Five patients were bitten by the Malayan krait Bungarus candidus (Linnaeus) in eastern Thailand or north western Malaya. Two patients were not envenomed but the other three developed generalised paralysis which progressed to respiratory paralysis in two cases, one of which ended fatally. One patient showed parasympathetic abnormalities. Anticholinesterase produced a dramatic improvement in one patient. Another patient probably benefited from paraspecific antivenom. The efficacy of antivenoms and adjuvants such as anticholinesterases in patients with neurotoxic envenoming requires further study.
Bacillus thuringiensis israeliensis (BTI) against culicine mosquitoes was tried out in cement sullage drains in Kelang municipal area at a dosage of 0.15 ppm. and 0.6 ppm. The results of the trial showed that at 0.15 ppm. the BTI was not effective, but at 0.6 ppm. it was effective giving about 95% kill. There was no residual effect and treatment had to be repeated weekly.
This paper attempts to explain both the persistence of traditional misconceptions about leprosy as well as the relative ineffectiveness of the Leprosy Control Programme. It has been pointed out that leprosy is a disease with tremendous social significance. To improve the Programme therefore, the human element which is of paramount importance must be identified and rectified. It is felt however, that we the providers should set our own house in order first. We need to find out the knowledge, attitudes and practices of the medical personnel and auxiliaries relating to leprosy, and identify the factors that contribute to their lack of motivation and undesirable attitudes which in turn deter patients from seeking and continuing treatment. Interventions based on the findings of such studies will contribute considerably towards the successful implementation of the Programme.
MeSH terms: Attitude of Health Personnel*; Humans; Leprosy/prevention & control*; Malaysia
A study was carried out to identify some of the cultural factors in the epidemiology of filariasis in an endemic community in Malaysia. The viewpoint of the community, data an responses on knowledge of illness and filariasis, host related factors, health examination, vector study were analysed and discussed. The observations noted on cultural factors were: Occupational pattern: Different agricultural occupations seemed to related to transmission in terms of body exposure. Activities not related to production of crops: Play groups in late afternoon, bathing of household members near and after sunset, congregations at prayer houses very much exposed the population to mosquito bites in different degree in terms of length of time spent outside the house. Knowledge of filariasis: Filariasis was understood in terms of elephantiasis, the chronic stage of the disease. Other signs of disease-adenolymphangitis, red lines running down one or both legs and abscess were generally recognized but not often annonated with specific disease. Attitude toward disease: Filariasis was not seen as a health problem and the idea of filarial worms was still hard to believe. Knowledge on disease causation: Biological causes were generally recognized, though the idea of bacteria was not widespread.
This report highlights some of the educational aspects on nutrition and tropical diseases. Health conditions in most of the countries in this region has improved but not at the same pace as the progress in medical sciences. The slow progress in tackling this problem has been partly due to the failure of understanding psycho-social, cultural and economic patterns. Many of the health workers and educators who are involved in the control of tropical diseases emphasize on practice rather than research. Due emphasis should be given to training and research in health education involving not only the professionals and auxiliary staff but also political leaders, policy makers and community leaders at grassroot level.
MeSH terms: Health Education*; Humans; Malaysia; Tropical Medicine*; Nutritional Sciences/education*
The present paper reviews the health problems of rural agricultural workers in Malaysia. As is common with most developing countries, the agricultural sector forms the pillar of the national economy in Malaysia, the major products being rubber, palm oil, rice and timber. Most of the agricultural workers, who form the largest occupational group in the country, live in the rural areas under poor socioeconomic and environmental conditions. Their general health problems include large families, substandard housing, overcrowding, lack of piped water supply and sanitary excreta disposal, malnutrition and prevalent diseases such as cholera, typhoid, dysentery and parasitic infections. The specific occupational health problems include infectious diseases, agricultural accidents, pesticide poisonings, physical hazards, keratitis nummularis and snake-bites. The organization of agricultural health services in developing countries is also discussed.
The IgM-globulin levels were determined for 5,167 cord-sera of apparently normal infants and 281 sera of defective infants aged 4 months and younger. The significant level for IgM-globulin in neonates was found to be 20 mgm/dl (2 SD above mean of the normal) above which the level was regarded as abnormally raised. Significant levels of IgM-globulin were found in 0.2% (11/5, 167) ofnormal neonates and in 40.6% (114/281) of defective infants which is more than 200 times the normal value. Combining the normal and abnormal rates, an overall figure of 23 intrauterine infections per 1,000 live births were obtained for Malaysia. The advantages and disadvantages of the use of serum IgM-globulin elevations for the diagnosis of intrauterine infections were discussed.
Enterobacteriaceae isolated from clinical sources were examined for antibiotic resistance and the ability to transfer resistance to Escherichia coli. Twenty-nine out of 80 strains tested transferred part or all oftheir resistance genes. The strains carrying R plasmids included the genera Escherichia, Klebsiella, Salmonella, Enterobacter, Proteus, Providencia and Citrobacter. These results indicate that R plasmids possibly play a major role in the emergence of antibiotic resistance among clinical isolates of Enterobacteriaceae.
