The causal explanation given by a 24-year-old Malay woman from a low socioeconomic class for her epilepsy is described. This case illustrates how cultural explanations can protect an individual from the stigma of illness. The Malay concept of the supernatural and the causation of illness is discussed.
Infants, one to 56-weeks-old, presenting with persistent diarrhoea were placed on a diet free of cow's milk protein which improved their clinical condition. Six weeks later, 67 infants were challenged with a low-lactose cow's milk formula and jejunal biopsy was taken before and 24-hours after challenge. On the basis of histological changes in the intestinal mucosa and development of clinical symptoms the infants were categorised into three groups: Group 1 (n = 16) with no clinical or mucosal abnormality, Group 2 (n = 20) with mucosal abnormality but lacking clinical symptoms, and Group 3 (n 31) with manifestation of mucosal abnormality and clinical symptoms. In addition to the total IgE the radioallergosorbent test (RAST) was performed on sera from the infants taken before and after milk provocation. The mean total serum IgE level ranged from 288 to 560 IU/ml. In Groups 2 and 3 the prechallenge serum IgE levels were significantly higher than the postchallenge levels but in Group 1 the levels remained unchanged on challenge. A positive RAST to milk proteins was observed in five infants (7.4%), that is, one in Group 2 and four in Group 3, of 67 infants studied. In a survey of 405 consecutive paediatric-age patients admitted for a variety of symptoms, 90 were positive for RAST specific for milk proteins. Interestingly the majority of the patients positive for RAST presented with gastrointestinal ailments. The measurement of specific IgE appears not to be a useful adjunct in the diagnosis of CMPSE in Malaysian children.
Perforated appendix is a serious surgical condition that carries a high morbidity. Antibiotic treatment is often started before the availability of bacteriological reports. The choice of antibiotics would depend on the bacteriology associated with perforated appendix. In a retrospective survey of the bacteriology of peritoneal pus obtained from cases of perforated appendix at the General Hospital, Kuala Lumpur, E. coli was found to be the most commonly encountered organism. This was followed in order of decreasing frequency by streptococci, Bacteroides species, Klebsiella-Enterobacter group and Pseudomonas aeruginosa. From the results of the antibiotic sensitivities an antibiotic regimen comprising of a combination of gentamicin, metronidazole and penicillin is recommended as appropriate chemotherapy in perforated appendix.
A survey was conducted on three different groups of population viz. inpatients in the medical wards of General Hospital, Kuala Lumpur, the people of Kampong Pandan and two rubber estates as to their analgesic consuming habits. It is found that 0.5 to 2.0% of the people surveyed had consumed more than 2 kg of analgesics and 4.6 to 9.6% of the people surveyed had consumed more than 250g of analgesics. The commonest analgesic consumed is paracetamol followed by Chap Kaki Tiga and Chap Harimau. The commonest reason for consuming analgesic is headache. The implications of the above findings are discussed.
One of the important functions of the Coronary Care Unit (CCU) is the continuous and intensive monitoring of cardiac function. To date, many monitoring techniques have been developed and tested. In this paper, both the conventional and computerised monitoring techniques are reviewed and evaluated. It is shown that a computerised system has several defirute advantages over the conventional system, e.g. lower false alarm rate, accurate and fast data processing, retrospective studies. However one also ought to be aware of the limitations,
MeSH terms: Arrhythmias, Cardiac/diagnosis; Coronary Care Units*; Electrocardiography*; Humans; Monitoring, Physiologic*; Signal Processing, Computer-Assisted*
An epidemiological investigation was carried out on a food borne outbreak in a National Type Primary School (Chinese). The findings of the outbreak are reported. Of the 495 Chinese students (ages between 7-12 years) interviewed, 321 were exposed to one or more of the food items sold at the school canteen. The median incubation period was one hour for the outbreak. The main symptoms were related to the upper gastro-intestinal tract (nausea and vomiting). Fried meehoon (rice vermicelli) was suspected as being the responsible vehicle. The causative organism was Staphylococcus aureus. 48 cases were treated in the Main Health Centre, Kapar.
