekosistem padi (Cheah & Lum 1998b).

Masa genting untuk mengawal tanaman padi adalah antara 15 hingga 30 hari selepas menabur (Azmi & Supaad 1990). Racun seperti bensulfuron (0.03-0.05 kg bahan aktiflhektar), pirazosulfuron (0.00 1-0.002 kg b.a/ha) dan metsulfuron (0.002 kg b.a/ha) digunakan pada hari ke-7 hingga 14 selepas menanam atau menabur untuk mengawal rumput rusiga dan rumpai daun lebar. Manakala kombinasi kinosulfuron (0.004- 0.008 kg b.a/ha) dan 2,4-diklorofenoksi (0.75 kg b.a/ha) serta kombinasi molinat (3.0 kg b.aha) dan 2,4-diklorofenoksi (0.75 kg b.a/ha) pula digunakan pada hari ke-14 hingga 30 selepas menanam atau menabur. Semburan molinat (3.0 kg bdha) dan 'quinclorac' (0.2- 0.3 kg b.a/ha) pada hari ke-7 hingga 14 atau pretilaklor (0.5 kg b.a/ha) pada hari ke-3 hingga 4 selepas menabur boleh mengawal pelbagai jenis rumput. Propanil (2.0-3.0 kg bdha) yang disembur dalam keadaan kering pada hari ke-7 hingga 14 selepas menabur boleh mengawal rumput-rumput penting (Azmi 1990). Gabungan racun-racun rumpai

tertentu seperti molinat + bensulfuron (2.5 kg b.a/ha + 0.03 kg b.a/ha), 'quinclorac' + bensulfuron (0.25 kg b.&a + 0.03 kg b.aha) dan molinat + 2,4-D IBE (2.5 kg b.a/ha + 0.75 kg b.dha) boleh mengawal rumpai dengan spektrum yang lebih meluas (Azmi & Lo 1990).

Di peringkat penyimpanan selepas tuai, beras atau bijirin untuk penggunaan di Malaysia biasanya diasapkan ('fogging' dan 'spraying') dengan gas racun serangga perosak seperti metil bromida dan aluminium fosfida. Penyemburan malation dan lindan atau pendebuan ('dusting') malation atau piretrum juga telah digunakan di kebanyakan gudang penyimpanan. Walau bagaimanapun, kebanyakan negara termasuk Malaysia menghadapi masalah yang melibatkan makhluk perosak tertentu yang rintang terhadap racun perosak seperti malation (Vreden & Abdul Latif 1986).

Penggunaan racun perosak secara berlebihan telah dibuktikan boleh meningkatkan kerintangan terhadap pelbagai jenis makhluk perosak. Pada masa yang sama ia akan mengakibatkan pencemaran persekitaran dan boleh membahayakan kesihatan manusia (Dzolkhifli & Kamaruzaman 2002).

Sisa Racun Perosak dalam Beras

Kehadiran sisa racun perosak dalam hasil pertanian bergantung kepada beberapa faktor seperti jenis racun perosak yang digunakan, jumlah dos, jangka masa dan kaedah penggunaan di samping penguatkuasaan yang dijalankan untuk memastikan keselamatan produk makanan di pasaran (Dzolkhifli & Kamaruzaman 2002).

Di Malaysia, penggunaan racun perosak dikawal oleh beberapa peraturan dan undang- undang terutamanya Akta Racun Perosak 1974. Akta lain yang terlibat dalam pengawalan racun perosak dari aspek tertentu tennasuklah Akta Makanan 1983 dan Peraturan-peraturan Makanan 19 85 yang mengawal sisa racun perosak dalam makanaw . di bawah penguatkuasaan Kementerian Kesihatan Malaysia. Jadual Ke- 16 (Peraturan 41) daripada Akta ini telah menetapkan kadar maksimum sisa ( M E ) yang dibenarkan dalam makanan. Kadar maksimum sisa bagi beberapa racun perosak yang dibenarkan dalam padi dan beras kilang adalah seperti yang ditunjukkan di dalam Jadual I .

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Jadual 1: Kadar maksimum sisa racun perosak yang dibenarkan dalam padi dan beras kilang (mg/kg)

Nama Biasa Kadar Maksimum Sisa (MRL) di Makanan dalam padi dan beras kilang (mdkg)

Bensulfuron metil Beras kilang 0.02 Bentazon Beras kilang 0.02 Bifenoks Beras kilang 0.1 2,4-D (2,4-diklorofenoksi) Beras kilang 0.05 Endosulfan Padi 0.1 Molinat Beras kilang 0.1 Oksadiazon Beras kilang 0.05 Parakuat Beras kilang 0.5

Padi 10 Pretilaklor Beras kilang 0.05 Propanil Beras kilang 2 Pirazol-sulfuron-etil Beras kilang 0.1 Trifluralin Beras kilang 0.05

Masyarakat secara umumnya semakin mengambil berat terhadap penggunaan racun perosak dan kehadiran sisanya dalam makanan. Oleh itu, banyak negara telah membuat pemantauan terhadap kehadiran sisa racun perosak terutamanya di dalam makanan utama seperti beras. Kajian sebegini perlu dijalankan bagi mendapatkan maklumat tahap pencemaran oleh bahan tersebut. Di Malaysia, walaupun tiada kajian terkini yang mengesan kehadiran sisa racun perosak dalam padi dan beras, tetapi terdapat beberapa kajian yang berjaya mengesan sisa racun perosak di dalam sampel-sampel yang diperolehi dari persekitaran sawah padi seperti, air, tanah, pokok padi, rumpai air, ikan clan sebagainya.

Terdapat kajian yang dijalankan oleh Cheah & Lum (1998b) bertujuan mengesan kehadiran sisa racun perosak di kawasan jelapang padi Muda, Kedah. Kajian ini telah mengesan kehadiran sisa racun serangga perosak di dalam kebanyakan sampel air agroekosistem tersebut pada aras di antara <0.005 - 25.5 ngiml. Antara racun perosak yang dikesan ialah p-endosulfan dan endosulfan sulfat yang boleh didapati di mana-mana kawasan kajian tersebut. Kehadiran racun serangga perosak kumpulan organoklorin lain seperti diklorodifeniltrikloroetana (DDT), lindan, aldrin dan dieldrin hanya dikesan sekali-sekala ("sporadic") pada aras kurang daripada 0.1 nglml (Cheah & Lum 199%).

Kehadiran sisa racun perosak lain seperti 2,4- diklorofenoksi (2,4-D), parakuat dan molinat pula adalah bermusim dan tersebar meluas semasa penggunaannya. Kebanyakan sampel air dikesan mengandungi sisa racun perosak 2,4-D melebihi piawaian yang ditetapkan oleh Kesatuan Eropah (EU) iaitu 0.1 ng/ml untuk air minuman. Walau bagaimanapun, tiada

sampel yang mengandungi sisa racun perosak parakuat melebihi 0.1 nglml. Sisa racun perosak molinat pula dikesan pada arm yang tinggi berbanding racun rumpai lain sehingga mencapai 12.7 nglml. Kajian ini juga mendapati bahawa sisa racun perosak tiobenkarb dan karbofuran tidak menimbulkan masalah kepada sumber air agroekosistem Muda. Ini kerana tiobenkarb hanya dikesan dalam dua sampel pada aras yang hampir dengan had pengesanan ("Limit of Detection - LOW) manakala sisa karbofuran juga dikesan pada aras hampir dengan LOD iaitu 2 mglml (Cheah & Lum 1998b).

Satu lagi kajian oleh Nashriyah et a]. (1998) juga dijalankan di kawasan agroekosistem padi Muda, Kedah untuk mengesan aras sisa racun perosak molinat di kawasan guna semula ("recycled area") dan tidak guna semula ("non- recycled area"). Penanaman padi di semua kawasan kajian ini menggunakan kaedah tabur term Racun perosak molinat sebanyak 35 kglhektar digunakan di antara hari ke-15 hingga hari ke-32 selepas penanaman padi. Hasil kajian mendapati aras sisa racun perosak molinat dalam padi, rumpai dan tanah lebih tinggi di kawasan yang tidak diguna semula walaupun tiada perbezaan yang ketara antara kawasan guna semula dan kawasan tidak diguna semula. Aras sisa molinat dalam sampel pokok padi di kawasan guna semula adalah lebih tinggi pada hari ke-10 selepas penggunaan racun perosak molinat iaitu 3.17 mglkg berbanding hari ke-30 (0.41 mgkg). Bagi sampel rumpai air padi di kawasan tidak guna semula, aras sisa molinat juga lebih tinggi pada hari ke-10 (2.14 mg/kg) berbanding hari ke-30 (0.22 mgkg). Aras sisa molinat dalam sampel tanah pada hari ke-10 dan ke-30 pula tidak menunjukkan perbezaan yang ketara (Nashriyah et al. 1998).


Kajian yang dijalankan di negara lain seperti negara China telah mengesan sisa heksaklorosikloheksana (HCH) dalam lebih daripada 90% sampel bijirin. Lebih daripada 7% gandum, padi dan jagung pula mengandungi sisa yang melebihi aras yang dibenarkan. Ini kerana racun perosak kumpulan organoklorin HCH dan DDT ini banyak digunakan untuk pertanian di sekitar tahun 1960-an dan 1970-an. Walaupun penggunaan HCH dan DDT telah diharamkan di China pada tahun 1983 tetapi kehadiran sisanya masih boleh dikesan disebabkan kestabilan dan keupayaan racun perosak ini untuk kekal dalam tanah dan persekitaran. Racun perosak kumpulan organoklorin ini dengan mudah mencemari tanaman walaupun ditanam di kawasan yang luas dan dalam tempoh yang lama selepas pengharamannya (Dai et al. 1998).

