Using a rice-based model weaning food, the effect of Lactococcus lactis on the growth and survival of a range of enteric pathogens has been investigated. The starter organism used produces the bacteriocin nisin and the physiological L-lactate isomer, thus avoiding the risk of D-lactate acidosis when consumed by infants. L. lactis was a less effective antagonist than stronger acid producers such as the DL lactate producer, Lactobacillus plantarum , and only produced a potentially useful inhibition of pathogens when present in a large numerical superiority (>105:1). Prefermentation of the weaning food with L. lactis for 24 h produced a product with a pH of 3.7-3.8 containing ≈ 0.25% lactate (>96% L-lactate). The prefermented product was bactericidal for pathogens introduced subsequently. Despite the production of 100-150 international units nisin per g during fermentation, the inhibition of pathogens could be ascribed to acid production alone.
Absence of physiological concentrations of extracellular Ca2+ in the Krebs-Henseleit incubation buffer did not affect the ability of 10 nM glucagon (< 5%) to increase hepatocyte intracellular cyclic AMP concentrations, but severely ablated (by approximately 70%) the ability of 10 nM insulin to decrease these elevated concentrations. Cyclic AMP metabolism is determined by production by adenylate cyclase and degradation by cyclic AMP phosphodiesterase (PDE). In the absence of added extracellular Ca2+ (2.5 mM), insulin's ability to activate PDE activity was selectively compromised, showing a failure of insulin to activate two of the three insulin-stimulated activities, namely the 'dense-vesicle' and peripheral plasma-membrane (PPM) PDEs. In the absence of added Ca2+, insulin's ability to inhibit adenylate cyclase activity in intact hepatocytes was decreased dramatically. Vasopressin and adrenaline (+ propranolol) failed to elicit the activation of either the 'dense-vesicle' or the PPM-PDEs. The presence of physiological concentrations of extracellular Ca2+ in the incubation medium is shown to be important for the appropriate generation of insulin's actions on cyclic AMP metabolism.
There is increasing evidence that insomnia is a common complaint. Furthermore, physicians tend to institute treatment without adequate assessment of the patients with insomnia. For the purpose of management, cases are presented on the basis of classification. A survey of doctor's knowledge and practice in the primary care department is discussed. Management principles and problems are outlined.
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Humans; Sleep Initiation and Maintenance Disorders; Health Knowledge, Attitudes, Practice; Malaysia; Outpatient Clinics, Hospital; Primary Health Care; Physicians, Primary Care
118 cases of cervical dysplasia were followed up by cytological smears for over 9 years to determine their biologic outcome. All grades of dysplasia showed evidence of regression and progression to more severe lesions, including carcinoma. Severe dysplasia however did not regress to normalcy and had the maximum conversion rates to malignancy. The period taken for transition to malignancy was found to be shorter than that generally described. Since even mild dysplasia carries with it a malignant potential, all patients with cervical dysplasia, irrespective of the grade, have to be followed up by repeated clinical and cytological examinations.
MeSH terms: Carcinoma; Follow-Up Studies; Head; Malaysia
Analysis of the nutritional status and its related factors of three different geographic areas was conducted. The areas were Kampong Sungai Gulang-Gulang, a traditional village in Kuala Selangor, vegetable farming area in Kuala Terla, Cameron Highland and housing flats in Kuala Lumpur. Assessment of nutritional status was done using anthropometric, clinical, biochemical, dietary and stool examination. The results show that 13% of the children in traditional village were stunted, 8% were wasted and 17% were underweight. In vegetable farming area the prevalence were 16.5%, 10.2% and 20.2% respectively. The prevalence of anaemia among toddler was 81.0% in traditional village, 77.2% in vegetable farming area and 55.3% in urban flats. Anaemia in the three areas was strongly associated with inadequate intake of iron.
A 13-year old Malay girl presented with multiple parasuicide attempts. She made multiple attempts at suicide and at the last attempt she developed liver damage. This article discusses the etiology and different methods used to prevent future suicidal attempts in this patient.
The knowledge of 16 medical officers and 21 house officers from the Department of Medicine regarding the technique of using the pressurised metered dose inhaler (MDI) was evaluated. The doctors were interviewed individually and each was requested to demonstrate the use of a placebo inhaler. Only 21.6% of the participants correctly performed all the ten steps considered to constitute correct inhalation technique. The most common mistake was failure to actuate the inhaler at the start of breathing in through the mouth. Although inhaler technique was better among the medical officers, all of whom claimed to have instructed patients on the use of pressurised MDIs, house officers who were also involved in patient instruction performed equally well. Unfortunately, doctors with inadequate technique had also instructed patients and this could be one of the causes of incorrect technique among patients. Key words: Correct technique, doctors, pressurised metered dose inhaler
Smoking cessation helps patients with COPD more than any specific medical treatment. By commencing treatment early, the main symptoms of COPD, i.e. cough, dyspnoea, and excessive mucus production, can be relieved and premature mortality from respiratory failure can, in many cases, be prevented. An anticholinergic aerosol offers the greatest bronchodilator benefit with the least side-effects to a patient with COPD. After maximising the dosage of an anticholinergic agent, either an inhaled beta2-agonist or oral theophylline may be added for additional bronchodilator effects. Corticosteroids may be beneficial in a subset of the patients. Selected patients with exercise limitation despite optimal medical therapy may gain from an increased sense of well-being enrolled in a supervised exercise rehabilitation progromrne. Long-term domiciliary oxygen therapy improves survival for patients who are chronically hypoxaemic. Antibiotics are reserved for acute exacerbations. The role of alpha-1-antitrypsin replacement and lung transplantation is still investigational.
The cultural and socioeconomic determinants (including the accessibility, costs and perceived effectiveness of medical care) of why and how individuals engaged in health-improving behaviours are essential information for policy makers in designing strategies towards increasing the efficient utilisation of public health services and interventions. Studies on such determinants are particularly needed for urban populations given their socioeconomic and cultural heterogeneity.
MeSH terms: Malaysia; Public Health; Urban Population