MeSH terms: Drug Resistance, Microbial; Enterobacteriaceae/genetics*; Humans; Malaysia; R Factors*
Genital discharge from patients unth. smear positive gonorrhoea was transported from the clinic to the laboratory in. Stuart's transport medium (Oxoid CM 111). Within. six hours of transit time the recovery rate of gonococci was 94%. When compared with "bedside" inoculation onto Modified Thayer Martin medium, there was no significant difference in recovery rates up to 6 hours of transportation in Stuart's transport medium, However, the rate of isolation of gonococci was significantly reduced after 20 to 30 hours of transportation. It is concluded that Stuart's transport medium is an acceptable transport medium for specimens containing gonococci when specimens reach the laboratory within 6 hours of collection.
MeSH terms: Culture Media*; Evaluation Studies as Topic; Female; Gonorrhea/diagnosis*; Humans; Specimen Handling*; Time Factors
Enterotoxin production by strains of Staphylococcus aureus isolated from foods unconnected with outbreaks offood poisoning was investigated. Twenty-three percent of 217 strains examined produced enterotoxins A, B, C, D or E. Enterotoxin C was found to occur most frequently. Enterotoxin A was not detected alone from any of the strains examined, but occurred together with other enterotoxins. The overall number of strains isolated from raw foods which produced one or more enterotoxins was higher than that for cooked foods. Antibiotic sensitivities were unrelated to enterotoxin production and no correlation could be found between methicillin resistance and enterotoxigenicity.
MeSH terms: Drug Resistance, Microbial; Enterotoxins/biosynthesis*; Food Microbiology*; Staphylococcus aureus/metabolism*
Two outbreaks involving 31 persons with jaundice are described. All had originally been diagnosed as having viral hepatitis. But subsequent investigations showed that all had been exposed to chloroform at work. Toxic jaundice from chemical exposure presents a similar clinical picture to that of viral hepatitis, but fever appears to be uncommon. Doctors who look after workers should be familiar with the type of work and health hazards of their patients. A knowledge of occupational medicine and epidemiology would enable doctors to help in detecting and preventing
occupational disease.
Two patients with ascending aortic aneurysms due to cystic medical necrosis are described. One of them was phenotypically normal while the other had features of Marfan's syndrome. Both were disabled by dyspnoea and angina which required corrective surgery.
A retrospective report (1970-1980) on patients (non-head injuries and head-injuries) admitted with cerebral ischaemia into the intensive therapy unit is presented. The principles of management to reduce and control intracranial pressure are outlined. Since 1978 continuous intravenous infusion with Althesin has been used instead of barbiturates in the regime. Mortality rate fell from 83.7 percent (1970-1977) to 43.7 percent (1978-1980) for non head injury patients and from 72.1 percent (1970-1977) to 45.6 percent (1978-1980) in the head injured group, the differences between the periods being statistically significant. The possible influencing factors are mentioned. The quality of salvage and survival requires investigation.
One hundred and fifty patients with urothelial tumours were reviewed. They form the majority of patients with bladder cancer referred to the Institute of Urology over the past three years. From the study it becomes very apparent that the majority of patients are seen late in the course of their disease. The results of treatment of patients with early lesions have been satisfactory but the patients with late invasive lesions have very poor prognosis. A plea is made that one be more aware of this condition and that symptoms of haematuria and urinary tract infections should have a full urological assessment early.
Carcinoma of the buccal mucosa is the commonest intra-oral malignancy seen in Malaysia. The purpose of this paper is to present 12 patients with carcinoma of the buccal mucosa who were seen by the authors between January 1981 to September 1981. The principal problems are those of late presentation and treatment, these aspects are illustrated, with a view of early return to normal life.
Thanatophoric dwarfism is a severe form of neonatal shortlimbed skeletal dysplasia. Most infants are stillborn or die soon after birth. This disorder has well defined radiological features which distinguish it from the other forms of neonatal dwarfism. We report two cases where short limbs were detected on sonography and a diagnosis was made on antenatal radiographs and fetography.
Psychiatric consultation in schools is not a new concept in the Western Countries but it is so in Malaysia owing to the lack ofa sufficient number of trained psychiatrists available locally. The aim of consultation is to help the school authorities to understand and to solve emotional and behaviourial problems of school children. The authors have begun a study project, on a voluntary basis, on the psychiatric problems of the school children of a secondary school in Kuala Lumpur. This was possible with the cooperation between the Department of Education, Kuala Lumpur, the Department of Social Welfare, Federal Territory and the Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur. The authors used two methods to gather data, namely through individual evaluation of the referred students (a total of 23 students having been interviewed) and through the holding of group therapy sessions with the consultee as the cotherapist. The authors found that minor behaviourial problems such as inattentiveness, talking, eating and sleeping in the classrooms constituted the majority of the reasons for referral. This was followed by problems concerned with poor academic performance, including the quality of class work. Major problems such as theft, extortion and gangsterism and personal emotional problems such as interpersonal relationship problems, boyfriend/girfriend problems and sexual problems were also encountered. Female pupils appeared to be more forthcoming in discussing their problems. The project has resulted in the school gradually adopting the guidance rather than the purely disclplinary concept in understanding the pupils' problems and their maladjustment behaviour in many cases. Joint efforts by psychiatrists, psychologists, professional social workers and school health personnel should be invested in this important area of school education.
MeSH terms: Adolescent; Adult; Child Behavior Disorders/therapy; Female; Humans; Malaysia; Male; Psychiatry*; Psychotherapy, Group; Referral and Consultation*; School Health Services*; Schools