Thirty-eight, adult, male, detoxified, Malaysian opiate addicts participated in this double-blind clinical evaluation of naltrexone. Addicts from three ethnic groups: Chinese, Malays, and Indians received a weekly regimen of naltrexone (100 mg on Days 1 and 3, and 150 mg on Day 5). Subjects were randomly assigned to receive intravenous challenge with either 25 mg heroin or placebo 12, 24, 48, and 72 h after the third naltrexone dose. Physiological and subjective parameters were measured at each challenge interval. Results indicated that naltrexone was effective in blocking the physiological and psychological effects of heroin for at least 48 and 72 h, respectively, in detoxified Malaysian opiate addicts. The efficacy of naltrexone did not differ among the three ethnic groups evaluated in this study.
A study carried out in the Maternity Hospital, Kuala Lumpur over a 6 year period from 1986 to 1991, showed that the annual rates of septicaemia ranged from 5.2 to 10.2/100 admissions. Septicaemia accounted for between 11.0 to 30.4% of all neonatal deaths. The case fatality ratios ranged from 23.0 to 52.2%, being highest in 1989 when basic facilities were compromised. Low birthweight neonates accounted for 55.5% of those with septicaemia. The most common causative organisms were Staphylococcus epidermidis and Staphylococcus aureus in 1986 and 1987, but from 1988 Klebsiella species became the most common. More than 50% of neonatal septicaemia occurred after the age of 2 days. The results of the study demonstrated the dynamism of infection control: when control measures introduced earlier were not sustained, outbreaks of nosocomial infection recurred or worsened.
Nine children, aged 2.5 months to 16 years, presenting with tachyarrhythmias were treated with intravenous (i.v.) flecainide, a type 1C antiarrhythmic drug. There were four boys and five girls; seven were supraventricular and two ventricular tachycardias and three had structural cardiac abnormalities. The i.v. dose required to terminate the arrhythmias ranged from 1.0 to 2.4 mg/kg (mean 1.55 mg/kg) although a mean of 1.94 mg/kg per dose was required to maintain sustained sinus rhythm after a single i.v. dose. Eight of the patients--six supraventricular and two ventricular tachyarrhythmias, required maintenance oral flecainide. Oral dosages of 6.7-9.5 mg/kg per day (mean of 7.97 mg/kg per day in three divided doses) were required to effectively prevent the tachyarrhythmias. Intravenous and oral flecainide are safe and effective in terminating supraventricular and ventricular tachyarrhythmias. No evidence of proarrhythmia was found in the patients during follow up of between 5 and 9 months. The present limitation of performing radiofrequency ablation on infants and small children justifies the important place of medical therapy for re-entrant supraventricular tachyarrhythmias.
A three day old male, term infant with hemothorax due to hemorrhagic disease of the newborn was treated successfully with vitamin K and thoracocentesis. Exclusive breast feeding and absence of vitamin K prophylaxis were important diagnostic clues, although hemothorax as a sole manifestation of hemorrhagic disease of the newborn is rare. This case highlighted the good prognosis of an uncommon complication when prompt diagnosis and appropriate treatment are instituted. The importance of vitamin K prophylaxis to all newborns is emphasized.
MeSH terms: Drainage; Vitamin K Deficiency Bleeding/complications*; Vitamin K Deficiency Bleeding/therapy; Hemothorax/etiology*; Humans; Infant, Newborn; Male; Punctures; Radiography, Thoracic; Thoracic Surgery; Vitamin K/therapeutic use
This survey explored patient-orientated services, beyond processing of prescriptions and dispensing of medications, provided by the Malaysian community pharmacist. The results revealed a trend towards the provision of such activities. Although this was not widely implemented by the pharmacists, activities such as patient counselling and providing drug information were part of their daily practice. Lack of time, large workload, and inadequate drug information sources were the constraints cited by the pharmacists for the provision of such activities. If willingness and abilities to perform such activities were the significant barriers, then educational programmes should be initiated to provide the missing competencies.
MeSH terms: Community Pharmacy Services/trends*; Counseling; Nonprescription Drugs; Malaysia; Patient Education as Topic; Patients; Pharmacists
A questionnaire survey to study the smoking habits and attitudes toward smoking among secondary school teachers in Kelantan, Malaysia was conducted between July and September 1992. Questionnaires were sent to 5,112 teachers through their respective headmasters. Sixty-three percent (3,208 teachers; 61% males, 39% females) responded satisfactorily. Overall, 625 teachers (20%) were current smokers, 141 (4%) were occasional smokers, 317 (10%) were ex-smokers and 2,123 (67%) had never smoked. Only six (0.8%) of the 766 regular and occasional smokers were females. The rates of smoking among parents and siblings of smokers were higher than parents and siblings of non-smokers. Seventy-four percent of the smoking teachers admitted to smoking in the school premises. The teachers' attitudes about the health effects of smoking were statistically different between smokers and non-smokers. However, both smoking and non-smoking teachers had similar views regarding methods to control the smoking habit which included banning cigarette sales, putting a halt to the tobacco industry and banning cigarette advertisements.
