Trends in selected pregnancy complications from 1969 to 1987 in a tertiary hospital in Malaysia are presented. Complications reviewed were abortion, ectopic pregnancy, anemia, hypertension, hyperemesis, antepartum and postpartum hemorrhage. Possible explanations for the observed trends were discussed, including the role of improved obstetric care and changes in the characteristics of the childbearing population. The data presented give some indication of maternal morbidity in the childbearing population served by this tertiary center and should lead to improvements in provision of services as well as in health data collection in the future.
Specific antibody to Pseudomonas pseudomallei exotoxin was detected in sheep sera exposed to natural infection. An enzyme-linked immunosorbent assay (ELISA) was used. Serum antitoxin was present in 49.3% of sera obtained from a flock of sheep naturally exposed to P. pseudomallei infection. Among these sera, 17.0% gave titers of 10,000. In contrast, serum antitoxin was present in only 6.0% of sera collected from sheep kept on a melioidosis-free farm. The ELISA reactivity of all positive sera could be completely absorbed with purified P. pseudomallei exotoxin. Similarly, preincubation of the exotoxin-coated wells with specific antiserum inhibited the ELISA reactivity of sheep sera. The results indicate that exotoxin is produced in vivo during infection by P. pseudomallei.
Vitamin D-binding protein (DBP) of crab-eating macaques (Macaca fascicularis) was examined by means of three electrophoretic methods. DBP phenotypes were observed to be one or two bands in each method. All of DBP molecular variants could be detected by the simultaneous typing with these three methods. Family analysis suggested that DBP variants followed the mode of autosomal codominant inheritance. A total of 17 phenotypes governed by at least 11 alleles were observed in the populations of Malaysia, Indonesia, and the Philippines. The genetic variability was high in Malaysian and Indonesian populations but low in the Philippine population.
The case records of 64 patients with malaria over a five year period admitted to the University Hospital, Kuala Lumpur were examined. There were 32 cases of P. falciparum, 26 cases of P. vivax and two cases of mixed infections. Four cases of P. malariae were recorded. The clinical findings, biochemical and haematological parameters were examined for any indication of a pernicious syndrome. A high index of suspicion of a malarial infection may be based on the findings of anaemia, thrombocytopaenia, hyponatraemia, renal failure and abnormal liver function tests in the face of a negative blood film. These pernicious syndromes occur more often in malignant tertian malaria (anaemia 50%, hyponatraemia 39.1%) but a high percentage of the other malarial species show these abnormalities (P. vivax anaemia 57.7%, hyponatraemia 19.2%). When these abnormalities are present but blood films for malaria parasites are negative, repeat blood films are warranted until a parasitological diagnosis is achieved and correct treatment may be started.
A representative group of 204 infertile couples from Kuala Lumpur, Malaysia were compared to a similar group of 633 couples from Aberdeen, UK in an attempt to study if there was any regional difference in the pattern of infertility seen. The protocol for investigation and diagnostic criteria for both centres were standardised. A significant difference (X2 = 63.43; p less than 0.001) was seen. The reasons for these differences are discussed.
MeSH terms: Adolescent; Adult; Female; Great Britain; Humans; Infertility/ethnology; Infertility/etiology*; Malaysia; Male
The clinical features and management of 12 patients with Fournier's gangrene are described. The patients differed from the usual description of Fournier's gangrene in that they were older, the disease had a less abrupt onset and a definite predisposing factor was identified in 10 of the 12 patients. The importance of early diagnosis and excision of necrotic tissue is emphasized.
Alpha-globin genes in crab-eating macaques were found to be triplicated at high frequencies according to restriction-enzyme comparisons. The frequencies of triplicated alpha-globin genes in macaques originally from Malaysia and Indonesia were 0.432 and 0.275, respectively, while no triplication was found in individuals from either the Philippines or northern and central Thailand. Quadruplicated alpha-globin genes were also observed, at frequencies of 0.045 (Malaysia), 0.075 (Indonesia), and 0.021 (the Philippines). A single locus was detected in only one of 40 chromosomes from Indonesia (frequency 0.025).