Negara Thailand juga menjalarikan pemantauan secara tetap terhadap hasil pertanian untuk mengesan sisa racun perosak yang masih kekal akibat penggunaannya yang berterusan dalam tempoh yang lama. Pada tahun 1996, suatu kajian telah dijalankan secara meluas di Thailand ke atas sampel beras daripada beberapa kawasan penanaman padi termasuk salah satunya adalah kawasan penanaman padi organik. Didapati sisa racun serangga daripada kurnpulan organoklorin yang kebanyakannya telah diharamkan penggunaannya dapat dikesan pada kebanyakan sampel daripada kawasan penanaman padi biasa. Antaranya termasuklah aldrin, dieldrin, benzen heksaklorida (BHC), DDT dan heptaklor. Racun serangga kumpulan organofosforus dan karbamat seperti diazinon, malation, karbofuran dan isoprokarb (MIPC) juga dikesan dalam sesetengah sampel pada aras yang rendah. Walau bagaimanapun, sisa racun perosak ini tidak dikesan di dalam sampel beras organik (Tayaputch 1998).

Aktiviti pengawalan dan pemantauan sisa racun perosak telah dijalankan secara meluas di Indonesia pada tahun 1986, 1988, 1990, 1991 dan 1993 yang merangkumi hasil-hasil pertanian seperti beras, buah-buahan dan sayur-sayuran. Hasil kajian menunjukkan bahawa kebanyakan sisa racun perosak yang dikesan dalam hasil tanaman termasuk beras adalah di bawah had maksimum sisa (MRL). Kebanyakan hasil tanaman yang dikaji mengandungi racun perosak kumpulan organoklorin terutamanya DDT (Untung 1998).

Sepanjang tempoh dua dekad yang lepas, sisa racun perosak dengan data yang ketara telah dikesan pada bahan makanan, hasil pertanian,

air dan tanah di India. Kajian yang dijalankan ini telah mendedahkan bahawa pencemaran oleh sisa racun perosak HCH dan DDT serta kepekatannya dalam bijirin adalah berbeza di kawasan-kawasan yang berlainan bergantung kepada jumlah penggunaan racun perosak sepanjang tempoh penyimpanan di dalam gudang (Jadhav 1986). Di Bombay, sampel beras dari sawah padi mengandungi sisa DDT dan HCH dalam julat di antara 0.01 - 0.8 ppm manakala sisa dalam beras dari gudang penyimpanan adalah di antara 1.0 - 13.9 ppm. Sampel yang dikumpulkan dari lokasi berlainan di kawasan bandar dan pedalaman Uttar Pradesh dan Bahagian Bengal Barat pula menunjukkan kehadiran sisa HCH dalam beras lebih tinggi di Bahagian Bengal Barat (Seth et al. 1998).

Di Filipina, kajian berkenaan sisa racun perosak dijalankan ke atas sarnpel pokok padi, air, tanah dan siput selepas tiga jam serta 1, 2, 3, 5, 7, 15 dan 30 hari selepas penyemburan racun perosak (90 hari selepas peringkat mengubah). Manakala di peringkat penuaian, sampel pokok padi dianalisis secara berasingan terhadap bahagian daun, batang dan bijirin padi (Varca & Tejada 1998). Daripada kajian ini, didapati sisa racun perosak karbofuran dan BPMC paling banyak dikesan dalarn daun, diikuti batang dan paling sedikit dalam bijirin padi. Kehadiran sisa racun perosak yang tinggi dalam daun adalah disebabkan oleh penggunaan racun perosak yang disembur terns kepada daun-daun tebal yang menyelaputi pokok padi. Namun begitu, selepas satu hari, hampir 90 peratus sisanya dipindahkan dari daun ke bahagian lain menyebabkan penurunan mendadak kepada 1.5 mgkg selepas tiga hari. Sisa racun perosak BPMC juga adalah lebih tinggi dalam beras kasar ("'rough rice") berbanding beras kilang ("milled rice") kerana aras kepekatannya berkurang melalui proses pengisaran. Sisa racun perosak klorpirifos pula masih boleh dikesan dalam daun selepas 15 hari penggunaannya. Sampel bijirin padi yang diambil semasa peringkat penuaian tidak mengandungi sisa racun perosak klorpirifos ini sama ada dalam bentuk tanpa 'sekam' atau 'beras kasar' (Tejada 1995).

Kesimpulan

Tidak dinafikan bahawa penggunaan racun perosak memberikan banyak manfaat dalam aktiviti pertanian. Penggunaannya didapati boleh menyelamatkan hasil pertanian daripada dimusnahkan oleh makhluk perosak. Namun, penggunaannya secara berlebihan atau penyalahgunaannya mungkin menyebabkan


kesan sanlpingan yang tidak diingini. Kadar penggunaan racun perosak yang sangat tinggi telah menimbulkan kebimbangan di kalangan pengguna kerana terdapat bukti bahawa racun perosak telah menyebabkan kesan buruk terhadap persekitaran dan kepada manusia sendiri (Ismail 1988). Bukan suatu yang mengejutkan jika racun perosak merupakan salah satu agen penyebab risiko yang utama memandangkan ia dihasilkan untuk membunuh. Disebabkan oleh penggunaannya yang berlebihan dan cara penggunaannya, racun perosak boleh dijumpai di mana-mana sahaja dalam air minuman, makanan, udara dan tanah (Vincent & Miley 1993). Antara punca utama keracunan racun perosak terhadap manusia adalah melalui sisa racun perosak dalam bahan-bahan makanan yang diambil. Masalah aras sisa dalam bahan- bahan makanan masih kurang diberi perhatian yang sewajarnya di negara ini. Sehingga kini, tidak banyak penyelidikan yang dijalankan untuk rnenentukan aras sisa racun perosak dalam hasil pertanian dan bahan makanan (Ismail 1988). Banyak penyakit sering dikaitkan dengan kehadiran sisa racun perosak yang memastiki tubuh manusia melalui sistem rantaian makanan. Kesan keracunan akibat racun perosak ini adalah bersifat kronik dan boleh menyebabkan penyakit seperti barah (Ismail 1988). Oleh itu, suatu kajian perlu dilakukan bagi mengesan kehadiran sisa racun perosak dalam makanan terutamanya beras yang merupakan makanan ruji dan setemsnya membuat penilaian risiko yang dikaitkan dengan kesihatan manusia sekiranya berlaku pengambilan makanan yang mengandungi sisa racun perosak pada aras tertentu.

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Pembangunan dan Peranan Perpustakaan IMR Selaku Penyelaras Perpustakaan Kementerian Kesihatan Malaysia

Siti Rodziah Othman Ketua Unit Perpustakaan & Sumber Maklumat,

Pusat Sumber Penyelidikan Perubatan Institut Penyelidikan Perubatan

Pendahuluan

Maklumat merupakan sumber yang sangat penting dalam pembangunan negara. Didalam negara menuju kearah K-management dan K-ekonomi maklumat terkini yang terdapat dalam pelbagai media merupakan sumber terpenting yang perlu diperolehi dengan cepat, pantas, tepat dan berkesan. Bagi memastikan kejayaan ini, komputer merupakan media yang amat perlu disediakan khususnya di perpustakaan u n a digunakan bagi tujuan tersebut. Ini bersesuaian dengan perkembangan teknologi maklumat dalam menjayakan projek Multimedia Supercorridor yang memerlukan komputer sebagai media utama bagi mencapai kejayaan ini.

Peranan perpustakaan sebagai 'one stop information centre' perlu direalisasikan bagi menjayakan pembangunan negara. Bukan itu sahaja, maklumat dan penerbitan yang terdapat di semua perpustakaan perubatan KKM perlu disebarluas untuk rujukan bagi pembangunan negara. Disamping itu juga, pangkalan data yang berkaitan penerbitan tersebut perlu diujudkan untuk dikongsi bersama oleh semua warga KKM.

Perpustakaan IMR

Perpustakaan IMR telah ditubuhkan seiring dengan penubuhan Institut Penyelidikan Perubatan. Koleksi perpustakaan hampir mencapai kepada 17,000 naskah buku dan 24,374 jurnal yang berjilid yang terdiri dari pelbagai perkara dalam bidang bioperubatan. Koleksi utama perpustakaan IMR adalah koleksi jurnal. Sehingga kini IMR mempunyai lebih dari 220 judul jurnal bercetak termasuk yang dilanggan dan diterima secara percuma dan pertukaran. Disamping itu juga mulai tahun 2000, IMR telah memulakan perkhidmatan langganan majalah secara online yang dilanggan melalui OVID. Pada awalnya IMR telah melanggan sebanyak 10 judul elektronik jurnal tennasuk jurnal utama selaku perpustakaan perubatan. Memandangkan terdapat beberapa judul telah dilanggan dibawah CME-Telehealth, 3 judul tersebut telah dibatalkan. Sehingga kini hanya 7 judul elektronik yang dilanggan khususnya bagi keperluan pengguna IMR. Disebabkan CME- Telehealth menghadapi masalah terdapat beberapa rungutan dari pengguna untuk menyambung semula judul yang dianggap merupakan satu keperluan bagi sesebuah perpustakaan perubatan. Disebabkan peruntukan yang terhad langganan ini tidak dapat diteruskan.

Pengguna perpustakaan IMR adalah terdiri dari staf IMR, pelajar dari Diploma Mikrobiologi Perubatan (DMM), Diploma Parasitologi Gunaan & Entomologi (DAP& E) dan Kolej Teknologi Makmal Perubatan serta staf

Kementerian Kesihatan Malaysia. Disamping itu terdapat juga sebilangan pengguna dari pelajar Institut Pengajian Tinggi Awam dan swasta yang membuat rujukan bahan di perpustakaan ini.

Beberapa perkhidmatan telah disediakan untuk pengguna perpustakaan seperti pinjaman perpustakaan, pencarian maklumat secara internet melalui pangkalan data yang dilanggan dan secara percuma, pinjaman antara perpustakaan samada buku dan permohonan artikel dari SEAMIC-EDDS, Jepun dan British Library dengan kadar yang telah ditetapkan. Disamping itu perkhidmatan ini juga dapat digunakan oleh semua staf Kementerian Kesihatan Malaysia.

