MEDICAL SURVEILLANCE - Noise

This past few weeks I am really busy analysing audiometric results of employees from 2 of our corporate clients. Analysing the audiometric results is very time consuming and painful especially if you dont have the previous result in hand. Lucky for me as I have created the audiometry surveillance database for me to keep the data of my clients so that I can compare their current audiometric results with the previous one. This is important especially if we want to determine the occurence of standard threshold shift (STS).

After the analysis done, the reports need to be revealed to the workers as well as their employer. Advising the employer on the important of implementing the Hearing Conservation Program is very important. Nonetheless, educating the employee on the risk of noise to their hearing and the important of wearing Hearing Protective devices is very challenging.

Generally, the findings will be classified into 3 categories:

1. Normal Hearing

2. Hearing Impairment

3. Noise Induced Hearing loss (hearing loss at high frequency 3 Khz - 6 Khz or typical 4 Khz notching).

The category 2 & 3, need to be notified to DOSH. Here is the problem start to emerge, some employers look scary and try to argue about the findings.

My advice to them will be:

Implement the Comprehensive Hearing Conservation Program and DOSH will be pleased with your effort.

Note: The above picture was captured from my humble database created using Filemaker Pro

Host-Agent-Environment Paradigm

Before we explore 'Health Prevention Concept' further, it is important at this juncture to understand another paradigm called 'Host-Agent-Environment' which contributes to ill health condition. In this paradigm, the Host, Agent and Environment interact with each other to form a condition that favors ill health or disease to occur. The Host is the person who has or at risk of specific disease. The Agent is the organism or direct cause of the disease. In occupational health we called its health hazards categorised as Biological, Chemical, Ergonomics, Physical and Psychological (BCEPP). The Environment includes the external factors which influence the host or his susceptibility to the agent and also the vector which transmits or carries the agent from the environment to the host. This paradigm explains the causation and transmission of many diseases. The combination of factors in these 3 premises in effects form a contagion of theories of disease causation.

The factors in the host which contributes to his susceptibility to the disease are age, gender, genetic, occupation, lifestyle, education etc. The agent's factors which contribute in disease susceptibility in the host are biological, type, characteristics etc. The factors in the environment are the economic, social condition,climate etc. This 'Host-Agent-Environment' complex interaction only can cause disease with Allah Willing.

BUERGER'S DISEASE

Tonite, one gentleman in his late twenties, came to our A&E Dept. with the above problem. He is suffering from this problem more than one year. He was previously treated in government hospital. On further questions, he claimed that he was a heavy chronic smoker and just quit recently. He came to A&E because he could not stand the pain on his fingers and toes. Some of his fingers and toes were already lost. At a glance, I diagnosed him as having Buerger's Disease. Detail about Buerger's Disease you can read here and also here.

When I asked him what is his occupation, he replied, "I was working at the Chemical Production Company. Now I already quit". I dont know whether his occupation has some relationship with his illness or not. I need to do some literature review on this subject. However, as far as my clinical knowledge on Buerger's Disease,I am sure it is related to heavy tobacco smoking. With this posting, I urge all of my fellow visitors of this blog who are smokers, please QUIT SMOKING. It is better now than later.

SWINE FLU RESOURCE

WHO raised its pandemic alert level over the deadly swine flu virus to PHASE 5.

What is Swine Flu?

Swine influenza or "Swine Flu" is a highly contagious acute respiratory disease of pigs, caused by one of several swine influenza A viruses.

For detail, click the following resource websites:

1. Ministry of Health Malaysia website on Swine Flu

2. Dr Vadivale's website on Swine Flu

3. WHO website: Swine Influenza Frequently Asked Questions

4. MOH & SOEM's Recommendations on Influenza Pandemic Prepareness for Industry in Malaysia

AWARENESS TALK ON HIV & AIDS

My 2nd Health Talk for IOT staff was held on 22 Dec. 2008 at its conference room. 15 staff attended the talk. To share some information of the latest statistic of HIV/AIDS in Malaysia:

Since 1986 until Dec. 2008 : 80 938 of HIV infected cases was reported in Malaysia. 13 636 were confirmed to have AIDS and 10 334 of them died.*This figure is from MAC & MOH.

The above figures revealed that 13 Malaysian were infected by HIV per day and 3 Malaysian suffering from AIDS per day.

HIV and AIDS is NOT the same ; HIV is the virus, AIDS is the disease. HIV only can be transmitted through blood, body fluid (semen & vagina fluid) and from mother to her fetus.

HIV carrier normally appears healthy as you and me, so it is difficult to differentiate them. The only way to fight HIV/AIDS is through PREVENTION. HIV/AIDS is not merely medical problem, it is a social problem....... everybody needs to fight inorder to prevent it from spreading. One of the preventive measures is to have a healthy life style. Note: 1 December every year is WORLD AIDS DAY.

You can visit Malaysian AIDS Council (MAC), here

Here is the list of reference, click

LEAD POISONING

In 2nd week of December recently, I examined one patient, 25 years old foreign worker, who was brought to our hospital's Accident & Emergency (A&E) Department around 9:00 a.m. for having severe abdominal pain associated with vomiting after taking food.

 2 week earlier, he came to our A&E with  the same problem and was treated as outpatient as a case of acute gastritis. His symptoms was relieved after given treatment.

This time, his symptoms were really severe, described as crampy abdomen and generalised body weakness. Clinical examination however showed his abdomen was soft but the bowel sound was hyperactive. Vital signs was stable. *Later examination also found he has bluish discoloration line of his gum (Burton's line) which is the sign of plumbum poisoning.(See photo on the top).

Due to severity of his symptoms , he was advised for admission.

He came with a company driver  where he works for 2 years. The company main business is battery manufacturing.

Initially I suspected the patient has Acute Gasteroenteritis (AGE) but later included Acute Lead Poisoning as the diagnosis after obtained his occupational history. His blood was sent for Lead/Plumbum level as well as full blood investigations.

Mean while  he was investigated for other causes of acute abdomen including abdominal xray(AXR) and abdomen ultrasound(AUS) and blood amylase as ordered by Physician in-charge. AXR & AUS were suggestive of subacute abdominal obstruction, however his blood amylase was normal. His Full blood counts and picture showed a feature of iron defieciency anaemia.

5 days later, his blood lead result was ready with a reading of 212 microgram/dL which is more than 5 times of normal limit as allowed by  Factories & Machinery Act(FMA) 1967 (Lead Regulations 1984) and USECHH 2000 Regulation under OSHA 1994 ( less than 40 microgram/dL).

This case is very misleading and show the importance of occupational history in history taking of the patient to get a clue to diagnose  acute lead poisoning, otherwise the diagnosis can be missed or delayed.