A turnaround time study was conducted for bacteriological culture tests in seven Malaysian general hospitals. The turnaround times were determined using a specially designed form that was completed by the ward staff. Doctors at these hospitals were also polled to find out whether they were satisfied with the promptness of bacteriological test reporting in their hospitals. The turnaround times obtained from this survey were found to be satisfactory taking into account the constraints of laboratory methods employed. Nevertheless only about a third of doctors expressed satisfaction with the timeliness of the bacteriological test reporting. Doctors and microbiologists should get together and agree on acceptable standards of turnaround times that are practical and reasonable.
Monoclonal plasma cell proliferative diseases such as multiple myeloma and plasmacytoma can involve extramedullary sites at the time of first presentation, or subsequently in the course of the disease. Under such circumstances, they can mimic primary or metastatic carcinomas, neuroendocrine or neuroectodermal tumours and lymphomas, and the pathologist often has to resort to immunohistochemistry as an aid to diagnosis. We studied the morphology and immunohistochemical properties of 10 cases of previously confirmed monoclonal plasma cell proliferative lesions retrieved from the files of the Department of Pathology, University of Malaya. Serial 4u thick paraffin sections were stained with H&E, the Unna-Pappenheim technique for nucleic acid and a panel of antibodies using a standard immunoperoxidase technique. Light chain restriction was demonstrable in most of the cases. Seven (70%) showed kappa and 2 (20%) lambda light chain restriction. The remaining case was not stainable with most of the antibodies in the panel. The majority (80%) of cases showed accompanying IgG heavy chain in the cytoplasm, while 1 case had IgA. Seven (70%) showed membrane positivity with antibody to epithelial membrane antigen (EMA) and 7 (70%) cytoplasmic positivity with antibody to vimentin. This study enhances our awareness that neoplastic plasma cells can be positive for EMA and vimentin, and cautions us from misinterpreting these lesions as carcinomas or sarcomas. Notwithstanding that, immunohistochemical staining for kappa and lambda light chains can be helpful in differentiating monoclonal plasma cell proliferations from polyclonal ones.
A healthy 17-year-old Chinese male suddenly collapsed and died during a game of badminton. The autopsy examination revealed a solitary calcified aneurysm of the left common coronary artery with marked stenosis of the orifices of the anterior descending and circumflex branches. Histology of the aneurysm was non-specific with hyalinised scar tissue and foci of calcification. The only illness of significance in the past was an episode of 'pyrexia of unknown origin' at the age of 8 months. A review of the notes of that hospital admission revealed that the illness was most probably Kawasaki disease.
Growth hormone (GH) levels were measured after a 75g oral glucose load (OGTT) in normal adults, patients with impaired glucose tolerance (IGT), insulin-dependent diabetes mellitus (IDDM) and acromegaly. Nadir GH levels at 2-hour post-OGTT in normal subjects ranged from 0.4 to 8.4 mIU/L, the 95% confidence interval being 0.4-4.4 mIU/L. In IGT and IDDM subjects basal fasting GH levels were not significantly different from normal and did not alter during OGTT. The high fasting GH level measured in one each of the IGT and IDDM patients was suppressible at 1-hour after glucose intake. In contrast, acromegalic patients had elevated fasting GH levels (11.8-178 mIU/L) although in 3 patients, the levels were mildly elevated and overlapped with normal. OGTT failed or only partially suppressed GH secretion in all acromegalics. Therefore, elevated fasting GH levels are not diagnostic and OGTT is required for accurate diagnosis and assessment of treatment of acromegalic patients.
Deoxyribonucleic acid (DNA) of twenty chronic myeloid leukemia (CML) and thirty acute lymphoblastic leukemia (ALL) patients were analysed by Southern hybridization. The DNA was digested with BglII and hybridized with a 4.5-kilobase (kb) ph1/bcr-3 DNA probe. All the 20 CML patients showed gene rearrangement within a 5.8-kb segment (the major breakpoint cluster region, M-bcr) of the breakpoint cluster region (bcr) gene of chromosome 22, indicating the presence of the Philadelphia chromosome. M-bcr rearrangement at the bcr gene of chromosome twenty-two was not detected in all the thirty ALL patients (nine adults and twenty-one children) and two normal controls.
