What is the likelihood that each of the 37 developing countries with populations of 15 million or more in 1990 will reach replacement fertility by the year 2015? These countries have a combined population of 3.9 billion, 91 percent of the population of all developing countries. For this article, a composite index was used as the basis for predicting future levels of total fertility. The index was constructed from socioeconomic variables (life expectancy at birth, infant mortality rates, percent adult literacy, ratio of children enrolled in primary or secondary school, percent of the labor force in nonagricultural occupations, gross national product per capita, and percent of the population living in urban areas), total fertility rates for the years 1985-90, total fertility rate decline from 1960-65 to 1985-90, family planning program effort scores in 1989, and the level of contraceptive prevalence in 1990. Eight countries are classified as certain to reach replacement fertility by 2015, and an additional thirteen probably will also. Five countries are classified as possibly reaching replacement fertility, and eleven as unlikely to do so.
The filaria vector competence of Anopheles stephensi was compared with Brugia-susceptible Aedes aegypti Liverpool strain, An. gambiae Badagry Lagos strain and An. dirus Perlis Malaysia strain. An. stephensi ingested more Brugia pahangi microfilariae, had the highest infectivity rate and yielded more infective mosquitoes than the other two anopheline species. The overall vector competence of An. stephensi was 0.13 times that of Ae. aegypti, 0.62 times that of An. gambiae and 2.17 times that of An. dirus. However, heavy mortality among infected An. stephensi in the present investigation indicates that the filaria vectorial capacity of the mosquito might be limited epidemiologically. The relationship between filaria vector competence and mosquito foregut armature is discussed. It was observed that the relative vector competence of the three anopheline species tested was in the same order as their relative degrees of armature elaboration. The converse would be expected if foregut armatures really give partial protection to the mosquitoes against filarial infection. It is suggested that high host microfilariae density favours larval survival proportional to the degree of armature development in Anopheles (Cellia) species.
Two cases of hypoglossia congenita with anterior maxillo-mandibular fusion are reported. One is a case of hypoglossia with anterior maxillo-mandibular fusion and the other is a case of hypoglossia-hypodactylia with anterior maxillo-mandibular fusion. This condition presents the anaesthetist with the problem of airway management during the surgery. A simple technique using a nasopharyngeal tube was used for these two cases, with satisfactory results.
A single nostril associated with alobar holoprosencephaly is a rare congenital lesion. This paper reports two female term neonates with holoprosencephaly. The first neonate asphyxiated at birth had a single nostril, hypotelorism, posterior cleft palate, inferonasal coloboma of the iris and disc and persistent tunica vasculosa lentis. The other neonate had cleft lip and palate and recurrent convulsions. Both neonates had gross motor and developmental delay. Cranial sonography and CT scan showed features consistent with alobar holoprosencephaly. Karyotyping for the first neonate and her family members was normal. Both of them were treated conservatively and supervised.
Internal jugular vein ectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children and adults. Literature reports of bilateral presentation are rare. Bilateral Doppler ultrasonography is the diagnostic investigation of choice. The possible pathology, aetiology and management are discussed. Conservative management of bilateral cases is recommended in uncomplicated cases.
A case is described of ameloblastoma of the mandible presenting with multiple recurrences and subsequent extension to the maxilla with resultant transformation into an aggressive (malignant?) epithelial odontogenic ghost cell tumour. The latter is a rare, biologically virulent entity that affects mainly males, exhibits a preference for the maxilla and is histologically characterized by atypical malignant odontogenic epithelium associated with areas of ghost cell formation and varying amounts of dentinoid.
The general lack of specialist obstetricians in a developing country such as Malaysia prompted us to develop a computer expert system for the management of fetal distress in rural hospitals. It was based on accepted production rules and implemented on a microcomputer. The clinical prototype was evaluated by 8 specialist obstetricians and 21 non-specialist doctors involved in obstetric care. The initial impression was that this type of expert system may help in diagnosis, decision-making and teaching.
Sudden blindness in pregnancy is a devastating experience for the patient, her family and the treating obstetrician. Four cases of cortical blindness with pregnancy induced hypertension are presented, seen at the General Hospital Kota Bharu, Kelantan, in 1990. The incidence at the GHKB was 1: 1559 (4 cases out of 6,237 deliveries) which is higher as compared to neighbouring Singapore. The pathophysiology of this condition is still not well understood, though it is hoped that newer sophisticated imaging techniques like magnetic resonance imaging (MRI), CT scan, and blood flow waveform analysis by Doppler ultrasound will throw some light on the subject. Two of our cases presented with antepartum and two with postpartum cortical blindness. Therefore, termination of pregnancy alone may not provide the solution to this therapeutic dilemma.
