The prevalence of coinfection, superinfection and chronic infection with the hepatitis delta virus (HDV) was studied in 324 hepatitis B surface antigen (HBsAg)-positive Malaysians. Of these, 10.0% (5/50) had coinfection, 5.7% (11/194) had superinfection, but none of the 80 patients with chronic liver disease (CLD) or primary hepatocellular carcinoma (PHC) had chronic infection with HDV. The overall HDV infection was 4.9% (16/324). One of the coinfection cases acquired the HDV infection as early as 1982. HDV superinfection was detected mainly among IV drug abusers (20% or 7/35) and promiscuous males and females (13.6% or 3/22). They were all asymptomatic. Only 0.8% (1/125) apparently healthy blood donors was infected with HDV. None of the 12 multi-transfused patients examined were positive. Malaysia is the only Southeast Asian country examined so far in which HDV infection was detected. The reason could be that the IV drug abusers and the sexually promiscuous groups missed being examined in the other countries. Comparing the HDV infection rates in 4 categories of infected Malaysians (viz. acute hepatitis B patients, IV drug abusers, blood donors and CLD patients) with those of other countries, it was noted that the Malaysian rates were similar to the lowest in the range of prevalence rates of each category in the latter group. The rate of coinfection in a preliminary study in 1982-84 (9.0% or 1/11) was not very different from that obtained to date (10.0% or 5/50).(ABSTRACT TRUNCATED AT 250 WORDS)
The histological location of amyloid within various organs in 25 cases of systemic AA amyloidosis was studied with a view to determine whether different morphological patterns exist in this category of amyloidosis. Although morphological variations due to progressive severity of disease were observed, there were appreciable variations in the patterns of amyloid deposition in the kidney and spleen that could not be simply explained on those grounds. Eleven (61%) of 18 kidneys examined showed severe glomerular involvement with mild degrees of vascular deposition while the remaining seven showed predominantly vascular involvement. The glomerular pattern appeared to be more ominous, being significantly associated with severe proteinuria or chronic renal failure. In nine (69%) of 13 spleens examined, amyloid was confined to the walls of small and medium-sized arteries while in the remaining four, vascular involvement was less severe and amyloid was deposited mainly along the reticulin of the white pulp. Possible explanations for these different patterns included resorption and redistribution of amyloid within the body during the course of the disease, and variation in tissue deposition as a manifestation of polymorphism of amyloid proteins. The latter appeared more feasible in view of the recent demonstration of SAA polymorphism and AA heterogeneity in man.
Schistosoma sinensium Pao, 1959, was first isolated from an unidentified snail in Szechuan Province, China, and was described on the basis of adult worms and eggs recovered from experimentally infected mice. We discovered snails, Tricula bollingi Davis, and rodents, Rattus rattus (L.) and Crocidura attenuata Milne-Edwards, infected with S. sinensium near Fang in northwest Thailand. Adult worms were recovered from small veins immediately adjacent to the small intestine. Eggs first appeared in the feces of experimentally infected mice at 25 days postinfection. Cercariae first emerged from experimentally infected T. bollingi at 40 days postinfection. Shortly after emerging, cercariae were found at the water surface, their bodies flat against the meniscus and tails hanging free in the water column. Our morphometric results for adults and eggs from naturally infected hosts agree well with those presented in the original description. The occurrence of a lateral spine on the egg of this Asian schistosome has created some confusion as to the affinities of S. sinensium. A comparison of 8 character states, including snail hosts, cercarial behavior, geographical distribution, and morphology of life cycle stages, indicates that S. sinensium is more closely related to S. japonicum Katsurada than it is to S. mansoni Sambon.
The defense secretions of five species of MalaysianNasutitermes,N. longinasus, N. matangensis, N, havilandi, N. johoricus, andNasutitermes species 01, are compared.N. longinasus andN. species 01 provide trinervitene alcohols,N. havilandi mainly tricyclic trinervitene and tetracyclic kempane alcohols and acetates, whereasN. matangensis furnish acetyl/propionyl derivatives of trinervita-11(12),15(17)-dien-3α,9β,13α-triol (XXI and XXII). A new diterpene, assigned as trinervita-11(12),15(17)-dien-3α,13α-diol-3,13-O-diacetate (XVII), is isolated fromN. havilandi. The mono- and diterpenoid compositions, being species-specific, are useful for chemotaxonomic and phylogenetic studies.
Anomalies in DNA replication, repair and recombination in ataxia-telangiectasia (A-T) point to a defect in structure or function of chromatin. In this study we have compared DNA-protein binding in nuclear extracts from control and A-T cells using two assay systems, filter-binding and DNA-accessibility. Interestingly, the extent of DNA protein binding over a range of protein concentration was significantly lower in A-T extracts. In addition the accessibility of the restriction enzyme Eco R1 to protein-bound plasmid was greater when A-T extracts were used. This is in keeping with the reduced binding observed in the filter-binding assay.
