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Background: Melioidosis is a tropical infectious disease associated with significant mortality due to early onset of sepsis. Objective: We sought to review case reports of melioidosis from Malaysia. Methods: We conducted a computerized search of literature resources including PubMed, OVID, Scopus, MEDLINE and the COCHRANE database to identify published case reports from 1975 to 2015. We abstracted information on clinical characteristics, exposure history, comorbid conditions, management and outcome. Results: Overall, 67 cases were reported with 29 (43%) deaths; the median age was 44 years, and a male preponderance (84%) was noted. Forty-one cases (61%) were bacteremic, and fatal septic shock occurred in 13 (19%) within 24–48 hours of admission; nine of the 13 cases were not specifically treated for melioidosis as confirmatory evidence was available only after death. Diabetes mellitus (n = 36, 54%) was the most common risk factor. Twenty-six cases (39%) had a history of exposure to contaminated soil/water or employment in high-risk occupations. Pneumonia (n = 24, 36%) was the most common primary clinical presentation followed by soft tissue abscess (n = 22, 33%). Other types of clinical presentations were less common—genitourinary (n = 5), neurological (n = 5), osteomyelitis/septic arthritis (n = 4) and skin (n = 2); five cases had no evidence of a focus of infection. With regard to internal foci of infection, abscesses of the subcutaneous tissue (n = 14, 21%) was the most common followed by liver (18%); abscesses of the spleen and lung were the third most common (12% each). Seven of 56 males were reported to have prostatic abscesses. Mycotic pseudoaneurysm occurred in five cases. Only one case of parotid abscess was reported in an adult. Of the 67 cases, 13 were children (≤ 18 years of age) with seven deaths; five of the 13 were neonates presenting primarily with bronchopneumonia, four of whom died. Older children had a similar presentation as adults; no case of parotid abscess was reported among children. Conclusions: The clinical patterns of cases reported from Malaysia are consistent for the most part from previous case reports from South and Southeast Asia with regard to common primary presentations of pneumonia and soft tissue abscesses, and diabetes as a major risk factor. Bacteremic melioidosis carried a poor prognosis and septic shock was strong predictor of mortality. Differences included the occurrence of: primary neurological infection was higher in Malaysia compared to reports outside Malaysia; internal foci of infection such as abscesses of the liver, spleen, prostate, and mycotic pseudoaneurysms were higher than previously reported in the region. No parotid abscess was reported among children. Early recognition of the disease is the cornerstone of management. In clinical situations of community-acquired sepsis and/or pneumonia, where laboratory bacteriological confirmation is not possible, empirical treatment with antimicrobials for B. pseudomallei is recommended. [ABSTRACT FROM AUTHOR]

Objectives: To establish the three-dimensional (3D) facial soft tissue morphology of adult Malaysian subjects of the Malay ethnic group; and to determine the morphological differences between the genders, using a non-invasive stereo-photogrammetry 3D camera. Material and Methods: One hundred and nine subjects participated in this research, 54 Malay men and 55 Malay women, aged 20–30 years old with healthy BMI and with no adverse skeletal deviation. Twenty-three facial landmarks were identified on 3D facial images captured using a VECTRA M5-360 Head System (Canfield Scientific Inc, USA). Two angular, 3 ratio and 17 linear measurements were identified using Canfield Mirror imaging software. Intra- and inter-examiner reliability tests were carried out using 10 randomly selected images, analyzed using the intra-class correlation coefficient (ICC). Multivariate analysis of variance (MANOVA) was carried out to investigate morphologic differences between genders. Results: ICC scores were generally good for both intra-examiner (range 0.827–0.987) and inter-examiner reliability (range 0.700–0.983) tests. Generally, all facial measurements were larger in men than women, except the facial profile angle which was larger in women. Clinically significant gender dimorphisms existed in biocular width, nose height, nasal bridge length, face height and lower face height values (mean difference > 3mm). Clinical significance was set at 3mm. Conclusion: Facial soft tissue morphological values can be gathered efficiently and measured effectively from images captured by a non-invasive stereo-photogrammetry 3D camera. Adult men in Malaysia when compared to women had a wider distance between the eyes, a longer and more prominent nose and a longer face. [ABSTRACT FROM AUTHOR]

Objective: It is clear that population-specific norms should be used when planning plastic and reconstructive surgery for selected patients. In this study, we aimed to generate nasal and labial reference values by applying a stereophotogrammetric technique. A further aim was to investigate the effect of sexual dimorphism, age-related changes, and the interrelation between nasal and labial morphology. Design: Cross-sectional study. Setting: The data were collected from different locations on the Malaysian peninsula. Participants: A total of 276 Asian Malays (138 males and 138 females) were included in this study, and a three-dimensional system was used for capturing data. The sample was divided into three age groups: 13 to 14, 15 to 17, and 18 to 36 years. Main Outcome Measure(s): Twenty-five dimensions of the nose and lips were measured and analyzed separately in males and females. Results: Significant differences between males and females were identified in 11 distances, and significant effects of age were found in most of the dimensions (p < .05). Significant correlations between the nasal and labial dimensions were recorded, particularly between lateral lip height and width of the ala insertion. A principal component analysis showed interrelationships between the nasal width distances and upper lip height. Conclusion: This study has provided a new three-dimensional database for nose and lip morphology in Malays and demonstrated patterns of variation that can be used by surgeons to make comparisons within and between different human populations and also to develop treatment plans for their patients. [ABSTRACT FROM AUTHOR]

The concentrations of Cd, Cu, Fe, Ni and Zn were analysed in different parts (shells, mantle plus gills and foot plus visceral mass) of the red blood cockle, Anadara granosa collected from an anthropogenic-receiving site at Kuala Juru and from relatively unpolluted sites at Jeram and Kuala Kurau. The metal concentrations (μg/g dry weight) in the total soft tissues of A. granosa ranged from 1.30-9.44 (mean: 4.69) for Cd, 91.9-203.5 (mean: 130.2) for Zn, 0.80- 16.15 (mean: 7.67) for Ni, 455.91-1125.5 (mean: 715.3) for Fe and 5.41-7.39 (mean: 6.14) for Cu. The present study revealed that the A. granosa was a potential biomonitor for Cu and Zn as observed in the comparison with those metals in the sediment. Although the elevated concentrations of Cu and Zn were found in the soft tissues of Kuala Juru's cockles, these metal concentrations were still below the maximum permissible limits established by the Malaysian Food Regulations 1985 and the WHO standard guidelines but the Cd concentrations of cockles from Jeram were higher than the maximum permissible limits established by both guidelines. As suggested by many reported studies found in the literature, regular biomonitoring of heavy metal concentrations at these three sites is needed since the edible A. granosa is a popular commercial bivalve in Malaysia. [ABSTRACT FROM AUTHOR]