A scoring system based on therapeutic intervention on critically ill patients called the therapeutic intervention scoring system (TISS) was used to assess the quantity of care provided in a medical intensive care unit. Besides observing the unit census, the severity of illness and the work load were studied. The survival rate was 77 percent. The non-survivors had admission TISS points higher than the survivors and their mean daily TISS was more than 20 points. The survivors at discharge had a mean TISS of five points. The work load showed that a nurse can effectively manage two patients who together may accumulate 24 TISS points per day. TISS points per patient rather than bed occupancy is a better indicator of the nurse's work load. Admission criteria and procedures before death certification are outlined.
Comment in: Delilkan AE. Therapeutic intervention scoring system in medical intensive care. Med J Malaysia. 1989 Dec;44(4):361-2
MeSH terms: Humans; Intensive Care Units/manpower; Intensive Care Units/standards*; Malaysia; Quality of Health Care*; Severity of Illness Index
In the humid tropics of SE Asia there are some 14 myrmecophytic species of the pioneer tree genus Macaranga (Euphorbiaceae). In Peninsular Malaysia a close association exists between the trees and the small, non-stinging myrmicine Crematogaster borneensis. These ants feed mainly on food bodies provided by the plants and have their colonies inside the hollow internodes. In a ten months field study we were able to demonstrate for four Macaranga species (M. triloba, M. hypoleuca, M. hosei, M. hulletti) that host plants also benefit considerably from ant-occupation. Ants do not contribute to the nutrient demands of their host plant, they do, however, protect it against herbivores and plant competition. Cleaning behaviour of the ants results in the removal of potential hervivores already in their earliest developmental stages. Strong aggressiveness and a mass recruiting system enable the ants to defend the host plant against many herbivorous insects. This results in a significant decrease in leaf damage due to herbivores on ant-occupied compared to ant-free myrmecophytes as well as compared to non-myrmecophytic Macaranga species. Most important is the ants' defense of the host plant against plant competitors, especially vines, which are abundant in the well-lit pioneer habitats where Macaranga grows. Ants bite off any foreign plant part coming into contact with their host plant. Both ant-free myrmecophytes and non-myrmecophytic Macaranga species had a significantly higher incidence of vine growth than specimens with active ant colonies. This may be a factor of considerable importance allowing Macaranga plants to grow at sites of strongest competition.
In the Constant Frequency portions of the orientation calls of various Rhinolophus and Hipposideros species, the frequency with the strongest amplitude was studied comparatively. (1) In the five European species of the genus Rhinolophus call frequencies are either species-specific (R. ferrumequinum, R. blasii and R. euryale) or they overlap (R. hipposideros and R. mehelyi). The call frequency distributions are approximately 5-9 kHz wide, thus their ranges spead less than ±5% from the mean (Fig. 1). Frequency distributions are considerably narrower within smaller geographic areas. (2) As in other bat groups, call frequencies of the Rhinolophoidea are negatively correlated with body size (Fig. 3). Regression lines for the genera Rhinolophus and Rhinolophus, species from dryer climates have on the average higher call frequencies than species from tropical rain forests. (4) The Krau Game Reserve, a still largely intact rain forest area in Malaysia, harbours at least 12 syntopic Rhinolophus and Hipposiderso species. Their call frequencies lie between 40 and 200 kHz (Fig. 2). Distribution over the available frequency range is significantly more even than could be expected from chance alone. Two different null hypotheses to test for random character distribution were derived from frequency-size-relations and by sampling species assemblages from a species pool (Monte Carlo method); both were rejected. In particular, call frequencies lying close together are avoided (Figs. 4, 5). Conversely, the distribution of size ratios complied with a corresponding null hypothesis. This even distribution may be a consequence of resource partitioning with respect to prey type. Alternatively, the importance of these calls as social signals (e.g. recognition of conspecifics) might have necessitated a communication channel partitioning.
