Determining the Required Vitamin D Level for Bone Health Based on Bone Turnover Markers

Tuan Salwani Tuan Ismail,Bayani Che Muda,Roznie Aida Mohd Rosdi,Azalina Zainuddin,Salbiah Isa,Zulkarnain Mustapaha 대한임상검사과학회 2017 대한임상검사과학회지(KJCLS) Vol.49 No.4

To date, no clear threshold that has been established for defining an adequate store of vitamin D for bone health. Therefore, this study aims to determine the required level of vitamin D to maintain a healthy skeleton based on bone remodelling process among healthy adult population. This was a cross sectional study, involving a healthy adult population in Kota Bharu, Malaysia, aged 18∼50 years. We measured serum 25(OH)D (vitamin D), serum parathyroid hormone (PTH), serum C-terminal telopeptide of type 1 collagen (CTX), and Procollagen 1 Intact N-Terminal (P1NP) in 120 healthy adults selected via multi stage sampling (64 males, 56 females) from 6 subdistricts in Kota Bharu. The mean level of 25(OH)D was 23.50 (±8.74) nmol/L. There was a significant difference of the vitamin D level between genders (26.81±8.3 nmol/L vs 19.72±7.68 nmol/L in males and females respectively) (p value<0.001). More than 50% of female subjects had 25(OH)D less than 20 nmol/L, while only 20.3% of male subjects had 25(OH)D below 20 nmol/L. Based on the LOESS plot, the bone turnover markers showed a plateauing result, at the 25(OH)D level of 35 nmol/L for CTX and 20 nmol/L for P1NP. Contrastingly, PTH showed a step rise in the 25(OH)D level of 20 nmol/L. Based on the LOESS plot for CTX, P1NP and PTH versus 25(OH)D, level of vitamin D between 20 to 35 nmol/L is recommended to maintain healthy skeleton.

Determining the Required Vitamin D Level for Bone Health Based on Bone Turnover Markers

Ismail, Tuan Salwani Tuan,Muda, Bayani Che,Rosdi, Roznie Aida Mohd,Zainuddin, Azalina,Isa, Salbiah,Mustapaha, Zulkarnain Korean Society for Clinical Laboratory Science 2017 대한임상검사과학회지(KJCLS) Vol.49 No.4

To date, no clear threshold that has been established for defining an adequate store of vitamin D for bone health. Therefore, this study aims to determine the required level of vitamin D to maintain a healthy skeleton based on bone remodelling process among healthy adult population. This was a cross sectional study, involving a healthy adult population in Kota Bharu, Malaysia, aged 18~50 years. We measured serum 25(OH)D (vitamin D), serum parathyroid hormone (PTH), serum C-terminal telopeptide of type 1 collagen (CTX), and Procollagen 1 Intact N-Terminal (P1NP) in 120 healthy adults selected via multi stage sampling (64 males, 56 females) from 6 subdistricts in Kota Bharu. The mean level of 25(OH)D was 23.50 (${\pm}8.74$) nmol/L. There was a significant difference of the vitamin D level between genders ($26.81{\pm}8.3nmol/L$ vs $19.72{\pm}7.68nmol/L$ in males and females respectively) (p value<0.001). More than 50% of female subjects had 25(OH)D less than 20 nmol/L, while only 20.3% of male subjects had 25(OH)D below 20 nmol/L. Based on the LOESS plot, the bone turnover markers showed a plateauing result, at the 25(OH)D level of 35 nmol/L for CTX and 20 nmol/L for P1NP. Contrastingly, PTH showed a step rise in the 25(OH)D level of 20 nmol/L. Based on the LOESS plot for CTX, P1NP and PTH versus 25(OH)D, level of vitamin D between 20 to 35 nmol/L is recommended to maintain healthy skeleton.

Important Considerations in Manufacturing of Natural Fiber Composites: A Review

Jamiluddin Jaafar,Januar Parlaungan Siregar,Salwani Mohd Salleh,Mohd Hazim Mohd Hamdan,Tezara Cionita,Teuku Rihayat 한국정밀공학회 2019 International Journal of Precision Engineering and Vol.6 No.3

The paper overviews the essential considerations in the manufacturing process of natural fiber composites which influence the performance of biocomposites. The evaluation of thermal properties of composites matrix and natural fiber chemical composition and physical properties appears to be necessary as the initial screening factors before the manufacturing process of biocomposites. On the other hand, considerations on fiber composition, type of manufacturing process and parameter used are seen as other crucial significant factors that need to be focused during the manufacturing of biocomposites. Moreover, the treatment used in the manufacturing process such as alkali treatment and coupling agent utilization should also be highlighted as additional important measures for better performance of biocomposites. In this review, all significant factors that influence the performance outcome of natural fiber composites are highlighted to provide the base-line source of literature for the manufacturing and production of composites sample. It is expected that the findings from the present study could further enhance the performance of natural fiber composites and able to become the preferred alternative or replacement for petroleum-based polymer in various industrial and commercial applications in the future.