Fungsi Perpustakaan Institut Penyelidikan Perubatan sebagai Penyelaras Perpustakaan dibawah Kementerian Kesihatan Malaysia

Disan~ping fungsi lain, perpustakaan IMR juga menjalankan tugas sebagai penyelaras perpustakaan dibawah Kementerian Kesihatan Malaysia. Diantaranya adalah:

(i) Pusat Penyer.ahan Penerbitan Kementerian Kesihntan Malaysia

Fungsi ini telah dijelaskan dalam Pekeliling Ketua Pengarah Kesihatan bil 2192. Pekeliling ini menyatakan bahawa setiap JabatadbahagiadHospital dibawah KKM perlu menyerahkan terbitan mereka kepada perpustakaan IMR sebanyak 5 naskah untuk

IMR Quarterly Bulletin No. 57/58: Jan/April2004

tujuan pemeliharaan dan rujukan kepada

(ii) Memberi Nombor Penerbitan Kementerian Kesihatan Malaysia

Setiapa Jabatan/bahagianlHospital dibawah KKM diwajibkan mendapatkan nombor penerbitan dari perpustakaan IMR sebelum terbitan tersebut diterbitkan. Fungsi ini juga ada dijelaskan dalam pekeliling Ketua Pengarah Kesihatan Malaysia bil. 7/96.

(iii) Menjalailkan aktiviti SEAMIC yang berkaitan dengan perpustakaan di Malapin

(iv) Memberi khidmat nasihat dan membantu perpustakaan dibawali Kementerian Kesihatan Malaysia berkaitan dengan perkhidmatan perpustakaan perubatan.

(v) Bekerjasama dengan Unit TelelzealtA dalam mempromosikan CME-Telehealth dan memberi cadangan judul jurnal yang sesuai untuk kegunaan warga KKM.

(vi) Lain-lain fungsi yang berkaita~i dengan perkhidmatan perpustakaan perubatan bagi memenuhi keperluan pengguna perpustakaan IMR dan KKkC

Penglibatan Perpustakaan IMR dalam Perkembangan Perpustakaan KKM

Sepanjang 5 tahun ini beberapa pencapaian telah dicapai oleh perpustakaan IMR khususnya sebagai penyelaras perpustakaan KKM iaitu:

(i) Pengisian jawatan professional iaitu Pustakawan disetiap perpustakaan Hospital Negeri berdasarkan kepada dasar baru yang diluluskan dalam tahun 1998. Jawatan yang telah diisi adalah di Hospital Tuanku Ampuan Rahimah, Klang, Hospital Kota Bahru, Hospital Ipoh, Hospital Seremban, Hospital Melaka, Hospital Sultanah Aminah, Johor Bahru, Hospital Pulau Pinang, Hospital Umum Sarawak, Institut Pengurusan Kesihatan, Ibupejabat KKM dan tambahan 2 jawatan pustakawan di IMR. Disamping itu juga beberapa pengisian jawatan pembantu perpustakaan di beberapa buah perpustakaan baru dibawah KKM juga telah dilaksanakan.

(ii) Telah memberi khidmat nasihat kepada beberapa buah perpustakaan perubatan iaitu Hospital Selayang dan Hospital Tuanku Ampuan Rahimah, Klang dalam memohon tambahan peruntukan dan permohonan jawatan pustakawan dalam meningkatkan pembangunan dan perkhidmatan perpustakaan. Juga IMR telah menempatkan seorang pustakawan di Institut Pengurusan Kesihatan

pengguna masa kini dan akan datang.

untuk membantu menguruskan perpustakaan berkenaan sehingga jawatan pustakawan diisi. Disamping itu juga, lawatan dan perbincangan dengan staf adan pegawai penyelia perpustakaan di beberapa buah perpustakaan juga telah dilakukan iaitu di Hospital Umum Sarawak, Kolej Kejururawatan Hospital Umum Sarawak, Hospital Pulau Pinang , Hospital Kolej Jururawat Pulau Pinang, Hospital Kota Bahru, Hospital Kolej KeJururawatan Kubang Kerian dan Hospital Sultanah Aminah, Johor Bahru dan Kolej Kejururawatan Hospital Sultanah Aminah, Johor Bahru. Beberapa cadangan telah dikemukakan semasa perbincangan tersebut.

(ii) Penempatan dan latihan dua orang pembantu perpustakaan dari Kolej KeJururawatan Sandakan dan Sekolah Jururawat Masyarakat Tawau telah dibuat bagi mempelaj ari berkenaan dengan pendokumentasian koleksi perpustakaan perubatan mengikut standard yang ditetapkan selama 2 minggu.

(iii) Bekerjasama dengan Unit Telehealth dalam mempromosikan perkhidmatan CME- TELEHEALTH. Telah memohon melalui Unit Telehealth untuk memastikan satu talian internet ditempatkan di setiap perpustakaan dibawah KKM.

(iv) Telah mengadakan Mesyuarat Pengurusan KKM pada tahun 200 1, 2002 dan 2003 yang bertujuan untuk mengetahui kedudukan semasa dan mengadakan perbincangan mengenai masalah yang dihadapi dalam memperkemaskinikan perkhidmatan perpustakaan perubatan sejajar dengan matlamat KKM seperti:

(a) Pada tahun 2001, Mesyuarat Pengurusan Perpustakaan Perubatan KKM telah diadakan di IMR pada 3 - 4 Oktober 2001. Semua Pustakawan, Penolong Pegawai Perpustakaan dan Pembantu Perpustakaan telah hadir. Beberapa ceramahltaklimat mengenai CME- Telehealth, Taklimat mengenai Pendokumentasian Bahan perpustakaan perubatan di perpustakaan perubatan dan Pendigitan bahan perpustakaan perubatan serta lawatan di perpustakaan Universiti Perubatan Antarabangsa telah diadakan.

(b) Pada tahun 2002, Mesyuarat Pengumsan Pustakawan KKM telah diadakan di IMR dan HUKM pada 28 - 29 Oktober 2002. Hanya Pustakawan dan Penolong Pegawai sahaja yang dijemput hadir. Satu bengkel yang lebih khusus


mengenai pendokumentasian bahan perpustakaan perubatan dan Bengkel Pencarian Maklumat menggunakan pangkalan data perubatan telah diadakan.

(c) Pada tahun 2003, Mesyuarat Pengurusan Perpustakaan Perubatan di bawah KKM telah diadakan di Hospital Umum Sarawak pada 13-1 5 Oktober 2003. Semua pustakawan, penolong pegawai perpustakaan dan pembantu perpustakaan telah dijemput hadir termasuk wakli dari Bahagian Kewangan KKM, Sumber Manusia dan Latihan. Mesyuarat dan perbincangan telah diadakan pada 13 Oktober 2003 manakala ceramah dan taklimat mengenai "Using Evidence Based Medicine (EBM) Resources in Search for Evidence", "Effective Online Information Retrieval technigues", "E-book and electronic resources' dan ceramah mengenai Sistem PERDANA dan pewujudan Knowledge Hub bidang perubatan dan kesihatan telah diadakan pada 14 Oktober 2003. Pada hari ketiga iaitu 15 Oktober 2003, satu lawatan ke perpustakaan UNIMAS, Pustaka Sarawak telah diadakan untuk mengetahui perkembangan perpustakaan berkenaan untuk dikongsi bersama.

Berdasarkan dari beberapa mesyuarat yang telah didakan didapati banyak kelemahan yang masih dihadapi oleh perpustakaan KKM dan di antaranya adalah:

Staf yang kurang mahir dalam mengendalikan perpsutakaan Perubatan dimana ia amat berbeza dengan peprustakaan lain;

Kurang keutamaan terhadap keperluan perpustakaan;

TiaddKurang peruntukan khusus untuk penyediaan koleksi perpustakaan terutama bagi langganan jurnal;

KurangITiada keperluan asas seperti talian internet untuk staflpengguna mengakses maklunat yang boleh diperolehi secara percuma seperti pangkalan data MEDLINE dan rujukan kerja melalui internet;

Lebih dari 75% perpustakaan KKM tidak memperolehi sistem perpustakaan dimana ia merupakan sebagai asas utama untuk menjadikan sesebuah perpustakaan sebagai perpustakaan elektronik.

Bekerj asama dengan Unit Dokumentasi dan Sistem Maklumat (IDS),

Bahagian Perancangan dan pembangunan KKM didalam aktiviti SEAMIC yang berkaitan dengan perpustakaan. Beberapa nama pustakawan dibawah KKM telah dicalonkan kepada IDS bagi menghadiri Travel Researrh Fellowship Programme yang dianjurkan oleh SEAMIC. Juga pada 2000, 2001 dan 2003, Ketua Unit perpustakaaan IMR telah menghadiri SEAMIC Technical Meeting bagi mewakili Malaysia dan telah membentangkan kertas kerja yang berkaitan di mesyuarat tersebut.

(vi) Menyediakan perkhidmatan SEAMIC-EDDS untuk semua staf KKM dalam mendapatkan artikel yang tidak terdapat didalam Malaysia dengan kadar yang minima.

(vii) Telah mengujudkan Pangkalan Data bagi terbitan KKM yang diterima di bawah Pusat Penyerahan KKM. Sehingga kini sebanyak hampir 300 rekod telah dimasukkan daripada hampi? 1000 bahan yang diterima. Kerja ini tertangguh kerana masalah staf. Data ini telah digabungkan dengan pangkalan data sediada menggunakan system baru.