The mortality pattern of a subpopulation of Semai Senoi of Malaysia is studied by using a two-census method. The method yields abridged life tables for both sexes as well as an estimate of the birth rate. The life tables show that Semai mortality is reduced compared to estimates based on stable population methods for the population prior to 1969. Increased health care availability seems to account for this lower mortality.
The fertility and parameters of population growth of the Semai Senoi of Malaysia are studied by using a two-census method based on nonstable population theory. Semai fertility is shown to be moderately high; female completed fertility is 7.42 children and the crude birth rate is greater than 0.050. Previous estimates of Semai mortality rates are also moderately high but are insufficient to balance birth; thus, the overall rate of growth is presently nearly 2%. Compared with an earlier description of the pre-1969 Semai population, fertility has increased markedly leading to a nearly threefold increase in the annual growth rate.
Iron deficiency is prevalent in childhood in the developed and developing countries. Programs of presumptive therapy, mass supplementation and food fortification have been introduced in many countries. The unresolved debate over the interaction of iron and infection in the clinical setting prompts re-evaluation of these practices. Situations of iron overload are associated with increased susceptibility to certain infections, although the exact mechanisms may vary with the main pathology. Iron treatment has been associated with acute exacerbations of infection, in particular malaria. In most instances parenteral iron was used. In the neonate parenteral iron is associated with serious E. coli sepsis. In one country, with endemic malaria, parenteral iron was associated with increased rates of malaria and increased morbidity due to respiratory disease in infants. In contrast in non-malarious countries studies of oral iron supplementation have if anything shown a reduction in infectious morbidity. Methodological problems in the latter reports indicate the need for further controlled prospective studies with accurate morbidity recording if informed recommendations are to be made.
A new nematode species, Paraphilometroides nemipteri sp. n. is described from the female specimens collected from the dorsal fin and operculum of the marine perciforme fish, Nemipterus peronii off Kuala Terengganu coastal waters in Malaysia. It considerably differs from all other species in Philometridae in the structure of the head end (presence of wide dorsal and ventral cephalic cuticular alae supported by special inner transverse muscular formations) and, therefore, a new genus Paraphilometroides gen. n. has been erected to accommodate it. Additional characteristic features of P. nemipteri are the presence of cuticular bosses on the body, eight cephalic papillae in the outer circle and four small papillae in the inner circle, and the absence of caudal protrusions.
Several new concepts are used to describe contraceptive use histories for nearly 1200 women in Peninsular Malaysia. These histories are summarized by 81 episode histories. Transition matrices provide useful summaries of the changes women make in their contraceptive practice from one pregnancy interval to the next. Data from the mid-1940s to mid-1970s, during which period there was a dramatic increase in contraceptive use, reveal considerable inertia in individual couples' contraceptive practice. Persistence with a method was greater the less effective the method: while 86% of couples using no method in one interval used no method in the next, only 56% of couples using the pill in one interval also used it in the next. Virtually all transitions are of three types: continuation with the same method, a change from no method to some method, or a change from some method to no method. For only 1% of all pregnancies did couples use one contraceptive method before a pregnancy and a different method after the pregnancy. Differences are examined by calendar year and education.
MeSH terms: Choice Behavior*; Contraception/methods*; Contraception/utilization; Contraception/statistics & numerical data; Female; Humans; Malaysia; Medical History Taking*; Research Design*; Models, Statistical
A double-blind randomized study in 230 Malaysian patients with duodenal ulcer was conducted to compare the proton-pump inhibitor, omeprazole 20 mg, given once daily in the morning, with ranitidine 300 mg, administered once daily at night. After 2 and 4 weeks of treatment, 222 and 220 patients, respectively, were evaluable according to the study protocol. Omeprazole produced significantly higher healing rates than ranitidine at both 2 weeks (75% versus 46%, respectively, P less than 0.0001) and 4 weeks (97% versus 83%, respectively, P = 0.001). Ulcer symptoms were relieved more rapidly by omeprazole than ranitidine. After 2 weeks, daytime epigastric pain was reported by 30% of ranitidine-treated patients but only by 15% of omeprazole-treated patients, which is a statistically significant difference (P = 0.004). No major clinical or biochemical side effects were recorded for either omeprazole or ranitidine. In conclusion, omeprazole 20 mg was found to be superior to ranitidine 300 mg administered once daily for the treatment of duodenal ulcer as measured by ulcer healing and pain relief.
