Thirty consecutive patients from peninsular Malaysia with clinically definite multiple sclerosis were studied; 80% were ethnic Chinese, with a female-male ratio of 5:1. The average age at onset was 29.7 years, with one relapse average every 1.9 years. Optic-spinal recurrence was the most common clinical pattern of the disease, accounting for 63.3% (19/30) of the cases. All the patients had spinal cord involvement sometime during the course of the illness. The mortality was high at 36.7% (11/30), with an average duration of symptoms of 7.6 years. There was characteristic severe residual visual and motor disability. At the time of the last examination, 12 patients had bilateral optic atrophy with blindness or severe visual acuity impairment. Sixteen patients were bedridden or confined to a wheelchair. The severe motor disability reflected the severe spinal cord involvement. It was the main factor that accounted for the high mortality. The cerebral, cerebellar, and brain-stem involvements were, however, generally transient. None of the patients' had a family history of similar illness despite the average sibling size of six. There was no example of Devic's disease. The clinical pattern was closest to those patients who presented from Taiwan.
During the 5-year (1981-5) surveillance period, 2322 salmonella isolations were recorded from animals and other non-human sources in Peninsular Malaysia. This was an increase of 356% over the preceding 5-year period. The 83 serotypes isolated were recovered from 41 sources. Of these 34 were new serotypes bringing the total number of serotypes isolated from non-human sources to date up 97. Food animals and edible animal products accounted for 92.2% of the total isolations, with cattle and beef accounting for 70% of the total. Salmonella dublin was the most frequently isolated serotype, whereas S. typhimurium had the widest zoological distribution. More than 80% of the non-human salmonella serotypes have also been reported in man in this country.
Schistosoma malayensis n. sp., a member of the Schistosoma japonicum complex is described from Rattus muelleri in Peninsular Malaysia and 2 strains are characterized. The only morphological differences noted among adults from natural hosts were that S. malayensis are in general smaller than S. mekongi and S. japonicum. But these differences may be the result of host-induced variations and therefore are of little taxonomic value. To minimize the effects of host-induced variations, adult worms recovered from laboratory mice with similar worm burdens at 50-56 days postinfection were compared. These comparisons revealed only minor morphometric differences among these 3 species. Schistosoma malayensis eggs from naturally and experimentally infected hosts are most similar to those of S. mekongi, with eggs of both species being, in general, smaller than those of S. japonicum. The egg index for S. malayensis is usually higher than for S. japonicum and lower than for S. mekongi. Differences were noted in the developmental rates in mice for 2 isolates of S. malayensis, S. mekongi, and S. japonicum (Philippine strain), but relatively large differences observed between isolates of S. malayensis indicate that, in this case, the developmental rate is not a useful taxonomic character. Schistosoma malayensis is erected principally on the basis of differences, reported elsewhere, in the life histories and in the electrophoretic migration patterns of isoenzymes of adult worms as compared to S. mekongi and S. japonicum. These comparisons indicate that S. malayensis is more closely related to S. mekongi than to S. japonicum.
In addition to generalized icterus, enlargement of the liver and severe photosensitization, signal grass (Brachiaria decumbens) toxicity also caused ruminal stasis and a decreased rumen pH in sheep. Ruminal stasis, which occurred within 3 weeks of grazing on this grass, may be the effect of the toxin produced in the rumen rather than a sequele of a decreased rumen pH. Animals were anorexic and the volume of their rumen content was very much reduced.
Results from a 6-year study of solar ultraviolet A (UVA) radiation measurements at the equatorial location of Penang (5 degrees N) are presented. On clear days, the diurnal flux reaches a very high dosage of about 3.0 x 10(-2) KWHM-2 around midday. The average daily total flux is in the range of 1.6 x 10(-1) KWHM-2 and does not change much seasonally. The high 83% cloud cover only reduces the incoming flux to about half. The radiation flux represents a lower limit of the incident UVA radiation applicable to much of the equatorial/tropical region.
