An abnormal, fast-moving 5'-nucleotide phosphodiesterase isozyme was found in 90.0% of 20 Malaysian patients with primary hepatoma and in 23.5% of 391 Malaysian patients with various malignant diseases; it was also discovered in 42.9% of 14 Malaysian and American patients with clinically active hepatitis B infection; in 16.7% of 18 healthy American blood bank donors who were positive for hepatitis B surface antigen (HBsAg); in 13.9% of 287 healthy Malaysian blood bank donors, some positive for HBsAg; and in none of 160 healthy American donors who were negative for HBsAg. A correlation of this abnormal isozyme with hepatoma and with infectious hepatitis B is clearly evident.
The first major Malaysian epidemic of dengue hemorrhagic fever with severe manifestations occurred in 1973, with 969 reported cases and 54 deaths. In a detailed study of 138 clinically diagnosed and laboratory confirmed cases at the General Hospital in Kuala Lumpur, hemorrhagic manifestations were observed in 68.7% and shock in 18.1% of the patients. The cases occurred mainly from May to September, largely in urban and suburban areas of the majority of the states in the country. A main focus of infection was Jinjang, a heavily populated outlying district of Kuala Lumpur, where unusually high incidences of morbidity, severe disease and mortality were seen. Severe disease was seen mostly in children under the age of 15 years, although a significant number of adults suffered milder illnesses. The Chinese population was chiefly affected, due to their living in crowded, low-income housing where the vector, Aedes aegypti, occurred in the greatest numbers. All four dengue types were recovered during the epidemic period, although dengue 3 (DEN-3) was incriminated as the major epidemic type. Entomological data revealed high indices of A. aegypti throughout the country and left little doubt that this epidemic was aegypti transmitted. Spraying and fogging operations were carried out in attempts to control vector populations.
A pilot study was conducted based on a questionnaire sent to Malaysian physicians surveying their opinions on 1) the value of traditional Malay medicine and 2) the role of auxiliary cosmopolitan health care practitioners-- Hospital Assistants (HA), in rural health care. The 98 responses (23%) can not be held representative of all Malaysian physicians, but emphasize the need for a more thorough survey. Three-fourths of the responding physicians found it of potential value to have their patients see a traditional Malay healer (bomoh) in certain circumstances and a majority supported closer contact between traditional Malay and cosmopolitan medical systems, particularly in the area of mental health care. The majority of physician respondants did not see the role of the HA as permanent and stated. that HAs should gradually be replaced by physicians. More general practitioners and physicians now practicing in rural areas held this opinion than physicians in other specialties. The issues of the appropriate roles and interrelationships of HAs and tradtional Malay folk healers within an overall health care system are complex, yet pertinent to the future of rural health care in Malaysia and warrant further study and consideration.
An investigation of an outbreak of acute conjunctivitis in Kuala Lumpur from May to August 1978 was made. A total of 2,133 cases was involved, most of whom were adult Malay males of low income status from the surrounding villages and low-cost flats. The majority of cases had bilateral conjunctivitis with clear discharge. Pain and subconjunctival haemorrhage were not common and recovery, mostly without complications, occurred within 1 week. Eye scrapings and paired sera specimens were examined and the causal agent was found to be Coxsackievirus A24 (CA24).
The high incidence of primary liver cancer in Malaysian males is not observed in childhood, where it constitutes 0.16 per 1000 paediatric hospital admissions and 3.20/0 of all childhood malignancies at the University Hospital, Kuala Lumpur. This frequency is comparable to that reported from several developed countries. The commonest liver tumour in children is the hepatoblastoma which is probably of embryonal origin and has a similar world wide "incidence. The relative infrequency of hepatocellular carcinoma in childhood and its association with cirrhosis, the hepatitis B antigen and its prevalence in the older age group helps to substantiate an acquired environmental aetiology.
MeSH terms: Child; Child, Preschool; Adenoma, Bile Duct/epidemiology*; Female; Carcinoma, Hepatocellular/epidemiology*; Hospitals, University; Humans; Infant; Liver Neoplasms/epidemiology*; Malaysia; Male
279 cases of pulmonary tuberculosis were diagnosed during a 10 year period from 1969 to 1978. 60% as a result of self-referral and 40% from mass miniature radiography of the chest. For every case of pulmonary tuberculosis picked up, the number of MMRs required has been steadily rising from 1 in 1900 to 1 in 6700. Using South Korea study figures, it costs US$42600 for a case of pulmonary tuberculosis detected by MMR. Besides being not cost effective, there is little advantage in early detection with regard to prognosis, in preventing subsequent cases and in picking up other lung or cardiac abnormalities. Unnecessary radiation results from frequent MMR whose dosage is 10 or more times greater than standard chest X-rays. MMR should be limited to. contact tracing, prior to overseas courses and on termination of service.
Study site: medical boards submitted to Medical Directorate, Ministry of Defence, Malaysia
MeSH terms: Cost-Benefit Analysis; Humans; Malaysia; Mass Screening*; Military Medicine/economics*; Tuberculosis, Pulmonary/radiography*
A total of 736 sera collected from cord blood babies, children and adults of both sexes and of different age groups in Malaysia were tested using indirect fluorescent antibody technique for Toxoplasma antibodies. The RH strain of Toxoplasma gondii zoites were used as antigen. One hundred and twenty five sera which were reactive at 1:64 or high titres were tested with IgM specific conjugate. Results of the present studies showed that the prevalence of Toxoplasma antibody was highest among the Malays and lowest among children than among adults. The significance of Toxoplasma specific IgM was discussed.
The presence, in the fruit of Averrhoa carambola (star fruit), of a depressant agent with properties similar to those of tranquilizers was demonstrated.
Non-haemoglobin liver iron was estimated in 275 presumably normal individuals from Kuala Lumpur and Singapore at necropsy. Liver Iron concentrations were highest during the first two years after birth but declined sharply during childhood. They then rose gradually and reached a value of 20 mg/100gm in adult males. Liver iron concentrations of childbearing women remained low and it was only after menopause that values in women rose to those of males. Liver iron stores increased with age to a plateau of about 300 mg in adults, suggesting that this value may represent the adult size for liver iron store. Among the three major ethnic groups in Malaysia and Singapore, Chinese, being in a better socio-eonomic class, had larger liver iron stores. The median liver iron concentrations of Malaysians and Singaporeans, on the whole, were lower than those reported from western populations and as many as 35 per cent of the women were in a subclinical state of iron deficiency.
A serum survey of several characteristic groups of humans in urban, rural, and forested areas of Peninsular Malaysia for evidence of infection with three alphaviruses (Sindbis, getah, and chikungunya) was made on 4384 specimens collected between 1965 and 1969. Analysis of the serological results indicated that 1) persons residing in predominantly rural and forested areas have higher frequencies of specific alphavirus antibody of all three viruses than persons residing in urban areas, 2) human infection with chikungunya virus appears to be at a low level of activity but is widespread, although more common and recent in the northern part of the country, and 3) Sindbis and getah viruses probably do not represent a threat to the public health, but chikungunya virus remains a potential menance and may be responsible for future epidemics transmitted by A. aegypti and A. albopictus mosquitoes.