From the start of the school milk feeding programme in February 1985 to October 1986, a total of 2,766 children aged six to nine years from 12 primary schools in Ulu Selangor were followed-up for about two years. The children's weight and height were monitored at the beginning, in the middle and at the end of the study. The study shows that there is a reduction in the prevalence of protein-energy malnutrition in terms of underweight (15.3% to 8.6%), stunting (16.3% to 8.3%) and wasting (2.6% to 1.7%) from the start of the school feeding programme to two years later. Associated with this there was an improvement in the attendance rate of the children during the same period. As there was no major developmental change in Ulu Selangor during that period, it is likely that the reduction in the prevalence of protein-energy malnutrition and the improvement of the attendance rate among the children are due to the impact of the school milk feeding programme.
MeSH terms: Animals; Child; Female; Food Services*; Humans; Malaysia; Male; Milk*; Nutritional Status*; Protein-Energy Malnutrition/prevention & control; School Health Services*; Schools; Program Evaluation
An anthropometric assessment was conducted on a sample of 309 children, aged twelve years and below, from an urban squatter community in Kuala Lumpur, Malaysia. The community consists mainly of Malays and Indians and is fairly established with a mean length of residence of about fifteen years. There was not much difference between the two ethnic groups with regard to educational status or income. Most of the residents were unskilled or semiskilled workers employed in factories and government agencies. About 40 percent of the infants and toddlers were found to be wasted, while about one-third of the older children were stunted. There appears to be some association between income per capita and nutritional status.
Over an 18 month period, 34,495 livebirths were delivered in the Kuala Lumpur Maternity Hospital. 36 neonates (1.044 per 1000 livebirths) had Down's syndrome. The observed rates of Down's syndrome per 1000 livebirths by single year intervals of maternal age were calculated. By using the discontinuous slope model, our study showed that the incidence of Down's syndrome among the Malaysian liveborns increased markedly when the maternal age exceeded 35 years. This study also suggested that the Malay mothers had increased risk of producing babies with Down's syndrome at a later age than the Chinese and the Indians. However, a larger number of babies in each racial group needs to be studied to confirm this.
MeSH terms: Down Syndrome/epidemiology*; Female; Humans; Infant, Newborn; Malaysia/epidemiology; Maternal Age*; Prospective Studies; Continental Population Groups
The activities of membrane marker enzymes in normal (3T3) and simian virus transformed mouse cells (SV3T3) are affected not only by densities of cultures but also by the sera types used in the growth media. We have assayed the levels of 5'nucleotidase, monoamine oxidase and rotenone insensitive NADH ferricyanide reductase in these cells grown to sparse and confluent cultures in medium supplemented with 10% newborn calf serum (n.c.s.) or in medium supplemented with 10% foetal bovine serum (f.b.s.). It was found that in 3T3 cells grown in 10% f.b.s. the transition from sparse to confluent cultures was associated with a reduction in the activities of the marker enzymes while in those grown in 10% n.c.s., the activities of these enzymes increased. In the SV3T3 cells, the activities of all the enzymes except for monoamine oxidase decreased from sparse to confluent culture densities in cells grown in 10% n.c.s. whereas in those grown in 10% f.b.s. there were no significant change in the activities of the enzymes over the same culture densities. The results suggest that the marker enzymes are affected by sera types and culture densities.