Fine dissection was carried out in 79 facial halves from formalin fixed Malaysian adult cadavers of various races, to trace the extracranial part of the facial nerve and its peripheral branches. The facial nerve trunk, after leaving the stylomastoid foramen was located at a depth of 1 to 2 cm from the skin in the vagino-mastoid angle. It bifurcates at the posterior border of the ramus of the mandible and in 3.8% trifurcation was found. Mean distance of bifurcation from the angle of the mandible was 28.06 mm and 81.0% were within the range of 21 to 35 mm. The branching patterns were classified into six types, and the frequency of occurrence was type I 11.39%, type II 15.9%, type III 34.18%, type IV 18.98%, type V 7.59% and type VI 12.67%. Type I, a classical text book pattern was found to be one of the least common patterns. There is no significant difference in percentage of each type between the present study and that of Koreans, though some differences with Caucasians were noted in three uncommon types. The frontal branch could be outlined between the two diverging lines from the earlobe to the lateral ends of the eyebrow and the highest frontal crease. Posterior to the facial artery, the mandibular branch was seen passing below the inferior border of the mandible in 20%; anterior to the artery, this nerve divides into one to four branches. In almost all the cases, branches to the mentalis and the depressor labii inferioris muscles and infrequently branches to the depressor angular oris were seen below the inferior border of the mandible.(ABSTRACT TRUNCATED AT 250 WORDS)
MeSH terms: Dissection; Facial Nerve/anatomy & histology*; Humans; Malaysia; Parotid Gland/anatomy & histology; Asian Continental Ancestry Group
The results of treatment using a locally-designed external fixator in 20 patients are presented. Open fractures were the main indications for external fixation. Pin tract infection occurred in 8 patients. Only 2 patients had unstable fixation which required removal of the device. One third of patients developed malunion exceeding 15 degrees and two thirds had joint stiffness after conversion to plaster cast. This external fixator is adequate in the treatment of most open fractures of the tibia. However, improved techniques of pin insertion and cast application upon removal of the external fixator may help to reduce the incidence of pin tract infections and malunion.
Continuous ambulatory peritoneal dialysis (CAPD), a widely used replacement therapy for end stage renal failure, is frequently complicated by bacterial peritonitis. The infecting organisms are mainly staphylococci and gram negative aerobes. Pefloxacin is a fluorinated quinolone with good in-vitro activity against these pathogens. The objective of this open non comparative study is to determine the effectiveness and safety of oral pefloxacin mesylate as a single first line antimicrobial treatment of CAPD peritonitis. 28 episodes of CAPD peritonitis were treated with a stat dose of pefloxacin 800 mg. followed by 400 mg. 12 hourly for about 15-18 days. A pefloxacin sensitive organism was isolated in 17 episodes. 11 episodes were culture negative. Treatment results showed a cure in seventeen (60.7%), no treatment response in seven (25%), and relapses in four (14.2%). Side effects encountered were not serious except for one incident of a generalized seizure. We conclude that oral pefloxacin is convenient, safe and effective enough as a single first line antimicrobial treatment for CAPD peritonitis.
This is a study of infant feeding practices of 126 mothers. Seventy-seven mothers or 61.1% practised breast feeding. The typical breast feeding mother was more likely to be a Malay, with lower family income and residing in the rural area. The educational status of the mother was not an important factor in influencing her to breast feed. Health education on breast feeding should be intensified in schools to reinforce the implementation of the Malaysian Code of Ethics for Infant Formula Products.
MeSH terms: Ambulatory Care Facilities; Breast Feeding/ethnology; Breast Feeding/statistics & numerical data*; Child, Preschool; China/ethnology; Cross-Sectional Studies; Family Practice; Female; Humans; India/ethnology; Infant; Malaysia; Malaysia/ethnology; Mothers; Private Practice; Rural Population; Socioeconomic Factors
Malignant lymphoma of nasal septum is uncommon. It presents a problem in diagnosis to both otorhinolaryngologist and pathologist. This case report is about one such patient in whom the local disease has been controlled with the treatment of radiotherapy alone. However it is suggested that combined treatment of radiotherapy and cytotoxic therapy might improve the survival rate.
MeSH terms: Humans; Male; Middle Aged; Nasal Septum; Nose Neoplasms/diagnosis; Nose Neoplasms/pathology*; Lymphoma, T-Cell/diagnosis; Lymphoma, T-Cell/pathology*
One thousand consecutive Brunei Darussalam patients referred with low Hb, and/or low MCV and MCH (Hb < 12.5g/dl, MCV < 76fl, MCH < 27pg) were studied in the laboratory for underlying haemoglobinopathies. 30.0% of such patients were proved to have either beta-thalassaemia trait, beta-thalassaemia major, Hb AE, Hb EE, Hb E beta-thalassaemia or Hb H disease. In some, the haemoglobin abnormality was not identified precisely. Alpha-thalassaemia was suspected in an additional 4.3% of cases but confirmation study by globin-chain synthesis was not available. Beta-thalassaemia trait which was the predominant disorder was equally distributed among the three major race groups of Brunei Darussalam. Hb E was found exclusive among the Malay population. Hb H disease appeared as more common among the Chinese or the Malays (p > 0.05). This study reveals that thalassaemia and haemoglobinopathies are prevalent in Brunei Darussalam.