(viii) Setiap terbitan KKM telah diberikan nombor yang telah ditetapkan. Sehingga kini hampir 500 rekod telah dikumpulkan secara manual. Kebanyakan bahan yang diberi nombor adalah Annual report, technical report, Guidelines, Bulletin, Journal, newsletter, Handbook dan lain-lain. Pangkalan data sedang diujudkan bagi memasukkan data berkenaan dan dicadangkan untuk di 'integrate' kan dengan penerimaan bahan dibawah Pusat Penyerahan KKM

Pembangunan Perpustakaan IMR dalam Era ICT

Institut Penyelidikan Perubatan (IMR) telah ditubuhkan lebih 104 tahun dan penubuhan perpustakaan IMR berkembang mengikut perkembangan semasa khususnya dalam bidang teknologi terkini. Ini ditambah pula dengan fungsinya sebagai Perpustakaan Pusat di bawah KKM dimana ia dipertanggungjawabkan bagi menjalankan fungsi Pusat Penyerahan Penerbitan jabatan/institusi/hospital di bawah KKM bagi penyerahan 5 salinan terbitan tersebut untuk di rekod dan di dokumentasi bagi tujuan rujukan masa kini dan akan datang serta ia bertanggungjawab Qdalam pemberian nombor untuk terbitan berkenaan. Dengan kedudukan ini ia merupakan satu aset terbaik bagi Kementerian Kesihatan Malaysia sebagai pusat pengumpulan dan rujukan maklumat dan penerbitan berkaitan dengan perubatan dan kesihatan di bawah KKM.


Perpustakaan IMR juga bertindak sebagai Penyelaras Perpustakaan Kementerian Kesihatan untuk semua perpustakaan KKM dan sebagai pusat penyelidikan untuk penyelidik khususnya dibawah Institut Kesihatan Kebangsaan (NIH). Perkara ini telah diluluskan semasa pembentangan Dasar Mempertingkatkan Perkhidmatan Perpustakaan Kementerian Kesihatan diseluruh Malaysia dalam mesyuarat Jawatankuasa Perancangan Pembangunan Kementerian Kesihatan pada 27 Januari 1997.

Pada masa kini perpustakaan IMR mempunyai koleksi sebanyak hampir 30,000 termasuk jurnal berjilid dalam pelbagai bidang bioperubatan sejak tahun 1900 sehingga kini. Setiap tahun perpustakaan telah memperuntukan peruntukan untuk melanggan jurnal perubatan untuk rujukan pada penyelidik kerana bahan ini merupakan rujukan utama bagi sebuah institusi penyelidikan perubatan utama di Malaysia. Perpustakaan IMR juga mempunyai kertas penyelidikan IMR (Reprint) yang dijalankan sejak tahun 1900 dan sebahagiannya telah ditukar format kedalam CD ROM. Ia adalah merupakan khazanah rujukan utama oleh penyelidik untuk mengetahui penyelidikan perubatan yang telah dijalankan sepanjang tempoh tersebut.

Sejak 1989, perpustakaan IMR telah menggunakan sistem perpustakaan "Columbia Library System" didalam mengaplikasikan fungsi perpustakaan seperti menginput datalrekod katalog buku, pinjaman buku, rekod patron serta pencarian maklumat. Mulai 2000 sistem berkenaan telah di'upgrade' kepada 'Library World" didalam memastikan sistem berkenaan dapat mematuhi Y2K oleh pihak pembekal. Walaupun pada asasnya fimgsi perpustakaan dapat dilaksanakan dengan jayanya tetapi perpustakaan menghadapi masalah khususnya dari segi penyelenggaraan kerana sistem berkenaan diperolehi secara terus dengan pembekal luar negara. Tambahan pula, beberapa features diperlukan bagi memastikan sistem berkenaan dapat diakses secara internet. Oleh itu pada tahun 2003, perpustakaan telah memperolehi Sistem Perpustakaan ILMU yang bertujuan untuk menaiktarafkan sistem sediada bersesuaian dengan keperluan dan kemajuan ICT semasa. Memandangkan peruntukan yang amat terhad, IMR hanya marnpu membeli aplikasi modul yang asas sahaja bagi membolehkan pangkalan data perpustakaan dapat diakses secara on line. Semua data yang terdapat dalam sistem terdahulu telah dipindahkan kedalam sistem baru termasuk data katalog buku, rekod patron, rekod pinjaman. Perpustakaan juga sedang

menginput rekod bahan yang diterima dibawah Pusat Penyerahan KKM iaitu terbitan KKM terutamanya Panduan dan Laporan dari jabatanhahagian dibawah KKM. Semua datalrekod yang dimasukkan dalam sistem perpustakaan ini dapat diakses melalui internet. Pengguna hanya perlu mengakses Web OPAC IMR Library melalui laman web IMR (http://www.imr.gov.my). Pengguna akan dapat mengetahui koleksi bahan perpustakaan yang terdapat dalam perpustakaan IMR dan boleh membuat pinjaman jika mereka adalah ahli perpustakaan IMR. Jika mereka bukan ahli perpustakaan IMR, pinjaman boleh dibuat melalui Pinjaman Antara Perpustakaan melalui perpustakaan di jabatan masing-masing. Sistem ini juga membolehkan perpustakaan IMR dapat meingkatkan perkhidmatan sediada. Buat masa kini, perpustakaan IMR dalam proses mengindeks artikel yang diterbitkan oleh staf IMR dalam pangkalan data "IMR Medical Literature". Bagi pangkalan data ini hanya pengguna IMR sahaja yang dapat mengakses artikel tersebut bagi tujuan rujukan. Pangkalan ini mengandungi artikefiertas kerja yang ditulis oleh IMR sejak tahun 1900 sehingga kini yang diserahkan ke perpustakaan IMR. Perpustakaan IMR juga dalam perancangan meng'digitise'kan semua jurnal IMR seperti IMR Quarterly Bulletin, IMR Jurnal untuk memudahkan pengguna mengakses artikel secara fulltext.

Perpustakaan IMR juga bercadang untuk menambah modul bagi melaksanakan aplikasi yang lebih advance dun dedicated bagi tujuan pencarian maklumat dalam pelbagai pangkalan data. Juga IMR mempunyai staf IT yang berkebolehan untuk memastikan sistem yang diperolehi dapat beroperasi sepenuhnya untuk kemudahan semua staf IMR dan juga staf KKM amnya.

Perancangan Masa Akan Datang

Sebagai penyelaras, IMR telah merancang beberapa tindakan untuk meningkatkan perkhdimatan pembangunan perpustakaan di bawah KKM. Diantaranya adalah:

(0 IMR sebagai Pusat K-management untuk KKM dengan cara memperolehi sistem perpustakaan secara bersepadu bagi semua perpustakaan di bawah KKM. Dengan ini semua maklumat yang terdapat disemua hospitalljabatanhahagian di bawah KKM dapat diakses dengan mudah menggunakan sistem tersebut.

(ii) Bengkel Pengurusan Perpustakaan Perubatan. Ia bertujuan untuk meningkatkan kemahiran dan pengalaman staf perpustakaan


dalam pengendalian perkhidmatan perpustakaan yang berkaitan untuk pengguna KKM khususnya.

(iii) Bengkel Pendokumentasian untuk pustakawan & pembantu perpustakaan. Kursus ini bertujuan untuk memberi panduan dan mempertingkatkan kefahaman didalam mendokumen buku, artikel menggunakan standard yang telah ditetapkan secara berkesan.

(iv) Memohon peruntukan bagi keseluruhan perpustakaan KKM termasuk institutljabataaahagian, hospital dan kolej di bawah KKM untuk pembangunan koleksi perpustakaan.

(v) Memohon langganan e-journal di buat secara konsortium bagi keseluruhan perpustakaan di bawah KKM

Kesimpulan

Perpustakaan merupakan satu sumber yang amat penting bagi sesebuah jabatan dalam

memperolehi maklumat yang berkaitan dalam memastikan sesuatu tindakan dan keputusan yang dilaksanakan adalah tepat dan berkesan. Perkhidmatan perpustakaan yang berkesan perlu disediakan yang merangkumi pelbagai jenis maklumat dan media sejajar dengan perkembangan ICT semasa. Dengan ledakan maklumat terkini yang boleh dicapai melalui internet, persediaan maklumat diperpustakaan perlu bersesuaian dengan kehendak pengguna dan boleh diperolehi dengan cepat, tepat dan pada masa yang diperlukan. Selaku perpustakaan yang lebih lama dan mempunyai koleksi yang agak terbesar dikalangan perpustakaan KKM adalah sewajarnya fungsi dan perkhidmatan ini dapat diperluaskan lagi bagi keperluan dan kehendak bukan sahaja pengguna perpustakaan. di IMR tetapi semua pengguna KKM amnya. Oleh itu, sokongan dan komitmen dari semua pihak diperlukan bagi menjayakan matlamat dalam memastikan maklumat yang terdapat disemua perpustakaan dapat dikongsi bersama agar tiada pertindihan peruntukan bagi perolehan perkara yang sama berlaku.


Implementation of MS I S 0 9000 in IMR: Achievement & Challenges

Prepared by Jawatan Kuasa Pasukan Pelaksana MS IS0 900 1 IMR

Introduction

The Institute for Medical Research has been awarded the Quality System Certification for "Sijil Pendaftaran Sistem Kualiti MS IS0 9001:1994" in March 2002 and MS IS0 9001: 2000 in August 2003. The scope for the quality system MS IS0 9001: 2000 in IMR is "Health Research". The certificate was presented by Y.B. Datuk Douglas Unggah Uggah Embas, the Deputy Minister in the Prime Minister's Department to Dr. Lye Mum Sann, director of IMR on the 7th May 2002 at Concorde Hotel, Shah Alam, Selangor.

The activities towards achieving the certification began in March 1998 with the identification of a task forcelsteering Committee (chaired by Director of IMR) and MS IS0 9000 IMR Implementation Team (chaired by Quality Management Representative). The role of the task force is to set up a framework of activities to be carried out for the accreditation of IS0 9001 in IMR. A Quality Management Representative (QMR) was nominated in 1998 to coordinate the activities during the process of documentation and implementation of the MS IS0 9000 in IMR.