Trimeresurus wagleri (speckled pit viper) venom exhibited the usual set of enzyme activities occurring in pit viper venoms but the content of alkaline phosphomonoesterase was unusually high, whereas the proportions of protease and arginine ester hydrolase were very low. The venom also exhibited weak thrombin-like activity but did not exhibit hemorrhagic or anticoagulant activity. Analysis of the Sephadex G-200 gel filtration fractions of the venom indicated that the lethal fraction was a low mol.wt protein, and that fractions exhibiting phosphodiesterase, phosphomonoesterase, arginine ester hydrolase, thrombin-like enzyme, L-amino acid oxidase and phospholipase A activities were not lethal. Two lethal toxins, designated as wagleri toxins 1 and 2, were isolated from the venom using Sephadex G-50 gel filtration chromatography followed by SP-Sephadex C-25 ion exchange chromatography. The mol.wts of the two toxins were 8900 by gel filtration. The LD50 (i.v.) values in mice for wagleri toxins 1 and 2 are 0.17 microgram/g and 0.19 microgram/g, respectively.
1. The lethalities, anticoagulant effects, hermorrhagic, thrombin-like enzyme, hyaluronidase, protease, arginine ester hydrolase, 5'-nucleotidase, L-amino acid oxidase, alkaline phosphomonoesterase, phosphodiesterase and phospholipase A activities of twenty-three samples of venoms from twelve species of Asian lance-headed pit vipers (genus Trimeresurus) were examined. 2. The results indicate that notwithstanding individual variations in venom properties, the differences in biological properties of the Trimeresurus venoms can be used for the differentiation of venoms from different species of Trimeresurus. 3. The results also suggest that differences in the biological properties of snake venoms are useful parameters in the classification of snake species. 4. Our results indicate that venoms from the species T. okinavensis exhibited biological properties markedly different from other Trimeresurus venoms examined. This observation supports the recently proposed reclassification of T. okinavensis as a member of the genus Ovophis, rather than the genus Trimeresurus.
1. The activity of cAMP phosphodiesterase (PDE) was studied in a 10,000 g particulate fraction prepared from rat brain. 2. Phospholipase C such as sphingomyelin choline phosphodiesterase (SMase), phosphatidylinositol phosphodiesterase (PIase) and phosphatidylcholine phosphohydrolase (PCase) were used to deplete phospholipid(s) from the particulate fraction and their effects on PDE activity were investigated. 3. Treatment with SMase or PIase did not affect PDE activity whereas treatment with PCase resulted in inhibition. 4. It was also found that the PCase used not only hydrolyzed phosphatidylcholine but also other phospholipids such as phosphatidylethanolamine, phosphatidylserine and sphingomyelin.
MeSH terms: Animals; Brain/enzymology*; Hydrolysis; Phosphatidylserines/pharmacology; Type C Phospholipases/pharmacology; Phospholipids/physiology*; 3',5'-Cyclic-AMP Phosphodiesterases/metabolism*; Rats
Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. The major presenting symptom was pain but an abdominal mass was palpable in 79.4% of cases. Torsion was more common on the right ovary and 50% were gangrenous at laparotomy. Most of the tumors were benign cystic teratomas. Only 8.7% of the tumors were malignant.
1. Acid secretion for each dog has reached a near maximum (100%) at the 6th samples, 90 min after the intravenous infusion of histamine (10 mu ghr-1, or approximately equal to 0.3 mghr-1). 2. 0.5 mgkg-1 Cimetidine had produced a mean inhibition of 47% on the stomach. 3. 0.1 mgkg-1 Ranitidine (D 14,951) could only inhibit a maximum of 28%, and the secretion had return to normal in just 30 min. 4. 0.025 mgkg-1 Tiotidine (D 15,104) had inhibited 53% acid secretion within 15 min of exposure. Recovery was quite similar to that of Cimetidine, at 150 min. 5. At a dosage one fifth of Cimetidine (0.1 mgkg-1) D 15,144 had depressed 35% of acid secretion at the first 15 min. The inhibition is gradually increased to about 43% (at 30 min), and was maintained for the next 105 min.