Multiple Endocrinologic Complications in Thalassemia Major

Wong, Siong Hu,Omar, Julia,Ismail, Tuan Salwani Tuan Korean Society for Clinical Laboratory Science 2017 대한임상검사과학회지(KJCLS) Vol.49 No.4

Thalassemia major is a genetic disorder with a defective synthesis of either the alpha or the beta chain of hemoglobin A. Blood transfusion is crucial for the survival in these patients. Unfortunately, endocrine dysfunction is a very common complication in these patients and is principally due to excessive iron overload as a result of frequent blood transfusions. Although regular blood transfusion may increase life expectancy, disturbances in growth and pubertal development, abnormal gonadal functions, impaired thyroid, parathyroid and adrenal functions, diabetes, and disorderly bone growth are common side effects. We hereby present a case of a 23-year-old, unmarried woman with beta thalassemia major presenting with primary amenorrhea, poor development of secondary sexual character, and short stature. Thorough history, clinical examination, and laboratory investigation, including dynamic function test (insulin tolerance test) were conducted. These tests confirmed that she had multiple endocrinopathies, including hypogonadotropic hypogonadism, growth hormone deficiency, and subclinical adrenal insufficiency, which were caused by iron overload. She required hormone replacement therapy. Early recognition of possible deficiencies in hypothalamo-pituitary-end organ hormones caused by iron overload in thalassemia patients that undergo frequent blood transfusion procedures is essential. Appropriate treatments, including transfusion regimen and chelation therapy, as well as specific treatment of each complication are the crucial for the successful management and improvement of quality of life these patients.

Gonadotropin-releasing hormone stimulation test and diagnostic cutoff in precocious puberty: a mini review

Siti Nadirah Ab Rahim,Julia Omar,Tuan Salwani Tuan Ismail 대한소아내분비학회 2020 Annals of Pediatirc Endocrinology & Metabolism Vol.25 No.3

The gonadotropin-releasing hormone (GnRH) stimulation test is a valuable tool in diagnosing and differentiating causes of early pubertal occurrences. Utility of the test can be limited in some instances, however, including the early phases of pubertal hypothalamic-pituitary-gonadal axis activation, in girls showing commonly overlapping pictures, and in obese children due to excess circulating estrogen that suppresses luteinizing hormone (LH). A lack of consistent baseline and stimulated gonadotropin cutoffs observed in different studies also contributes to limitations in testing. Nevertheless, early detection of true pathological causes for pubertal disorders is needed to allow prompt treatment and better prognosis. While basal LH can be beneficial as a good screening tool for detecting pubertal disorder, it does not preclude the need for GnRH testing. The aim of this review was to highlight the role of GnRH stimulation tests and varying testing cutoffs in diagnosis of precocious puberty and its classification.

Multiple Endocrinologic Complications in Thalassemia Major

( Siong Hu Wong ),( Julia Omar ),( Tuan Salwani Tuan Ismail ) 대한임상검사과학회 2017 대한임상검사과학회지(KJCLS) Vol.49 No.4

Thalassemia major is a genetic disorder with a defective synthesis of either the alpha or the beta chain of hemoglobin A. Blood transfusion is crucial for the survival in these patients. Unfortunately, endocrine dysfunction is a very common complication in these patients and is principally due to excessive iron overload as a result of frequent blood transfusions. Although regular blood transfusion may increase life expectancy, disturbances in growth and pubertal development, abnormal gonadal functions, impaired thyroid, parathyroid and adrenal functions, diabetes, and disorderly bone growth are common side effects. We hereby present a case of a 23-year-old, unmarried woman with beta thalassemia major presenting with primary amenorrhea, poor development of secondary sexual character, and short stature. Thorough history, clinical examination, and laboratory investigation, including dynamic function test (insulin tolerance test) were conducted. These tests confirmed that she had multiple endocrinopathies, including hypogonadotropic hypogonadism, growth hormone deficiency, and subclinical adrenal insufficiency, which were caused by iron overload. She required hormone replacement therapy. Early recognition of possible deficiencies in hypothalamo-pituitary-end organ hormones caused by iron overload in thalassemia patients that undergo frequent blood transfusion procedures is essential. Appropriate treatments, including transfusion regimen and chelation therapy, as well as specific treatment of each complication are the crucial for the successful management and improvement of quality of life these patients.

