A review of consecutive biopsies from 85 Malaysian patients with primary localised cutaneous amyloidosis (PLCA) revealed 63 with papular amyloidosis (PA) and 22 with macular amyloidosis (MA). PLCA appeared to affect the Chinese more frequently than the other major ethnic groups but MA was more common than expected among the Indians. Of patients with PA, one had systemic lupus erythematosus, one scleroderma and in another, connective tissue disease was suspected. MA was not found to be associated with any other disease. Histologically, PA differed from MA by the larger size of amyloid deposits in the papillary dermis. There was no difference in their tinctorial and immunohistochemical characteristics. Deposits were permanganate-resistant and negative for AA protein, immunoglobulin light chains and keratin. A few cases exhibited positively for cytokeratin. Strong immunoreactivity for AP protein was observed. PA and MA appear chemically similar and are likely to be of epidermal origin.
The concept of epidemiological transition is now quite widely recognized, if not so widely accepted. The transition appears to progress at varying speeds and to different extents spatially; it seems that there can be considerable international, regional and local variations in its progress. The paper examines this contention in the case of a number of countries in Southeast Asia, principally Hong Kong, Malaysia and Thailand. Drawing on evidence from this region, the paper highlights the importance when researching epidemiological transition of the time period under consideration; socio-cultural variations; the nature and quality of data, and spatial scale. It makes some suggestions as to the potential of the concept of epidemiological transition in health care planning and development studies.
At the faculties of dentistry in Chiang Mai, Thailand (CM), and Kuala Lumpur, Malaysia (KL), 234 and 233 consecutive out-patients were interviewed concerning tobacco and chewing habits and examined for the presence of oral melanin pigmentation. Tobacco was regularly used by 32% and 28% of the studied populations in CM and KL. Cigarette smoking was the predominant habit, but the chewing of betel and tea leaves (miang) and the smoking of banana leaf cigars (khi yo) was also registered. The genetically acquired pigmentation dominated. Although nearly all non-tobacco users in the Malay and Indian populations had oral melanin pigmentation, it was found that tobacco smokers had significantly more oral surfaces pigmented than non-tobacco users. Among Thais, the percentage of pigmented individuals was significantly higher among tobacco smokers. It was concluded that tobacco smoking stimulates oral melanocytes to a higher melanin production also in dark-skinned ethnic groups.
A case of Koro is described in a Malaysian Chinese man in the setting of martial dysharmony and sexual rejection. A distinction is suggested between the epidemic form of Koro and the Koro symptom occurring sporadically. Existence of the sporadic Koro syndrome is discussed and a unified classificatory system is proposed.
1. Substrate specificity of purified king cobra (Ophiophagus hannah) venom L-amino acid oxidase was investigated. 2. The enzyme was highly specific for the L-enantiomer of amino acid. Effective oxidation of L-amino acid by the enzyme requires the presence of a free primary alpha-amino group but the alpha-carboxylate group is not as critical for the catalysis. 3. The enzyme was very active against L-Lys, L-Phe, L-Leu, L-Tyr, L-Tryp, L-Arg, L-Met, L-ornithine, L-norleucine and L-norvaline and moderately active against L-His, L-cystine and L-Ileu. Other L-amino acids were oxidized slowly or not oxidized. 4. The data suggest the presence of a side chain binding site in the enzyme, and that the binding site comprises at least five 'subsites': the hydrophobic subsites a, b and c; and the two 'amino' binding subsites d and e. Subsite b appears to be able to accommodate two methylene/methyl carbons.
Three polycentric rumen fungi, LL, LC2 and Ruminomyces elegans (C2), isolated from the rumen of cattle were grown in six culture media. LL and LC2 were morphologically similar. Their characteristics resembled those of Orpinomyces and Neocallimastix joyonii, and they grew well and produced sporangia after 3-4 d growth in all the media. R. elegans differed morphologically from LL and LC2, but although it also grew well in all media, abundant sporangia occurred only after 2-3 d growth in media containing cellulose. Undifferentiated sporangia were produced by all three isolates; differentiation of the sporangia did not occur in the spent growth media. However, if thalli possessing recently-formed sporangia were transferred to, or flooded with, fresh liquid medium or rumen fluid, zoosporogenesis and liberation of zoospores occurred within 17-20 min for isolates LL and LC2 and 30 min for R. elegans. Procedures for inducing zoosporogenesis by polycentric anaerobic fungi are described.