Deinstitutionalization has shifted much of the burden of care of chronic schizophrenia from mental institutions to the family. The aim of this study is to asses the prevalence of mental disorders among 210 primary carers of Malay schizophrenic patients, explored the burden and hardship experienced by them. This is a two-stage psychiatric screening procedure. All the cases suspected from initial screening with WHO Self-Reporting Questionnaires (SRQ-20) were called for clinical interview. Patients' behavioural problems and the burden of relatives were assessed by the Social Behaviour Schedule and the Interview Schedule respectively. It was found that about 23% of the carers developed neurotic disorders resulting from the stress; nearly half of them had neurotic depression. Despite their burden, they do not complaint about it. Neurotic carers compared with non-neurotic carers had significantly more subjective burden and distress related to the product of active psychosis. The carers were generally able to tolerate the negative symptoms of schizophrenia. The number of problem behaviours and previous admissions were significantly correlated with the severity of burden.
We prospectively studied 37 consecutive patients implanted with the Carbomedics prosthetic heart value in the mitral position (without clinical evidence of prosthetic valve dysfunction) with two-dimensional and Doppler echocardiography. The peak mitral prosthetic gradient ranged from 4.60 to 14.63 (mean 8.97 +/- 2.29) mm Hg; mean mitral prosthetic gradient ranged from 1.67 to 6.18 (mean 3.24 +/- 0.95) mm Hg; pressure half-time derived mitral valve area ranged from 1.67 to 5.30 (mean 2.70 +/- 0.80) cm2. These values compare favorably with that of another bileaflet valve (i.e., the St. Jude Medical valve). There was a wide overlap in peak and mean transmitral gradients, even with the valves of the same size, with a significant but weak inverse relationship between peak mitral gradients and valve size (p = 0.03, r = -0.36). The performance index showed a smaller range of values, again with a significant but weak inverse relationship with valve size (p = 0.001, r = -0.54). The inverse relationship between valve size and peak mitral gradient and performance index should be borne in mind when analyzing Doppler hemodynamic data.
A postal questionnaire survey concerning dentists' attitudes toward auxiliaries in Malaysia resulted in a 73.1 per cent response rate. The result of the study indicates that whilst the majority of the dentists agreed that dental auxiliaries usually increase productivity and permit the dentists to devote more time for more challenging tasks, a majority felt uncomfortable to be held accountable for the performance of auxiliaries. A majority of the dentists agreed that dental auxiliaries work best under direct supervision. The perceived value of the auxiliaries was more positive among public sector dentists as compared to private practitioners. Almost three-quarters of the dentists were positive towards legalising properly trained auxiliaries to work in private practice performing mainly preventive procedures. The implications of these findings relative to existing regulations, mode of practice and the future prospect in the delivery of oral health care are discussed.
MeSH terms: Adult; Attitude of Health Personnel*; Dentists/psychology*; Female; Humans; Interprofessional Relations*; Malaysia; Male; Middle Aged; Practice Management, Dental/economics; Chi-Square Distribution
The effect of Artocarpus integer lectin (lectin C) on the functional activity of guinea-pig complement was investigated. Purified and crude extract of lectin C from six cultivars of Artocarpus integer seeds were found to consume complement and thus decreased the complement-induced haemolytic activity of sensitized sheep erythrocytes. The change in the complement-mediated haemolytic activity was significantly decreased when incubation of the lectins was performed in the presence of melibiose. The reversal effect of the carbohydrate, which is a potent inhibitor of the lectin's binding to O-linked oligosaccharides of glycoprotein, demonstrate involvement of the lectins interaction with O-glycans of glycoproteins in the consumption of guinea-pig complement.
BACKGROUND: The benefit of adding theophylline to beta 2 agonists in acute asthmatic attacks has been debated frequently.
METHODS: In an open randomised study 25 patients with severe acute asthma who presented to the emergency department were treated with either a combined nebulised salbutamol (5 mg/dose) and aminophylline infusion (0.6-0.9 mg/kg/hour), or nebulised salbutamol alone.
RESULTS: The responses to treatment as measured by peak expiratory flow (PEF) and the time taken to achieve maximum PEF were similar in both groups. Side effects were observed more commonly in patients receiving the combined treatment.
CONCLUSIONS: Nebulised salbutamol is equally efficacious in acute asthma when given alone or in combination with aminophylline.
Study site: Emergency department, Hospital Kuala Lumpur, Malaysia
A cross-sectional exploratory survey was conducted in six West Malaysian schools involving 762 fifteen- to eighteen-year-old secondary school students. Periodontal health status was assessed using the Community Periodontal Index of Treatment Needs (CPITN), utilizing six index teeth to represent the six sextants of the mouth. The results indicated that 66.8% of the students examined had healthy gingiva (Score 0), 2.6% had bleeding of the gingiva on gentle probing, while 30.6% had calculus on their teeth. In terms of treatment needs, 35.0% of those examined needed oral hygiene education, 34.4%, on the other hand, required scaling. No student was found to require complex treatment. Sex-specific comparison revealed a slightly higher prevalence of calculus formation in male students. In terms of race, the Malays had a higher prevalence of calculus formation than either Chinese or Indians.