Poster Session : PS 0326 ; Hematology : Splenic Tuberculosis Presenting as Hemophagocytic Syndrome : A Case Report

( Ganis Irawan ),( M Riswan ),( Krishna Sucipto ),( Hendra Zufry ),( Desi Salwani ),( Muslim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Hemophagocytic syndrome (HPS) is a rare, life-threatening, hematologic disorder which might arises secondary to infection, autoimmune disease or malignancy. It is most often characterized by prolonged fever, splenomegaly, and cytopenia of at least two lineages. Splenic tuberculosis is a rare form of extrapulmonary tuberculosis. No particular set of clinical symptoms or imaging findings is characteristic for splenic tuberculosis. We are reporting a case of HPS associated with splenic tuberculosis in 36 year old male who was admitted to our hospital due to persistent fever for the past 3months. He complained of distended belly, weakness, night sweats and weight loss. He lives in a rural village which is known to be an endemic area of malaria and tuberculosis. Histopathological examination of spleen tissue supported the diagnosis of splenic tuberculosis. Diagnosis of HPS were established by the presence of fever, splenomegaly, pancytopenia, hypofi brinogenemia and serum ferritin level more than 500 μg/l. Additional supportive evidences were hepatomegaly, elevated lactate dehydrogenase and slightly-hypoplastic marrow.

Finite Element Analysis of Buckling Behavior for Cold-Formed Steel Hat Purlins with Openings

Fatimah De’nan,Kok Keong Choong,Jin Ying Ling,Nor Salwani Hashim 한국강구조학회 2022 International Journal of Steel Structures Vol.22 No.4

In urban building design, introducing openings in the webs of structural members allows the fl exible installation of ductwork and piping. This study investigated the eff ects of the shape, location, and spacing of web openings on the buckling behavior of cold-formed steel hat purlins. Eigenvalue analysis shows that the existence of web openings reduced the buckling moment of a section by up to 24%. The shape and location of the web openings also aff ected the buckling behavior. In particular, the buckling moment decrease when the web opening was located at mid-span. It was found that, the buckling moment increase when the web opening spacing increases. The section with diamond web openings shows the highest buckling moment and the section with elongated circle openings shows the smallest buckling moment compared to other web opening shapes. The results of this study should provide guidance on hat purlins with openings design to meet structural performance requirements.

Perforation Effect on the Bending Behaviour of Cold-Formed Steel Hat-Purlin Section

Fatimah De’nan,Kok Keong Choong,Jin Ying Ling,Nor Salwani Hashim 한국강구조학회 2022 International Journal of Steel Structures Vol.22 No.1

Many structural members, for example, cold-formed steel members, hot-rolled steel members, and composite beams were extensively used in steel construction due to economic development in cities building design. This was to allow fl exible installation of ductwork, piping and other systems. Substantial research has been performed on Channel and Zee cold-formed steel sections, but the papers on Hat section steel purlins turned out to be few only, especially Hat-purlin with perforations. Hence, numerical study on cold-formed Hat section steel purlin with perforation was carried out to investigate the eff ect of perforation to bending behaviour of such sections. Finite element method using LUSAS software was chosen to carry out the research study. Five diff erent perforation shapes were selected, which were circle, diamond, C-hexagon, square and elongated circle. Perforation depth was fi xed at 0.5D2, where D2 is the inclined web depth of the section. The results showed that perforated section had lower bending moment than that of the section without perforation, with a percentage diff erence of not more than 4%. Most of the perforated sections had similar bending characteristic despite of the diff erence in perforation shapes, where the yield moment diff erence was less than 2%. Critical opening length played a crucial role in aff ecting the bending behaviour of section. Furthermore, the location of perforation also infl uenced the bending behaviour of Hat-purlin. Regardless of perforation spacing, the perforated sections with equal number of perforations behaved similar elastic characteristic before yielding. Section with diamond perforation had higher bending moment than other perforated section whereas section with elongated circle perforation had the lowest bending moment. The presence of perforations gives minor eff ect on the bending behaviour of cold-formed steel Hat-purlin.