The Challenges The Task force started working diligently to prepare the Quality Document. The documents underwent an Adequacy Audit by MAMPU on 22 nd March 200 1, followed by the Compliance Audit in December 2001 by SIRIM QAS International Sdn Bhd. The top management and all staff of IMR were hlly committed torwards the achievement of the accreditation for MS IS0 9001: 1994 on 1 gth arch 2002.

The challenges encounted by the Institute through the processes for the accreditation were many. The implementation team played a pivotal role to facilitate the activities for the implementation of MS IS0 9000. The continued support from the director, top management and the staff of IMR could not be over emphasized. The practice of Ministry Of Health's corporate culture, team work, caring and professionalism ultimately lead to the achievement of MS IS0 9000 in IMR.

The procedures documented in MS IS0 9000 requirement has been implemented since 2001. To ensure that the objectives of the Quality Systems MS IS0 9001: 2000 are achieved, several "awareness" seminars were conducted. To assist in the monitoring of all IS0 activities several sub-committees were formed. The committees were Research Panel Committee (Jawatan Kuasa Panel Penyelidikan IMR (JPP IMR)), CME Committee (Jawatan Kuasa CME (JK CME)), Training Committee (Jawatan Kuasa Latihan) and Internal Quality Audit

MS IS0 900 1 : 1994 documents were prepared which includes Manual Kualiti, Prosedur Kualiti and Prosedur Sokongan as required in

the standard of MS IS0 9000: 1994. Relevant standard procedures have been introduced to the staff and relevant standard forms were adopted.

Another challenge faced by the institute in its implementation of MS IS0 9000 was turn over of human resources. In 1999, Dr. Tee E Siong, Head of Cardiovascular, Diabetes & Nutrition Research Centre was nominated to be QMR MS IS0 9000 and the secretary was Pn Khor Swan Choo. Since then we have had several changes due to stafflcommittee members left for promotion, study leave and retirement. In the beginning of 2002, Dr. Tee E Siong retired and Dr. Hanjeet Kaur, Head of Medical Research Resource Centre, was nominated as new QMR, Puan Khor, the secretary was promoted and left IMR.

Conversion of MS 9001: 1994 to I S 0 9001: 2000

MAMPU through "the Meeting of the Panel for Development of Public Administration (PANEL)" on 8th December 2002 urged government agencies which had been accredited with IS0 9001 : 1994 to convert to the MS IS0 9001: 2000 standard. Several activities were planned following the proceedings of this meeting, Development Administration Circular Letter No. 2 of 2002 entitled "Guidelines for the Implementation of MS IS0 9001: 2000 in the Public Service (SPKPS 212002)". The Implementation Team conducted a series of seminars and awareness sessions for the IMR staff. A facilitator from SIRIM Sdn Bhd was invited to give a talk on the new standard of MS IS0 9001 : 2000 to the


IS0 team in IMR. A three day workshop was conducted to produce the first draft of the quality document of the MS IS0 9001: 2000. This workshop was attended by all the top management of IMR which was held from 19 - 21 July 2002 in Port Dickson, Negeri Sembilan. The task force continued to work on the document to fine tune the details and produced the final document which was presented to the steering committee on the 27 October 2002 and endorsed by the director of IMR.

Six Prosedur Kualiti Umum has been introduced in this new standard, they are Kawalan Dokumen, Kawalan Rekod, Audit Kualiti Dalaman, Kawalan Ketakakuran, Tindakan Pembetulan and Tindakan Pencegahan. These documents are compulsory documents in the new standards. The documents for the new standards are Manual Kualiti, Prosedur Kualiti Umum (6 Procedures), Prosedur Kualiti penyelidikan (9 procedures) and Prosedur Kualiti Pentadbiran (1 1 procedures). The documents were approved by the Steering committee for implementation. Training and awareness for the staff was arranged to ensure they are aware of the new procedures.

The new documents were submitted for an Adequacy Audit by SIRIM QAS International Sdn Bhd on the 11 June 2003 followed by a 3 day Compliance Audit on 23 - 25 July 2003. The Compliance Audit was carried out successfully and the certificate for MS IS0 9001: 2000 was awarded on the 29 August 2003. The scope for the Quality system is the same, "Health Research". For maintenance of

the IS0 certificate, a Surveillance Audit was conducted on 3 September 2004 by SIRIM QAS Sdn Bhd. A good report assured IMR the MS IS0 9001: 2000 certificate for another year, till 2005.

Achievements of MS IS0 9000 in IMR

The aim of implementiong MS IS0 9000 was to build up a quality system for the institute and to ensure the consistency and improvement of working practice up to the Quality system. The benefits aimed from this system are:

Standardization of working procedures in every Centretunit; The research activities are carried out according to the procedures that have been documented; Research is monitored at all levels by the superiors or a subcommittee; All staff must be trained in their relevant fields to ensure their competency; The corporate culture of Ministry of Health Malaysia, "Caring, Team Work and Professionalism" is being practiced continuously.

Conclusion

The achievement of the MS IS0 9001:2000 quality system has been very meaningful to the Institute. The Institute has improved its management operations in terms of daily management and management towards quality research.


LAMPIRAN

DASAR KUALITI

Dasar kualiti IMR adalah seperti berikut,

(i) IMR beriltizam untuk menghasilkan penemuan penyelidikan kesihatan berkualiti bagi mencapai kepuasan pelanggan dan kecemerlangan organisasi melalui pelaksanaan Sistem Pengurusan Berkualiti yang akan diperbaiki keberkesanannya secara berterusan dan selaras dengan Standard IS0 9001 : 2000.

(ii) IMR juga beriltizam untuk mencapai objektif kualiti yang ditentukan, dipantau dan disemak dari masa ke semasa selaras dengan matlamat organisasi.

(iii) Pihak pengurusan akan memastikan dasar ini difahami dan dihayati oleh semua staf IMR

OBJEKTIF KUALITI

Untuk menghasilkan penyelidikan kesihatan yang dijalankan berkualiti, IMR akan memastikan:

(i) Sekurang-kurangnya 80% projek penyelidikan yang diluluskan dijalankan dengan menggunakan

peruntukan yang diberi dalam jangka masa yang telah ditetapkan.

(ii) Sekurang-kurangnya, satu penulisan saintifik dihasilkan dalam masa 12 bulan dan satu

penerbitan saintifik dalam 'refereed journal' dihasilkan daripada setiap projek penyelidikan

yang telah diselesaikan.

(iii) Sekurang-kurangnya, satu pembentangan semasa penyelidikan dijalankan atau dalam masa 12

bulan untuk setiap projek penyelidikan yang telah diselesaikan.

(iv) Setiap penyelidik dan juruteknologi makmal perubatan yang telibat dalam penyelidikan

memperolehi sekurang-kurangnya 30 dan 15 markah masing-masing untuk Pembelajaran

Perubatan Berterusan (CME) atau Perkembangan Profesional Berterusan (CPD) setiap

tahun.

(v) Setiap penyelidik dan juruteknologi makmal perubatan yang terlibat dalam penyelidikan perlu

menghadiri latihan yang berkaitan sekurang-kurang nya sekali dalam jangka masa 3 tahun.

(vi) Sekurang-kurangnya 80% projek penyelidikan yang telah selesai perlu mencapai sekurang- kurangnya 60% objektif nya


SENARAI PROSEDUR SISTEM PENCURUSAN KUALITI MS I S 0 9001: 2000 INSTITUT PENYELIDIKAN PERUBATAN

1. PROSEDUR KUALITI UMUM (i) PKUAMR - 0 1 Kawalan Dokumen (ii) PKUIIMR - 02 Kawalan Rekod (iii) PKUIIMR - 03 Audit Kualiti Dalarnan (iv) PKUAMR - 04 Kawalan Ketakakuran (v) PKUAMR - 05 Tindakan Pembetulan (vi) PKUAMR - 06 Tindakan Pencegahan

2. PROSEDUR KUALITI PENYELIDIKAN PKPAMR - 01 PKPAMR - 02(1)

PKPAMR - 03(1)

PKP/IMR - 03(2)

PKPAMR - 04

PKPAMR - 05(1)

PKPAMR - 05(2)

PKPIIMR - 05(3)

Penyediaan Cadangan Projek Penyelidikan Penilaian Cadangan Projek Penyelidikan untuk Permohonan Peruntukan dari IRPA dan surnber Lain Penilaian Cadangan Projek Penyelidikan untuk Permohonan Peruntukan dari Kementerian Kesihatan Malaysia Pengumpulan Data Penyelidikan di Lapangan dan Penyediaan Laporan Kemajuan Projek Pengumpulan Data Penyelidikan di Makmal dan Penyediaan Laporan Kemajuan Projek Penganalisis Data Penyelidikan dan Penyediaan Laporan Tamat Projek Penyebaran Penemuan Penyelidikan melalui Penerbitan Penyebaran Penemuan Penyelidikan melalui Pembentangan Penyebaran Penemuan Penyelidikan melalui Lain-lain Penerbitan

3. PROSEDUR KUALITI PENTADBIRAN

PKTIIMR - 01(1) PKTIIMR - 0 1 (2)

PKTAMR - 0 1 (3) PKTAMR - 02(1)

PKTIIMR - 02(2) PKTIIMR - 03 PKTAMR -04 PKTAMR -05 PKT/IMR -06 PKTAMR - 07 PKTIIMR - 08

Perolehan Secara Tender Perolehan Melalui Jawatankuasa Sebutharga IMR Perolehan Melalui Pembelian Terus Perkhidmatan Penyelenggaraan dan Kalibrasi Peralatan Perkhidmatan Pembaikan Peralatan Pengurusan Latihan dan Kompetensi Staf Pengendalian Aduan Pelanggan Pengurusan Kepuasan Pelanggan Pengumsan dan Pemarkahan Aktiviti CMEICPD Mesyuarat Kajian Semula Pengurusan Penyediaan Anggaran Belanjawan