A control programme against subperiodic brugian filariasis was implemented in three villages, (Kg. Ampungan, Kg. Sebangkoi and Kg. Sebamban) in Sarawak, Malaysia. In Kampong Ampungan, the mass administration of diethylcarbamazine (DEC-citrate) combined with residual house spraying of pirimiphos-methyl reduced microfilarial rate to 8% of the pre-treatment level and microfilarial density (MfD50) to 44% of the pre-treatment level over a period of four years. In Kampong Sebangkoi and Kampong Sebamban, where only mass DEC therapy was applied, the microfilarial rate and MfD50 declined distinctly in the second blood survey but increased gradually in two subsequent follow-up blood surveys. In Kg, Ampungan, we observed a significant reduction of infective biting rate (88.3%), infection rate (62.5%) and transmission potential (88.1%) of Mansonia bonneae at the fourth spray round. The corresponding reduction rates in Kg. Sebangkoi and Kg. Sebamban were 35.3%, 26.7%, 42.2% and 24%, 30.8% and 15.4% respectively. The biting density of the vector was reduced by 79.8% indoors and 31.8% outdoors at the sprayed village, while only a slight decrease in densities (17.9% indoors and 12.4% outdoors) was observed at the unsprayed village. Bioassay tests revealed that pirimiphos-methyl had a substantial fumigant effect on the vector. The integrated control measure in controlling subperiodic brugian filariasis is discussed.
Successful colonization of Mansonia dives, the principal vector of subperiodic Brugia malayi was established in a field insectary. Mean egg clusters laid on Eichhornia crassipes, Pistia stratiotes, Homalomena cordata and polystyrofoam strips were 12.0, 10.4, 9.5 and 13.7 respectively. However, the mean number of first instar larvae hatched from each egg cluster laid by females on the three plant substrates (range 51.1 to 58.6) was higher than that laid on the polystyrofoam strips (41.8). There were no significant differences in the success pupation and adult emergence rates among the three host plants used as attachment substrates. Adult emergence occurred at a mean of 10.8 days. The first adult emergence was observed at the 25th day after hatching and continued till the 50th day. The 50% mortality rates for the adults were estimated as 8 days for the males and 14 days for the females. The mean gonotrophic cycle ranged from 3.8 to 4.3 days with a mean of 4.04 days. 63.6% of Ma. dives females oviposited in a medium of rat dung and water. The mean incubation period of eggs ranged from 5.2 to 6.5 days with a mean of 5.7 days. The biology of Ma. dives and Ma. bonneae is briefly compared.
A case of chronic mucocutaneous candidiasis in a Malaysian child who subsequently developed disseminated tuberculosis and toxoplasmosis is described. The phenotype of her peripheral blood mononuclear cells showed discordance for her T cell markers. The presence of a subpopulation of CD2-/CD3+ mononuclear cells leading to an immunodeficiency state is consistent with failure of activation of CD2-mediated alternative pathway resulting in immunodeficiency. Such abnormal CD2-/CD3+ subpopulations have been described in lepromatous leprosy and foetal abortuses.
Most methods used in double esterase cytochemistry for the diagnosis and classification of acute myeloid leukaemias require double incubation and staining, using separate coupling reagents. We evaluated a method by Swirsky on our normal and abnormal blood and bone marrow smears where only a single incubation and the use of a single coupling reagent is required. Its short incubation period and its strong positive reaction for butyrate esterase in demonstrating cells of monocytic lineage gives it an advantage over the conventional double incubation technique.
In a study of 124 adult patients with bronchial asthma, 65% of them had associated rhinitis. In the asthmatics who had associated rhinitis, both diseases usually started within two years of one another but either disease might develop first. In 21% of the patients, asthmatic attacks were preceded or precipitated by rhinitis symptoms. In the patients who had asthma alone or those associated with rhinitis, no significant difference were found in terms of age and sex distribution, age of onset, and a positive family history of asthma, rhinitis or allergic diseases. Response to skin prick test using six different types of allergens also showed no difference in the two groups of patients. Sensitivity to house dust was common among both groups of patients as well as in the normal controls suggesting a common occurrence of house dust mite in our community and making the skin prick test using this allergen unsuitable as a test for atopy in our population.