Some infants intolerant to cow's milk protein (CMP) are often also intolerant to other food proteins including soy protein (SP). The effect of CMP and SP in infants recovering from diarrhoeal disease was studied in 22 infants who were maintained on an hypo-allergenic formula for 4-6 weeks. The infants were then challenged successively, initially with SP, followed 24 h later with CMP and then rechallenged with SP 24 h after CMP provocation. Three groups were recognized on the basis of clinical symptoms and mucosal changes following SP challenge. Group 1 comprised four infants who developed clinical and histological reactions on SP challenge. The subsequent CMP challenge, 24 h after the initial SP challenge, resulted in clinical symptoms in three of the four infants, and they developed increased mucosal injury. Rechallenge with SP in the three infants caused development of severe clinical symptoms. Group 2 comprised 12 infants who developed histological reaction but had no clinical symptoms to initial SP challenge. The subsequent CMP challenge caused further progression in mucosal pathology in 11 of the 12 infants and six also had associated clinical symptoms. Rechallenge with SP in the latter six infants resulted in development of clinical symptoms in three and tolerance to SP in three infants. Group 3 comprised six infants who tolerated SP and CMP but one of these infants developed mild histological changes to CMP. The progression of mucosal injury following SP and CMP challenge was associated with a significant decrease in mucosal disaccharidases, alkaline phosphatase levels and presence of reducing sugar in the stools. The 1 h blood xylose level continued to decrease significantly following the pre-SP, post-SP, and post-CMP challenge. It appears that the small bowel mucosa of young infants recovering from diarrhoeal disease remains sensitive not only to CMP but also to SP. The feeding of these proteins in rapid successive sequence to infants with mucosal damage might result in further progression of the mucosal injury. Thus, the exclusion for a variable period of time of antigenic food proteins like CMP and SP from the diet of young infants recovering from diarrhoea might reduce the risk of inducing mucosal sensitivity to these proteins in susceptible infants.
A review of patients with diphtheria seen in the Paediatric Unit, Alor Star General Hospital, from January 1985-March 1987 is reported. Their clinical presentation, diagnosis, treatment and outcome were analysed and discussed. Clinical awareness regarding the diagnosis of diphtheria is emphasised.
A study was conducted to determine the prevalence of locomotor disability in a Malay Community in Tanjung Karang, Kuala Selangor in 1984. The causes of these disabilities, the mobility and occupational handicaps they caused and the types of treatment received were determined. Fifty percent of the households in this area were selected by stratified random sampling and all persons above seven years of age were included in the sample. The prevalence of locomotor disability was 3.9%. The prevalence among males was 5.2% and among females 2.6%. The prevalence increased with age, being as low as 0.6% in the 7-14 year age group and as high as 20.5% in the above 55 year age group. The disabilities resulted mainly from trauma (49%) and musculoskeletal and neurological problems (46.9%). Ninety percent (44 cases) had difficulty only in performance of daily activity and 20 cases (40.8%) had no mobility handicap whatsoever. Forty two (85.7%) of the 49 cases had received treatment.
Circadian variations have been observed in the onset of acute coronary syndromes including acute myocardial infarction. We studied 422 acute myocardial infarction patients who presented to the coronary care unit of General Hospital Kuala Lumpur. Of the 318 (75.4%) patients whose data was complete, a circadian rhythm with bimodal peak was demonstrated. The second quarter of the day i.e. 6.00 a.m. to 12 noon was shown to have a significantly increased frequency of onset of acute myocardial infarction (p less than 0.05). Time delay in presenting to the hospital was also determined. This showed that 56.8% of acute myocardial infarction patients presented early, within four hours of the onset of symptoms. By six hours, more than 71% had sought hospital care. This early presentation to the hospital may offer a realistic opportunity for optimal thrombolytic therapy should this treatment modality be offered as routine to infarct patients.
Impairments of lung functionality as long-term effects of cigarette smoking have been well established. To our knowledge, no study on acute recovery patterns in any important lung function index after smoking a very limited number of cigarettes has ever been reported. The present study reports recovery patterns of lung transfer factor (TF) and related parameters in smokers and non-smokers who smoked two Camel cigarettes. Lung transfer factor and other indices were determined by the single breath-holding technique. From our results, the TF and related indices of healthy Malaysians are similar to previously published normals of comparable age. On smoking two cigarettes, male smokers began to recover from the 30th minute; male non-smokers had not begun recovery even by the 50th minute. Extrapolation of the recovery curves suggests that a "safer" interval between cigarettes for male smokers is about 114 minutes.