MeSH terms: Adolescent; Adult; Cross-Sectional Studies; Female; Health Services Needs and Demand; Humans; Malaysia/epidemiology; Male; Periodontal Diseases/ethnology; Periodontal Diseases/epidemiology*; Periodontal Index*; Sex Factors; Prevalence; Chi-Square Distribution
The prevalence of Helicobacter pylori infection was determined in peptic ulcer patients, in non-ulcer dyspepsia (NUD) patients, and in the general adult population. The H. pylori infection rate ascertained by microbiologic examination of multiple gastric antral biopsy specimens was 50% (17 of 34) in duodenal ulcer (DU), 5% (1 of 22) in gastric ulcer, and 9% (15 of 159) in NUD patients. A seroepidemiologic survey showed a prevalence of only 4.2% among 496 blood donors and 4.8% among 921 subjects who attended health screening clinics. H. pylori infection is relatively uncommon and does not appear to be the predominant factor in the pathogenesis of peptic ulcer disease in the area. The incidence of peptic ulcer perforations in the area in 1991-92 was 1.5 per 100,000 person-years, reflecting a relatively low frequency of peptic ulcers, which might be due to the low prevalence of H. pylori infection in the population.
There is an increasing prevalence of diabetes mellitus around the world associated with rapid sociocultural development and changing lifestyles. Increased prevalence of obesity, with a higher consumption of animal products and lower consumption of fruits and vegetables, increases the risk of diabetes mellitus and other chronic degenerative diseases. Insulin-dependent diabetes (IDD) is caused by insulin deficiency, whereas the main feature of non-insulin-dependent diabetes (NIDD) which accounts for more than 90% of diabetics, is hyperinsulinemia and insulin resistance, which may eventually lead to actual insulin deficiency. Hyperinsulinemia is undesirable because it increases the risk of developing vascular disease. In Malaysia, the prevalence of NIDD in some communities now exceeds 5%, and of impaired glucose tolerance 10%. Along with these increases in prevalence of hyperglycemia are increases in prevalence of overweight (BMI>25) and almost certainly abdominal fatness. In terms of management, nutrition is given priority. Insulin and hypoglycemic drugs (sulphonylureas or biguanides), where required, may adversely affect body composition if overused. Newer therapeutic strategies require greater attention to the underlying problem in NIDD of abdominal fatness by attention to the relevant nutritional factors, physical activity and other lifestyle factors like cigarette smoking and alcohol. The greater impact of obesity and diabetes on Malaysian women as opposed to men also needs to be addressed.
MeSH terms: Attention; Biguanides; Body Composition; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Fruit; Humans; Hypoglycemic Agents; Insulin; Insulin Resistance; Life Style; Malaysia; Male; Obesity; Vascular Diseases; Vegetables; Exercise; Body Mass Index; Prevalence; Glucose Intolerance; Overweight
Fourteen goat kids of the local indigenous breed naturally infected with Eimeria species were divided into two equal groups. The first group was superinfected with 500,000 Eimeria species oocysts and the second group was treated with amprolium. Sixty days later both groups were infected with 5000 third-stage caprine Haemonchus contortus larvae. The goats experimentally superinfected with eimeria shed more H contortus eggs and gained weight more slowly.
Two hundred and forty nucleotides from the pre-M gene region of 10 Japanese encephalitis (JE) virus strains isolated in Malaysia in 1992 were sequenced and compared with the other JE virus strains from different geographic areas in Asia. Our JE virus strains belong to the largest genotypic group that includes strains isolated in temperate regions such as Japan, China, and Taiwan. Our Malaysian JE virus strains differed in 32 nucleotides (13.3%) from WTP/70/22 strain isolated from Malaysia in 1970, which belonged to another distinct genotypic group.
With the increasing recognition of the importance of H. pylori in gastrointestinal disease, there is a need for a reliable, efficient and yet inexpensive diagnostic test. The performance of the rapid urease test (RUT) as an endoscopy suite diagnostic test was compared to the established methods of culture, histology and Gram stain of tissue smear, in 274 gastric biopsy samples. Histology had the highest sensitivity of 99.3% followed by the RUT (96.6%). Culture and Gram stain of tissue smear had 100% specificity, while the rapid urease test had 99.2% specificity. The RUT had a positive predictive value of 99.3% and a negative predictive value of 96.2%. The RUT is an inexpensive, rapid and reliable diagnostic test of H. pylori infection.