PUBLISHED ABSTRACTS


A study on Malaysian's practice towards waste disposal

Wan Rozita WM, Hanjeet K, Sumarni MG, Lim KH Epidemiology & Biostatistics Unit, Institute for Medical Resarch, 50588, Jalan Pahang, Kuala Lumpur

Presented at 15th National Scientific Conference MIMLS from 27-29th Sept 2004

Abstract

A study was conducted at the end of 2001 prior to the implementation of the Ministry of Health's nationwide 'Healthy Lifestyle Campaign 2002: Promotion of Healthy Environment'. The main purpose of the survey is to obtain baseline data on the knowledge, attitude and practice of Malaysian's pertaining to healthy environment, smoke free environment and food safety and hygiene. The target population for the study are the adults age 18 years and above from 10547 selected households. A stratified two-stage sampling was applied to the year 2000 census data. The first stratification of sampling was applied to the Enumeration Blocks (EBs) and the second stage was the households. List of households are obtained from the Statistics Department using the Enumeration Blocks from the 2000 census data. This paper presents the preliminary findings from the healthy environment scope, focusing on Malaysian's practice towards kitchen waste. Results: 338 from 10547 (3.2%) respondents throw garbage into the drain and out of 338, 66 of them (19.52%) are from Selangor. Sarawak has the highest percentage of throwing the rubbish into the river (26.76%) compared to other states. Those respondents that were involved mostly came from rural areas (78.9%) with only primary school background. Primary school background is a contribution factor towards this bad attitude because 40% of them that throw rubbish to the abandoned area are from this group. 76.10% practiced housekeeping and Selangor residents has the highest percentage (89.69%). Selangor residents too has the highest percentage of practicing good habit by placing the garbage into the plastic bag and throw it into the garbage bin. Malaysia has a long way to go in its waste management because some of us are still in the habit of dumping trash wherever and however we please. We do not know that eventually every one of us suffers when the air we breathe and water we drink becomes contaminated. We should not depend on laws to keep our country clean. We must adopt healthier habits because they are for our own good.

Tissue engineering of ear and trachea

B. S. Aminuddin, K. H. Chua, A. L. Mazlyzam, H. Fauzina, B. S. Lokman, B. S. Munirah, B. H. I. Ruszymah

Medical Journal of Malaysia, Vol. 59, Supplement A, 2004

Otorla yngology Cliliic, Ampang Pztteri Hospital Department of Physiology Medical Faculty, UKAl

Tissue Engineering Lab, HUKM Institute of Medical Research Malaysia

Department of Otorlayngology, Medical Faculty, UKM

Abstract

Tissue engineering has emerged as an important research tool in Otorlaryngology. We have started the tissue engineering lab in year 2000 and one of our main interest is to form a reliable and stable tissue engineered cartilage construct in the space of the human ear and trachea.


Space Spraying of Bacterial and Chemical Insecticides against Anopheles Balabacensis Baisas for the control of Malaria in Sabah, East Malaysia

P. Seleena, HL Lee, KH Chooi and S. Junaidih

Southeast Asian Jounial of Tropical Medicine and Public Health, Vol. 35, no. 1, 2004

Division of Medical Entomologv, Imtitute for Medical Research, Kuala Lumpur Vector Borne Disease Control Program, Department of Health Sabah, Malaysia

Abstract

A pilot study was undertaken to determine the effectiveness of space application of insecticides for the control of malaria in Ranau, a district in Sabah. A village each was treated monthly: with chemical adulticide - alpha cypermethrin (Fendona ScR 1 1 0 s ~ ~ ) at 2 g a.i./10,000m2 in Pahu; with biological larvicides - Bacillus thuringiensis israelensis (Vectobac 12 AS^) at 500m1110,000m2 or B. sphaericus (Vectolex W G ~ ) at 500~/10,000m~ in Pinawantai: and with a mixture of chemical adulticide and biological larvicide in Togop Laut. All sprayings were conducted using a portable mist blower. During the study period all villages, including Tarawas the untreated village, received the conventional malaria control measures. Entomological and epidemiological surveillance was used to measure the effectiveness of the space application. The entomological surveillance indicated that the An. Balabacensis population was significantly reduced by alpha cypermethrin in Pahu and Togop Laut and B. sphaevicus in Pinawantai; but was not reduced by B. t. i. in Pinawantai. There was a significant reduction in the number of malaria cases and in the slide positivity rate in the treated villages during the study period. The pilot study does indicate that space application of larvicidesladulticides or a mixture of both is able to reduce the malaria vector population and the malaria transmission. A larger scale study needs to be undertaken in a malarious village1 province to determine whether space application of insecticides together with other malaria control measures will be able to eradicate malaria.

Effect of ten chlorophytes on larval survival, development and adult body size of the mosquito Aedes Aegypti

Rohani Ahmad, Wan-Loy Chu, Zarnree Ismail, Han-Lim Lee and Siew-Moi Phang

Soufheast Asian Journal of Tropical Medicine and Public Health, Vol. 35, no. 1, 2004

Medical Entomologv Unit, Infectious Disease Research Center, Institute for Medical Research, Kuala Lumpur

International Medical University, Sesama Center, Kuala Lumpur Institute of Biological Sciences, University ofMalava, Kuala Lumpur

Abstract

The effect of ten microalgal chlorophytes isolated from mosquito breeding containers on the survival, larval development and adult body size of the mosquito Aedes aegypti was investigated. All larvae fed with six of the microalgal isolates died after 7 days. These isolates were found to be resistant to digestion by mosquito larvae. Delayed pupation and body size reduction of the mosquitos fed with Chlorococcum UMACC 218 and Scenedesmus UMACC 220 were observed. In contrast, larvae fed with Ankistrodesmus convolutus UMACC 101 and Chlorococcum UMACC 213 were bigger in size than those fed with normal insectary feed. The present study showed that microalgal chlorophytes have the potential to be used as larvicidal agents for mosquitos.


Molecular subtyping of Salmonella Entevica Serovar Tshiongwe recently isolated in Malaysia during 2001 - 2002

Kwai Lin Thong, Shamsilawani Ahmad Baker, Kin Seng Lai, Yin tee Koh, Mohd Zainuldin Taib, VKE Lim and Rohani Md. Yasin

Southeast Asian Journal of Tropical Medicirze and Public Health, Vol. 35 , no. 1, 2004

Institute of Biological Sciemes, Universih. of Malaya, Kuala Ltmzpur Bacteriology Unit, InsNtz~te for Medical Research, Kuala Lumpzn-

Abstract

Pulsed field gel electrophoresis (PFGE) and antimicrobial susceptibility analysis were undertaken on twenty-three strains of Salmonella enterica serovar Tshiongwe, an unusual serovar, which recently emerged in Malaysia. Antimicrobial susceptibility analysis showed that all the strains were sensitive to ampicilin, chloramphenicol, cotrimoxazole, and kanamycin. Twenty (87 %) and 8 (3.5 %) strains had resistance to tetracycline and streptomycin respectively. PFGE analysis subtyped 23 strains into 10 profiles ( Dice coefficient of similarity, F = 0.7 - 1.0 ). The predominant profile, XI was found in both clinical and environmental isolates and was widely distributed in different parts of Malaysia during the study period. In addition, isolates recovered from food, a hand-towel, apron and the surface of a table- top in one particular location had unique, indistinguishable profiles (X414a) and identical antibiograms. Similarly, isolates from cooked meat and a chopping board had PFGE profiles similar to some human isolates. These probably indicated cross-contamination and poor hygiene in food practices, hence contributing to Salmonellosis. Factors causing the emergence of this rare Salmonella serovar being responsible for food poisoning episodes during the study period remained unclear. The study reiterated the usefulness and versatility of PFGE in the molecular subtyping of this rare Salmonella serovar in Malaysia.

Susceptibility of laboratory and field animals to experimental infection by Schistosoma spindale cercaria

Krishnasamy M, Chong NL, Ambu S, Inder SK, Jeffery J, Edariah AB and Oothuman P.

Tropical Bionzea'icine, Vol. 20, no. 2, Dec. 2003

Environmental Health Research Centre (Medical Ecology), Institzlte for MedicaI Research, Jalan Pahang, 50588 Kuala Lzlmpur, Malaysia.

School of BioIogical Sciences, Uniwrsity Sains Malaysia, 11800 Penang Malaysia. Department ofParasitology and Medical Erztomologv, Faculty of Medicine, Uiziversiti Keba?zgsaan

Malaysia, P.O. Box 12418, 50778 Kuula Lunlpur; Malaysia. Kulliyah of Medicine, International Islamic Universit?/, P.O. Box 141, 2571 0 K~tantan, Paharzg.

Abstract

Sixty two white mice, 14 white rats, 10 hamsters, 2 gerbil, 6 guinea pig, 2 rabbits, 13 Barzdicota indica, 2 Macaca fasciularis, 2 Macaca nemestrirza and 11 Capra hircus were exposed to Schistosonza spindale cercariae in the laboratory. Forty mice, 24 white rats. 17 hamsters, 10 guinea pigs, 4 rabbits, 12 field rats, 4 mongooses, 14 ducklings, 4 pigeons, 2 myna birds and 4 quils were also exposed in a river known to be infected with S. spindale cercaria. Variability occurred in the infection and rate of development of the parasites. The parasites were found to be mature (patent) within 30 days in goats. In the other animals, the trematode attained maturity within 2-3 months. And in some animals only immature females were found. One hundred percent infection was observed in four of the species, namely Macaca fascicularis, Meriorzes ung~~iculalus, Cavea porcellza and Orctolagus cuniculzrs.


