Four Presbytis cristata were treated with oral ivermectin at the same time as the subcutaneous inoculation of 100 infective larvae monthly for three months. Two animals given 0.2 mg/kg monthly and two others given 0.3 mg/kg monthly as well as three control animals became patent for microfilaraemia. However, only 1% of the infective dose was recovered as adult worms from animals in the higher drug dosage group compared to 8.2% and 6.2% in the lower dosage and control groups respectively.
This paper reports the experimental transmission of a bird parasite into jirds. Infective larvae of Cardiofilaria nilesi obtained from laboratory colonized Coquillettidia crassipes mosquitoes which had fed on an infected chicken were inoculated subcutaneously into jirds. The number of larvae per jird varied from 10 to 228. Microfilaraemia appeared 22 to 89 days after inoculation of the infective larvae. Experiments were carried out with 24 jirds through six generations extending over a period of 22 months and 17 produced patent infections. At present 8 infected jirds are being maintained in the laboratory; their patent periods ranging from 6 to 13 months. However, the longest patent period observed was about thirteen months. The percentage of adults recovered in autopsied jirds ranged from 0 to 40 with an average of 16. The chicken showed a microfilarial periodicity with the peak microfilarial density around 2200 hours. However, in jirds there was a change in sub-periodicity. This model in the jird may be very useful for the screening of filaricides and in immunological work.
The traditional birth attendant (bidan kampong) or the TBA is still responsible for a substantial number of deliveries in Peninsular Malaysia. In the study area, the TBA s were responsible for about 47.2% of the deliveries in 1976. They were also responsible tor a substantial number of maternal deaths in the district. Therefore it was decided to identity and train the TBAs to identity ‘at risk’ cases at mothers and children and refer them to the nearest health facility. The TBA s were trained to use simple hygenic and aseptic procedures. At the end oi their training all at them were presented with a UNICEF midwifery kit. The short training proved useful because they now deliver fewer ‘at risk' cases and there is an in- creasing trend among them to refer the ‘at risk’ cases to the hospitals. The utilizations of TBA s in the maternal and child health program is a useful tool for the attainment at primary health care objective for developing countries by the year 2000.
MeSH terms: Ambulatory Care Facilities; Female; Humans; Malaysia; Maternal-Child Health Centers; Midwifery/education; Pregnancy; Rural Health*
Plesiomonas shigelloides was isolated from 5 (2.1%) of the 234 children with diarrhoea and none of the 230 controls. In one child, the organism was found in association with Salmonella. Two strains had Shigella sonnei phase I antigen. All the strains were susceptible to the aminoglycosides, cephalosporins, nalidixic acid, nitrofurantoin, chloramphenicol and cotrimoxazole; but resistant to the penicillins. Alkaline peptone water enrichment subcultured to desoxycholale citrate agar proved to be a useful method for isolating this organism from faeces. As the roie of P. shigelloides in causing gastrointestinal disease remains controversial, further studies are necessary to determine its enteropathogenicily.
Eight-hundred patients recruited between September 1981 and December 1984 were admitted to a randomized prospective trial of the Nova T (NTCu200Ag) and Multiload 250 (MLCu250) IUDs. At the cut off date, 31 December 1986, 206 patients had completed the 4-year trial period, 379 had terminated before completion and 215 were in the fourth year of use. For the third and fourth years, the MLCu250 had a significantly lower accidental pregnancy rate (p less than 0.05).
A prospective study of acute renal failure (ARF) over a three month period showed that 60 out of 22,033 inpatients developed AR"F (Serum creatinine exceeding 0.200 mmol/L). The ARF was oliguric in 22% and nonoliguric in 78%. Poor cardiac output or diminished intravascular volume, nephrotoxins and infections were the main aetiological factors associated with ARF in 85% of cases. Mean peak serum creatinine and blood urea values were higher in the oliguric than the non oliguric group. The oliguric group required dialysis more frequently (53.8% vs 4.3%) and had a higher mortality (53.8% vs 8.5%) than the non oliguric group. Nonoliguric ARF occurs more commonly and has a better prognosis than oliguric ARF. Acute renal failure is a serious condition with significant mortality and remains a frequent occurrence in the setting of large general hospitals. A Previous reports on acute renal failure in Kuala Lumpur comprised patients treated at the Department of Nephrology at the General Hospital Kuala Lumpur, but did not include patients with acute renal failure treated at other departments in the hospital. This report is based on a prospective study of acute renal failure occurring in the General Hospital Kuala Lumpur over a three-month period to evaluate the clinical spectrum of this disease, and its outcome.