MeSH terms: Age Factors; Asia; Asia, Southeastern; Birth Rate*; Contraception; Contraception Behavior*; Demography; Developing Countries; Emigration and Immigration; Ethnic Groups; Family Planning Services; Fertility*; Geography; Infant Mortality; Health Knowledge, Attitudes, Practice; Malaysia; Mortality*; Population; Population Characteristics*; Population Density; Population Dynamics*; Population Growth*; Public Policy*; Residence Characteristics; Sex Ratio; Urban Population; Family Planning Policy
Subcutaneous body fat and Quetelet's Indices (QI) of 52, 18-29 year old normal female volunteers were determined. These body mass indices were then grouped according to the phase of each subject's menstrual cycle, early or late follicular and early or late luteal phase. The subcutaneous body fat is 27.07 +or- 1.0% in the early follicular but drops to 24.68 +or- 1.84% in the late follicular phase. The value then rises significantly higher than that in the late follicular phase to 30.14 +or- 1.15% (P0.02) in the early luteal drops to 27.17 +or- 0.55% towards the level of the early follicular phase (P0.05). Variations in the values of QI during each menstrual cycle exactly mirror those for subcutaneous body fat. The fall in the 2 body mass indices during the late follicular phase coincides somewhat with the established preovulatory LH and FSH surges as well as the high levels of estrogen of this period. On the other hand the significant rise in the 2 parameters during the early luteal phase coincides with the marked rise in the ratio of progesterone to estrogen. Clearly, increased levels of progesterone relative to estrogen appear to cause an increase in the body fat during each menstrual cycle. The implication of this finding for women on contraceptive pills which are predominantly progesterone and those whose normal menstrual cycle is "interrupted" at the early luteal phase by a successful fertilization raises very interesting questions with regards to prediction of ovulation.
Two hundred and twenty-five hair samples (150 Chinese, 44 Malays and 31 Indians) from healthy residents not occupationally exposed to mercury were analyzed by cold vapour atomic absorption spectrophotometry to determine their total, inorganic and organic mercury levels. The arithmetic means of total mercury levels in hair were 6.1, 5.2 and 5.4 ppm for the Chinese, Malays and Indians, respectively. Factors contributing to the amount of mercury in hair, including consumption of fish and marine products, use of traditional ethnic medicines, artificial hair waving, age, sex and ethnicity were analyzed. Fish consumption, sex and ethnicity are factors found to contribute significantly (p less than 0.05) to mercury levels in hair.
Thirty four patients with cryptococcal meningitis seen in the University of Malaya medical centre since 1980 were reviewed. Eleven patients had bilateral papilloedema and visual impairment but eventually survived. Seven patients had intensive aggressive measures, including shunting to reduce intracranial hypertension irrespective of ventricular size shown in CT scan, and showed substantial improvement in vision. It is concluded that papilloedema and visual failure in cryptococcal meningitis reflects raised intracranial pressure and that this should be treated vigorously.
The results of speech, language and hearing assessment of repaired cleft palate children and adults over a 4-year period at the Speech/Language therapy unit, Department of ENT, Faculty of Medicine, UKM are reported. The subjects were 33 incomplete cleft lip palate (ICLP), 48 unilateral complete cleft lip and palate (UCLP) and 26 bilateral complete cleft lip and palate (BCLP). Results obtained for the following assessments are reported and discussed: (i) Hearing assessment, (ii) intelligibility rate, (iii) severity of hyper-nasality and (iv) types of articulation errors and school/behaviour problems and nasal grimace. Due to subject variability in ethnicity, language and dialects and the lack of normal data, it is difficult to compare or repeat previously reported results. Assessment of intelligibility, hypernasality and articulation were conducted using the Malay language. Results obtained were compared among the three groups of subjects. The significant findings were that hypernasality, intelligibility and articulation errors were more severe in the ICLP group than in the UCLP or BCLP groups of patients. This is contrary to expectations and cannot be explained in terms of the type and/or the degree of clefting. Hence, special attention should be paid to the less overt type of cleft patients in so far as their speech assessment and rehabilitation are concerned.