Sixty four percent (104 patients) of Malay patients attending the Psychiatric Clinic for the first time were interviewed. A similar number from the general Out-patients Department (O.P.D.) randomly chosen, served as the control group. Seventy six (73.1%) psychiatric patients had consulted a bomoh prior to their visit to the clinic as compared to 26 (25%) O.P.D. patients. The number of bomohs consulted was significantly higher among the psychiatric patients than the O.P.D. patients. The strength of social support, the availability of a bomoh and the belief of the patients, friends and/or relatives in the bomoh have been suggested as the main factors that influenced the Malay patients in seeking bomoh treatment. The belief that mental illness is due to supernatural causes is firmly held by bomohs who reinforce this notion in those who seek their advice. The importance of understanding the patient's cultural background in treating psychiatric patients is highlighted.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
MeSH terms: Mental Disorders/etiology; Mental Disorders/therapy*; Consultants*; Cross-Sectional Studies; Cultural Characteristics*; Culture*; Female; Hospitals, University; Humans; Malaysia; Male; Medicine, Traditional*; Outpatient Clinics, Hospital; Social Support
Cord blood from 8,975 babies delivered in Hospital Sultanah Aminah Johor Bahru over a period of eight months (1st August 1985 to 31st March 1986) were screened for G6PD deficiency. The overall incidence was 4.5% in Chinese, 3.5% in Malays and 1.5% in Indian babies. One hundred of these babies were observed in the nursery for seven days and their daily serum bilirubin recorded. The serum bilirubin peaked at 96 hours to a value of 12mg%. None of the babies in the nursery developed a serum bilirubin level of more than 15mg%. Six of the babies with G6PD deficiency that were sent home were readmitted with hyperbilirubinaemia that needed exchange transfusion.
Over a seven month period in 1986, 164 (1.1%) of a total 15,131 neonates delivered in the Maternity Hospital, Kuala Lumpur were born to mothers with prolonged rupture of the fetal membranes. Septic work-ups were performed on 163 of these babies shortly after birth, 77 of them had no bacteriological, radiological or other clinical evidence of infection. The remaining 86 had additional history of illness. Nine of these 86 babies had proven infection: four with septicemia, one with meningitis and four others with congenital pneumonia. This study showed that neonates had risk of infection only when maternal history of prolonged rupture of the fetal membranes was associated with other clinical evidence of infection. However, even in this group of neonates at risk, 89.5% of them were not infected. Therefore, there is still a need to develop a simple, rapid, reliable and cheap laboratory method to help early identification of the infected from the non-infected neonates in order to prevent unnecessary antibiotic treatment and hospital stay.
Bladder stones in men are thought to be almost exclusively due to outflow obstruction. We studied the incidence of operations for urinary outflow obstruction and bladder stone to establish the relationship between these two conditions in Kelantan. In only 48 (31%) of 154 men undergoing removal of bladder stones was a procedure for outflow obstruction performed. Thus the remaining 69% had no clinical obstruction to account for their stones. Bladder stones were more common in prostatectomy patients than expected (42/193: 22%). We suggest that other causes may be important in the aetiology of bladder stones in Kelantan.
A retrospective study of 1000 cases of microscopically diagnosed head and neck cancers in the University Hospital, Kuala Lumpur was done. Head and neck neoplasms comprise 7.1% of all tumours diagnosed in this Hospital and the commonest sites of involvement are the nasopharynx (29.1%), cervical lymph nodes (22.6%), oral cavity (10.2%), thyroid (8.2%) and skin (6.5%). Histologically, 87% of tumours are epithelial in nature. The results of this study show that nasopharyngeal carcinoma is commonest in Chinese males, while oral and laryngeal malignancies occur more frequently in Indians.
MeSH terms: Biopsy; China/ethnology; Head and Neck Neoplasms/ethnology; Head and Neck Neoplasms/epidemiology; Head and Neck Neoplasms/pathology*; Humans; India/ethnology; Malaysia/epidemiology; Retrospective Studies; Asian Continental Ancestry Group
Thirty one cases of malignant tumours of the maxillary sinus presenting to the Department of Otolaryngology, Universiti Kebangsaan Malaysia over a four year period from 1982 to 1986 are reviewed. 18 cases (58.1%) were squamous cell carcinoma while seven cases (22.5%) were Non-Hodgkin's lymphoma. There were four cases (12.0%) of adenoid cystic carcinoma while in two cases (6.5%) the tumours were undifferentiated. Presentation was generally late. Nasal obstruction, facial swelling and epistaxis were the main presenting symptoms. Nasal involvement was found in 61.3% of cases, while 51.6% had involvement of the palate as well. Metastasis to the cervical lymph node were uncommon (6.5%). Surgery and radiotherapy with or without chemotherapy were the main modes of treatment in the management of malignant tumours of the maxillary sinus.