Study site: Chest clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Gas-Liquid chromatography (GLC) was used to detect the presence of isocaproic acid produced by Clostridium difficile from 54 stool samples grown in cycloserine-cefoxitin broth. Isocaproic acid was detected in 12 samples of which 5 were confirmed to be Clostridium difficile by culture and biochemical tests. The detection of isocaproic acid by GLC together with the presence of presumptive colonies on primary selective culture media provides a more rapid laboratory diagnosis for Clostridium difficile.
A total of 676 patients were admitted to the intensive care unit, University Hospital, Kuala Lumpur between January 1989 and March 1990. Fifty-one hospital-acquired infections were recorded, giving a rate of 7.6%. The most frequent site of infection was the respiratory tract (41.2%), followed by the urinary tract (27.5%). Most of the pathogens were gram-negative bacilli (71%). The three most common pathogens were Klebsiella species, Pseudomonas aeruginosa and Staphylococcus aureus.
Squamous cell carcinoma-related antigen (SCC-Ag), first described by Kato and Torigoe in 1977, has been cited by various workers as a serological marker for some epithelial neoplasms. The most well-studied is its association with carcinoma of the uterine cervix. In January 1989, we embarked on a prospective, multivariate study at the University Hospital, Kuala Lumpur to assess the usefulness of serologically assaying SCC-Ag (using the Abbott RIA diagnostic kit) in our patients with carcinoma of the uterine cervix. We were also interested to ascertain whether SCC-Ag is a 'general' marker for all histological types of cervical carcinoma or specific for squamous carcinoma. From the time of commencement to June 1990, 35 newly-diagnosed and histologically-proven cases were entered into the study. Of these, 4 were keratinising squamous carcinoma, 18 large cell non-keratinising carcinoma, 3 adenosquamous carcinoma, 7 adenocarcinoma and 3 carcinoma-in-situ. Our preliminary results show that all keratinising squamous carcinoma and 1/3 each of large cell non-keratinising carcinoma, adenosquamous carcinoma and carcinoma-in-situ had positive pre-therapy serum SCC-Ag levels (i.e greater than 2 ng/ml, 2 ng/ml being an arbitrarily selected 'cut-off' value). In contrast, no adenocarcinoma was serologically positive. In addition, keratinising squamous carcinoma had the highest mean pre-therapy serum SCC-Ag level. The results imply that serum SCC-Ag is related to the (1) presence of squamous and not glandular differentiation and (2) degree of squamous differentiation.
Raised prolactin levels have been implicated as a cause for infertility in patients with endometriosis. This study was done to investigate if serum prolactin levels were significantly raised in infertile patients with endometriosis. Serum prolactin levels were studied in 43 infertile patients with endometriosis. For controls, 36 infertile patients with normal pelvic findings were used. For standardization, blood samples were drawn on day 21 of the menstrual cycle. Analysis was done by radioimmunoassay using reagent kits. The mean prolactin level in the endometriotic group was 372 mIU/l (range 187-752) while that in the controls was 333 mIU/l.(range 124-767). There was no statistical difference (t = 1.12). Furthermore the accepted normal level for serum prolactin in our population is less than 540 mIU/l. These results show that there is no evidence to implicate raised prolactin levels as a cause for infertility in patients with endometriosis.
As general pathologists in Malaysia are required to perform medico-legal autopsies, this paper is written with the hope that it may serve as a guide to the less initiated. An account of elementary ballistics is included because it is essential for understanding the features of wounds produced by firearms. A complete autopsy examination including a systematic approach to the injuries is advocated. The recognition and interpretation of firearm injuries can often be difficult and it is essential that all features of injuries and other relevant findings are carefully observed and recorded. Relevant observations, documentation and opinions necessary for accurate determination of the true circumstances of death are discussed.
Mixed reagents for the Glucose-6-phosphate dehydrogenase (G6PD) deficiency fluorescent screening test were freeze-dried in plastic tubes. The reagents were then reconstituted with distilled water and the test was performed in the usual way. Initial testing with the freeze-dried mixed reagents gave consistent positive reaction to 12 normal blood samples and negative reaction to 9 G6PD deficient blood samples. This will enable a laboratory with freeze-drying facilities to prepare reagent tubes in bulk. As these tubes can be kept at 4 degrees C and do not require to be stored at -20 degrees C, a major laboratory can prepare these tubes and supply small laboratories for screening purposes.