200 doctors are gazetted as practising in Sarawak in 1982. 88% are males and only 12% are females. Of the 200, 65.5% are Chinese and the natives of Sarawak and Indians form 15.5% each. Nearly 30% are graduates from local universities, 44% from universities in Commonwealth countries and a few from universities in other countries. The majority of the doctors are under 40 years of age. 55 % are in government service, while 45% are in the private sector. All private practices are solo practices except three-one each in Kuching, Sibu and Miri which are based on partnership. The number of doctors with specialist qualifications is not known as it is not essential for these qualifications to be entered in the Register. The doctor-to-population ratio in Sarawak has improved from 1:14000 in 1964 to 1:6856 in 1982. To reach the Ministry of Health's target of 1:2500 by 1990, a yearly recruitment of 58 doctors would be needed from 1983 to 1990. This would be feasible if either an admission quota to the local medical faculties for Sarawakians is implemented or more doctors are posted to serve in Sarawak.
One-hundred-and-four patients unth. hand eczema were studied. The female to male ratio was 1.9:1 and peak incidence was in young adulthood. In females, housewives constituted the biggest group while in males, mechanics/engineers was the biggest group. 30% of the patients had contact sensitivity on patch testing to a standard series. Balsams, medicaments, rubber ingredients, nickel and formaldehyde were the common allergens. The contact sensitivity was considered relevant in 65% of cases.
MeSH terms: Dermatitis, Atopic/etiology; Dermatitis, Atopic/epidemiology; Dermatitis, Contact/etiology; Dermatitis, Contact/epidemiology; Female; Hand Dermatoses/etiology*; Hand Dermatoses/epidemiology; Humans; Malaysia; Male
A survey on the incidence of Salmonellae in soil was conducted on 12 kindergartens in the Klang District, The organism. was isolated from five (three urban and two rural) kindergartens from one or more soil samples tested. Ten isolates comprising six serotypes, namely, Salmonella bareilly, S. haifa, S. abony, S. weltevreden, S. agona and S. stanley, were encountered. The possible role that these soil isolates may play in the transmission. of salmonellae is discussed. The need to use more than one media in the detection of salmonellae is emphasised.
Serum prolactin (hPRL) levels in nonpregnant, pregnant and postpartum women during sleep were investigated. The study showed that in non-pregnant women, there is an immediate shift of hPRL release with reversal of sleeping period. Thus, the nocturnal surge for prolactin is sleep related. In pregnant women, however, while there is an increase in hPRL level during pregnancy, the nocturnal rise of this hormone is not detected and this is observed as early as the first trimester of pregnancy.
A prospective study was performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur. Over a period of 14 months from 1 January 1982, 12 new cases of analgesic nephropathy (AN) were documented. Contrary to the experience in the West and in Australia, AN in Malaysia tends to have a male preponderance and occurs even in the younger age groups. The common analgesics abused are paracetamol, Chap Kaki Tiga and Chap Harimau. The main reasons for analgesic abuse are headache and arthritis. In addition to radiological features of renal papillary necrosis patients have the other manifestations of the disease such as peptic ulceration, anaemia, neuro-psychiatric disorders and ischaemic heart disease.
A clinical isolate of Salmonella typhi (Vi phage type 25), resistant to chloramphenicol, streptomycin and tetracycline, was examined for the presence of R plasmids. Results from conjugation, agarose gel electrophoresis and transformation experiments indicated that it harboured a single large self-transmissible R plasmid which coded for both the chloramphenicol and tetracycline resistance traits.
Eight infants between the ages of one and three months with prolonged conjugated hyperbilirubinaemia had duodenal aspirations performed to differentiate between biliary atresia and neonatal hepatitis. Four infants had bile-stained aspirates and in all of them the jaundice subsided completely by eight months of age. We have found duodenal aspiration a safe, inexpensive and simple procedure to undertake in helping us make a rapid differentiation between patients with conjugated hyperbilirubinaemia requiring urgent laparotomy and those that do not require surgery. This approach appears to be reliable although further studies need to be undertaken.
Features of the typical ameloblastoma of the mandible are outlined. Three cases managed by conservative surgical treatment maintaining the continuity of the mandible are described. The factors taken into consideration when instituting this method of treatment are discussed. Results obtained are encouraging.
Sexually deviant behaviour is a fairly common phenomenon but because it is socially embarassing, a few cases come forward for consultation and treatment on a voluntary basis. Most cases are referred by the law courts. Two such cases, one of exhibitionism and the other offetishism, were referred to the University Hospital, Kuala Lumpur in 1982. Their development histories were elaborated. A third case of sexual sadism came voluntarily for help out defaulted after the initial session. A review on the current western concepts on sexual deviation is included in the text. It is concluded that although it is generally thought that neurological conditions give rise to deviant sexual behaviour, this assumption should not be arrived at hastily, as many cases of organic mental disorders do not exhibit deviant sexual
behaviour.