Faecal egg counts and serum prolactin concentrations in 13 pregnant and five non-pregnant Angora goats were monitored over a period of 20 weeks. The mean weekly egg counts of pregnant goats were significantly higher (P less than 0.01) than those of non-pregnant goats. In pregnant goats the mean egg counts in the 6 week post-partum period were significantly higher (P less than 0.01) than those of 6 weeks prepartum. The mean prolactin concentration of pregnant goats during the 6 week post-partum period was significantly higher (P less than 0.01) than that of 6 weeks pre-partum. During the 6 to 3 weeks before parturition, the prolactin values generally remained low (below 100 ng ml-1). The rise in prolactin concentration started between 3 weeks and 1 week before parturition. Only in pregnant goats was there a positive linear regression between prolactin levels and faecal egg counts.
There have been changes in the national policy regarding population growth in Malaysia from 1982. This report studies the changes in contraceptive practice among the three racial groups in this country, i.e. Malays, Chinese and Indians, over a 5-year period with an interval of 10 years. This is a retrospective study based on the attendance at the same family planning clinic in an urban setting. The striking change noted is the change in the racial composition of contraceptive usage in the two study periods with a shift from the Chinese being predominant in 1975-1979 to Malays in 1985-1989. There was no change among the numbers of Indians using contraception. The results also reveal a significant trend of change for users of the pill and those undergoing sterilization. There were no significant changes in IUD, condom and injectable usage. The study demonstrates how national policies, level of education and rural urban migration can significantly alter contraceptive practice.
MeSH terms: Adolescent; Adult; China/ethnology; Contraception/methods*; Educational Status; Family Planning Services/trends*; Female; Humans; India/ethnology; Intrauterine Devices; Longitudinal Studies; Malaysia; Middle Aged; Retrospective Studies; Socioeconomic Factors; Asian Continental Ancestry Group; Oceanic Ancestry Group; Continental Population Groups
1. The L-amino acid oxidase of the monocellate cobra (Naja naja kaouthia) venom was purified to electrophoretic homogeneity. The molecular weight of the enzyme was 112,200 as determined by Sephadex G-200 gel filtration chromatography, and 57,400 as determined by SDS-polyacrylamide gel electrophoresis. 2. The enzyme had an isoelectric point of 8.12 and a pH optimum of 8.5. It showed remarkable thermal stability, and, unlike many venom L-amino acid oxidase, was also stable in alkaline medium. The enzyme was partially inactivated by freezing. 3. The enzyme was very active against L-phenylalanine and L-tyrosine, moderately active against L-tryptophan, L-methionine, L-leucine, L-norleucine, L-arginine and L-norvaline. Other L-amino acids were oxidized slowly or not oxidized. 4. Kinetic studies suggest the presence of a side-chain binding site in the enzyme, and that the binding site comprises of at least four hydrophobic subsites.
Although delays in seeking dental care among patients are frequently observed in daily practice, this problem has never been investigated in other utilization studies. This study attempts to establish the magnitude and severity of the problem of delay in a delivery system where cost is not a major barrier to utilization. 555 users of Government dental services were interviewed. Only 37% of them came promptly within 6 days of perceiving a dental need. The majority (63%) had delayed their dental visit for more than 1 week. In fact, the highest frequency of delay was for more than 1 month. Prompt attendance was found to be associated with people who regularly came for asymptomatic check-ups. In contrast, more than 50% of those who thought they needed fillings and extractions had delayed their visit for more than a month. The main causes of delays were attributed to work commitments and the lack of perceived need for urgent care. Barriers related to transport or financial problems were ranked very low. The implications of these findings are discussed.
MeSH terms: Age Factors; Dental Health Services/statistics & numerical data*; Health Services Needs and Demand/statistics & numerical data; Humans; Malaysia/ethnology; Oral Health; Surveys and Questionnaires; State Dentistry/statistics & numerical data*; Time Factors; Health Behavior/ethnology