Recent studies of drug promotion and labeling in Third World countries since 1972 have observed important changes in the policies of multinational corporations. Earlier studies found that multinational and national drug companies often grossly exaggerated the indications for the drugs and minimized or ignored the hazards. In the latest study, initiated in 1987, considerable improvement in promotional practices of the multinational corporations has been found, but little or no improvement on the part of the national companies. As a result, physicians are still provided with grossly exaggerated claims and the hazards of prescription drugs are covered up or glossed over. A very serious problem--the marketing of fraudulent drug products--has been identified in a number of Third World countries. Drug products are shaped and colored to resemble the original multinational company product, but contain only a small percentage of the active ingredient stated on the label, or perhaps none at all. In Indonesia fraudulent drug products may represent 20-30% of all drug products in the market. Similar fraudulent products have been reported in Brazil, Thailand, Bangladesh and Malaysia.
MeSH terms: Developing Countries*; Drug Industry; Drug Labeling*; Fraud*; Humans; Marketing of Health Services/methods*; World Health Organization
Between January 1982 and December 1989, 12 patients with 13 acute extradural haematomas as a result of injury involving the venous sinuses were treated by the first author. The CT scan appearances in 6 cases were remarkable in that there were large bubbles of low density in the hyperdense haematomas and liquid blood was found during the operation. The possible underlying pathophysiological changes that gave rise to this appearance are discussed. The CT scan appearance and the proximity of the clot to the venous sinuses should alert the neurosurgeon to the high probabilities of venous sinus tear such that proper treatment can be offered.
A total of 627 subjects comprising 455 Chinese, 127 Dravidian Indians and 45 Malays were investigated for serum Apo A-IV polymorphism. The frequency of Apo A-IV*2 was found to be significantly higher (p less than 0.001) in Indians (0.043) compared to that in the Chinese (0.010) and Malays (0.011). The frequency of A-IV*3 was found to be around 0.02 in all the ethnic groups. A low frequency of A-IV*4 (less than 0.01) was observed in the Chinese and Indians. The phenotypic distribution of Apo A-IV was at Hardy-Weinberg equilibrium in the three ethnic groups.
The aim of this study was to determine the periodontal status in relation to the quality of the adjacent proximal tooth surface. The gingival index (GI) and probable pocket depth (PD) were measured in 144 contra-lateral pairs of sound vs. restored and 95 contra-lateral pairs of sound vs. carious surfaces in 124 patients. The restorations studied were silver amalgams and tooth-coloured filling materials, the margins of which were supragingival or level with the gingival margins. The results showed that the GI and PD were greater for both restored and carious tooth surfaces than for the contra-lateral sound surfaces. When all the teeth were grouped together, the differences in the mean values of GI and PD were statistically significant at the P less than or equal to 0.05 level. A comparison between restored and carious (non-paired) tooth surfaces revealed higher mean values of GI and PD for the latter, which were highly significant at the P less than 0.001 level. Thus the present study shows that proximal tooth surface quality influences the health status of the adjacent periodontium.
In a study to test the association between soil transmitted intestinal helminthiasis and abdominal symptoms in a non-paediatric age group, 242 randomly selected patients (137 males, 105 females, median age 45 years) were asked specific questions pertaining to abdominal symptoms at the time of admission to the adult medical wards. Stool examination on all patients revealed a round worm prevalence rate of 21%. A larger proportion of stool positive female patients were symptomatic than stool negative females (68% vs 30%, p = 0.04). There was no significant difference in symptoms between stool positive and stool negative male patients (34.6% vs 31%, p = 0.91). The results suggested an association between intestinal nematode infection and abdominal symptoms in females but not in males.
It has been known that intrahepatic biliary lithiasis (IHBL) is prevalent in East Asia including Japan, South Korea, Taiwan, Malaysia, Hong Kong, and Singapore. In contrast, the entity has drawn little attention in Europe and the United States where only scattered reports appear. IHBL can be placed in the category of the benign disease. Its distinctive clinical picture is an intractable course necessitating multiple surgical interventions because recurrence is usual, rather than exceptional. This is in distinct contrast to ordinal stones which originate in the gallbladder. Patients with IHBL do not rarely die of progressive hepatic damage resulting from longstanding obstructive jaundice, cholangitis, liver abscess, septicemia, and so forth.
MeSH terms: Bile Duct Diseases/epidemiology; Bile Duct Diseases/radiography; Bile Duct Diseases/surgery; Bile Ducts, Intrahepatic/radiography; Bile Ducts, Intrahepatic/surgery; Cholelithiasis/epidemiology*; Cholelithiasis/radiography; Cholelithiasis/surgery; Europe/epidemiology; Far East/epidemiology; Humans; Prognosis; United States/epidemiology; Incidence
Enteritis necroticans (EN), known as pigbel in Papua New Guinea (PNG), may be the important predisposing lesion to mid-gut volvulus, jejunal and ileal ileus and other forms of small bowel strangulation in communities where protein deprivation, poor food hygiene, epochal meat feasting and staple diets containing trypsin inhibitors co-exist. Such human habitats occur in Africa, Central and South America, western Pacific, Asian and south-east Asian cultures. Isolated outbreaks of necrotizing enteritis have been reported from Uganda, Malaysia and Indonesia but as yet no systematic epidemiological study of the prevalence of small bowel strangulations has been described in the surgical literature of 'third world' countries. Now that enteritis necroticans is preventable by vaccination, such studies should be undertaken. This paper outlines the story of pigbel and its control in PNG.