A retrospective study of 84 cases of neonatal septicaemia admitted into a neonatal unit in a rural area of Malaysia for 1 year between 1st September 1985 to 31st August 1986 was carried out to determine the spectrum of micro-organisms and predisposing factors in relation to early and late onset septicaemia. The incidence of neonatal septicaemia was 2.13 per 1,000 live-births per year and the case fatality was 41.7% with higher case fatality in those who were premature, those who presented as early onset and those who had gram negative septicaemia. The mean age of onset of septicaemia was 7.8 days (range from 2 hours to 27 days). Forty four (52%) neonates had early onset septicaemia with mean age of onset at 2.7 days; forty (48%) neonates had late onset septicaemia presenting at 13.6 days of life. Gram negative organisms such as Klebsiella, Pseudomonas, sp., E. coli and Streptococcus, especially group B Streptococcus were the major organisms in the early onset septicaemia. Staphylococcus aureus and Staphylococcus epidermidis were the major organisms responsible for the late onset septicaemia. Obstetrical factors played an important role in early onset septicaemia. Prematurity was the most common predisposing factor. Invasive diagnostic and therapeutic procedures including surgery highlighted once again the importance of these procedures in predisposing the newborn to infection.
Although neuroleptic malignant syndrome (NMS) was initially thought to be a rare, idiosyncratic complication, the incidence estimates have been rising over the years. A part of this increase can be explained on the basis of an over-inclusive definition of NMS. The unitary concept of NMS has been challenged recently and a spectrum concept has been enunciated on the basis of findings of retrospective chart-reviews which have used too broad a definition of NMS. The authors describe three cases of neuroleptic-related toxicity with different clinical presentations which appeared in a manner apparently supporting the spectrum concept. They discuss this controversial concept critically, however, and caution against its overzealous use in routine clinical practice owing to its far-reaching clinical implications.
In Singapore, cancer incidence is documented separately for the different Chinese dialect groups, as a means of providing a possible insight into environmental or genetic factors which may be involved in the aetiological process. Thus, it would be useful to determine whether or not the Chinese population in Singapore still comprises distinct dialect groups. In view of this, an investigation into the dialect group of the parents of 792 hospital in-patients (cases and controls) was carried out. It was found that the vast majority of patients (94.2%), most of whom were born before 1940, had parents of the same dialect group. The percentages of within-dialect marriages were only slightly less for offspring born in Singapore or Malaysia as opposed to China, and decreases with time were small. Thus in 1985-87 Chinese cancer patients and controls in Singapore, of the ages represented in this study may indeed be classified according to their father's dialect and this is likely to be the case for at least the next decade or so. This finding will be of use to cancer epidemiologists as well as others studying Chinese dialect group variations in disease patterns.
Three cases of embryonal rhabdomyosarcoma in the middle ear and mastoid in children are presented. Diagnosis was confirmed by histopathology. A multidisciplinary approach employing surgery, chemotherapy and radiation therapy is the method of choice in the management of this rare and highly lethal condition.
An immunohistochemical assay was developed combining an avidin-biotin-glucose oxidase complex procedure (ABC-GO) with light microscopy to detect specific antibody against Plasmodium falciparum. Thin blood films were prepared from culture material of P. falciparum and fixed with acetone. Antibody was detected by successive incubations with test serum, biotinylated goat antihuman antibody, avidin-biotin-glucose oxidase complex, and glucose oxidase substrate. In the presence of reactive serum, a blue precipitate formed on the parasites and could be visually observed with a 40x objective. Sera from patients with single infections for P. vivax or P. ovale were unreactive. No cross-reactivity was observed with sera from patients with rheumatoid arthritis, filariasis, amebiasis, schistosomiasis, dengue, scrub typhus, leptospirosis, or toxoplasmosis. The sensitivity of ABC-GO is comparable to that of the indirect fluorescent antibody test.
The incidence of surgery for gastric cancer in Singapore increased during the period 1951 to 1980 (males from 3.5 to 8.7 per 100,000 per year: females from 0.5 to 4.2 per 100,000 per year). This increase occurred mainly during the first decade of the study and was confined to persons aged 55 and above. Chinese had the highest incidence, followed by Indians and then Malays. These racial differences remained unchanged over the period of study.
MeSH terms: Adult; Age Factors; Aged; Aged, 80 and over; China/ethnology; Female; Humans; India/ethnology; Malaysia/ethnology; Male; Middle Aged; Sex Factors; Singapore; Stomach Neoplasms/ethnology*; Stomach Neoplasms/epidemiology; Stomach Neoplasms/surgery