Six independent isolates of Klebsiella from hospital environmental sources in Malaysia were found to be resistant to at least ampicillin, carbenicillin, cefoperazone, chloramphenicol, gentamicin and tetracycline. On the basis of their antibiograms, they were divided into four antibiogroups. They transferred all or part of their multiple antibiotic resistance traits to E. coli by conjugation. The results suggest that these Klebsiella strains harbour self-transmissible R plasmids. The significance of these findings are discussed.
One hundred and ten consecutive patients with falciparum malaria were treated with Fansidar and primaquine. Of the 61 patients who were followed up at one week, 4 (6.5%) failed to clear their parasitemia (1 R III and 3 R Il treatment failures). Of the subsequent 40 patients who were seen again at one month, another 3 (7.5%) had recrudesced (R 1 treatment failure). A total of 7 patients thus experienced some form of treatment failure in the cohort of 40 who completed the one month follow up. Only 1 of these 7patients (with R III treatment) failure) failed to respond to repeat Fansidar treatment, and may be the only one with true Fansidar resistance. The overall treatment failure rate of 17.5% (95% confidence interval: 6-29%) in the cohort who completed the study is consistent with the known clinical efficacy of Fansidar. These results suggest no significant Fansidar resistance in falciparum malaria found in Sabah.
The sensitivities and specificities of the indirect microimmunofluorescent antibody (IFA) and Weil-Felix (OXK) tests for scrub typhus were established for a range of titers using groups of diseased and control (other febrile illnesses) patients diagnosed by other methods. At a cut-off point of greater than or equal to 1:400, the IFA test was 0.96 specific, and at greater than or equal to 1:320, the OXK was 0.97 specific. Using either these highly specific levels of antibody or other rigorous diagnostic criteria (isolation or 4-fold rising titers), the prevalence of scrub typhus infection was determined to be 0.22 in an unselected population of febrile patients in a rural Malaysian hospital. Probability values (Pr) for the correct diagnosis of scrub typhus were then calculated from the specificity, sensitivity and prevalence determination for a range of titers. The Pr for an OXK titer of greater than or equal to 1:320 was 0.79, and the Pr for an IFA titer of greater than or equal to 1:400 was 0.78. When both these titers were present in a single specimen, the Pr increased to 0.96.
The belief that it is unwise to alter the initial response to a multiple choice question is questioned. Among 39 380 MCQ responses, there were 1818 changes (4.62%) of which 21.9% were correct to incorrect responses, 46.3% incorrect to correct responses and 31.8% incorrect to incorrect. This effect was very much more marked among the better students, incorrect to correct changes accounting for 61% of the responses in the upper group, 42% in the middle group and 34% in the lower group.
Albendazole, a new anthelmintic drug was evaluated in Malaysia in 91 patients, with single or mixed infections of Ascaris, Trichuris, and hookworm. Albendazole was administered as a single dose of 400 mg, 600 mg, or 800 mg. The cure rate for Ascaris at all three doses was 100% at days 14 and 21 post-treatment; for hookworm it was 98.8%, 100% and 98%, respectively, at day 14 and 68.8%, 100% and 84%, respectively, at day 21; for Trichuris it was 31.2%, 57.1% and 42.3%, respectively, at day 14 and 27.3%, 60.9% and 48.0%, respectively, at day 21. The egg reduction rate at day 21 was 100% at all three doses for Ascaris, 94.5%, 100% and 96.1%, respectively, for hookworm; and 39.2%, 85.1% and 72.8%, respectively, for Trichuris. There were no side effects, and biochemical examination of blood and urine did not indicate any unfavourable changes. Based on this trial, the recommended dosage for Ascaris and hookworm is a 400 mg single dose, and for Trichuris is a 600 mg single dose. Albendazole appears to be more effective than other available anthelmintic drugs.
To determine if the unusually high incidence of salmonellosis reported on Guam for several years might be the result of more frequent bacteriologic examination of gastroenteritis/diarrhoea patient stool specimens, a survey of medical clinic and laboratory activities was undertaken among countries in the Pacific Basin Area. Survey results suggest that while Guam laboratories may be particularly proficient in isolating Salmonella organisms, the quantity of stool specimens examined could not account for the higher incidence of salmonellosis observed on the island.
A retrospective analysis of 285 patients who had sustained maxillojacial fractures over a period of a decade was undertaken. The commonest cause of injury was motor vehicle accidents (71.9%). The mandibular body was the most common site fractured. 80% of the patients were males and almost 50% were Chinese. Practically all types of fixation were employed. The results obtained were satisfactory.
A consecutive series of 56 male patients with uncomplicated gonococcal urethritis were treated with 2 gm of kanamycin intramuscularly. Twenty (35.7 per cent) specimens of gonococcus were PPNG, while 36 (64.3 per cent) were non-PPNG. An overall failure rate of 12.2 per cent was observed. Further breakdown showed failure rate of 20 per cent with PPNG and 7.7 per cent with non PPNG.
31 cases of ocular toxoplasmosis were seen at the Ophthalmology Clinic, Uniuersiti Kebangsaan Malaysia, Kuala Lumpur during a one-and-a-half year period. All these cases were diagnosed as congenital ocular toxoplasmosis. As this condition appears not to be uncommon in. Malaysia, greater effort should be made towards its prevention especially among pregnant women.
Study site: Ophthalmology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Hailey-Hailey disease or Chronic Benign Familial Pemphigus is probably rare in this region and to date there is no case report from Malaysia. I report here a Malay patient with this disease but with no family history and who was believed to be suffering from Atopic Eczema for several years. Dapsone effectively controlled the disease in this patient. The clinical features, histology and the therapy are discussed.
Eighty-eight (1.96%) out of 4,500 patients had teeth stained by tetracycline. The majority had yellowish-brown stains (59.1%), whilst 37.5% had greyish-brown and 3.4% had black stains. A large number of teeth (79.6%) were stained up to two-thirds of their crowns. The deciduous teeth, permanent incisors and first molars were most commonly affected (73.9%). Teeth are only stained by tetracycline if this drug is administered during their calcification periods. For aesthetic reason, the drug should not be prescribed from the fourth month of pregnancy till the seventh year of life. The social embarrasment due to such discolouration may be overcome by tooth bleaching and construction of tooth facings and crowns.
Obturator hernia is a rare clinical entity usually presenting with strangulation. Preoperative diagnosis is seldom made and this has contributed to a high. mortality. One should suspect a strangulated obturator hernia in an elderly thin female patient presenting with vague abdominal symptoms or intestinal obstruction associated with a positive Howship-Romberg sign. Urgent laparotomy is indicated to establish the diagnosis and for resection of bowel if indicated.