PIP: At the Population and Natural Resources Workshop of the World Conservation Union (IUCN) General Assembly in Perth, Australia, December 1990, population and quality of life issues were stressed as one of the central items to be placed on the 1992 Agenda of the UN Conference on Environment. The pace of environmental degradation is quickening, the causes are becoming more entrenched, and indecision will narrow our options. Poverty and population growth are making development unsustainable. Technological miracles will not appear to restore balance. Deforestation, soil erosion, decertification and loss of water resources are fueling urbanization. Therefore the World Commission on Environment and Development, known as the Brundtland Commission, ranks human resources development as a top priority in sustainable development and quality of life. Human resources can be improved by providing maternal and child care, family planning and improving the status of women. Successful family planning programs as seen in Thailand and Malaysia can show results very quickly once national population policies, institutions and capacity are in place.
MeSH terms: Congresses as Topic*; Delivery of Health Care; Demography; Economics; Environment*; Family Planning Services*; Health; Health Manpower*; Health Services; Maternal-Child Health Centers*; Population; Population Dynamics; Population Growth*; Primary Health Care; Quality of Life*; Social Welfare; Socioeconomic Factors; Women's Rights*
PIP:
Fertility trends and prospects for east and southeast Asian countries including cities in China, Taiwan, the Republic of Korea, Thailand, Indonesia, Malaysia, the Philippines, Myanmar, and Viet Nam are described. Additional discussion focuses on family planning methods, marriage patterns, fertility prospects, theories of fertility change, and policy implications for the labor supply, labor migrants, increased female participation in the labor force (LFP), human resource development, and social policy measures. Figures provide graphic descriptions of total fertility rates (TFRS) for 12 countries/areas for selected years between 1960-90, TFR for selected Chinese cities between 1955-90, the % of currently married women 15-44 years using contraception by main method for selected years and for 10 countries, actual and projected TFR and annual growth rates between 1990-2020 for Korea and Indonesia. It is noted that the 1st southeast Asian country to experience a revolution in reproductive behavior was Japan with below replacement level fertility by 1960. This was accomplished by massive postponement in age at marriage and rapid reduction in marital fertility. Fertility was controlled primarily through abortion. Thereafter every southeast Asian country experienced fertility declines. Hong Kong, Penang, Shanghai, Singapore, and Taipei and declining fertility before the major thrust of family planning (FP). Chinese fertility declines were reflected in the 1970s to the early 1980s and paralleled the longer, later, fewer campaign and policy which set ambitious targets which were strictly enforced at all levels of administration. Korea and Taiwan's declines were a result of individual decision making to restrict fertility which was encouraged by private and government programs to provide FP information and subsidized services. The context was social and economic change. Indonesia's almost replacement level fertility was achieved dramatically through the 1970s and 1980s by institutional change in ideas about families and schooling and material welfare, changes in the structure of governance, and changes in state ideology. Thailand's decline began in the 1960s and is attributed to social change, change in cultural setting, demand, and FP efforts. Modest declines characterize Malaysia and the Philippines, which have been surpassed by Myanmar and Viet Nam. The policy implications are that there are shortages in labor supply which can be remedied with labor migration, pronatalist policy, more capital intensive industries, and preparation for a changing economy.