Notes on the ectoparasites of rodents from the Ulu Gombak Forest reserve, Selangor

Salleh Ismail, Baharudin Omar, Sallehudin Sulaiman, Juraihan Sulaiman and Zuraidawati Zolkaflee.

Tropical Biomedicine, Vol. 20, no. 2, Dec. 2003.

College of Medical Laboratory Technolog??. Institute for Medical Research, 50588, Kuala Lumpur.

Department of Biomedical Sciences, Faculty ofAllied Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia.

Abstract

A survey of ectoparasites was carried out at Ulu Gombak Forest reserve from June to December 2002. A total of 50 rodents comprising of 9 species were trapped. From these rodents, 5 species of mesostigmatid mites, 8 species of chiggers and 3 genera of ticks were collected. Sundamys muelleri (Jentink) and Maxomys rajah (Thomas) showed the richest host ectoparasites species richness and Jaccard Index showed S. muelleri and M. rajah shared six species of ectoparasites (Cj=0.429). Two medically important species of ectoparasites lxodes granulatus Supino, 1897 and Leptotrombidium deliense Walch, 1922 were also collected in this study.

Collection of domiciliary cockroaches and their parasites from the Faculty of Medicine, University of Malaya, Kuala Lumpur.

John Jeffery, Sulaiman Abdullah, Khairul Anuar, Baharudin Omar, Norhayati Moktar, Sallehudin Sulaiman, Hidahatulfathi 0 and Krkhnasamy M.

Tropical Biomedicine, Vol. 20, no. 2, Dee. 2003.

Department ofParasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, P.O. Box 12418, 50778 Kuala Lumpur, Peninsular Malaysia.

Faculty of'Medicine, University of Malaya, 50503 Kuala Lumpur. Department of Biomedical Science, Faculty of Allied Health Sciences, Universiti Kebangsaan

Malaysia, P. 0. Box 124 18, 50778 Kuala Lumpur, peninsular Malaysia. Medical Entomology Unit, Infectious Diseases Research Centre, Institute for Medical Research, Jalan

Pahang, 50588 Kuala Lumpur, Peninsular Malaysia.

Abstract

In a survey for cockroaches and their parasites conducted in the Faculty of Medicine, University of Malaya from November 2000 to April 200 1, 1003 specimens consisting of 1 13 Periplaneta americana, 12 Periplaneta brunnea and 878 Blattella germanica were collected using beaker-traps bites with mouse chow. Cystacanths of the acanthocephalan, Moniliformis munilifomis was recovered from 4 P. Americana. Larval pentastome of the genus Raillietiella and the spururoid, Gongylonema neoplasticum was found in 3 P. americana. All 3 cockroaches species harboured commensal nematodes and protozoa.


Domiciliary cockroaches and house lizards and their parasites from Kg. Tebengau, a rice-growing village in Kedah

John Jeffery, Nor Afandy H, Sulaiman Abdullah, Sallehudin Sulaiman, Norhayati Moktar, Baharudin Omar, Hidayatulfathi 0 , Ismail MG, Ahmad Firdaus MS and Krishnasamy M.

Tropical Biomedicine, Vol. 20, no. 2, Dec. 2003.

Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, P.O. Box 12418, 50778 Kuala Lumpur, Peninsular Malaysia. Multidiscipline Laboratory2, Faculty ofMedicine, University of Malaya.

Department of Biomedical Sciences, Faculty of Allied Health Sciences, University Kebangsaan Malaysia, P.O. Box 12418, 50778 Kuala Lumpur, Peninsular Malaysia.

Medical Entomology Unit, Infectious Diseases Research Centre, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Peninsular Malaysia.

Abstract

Domiciliary cockroaches trapped from Kg. Tebengau, a rice-growing village in Kedah consisted of the following: Periplaneta americana (7 females, 3 males, 1 nymph), Periplaneta australasiae (4 females, 2 nymphs), Periplaneta brunnea (4 females, 3 males), Neostylopyga rhombifolia (7 females, 3 males) and Supella longipalpa (1 nymph). The cockroaches oothecal parasitoid, Evania appendigaster was also collected. Four Hemidactylus frenatus lizards dissected had adult Raillietiella sp. in the lungs. The five cockroach species, E. appendigaster and Raillietiella sp. constitute new records for the state of Kedah, peninsular Malaysia.

REPORTS


National Surveillance on Antibiotic Resistance Report for 2003

Dr. Rohani Md Yassin Institut Penyelidikan Perubatan

Jalan Pahang, 50588 Kuala Lumpur

For the year 2001 46,331 antibiotic resistance data was analysed and 55,958 in 2002. The 5 most common specimens contributed for the bacterial isolates were pus followed by urine, blood and specimens from respiratory tract (Table 1). Staphylococcus aureus, E. coli Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter sp. are 5 most common bacterial pathogen isolated (Table 2).

The resistance rate of bacterial isolates varies from hospital to hospital. It must be noted that the margin of error in which only a small number was tested would be high, and for some dmgs were categorised as second line drugs which will be tested only if the isolates was resistance to the first line dugs.

Staphylococcus auveus is the most frequent organism isolated. More than 86% of them were resistant to penicillin and about 33.9% of them were MRSA. The rate are almost consistant in the last 5 years. Rate of MRSA among S. auveus isolated from the community (out patient) is much lower about 16.6%, similarly with some other antibiotics. The rate of MRSA in different hospitals varies from 11.6% in Hospital Kota Bharu to 43.9% di Hospital Kuala Lumpur. Vancomycin resistant S. aureus was reported but this resistance was not verified. Table 4a - 4c shows the resistant pattern of gram-positive bacteria. Resistance rate among S. pneumoniae causing invasive infection is lower compare to isolate recovered from respiratory specimens.

Table 3a - 3d shows the resistant pattern of gram-negative bacteria. Table 5a - 5b shows the rate of specific resistant of specific bacteria in different hospitals for 2003. Rate of chloramphenicol and ampicillin resistant among H. influenzae have increase from 4.4% and 9.6% in 2002 to 7.3% and 11.6% respectively in 2003. The rate of penicillin resistant among S. pneumoniae has increase from 8.9% in 2002 to 11.5% in 2003.


Table 1: 25 most common bacteria isolated - - -- -

Organism No. isolate Percentage

Staphylococcus aureus 13934 16.1 Escherichia coli 10847 12.5 Pseudomonas aeruginosa 9801 11.3 Klebsiella pneumoniae 8625 10 Candida albicans 4825 5.6 Staphylococcus, coag-neg 465 1 5.4 Strept, beta-haem. Group B 3882 4.5 Acinetobacter sp. 3 185 3.7 Klebsiella sp. 2996 3.5 Acinetobacter baumannii 2425 2.8 Candida sp. 1659 1.9 Proteus mirabilis 1481 1.7 Enterobacter cloacae 1200 1.4 Staph epidermidis 1145 1.3 Enterobacter sp. 1136 1.3 Enterococcus sp. 1003 1.2 Pseudomonas sp. 835 1 KlebsielIa ozaenae 697 0.8 Stenotropho maltophilia 607 0.7 Strept, beta-haem. Group A 504 0.6 Morganella morganii 503 0.6 Proteus sp. 502 0.6 Enterobacter aerogenes 446 0.5 Strept viridans, alpha-hem. 415 0.5 Klebsiella oxytoca 412 0.5 Others 8837 10.2

Total 86 '553 100

Table 2: Common specimen with positive isolate

Specimen Type No. isolate Percentage

Urine Blood Pus Swab Genital specimen Sputum Wound include Surgical Respiratory Cerebrospinal fluid TracheaITracheal Aspirate Bronchial/Broncho-Alveolar Lavage Tissue Eyes Catheter Abdominal fluid Stool Ear Nose swab Others

Total 86553 100

IMR Quarterly BulletinNo. 57158: JaniApril2004

Table 3a: Antibiotic Resistant Pattern of Gram Negative Bacteria

Acenitobacter

Antibiotic SPP

No. tested %R

Amikacin

Amo-Clav

Ampicillin

Amp-Sulb

Cefepime

Cefoperazone

Cefo-Sulb

Cefotaxime

Ceftazidime

Ceftriaxone

Cefuroxime

Cephalothin

Chloramphenicol

Ciprofloxacin

Gentamicin

Imipenem

Meropenem

Netilmicin

Nitrofurantoin

Piperacillin

Tetracycline

Cotrimoxazole

A. baumannii

No. tested %R

Citro. fruendii

No. tested %R

Enterobacter SP

No. tested %R

E. cloacae

No. %R tested

* Resistant not verified


Table 3b: Antibiotic Resistant Pattern of Gram Negative Bacteria

Antibiotic

- -

Escherichia coli

No. tested %R

Amikacin

Amo-Clav

Ampicillin

Amp-Sulb Cefepime

Cefoperazone Cefo-Sulb

Cefotaxime Ceftazidime

Ceftriaxone

Cefuroxime Cephalothin

Chloramphenicol

Ciprofloxacin

Gentamicin

Imipenem

Meropenem Netilmicin

Nitrofurantoin

Piperacillin

Tetracycline

Cotrimoxazole

Cephalexin . 3432 20.3 * Resistant not verified

E. coli (urine)

No. tested %R

E. coli (Nonurine)

OAR tested

- - -

H. influen (noninvasive)

No. tested %R

-

H. influen (Invasive)

No. tested %R

IMR Quarterly Bulletin No. 57/58: Jan/April2004

Table 3c: Antibiotic Resistant Pattern of Gram Negative Bacteria

Klebsiella sp. Antibiotic

No. tested %R

Amikacin Amo-Clav Ampicillin Amp-Sulb

Cefepime Cefoperazone Cefo-Sulb Cefotaxime Ceftazidime Ce fh-iaxone Cefuroxime Cephalothin Chloramphenicol Ciprofloxacin

Gentamicin Imipenem Meropenem Netilmicin Nitrofurantoin Piperacillin Tetracycline Cotrimoxazole Cephalexin


K. M. moganii pneumouiae mirabilis I I prOteYs

No. tested 1 t$~d %R I tzpkd %R

Proteus vulgaris

No. %R. tested


Table 3d: Antibiotic Resistant Pattern of Gram Negative Bacteria

P. aeruginosa Antibiotic

No. tested %R

Amikacin Amo-Clav

Ampicillin Amp-Sulb Cefepime Cefoperazone Cefo-SuIb Cefotaxime Ceftazidime Ceftriaxone Cefixoxime Cephalothin

Chloramphenicol Ciprofloxacin Gentamicin Imipenem Meropenem Netilmicin Nitrofurantoin Piperacillin Tetracycline Cotrimoxazole

S. maltophilia

-

No. tested %R

S. typhi

No. tested %R

Salmonella SP.