One hundred and seventy five patients treated for burns during 1983 and 1984 were reviewed. The majority of these patients were below eight years of age. These injuries were mainly sustained at home (83.4%) and were usually caused by hot liquids (41.7%). The infection rate was 57.1% and many developed septicaemia (21.7%). Mortality in patients sustaining burns involving greater than 30% of the body surface area was high at 52%.
In 1985, 140 (26.1 %) of 536 admissions to the intensive care unit (ICU) were general surgical cases. Retrospective review of 107 of these admissions revealed four factors to be significantly different between survivors and non-survivors, p < 0.01. They were duration of stay, organ system failure, sepsis and complications. The role of the surgeon in an ICU where management is interdisciplinary is emphasised.
MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Hospitals, University; Humans; Infant; Infant, Newborn; Intensive Care Units*; Length of Stay; Malaysia; Male; Middle Aged; Multiple Organ Failure; Postoperative Complications; Prognosis; Retrospective Studies; Surgical Procedures, Operative*
Fifty seven strains of Pseudomonas pseudomallei were tested for in vitro susceptibility to 15 antimicrobial agents. Amongst the generally recommended antibiotics for therapy of melioidosis, only 86%, 84% and 58% of the strains were found to be sensitive to trimethoprim-sulphamethoxazole, chloramphenicol and tetracycline respectively. Of the newer B-Iactams, in descending order of activity were, ceftazidime, ceftriaxone, cefotaxime, cefoperazone and cefuroxime. But on a weight for weight basis, ceftazidime was the most active agent and as such, may be considered in the therapy of acute septicaemic melioidosis."
An 84 year old man who presented with Stokes Adams syncope with exertion was found to have complete heart block on walking with reversion to sinus rhythm on recovery. The resting ECG showed evidence of ischemic heart disease with old anteroseptal and old inferior infarction but there was no recent myocardial infarction as shown by normal cardiac enzymes levels. The probable explanation for the mechanism and causation of the transient A-V block is described.
Myelodysplastic syndromes appear to be a rare group of blood disorders in Malaysia. It usually affects the elderly and some of the cases were reported to evolve into acute leukemia. We describe our experience with five cases, seen and managed by us over a 5-year period. All patients receiving supportive therapy died with one of them definitely known to transform to acute leukemia. The patient who survives till the time of writing received low dose continuous cytosine arabinoside infusion.
Thirteen cases of late haemorrhagic disease of infancy due to vitamin K deficiency presenting with intracranial haemorrhage were seen over a three - year period from 1984 to 1986. The clinical picture was fairly typical; a short history of being unwell (poor feeding, vomiting, irritability, high pitched cry, fits) and physical findings of pallor, a normal body temperature, impairment of consciousness, abnormal respiration and a very tense anterior fontanelle. Vitamin K deficiency was implicated by the prolonged prothrombin time which rapidly returned to normal with vitamin K injection. The outcome was poor. Possible factors giving rise to vitamin K deficiency are discussed. The author suggests the introduction of the giving of vitamin K to all new-borns.
About two-thirds (67.6%) of 142 Ibans (from birth to 90 years of age) from 26 house-holds in a longhouse in Nanga Atoi in the Second Division of Sarawak were infected with intestinal parasites. The more common helmintic infections were hookworms (47.2%) and Trichuris trichiura (43.0%). Intestinal protozoan infections were less common. Single helmintic infections were more common than multiple infections and the commonest type of multiple infections was Trichuris mixed with hookworms. Malaria and filariasis were not reported among these inhabitants surveyed.
Leiomyoma of the caecum is a rare tumour. While leiomyomata are known to arise from any part of the large bowel, caecum is a rare site. The largest series to date is that of Mackenzie" who reviewed 37 cases of myomatous tumours of the colon, two of which were complicated by perforation. More recently, Swerdlow" reported another case of a perforated caecal leiomyoma. We now report a patient who was operated at the stage of abscess formation without perforation.
Lactic acid concentration was determined in 37 specimens of cerebrospinal fluid by gas liquid chromatography. It was found to be raised (30 mg/dl) in 15 specimens from culture positive cases of bacterial meningitis and one of fungal meningitis. It was < 30 mg/dl in cerebrospinal fluid from four cases of viral meningoencephalitis and 10 contaminated specimens. It was also raised in two specimens from culture negative cases. Determination of cerebrospinal fluid lactic acid concentration by gas liquid chromatography provides a useful, additional test in the diagnosis of bacterial meningitis
Human infections due to Phialophora richardsiae, first described in 1968, is usually associated with subcutaneous cysts, although there have been reported cases of ulcerative lesions with discharging sinuses as well as infection of bones and tendon sheaths.1,2,3 Because infections by P.richardsiae are rare and the fungus relatively unknown in Malaysia, it was thought worthwhile to report the isolation of this fungus from a cutaneous lesion.