MeSH terms: Asia; Asia, Southeastern; Birth Rate*; Contraception*; Contraception Behavior*; Demography; Developing Countries; Economics; Emigration and Immigration*; Employment*; Family Planning Services; Far East; Fertility*; Health Manpower; Health Planning; International Agencies; Marriage*; Organization and Administration; Organizations; Policy Making*; Population; Population Dynamics*; Public Policy*; United Nations*
PIP: The population explosion has been abating since the 2nd half of the 1960s. The birth rate of the 3rd World dropped from 45/1000 during 1950-55 to 31/1000 during 1985-90. From the 1st half of the 1960s to the 1st half of the 1980s the total fertility of such countries dropped from 6.1 to 4.2 children/woman. In Taiwan, Singapore, Hong Kong, South Korea, and Malaysia living standards improved as a result of industrialization, and fertility decreased significantly. In Sri Lanka, China, North Vietnam, and Thailand the drop of fertility is explained by cultural and religious factors. In 1982 about 78% of the population of developing countries lived in 39 states that followed an official policy aimed at reducing the population. Another 16% lived in countries supporting the concept of a desired family size. However, World Bank data showed that in the mid-1980s in 27 developing countries no state family planning (FP) programs existed. India adopted an official FP program in 1952, Pakistan followed suit in 1960, South Korea in 1961, and China in 1962. In Latin America a split policy manifested itself: in Brazil birth control was rejected, only Colombia had a FP policy. In 1986 the governments of 68 of 131 developing countries representing 3.1 billion people considered the number of children per woman too high. 31 of these countries followed concrete population control policies. On the other hand, in 1986 24 countries of Africa with 40% of the continent's population took no measures to influence population growth. In Latin America and the Caribbean 18 of 33 countries were idle, except for Mexico that had a massive state FP program. These programs also improve maternal and child health with birth spacing of at least 2 years, and the prevention of pregnancies of too young women or those over 40. The evaluation of rapidly spreading FP programs in the 1970s was carried out by the World Fertility Survey in 41 countries. The impact of FP programs was more substantial than socioeconomic factors. Contraceptive use increased in Mexico from 13% in 1973 to 41% in 1978 among women of fertile age. According to 1984 and 1988 UN data modern methods of contraception were used by 70% of women in China, 60-65% in Southeast Asia, Costa Rica, and Puerto Rico. In contrast, less than 5% used them in most countries of Africa, 15-20% in West Asia, 25-30% in South Asia, and 40% in Latin America. The pill was the most popular method. From the early 1980s in South and East Asia 1/5 of women got sterilized after attaining the desired family size. Less than 10% of women used IUDs in developing countries. FP programs have benefited from higher education levels and economic incentives and sanctions and exemplified in Singapore, China, South Korea, Thailand, and Taiwan.
MeSH terms: Asia; Asia, Southeastern; Birth Rate*; Contraception*; Contraception Behavior*; Demography; Developing Countries*; Economics*; Education*; Family Characteristics*; Family Planning Services; Fertility*; Government*; Health Planning; Industry*; Latin America; Motivation*; Politics; Population; Population Control*; Population Dynamics; Population Growth*; Public Policy*; Social Change*; Socioeconomic Factors*; Program Evaluation*; Family Planning Policy*
PIP:
In the Philippines the number of children per woman is envisioned to be 2 by the year 2000 to reach simple replacement level. The crude birth rate had dropped from 43.6% in 1960 to 32.3% during 1980-85 corresponding to 4.2 children/woman. However, the corresponding rates for Thailand and Malaysia were 28% and 32.1%, respectively. The total fertility rate (TFR) was still a high 4.7% in 1988. In 1980 TFR was 3 in Manila, but 3/4 of the provinces still had TFR of 5-6.8 in 1985. Yet the World Fertility Survey of 1970 indicated that the total married fertility rate had decreased from 9.6 in 1970 to 9.1 in 1977. Married women had an average of 4.5 children in 1968 and still 4 children in 1983. Only 1/2 of married women aged 15-45 used contraception. In 1983, only 26.2% of all fertile married women used effective contraception. 63% of Moslim women, 70% of Catholics and Protestants, and 83% of members of the Church of Christ advocate modern contraceptives. From 1967 the National Population Outreach Program of the state sent out family planning advisers to unserviced areas. In 1983 only 37% of married women knew about such a service within their locality, and in 1988 a World Bank investigation showed that 67% could not afford contraceptives. The education, employment, income, urbanization of the household as well as medical care of women and children strongly influenced reproduction. The lifting of living standards and improvement of the condition of women is a central tenet of Philippine family planning policy. A multiple regression analysis of the World Fertility Survey proved that professional women tended to have smaller family size, however, most women worked out of economic necessity not because of avocation. The higher the urban family income, the lower marital fertility; but the reverse is true in rural areas where traditionally large families have had more income, and children have provided future material security. In 1983 1/3 of women with children over 18 received regular financial remittances from them. Thus, appropriate family planning program evaluation has to be concerned with the relationships of fertility and rural areas, the economic development of the community, and the physical access to a family planning clinic.
MeSH terms: Asia; Asia, Southeastern; Behavior; Birth Rate*; Contraception*; Contraception Behavior*; Demography; Developing Countries; Economics; Educational Status*; Family Planning Services; Fertility*; Health Planning*; Income*; Marriage*; Maternal Age*; Philippines; Population; Population Characteristics; Population Dynamics*; Public Policy; Religion*; Rural Population*; Social Behavior; Social Class; Socioeconomic Factors; Women's Rights*; Family Planning Policy*