No. tested %R

Serratia marcescens

No. %R tested



Table 4a: Antibiotic Resisfant Pattern of Gram Positive Bacteria

Streptococcus

Antibiotic GP A No.

tested %R

Ampicillin 165 1.2

Cefepime 24 0

Cefotaxime 125 2.4

Ceftriaxone 62 4.8

Cefuroxime 93 0

Chloramphenicol 119 7.6

Ciprofloxacin 28 3.6

Erythromycin 420 10.2

Gentamicin 57 15.8

Genta-High Imipenem Nitrofurantoin Penicillin G 451 5.3

Rifampin Tetracycline 315 46

Cotrimoxazole 316 65.8

Vancomy cin 135 2.2

Clindamycin 160 7.5 [ ] No. tested * Resistant n

Streptococcus GP B

No. tested %R

751 0.5

199 2.5

889 1.5

318 2.2

585 0.9

639 1.9

150 5.3

3146 8.1

151 74.8

26 3.8

47 4.3

3265 2.4

2510 64.4

2621 54.2

679 1.3

886 11.3 verified

Enterococcus SP

- - ----

No. tested %R

Table 4b: Antibiotic Resistant Pattern of Gram Positive Bacteria

Streptococcus

Antibiotic GP A No.

tested %R

Ampicillin Cefepime Cefotaxime Ceftriaxone Cehroxime Chloramphen Ciprofloxacin Erythromycin Gentamicin Genta-High Imipenem Nitrokrantoin Penicillin G Rifampin Tetracycline Cotrimoxazole Vancomycin Clindamycin 21

[ ] No. tested * Resistant n

Streptococcus GP B

No. tested %R

verified

54

Enterococcus

No. tested %R

E. faecalis

No. %R tested

E. faeceum

No- %R tested


Table 4c: Antibiotic Resistant Pattern of Gram Positive Bacteria

Staph aureus Antibiotic

No. tested %R

Amikacin

Amoxi-Clav

Ampicillin

Amp-Sulb

Cefepime

Cefoperazone

Cefotaxime

Ceftazidime

Ceftriaxone

Cefuroxime

Chloramphenicol

Ciprofloxacin

Erythromycin

Fusidic acid

Gentamicin

Imipenem

Methicillin

Mupirocin

Netilmicin

NitrofLrantoin

Penicillin G

Rifampin

Tetracycline

Cotrimoxazole

Vancomycin

Clindamycin

[ ] No. tested * Resist;

-- - ---

S. aureus (out pt)

No. tested %R

50 2

37 56.8

59 1.7

114 7.9

216 18.5

1461 21.2

1459 10.9

1414 18.3

1432 16.6

40 10

11 63.6

58 5.2

994 85.6

1269 6

86 15.1

1260 17.1

1260 0

383 3.1

not verified

- -

S. aureus (blood)

No. tested %R

Staph Coag Neg

No- %R tested

S. epidermidis

No. tested %R

S. saprophyticus

No. tested %R


Table 5a: Percentage of Specific Resistant of Specific Bacteria (Jan-Dec 2003)

S. aureus S. aureus N. gonorrh N. gonorrh H-influenzae H.influenzae ~ ~ ~ ~ j t ~ l (Methicillin R) (Vanco R) (PPNG) (SpectinoR) (ChlorR) (Amp R)

HKB 13.6 11.6 0 0 0 50 - 5.9 16.8 7.7 16.7

[706] [lo641 [96] [lo641 [4] - [4] - [17] [I901 [26] [32]

HPP 41.3 42 0 0 50 40 5.6 0 0 0 0 16.7

HKL 38 43.9 0 0 40.8 38.7 3.8 0 3.9 3.2 17.1 13.8

[3038] [4287] [I1531 [3948] [49] [94] [52] 1181 [2051 [I881 [2051 [I881

HTAR 25.6 0 11.4 16.7 9.5 19

HJB 36 30.6 0 0 0 0 0 0 0 2 15 12

[l503] [I7681 [I5031 [3324] [4] [20] [4] [15] [311 [471 [341 [491

HMEL 13.2 18.6 0 1.9* 13.3 0 0 0 0 0

[I8741 [I6091 [I8741 116091 [15] [2] [15] [I] [31 - [31 - HTAA 26.8 24.5 0 0 0 0 5.2 15 9.1

[1365] [8654] [I1721 [836] [ l ] - - [211 [581 Pol [551

HQE 24.3 21.2 0 0 0 0 0 0 0.8 0

HIPH 31.9 0 0 0 7.7 31.8

[I9781 [I9251 131 [I] 1391 [441

HSER 24.7 25.2 0 0 40 100 0 0

[I4691 [I4571 [I7791 [I4571 [5] - [I] P I - [31 - HAS 26.4 24.2 0 0 37.5 - 0 0 3.1 3.8 6.3

[2448] [2229] [1871] [2229] [8] - [8] - [I781 [95] [158] [95]

HSEL 37.5 34.7 0 0.1* - 16.7 16.7 8.3 16.7

[lo331 [1125] [735] [lo811 - - [I21 [6] [I21 [61

HKT 12.12 0.18* 5.36 22.22

[I1381 [I1381 ~561 ~271

HKGR 13.6 7*

[4181 [3991

ALL 29.3 27.8 0 0.3* 35.9 31.7 5.6 0 4.4 7.3 9.6 11.6

[20521] [26402] [I54911 [I89411 [I141 [126] (1251 (601 [689] [675] [675] (4901

[ ] No. tested * Resistant not verified


Table 5b: Percentage of Specific Resistant of Specific Bacteria (Jan-Dec 2003)

S. pneumo S. typhi V. cholerae Strep Gp A Strep Gp B Enterococci Hospital (Penicillin R) (Chloramphe

R) (Tetracy R) (Penicill R) (Penicill R) (Vanco R)*

2002 2003 2002 2003 2002 2003 2002 2003 2002 2003 2002 2003

HKB 5.9 8 0 0 0 2.6 25* 14.9 0 0 0

[391 [681 PI51 [@I - [381 181 [ lol l P I 161 P I1

HPP 14.8 26.8 0 0 0 0 0 1.2 0 0 0

[27] [41] [3] [4] [I41 - [I61 [I21 [161] [242] [I491 [I511

HKL 11.2 19 0 0 0 0 0 0 0 0 0 1.1*

[98] [121] [ l] [ l l ] [3] [I] /I561 [I411 [I4121 [I6211 [424] [556]

HTAR 26.3 0 0 0 0 6.5

~191 PI POI [lo61 ~6621 [ 1071

HJB 27 16 0 13 0 I* 0 1 * 0 0

1261 [57l [71 [I61 - - [77] [226] [302] [541] [143] [327]

HMEL 0 18.2 0 0 0 16.3* 1.1 12* 0.4 7*

171 [111 PI PI - [I171 [44] [272] [I621 [270] [I471

HTAA 0 0 0 0 0 2.8 0 0 0 3.6 1.1*

[18] [22] [4] [6] [ I ] - [I07 [62] [249] [278] [62] [41]

HQE 0 0 0 0 0 0 0 0 0 20 4.7*

[86] [29] [27] [23] [I801 [I81 [87] [38] [252] - [lo] 1211

HIPH 6.2 0 0 0 0

[321 [41 [781 11561 [I41

HSER 5.4 0 0 0 4.4 5.6* 7 5.2* 0 0

[551 P I ] [51 [2] - [I141 [36] [285] [440] [47] [133]

HAS 0 0 0 0 0 0 0 0 0 0 0

[4Ol [321 [41 161 [31 - [491 [541 [5581 [4951 [871 11481

HSEL 0 0 50 0 0 0 0 0 0 0

[221 [241 [2] [31 - [35] [49] [I421 [12] [I541 [I211

HKT 0 0 1.87* 3.7* 3.1*

1131 [41 [lo71 ~8661 r321

HKGR 0 23.8* 39.4*

[41 [211 [941

ALL 8.9 11.5 1.5 0.7 0 0 0.8* 2.6* 1.0* 2.5* 0.7* yu

14691 [420] (1301 [291] [29.5] [19] [1015] [798] [4694] (47.591 [I6271 116981

[ ] No. tested * Resistant not verified

EDITORIAL BOARD


Advisor

Editor-in-Chief

Editors

Secretary

Editorial Assistant

Published by

EDITORIAL BOARD

Dr. Ng. Kok Han

Dr. Stephen Ambu

Dr. Azizah Radhi Dr. Sumitra Sithamparam Cik Nur Ain Meskam En Salleh Ismail

Pn. Siti Rodziah Othman

Puan Low Lian Geok

Institute for Medical Research Jalan Pahang 505 88 KUALA LUMPUR

Bangunan IMR - 1928

Bangunan IMR - 1977

Diterbitkan oleh:

Institut Penyelidikan Perubatan, Jalan Pahang, 50588 Kuala Lumpur, Malaysia.

Tel : 03-2698 6033 Fax : 03-2693 7367 e-mail: directomimr.gov.my

Documents

IMR Bulletin Jan Apr 2004