MeSH terms: Cross-Sectional Studies; Female; Humans; Health Knowledge, Attitudes, Practice*; Malaysia/epidemiology; Male; Motivation; Surveys and Questionnaires; Schools; Smoking/epidemiology*; Smoking/prevention & control; Smoking/psychology*; Smoking Cessation/methods; Smoking Cessation/psychology; School Teachers
1. The effects of alpha-tocopherol and gamma-tocotrienol on glutathione S-transferase (GST) and gamma-glutamyl transpeptidase (gamma-GT) activities in cultured hepatocytes prepared from rats treated with diethylnitrosamine (DEN) and 2-acetylaminofluorene (AAF) were investigated. 2. Both the alpha-tocopherol and gamma-tocotrienol treated hepatocytes showed significantly higher (P < 0.05) GST activities than untreated hepatocytes prepared from the carcinogen treated rats in the first 3 days of culture. Treatment with alpha-tocopherol and gamma-tocotrienol generally resulted in a tendency to increase the GST activities above that in the untreated hepatocytes. 3. Treatment with high doses (125-250 microM) of alpha-tocopherol and low doses (12.5-25 microM) of gamma-tocotrienol generally resulted in a significant reduction in gamma-GT activities at 1-3 days. gamma-GT activities are reduced as the dose of alpha-tocopherol and gamma-tocotrienol are increased.
Clostridium bifermentans serovar malaysia (C.b.m.) is highly toxic to mosquito larvae. In this study, the following aquatic nontarget invertebrates were treated with high C.b.m. concentrations (up to 1,600-fold the toxic concentration for Anopheles stephensi) to study their susceptibility towards the bacterial toxin: Planorbis planorbis (Pulmonata); Asellus aquaticus (Isopoda); Daphnia pulex (Cladocera); Cloeon dipterum (Ephemeroptera); Plea leachi (Heteroptera); and Eristalis sp., Chaoborus crystallinus, Chironomus thummi, and Psychoda alternata (Diptera). In addition, bioassays were performed with mosquito larvae (Aedes aegypti, Anopheles stephensi, and Culex pipiens). Psychoda alternata larvae were very susceptible, with LC50/LC90 values comparable to those of mosquito larvae (about 10(3)-10(5) spores/ml). The tests with Chaoborus crystallinus larvae showed significant mortality rates at high concentrations, but generally not before 4 or 5 days after treatment. The remaining nontarget organisms did not show any susceptibility. The investigation confirms the specificity of C.b.m. to nematocerous Diptera.
In Armigeres subalbatus, 60% and 3% of the ingested Brugia pahangi microfilariae (mf) respectively migrated into the haemocoel and the thorax within 5 minutes post ingestion (p.i.). Most of the mf had migrated from the gut into the haemocoel within the first 10 minutes p.i. There was no correlation between the number of mf ingested and the migration rate though those in mosquitoes with a low mf burden tend to migrate earlier. At 24 hours p.i., 5-30% of the mf were still in the gut; 19% of these mf were immobile. At 48 hours p.i. only 2% of the mf were mobile. B. pahangi mf isolated from blood meals at 24 hours p.i., failed to develop when inoculated into Armigeres subalbatus. 54% and 73% of the mf isolated from a 24 hour old clotted blood of a B. pahangi-infected cat and fresh peripheral cat blood respectively developed into stage-1 larva. Probably mf left in the midgut at 24 hours p.i. are the young and immature worms and are physiologically incapable of penetrating the gut.
The effect of ovariectomy and sex hormone/s replacement in female rats was investigated by the determination of the tumour marker enzymes gamma-glutamyltranspeptidase (GGT) and alkaline phosphatase (ALP). This was compared to ovariectomized rats receiving sex hormone replacement and treated with carcinogen. Ovariectomy significantly increased the activity of plasma GGT. Plasma and microsomal ALP and microsomal GGT were unchanged. When replacements of estrogen (E), or progesterone (Prog), or combinations of both estrogen and progesterone were given to ovariectomized rats, the activity of plasma GGT was brought to the level of normal intact females. Treatment with carcinogen increased the PGGT activities in intact rats. In ovariectomized rats receiving carcinogen, the PGGT activities were significantly lower than in intact females and rats receiving both hormone replacement and carcinogen (p < 0.01). Carcinogen treatment in case of estrogen or progesterone replacement, either individually or in combination, showed GGT activities comparable to intact females receiving carcinogen. Both plasma and microsomal ALP were not affected by carcinogen administration. These results showed that ovariectomy reduced the severity of hepatocarcinogenesis while sex hormone replacement worsened the process.
A study was conducted to determine the feasibility of establishing a sentinel human immunodeficiency virus (HIV) surveillance system involving patients with sexually transmitted diseases attending private clinics and a government sexually transmitted disease clinic in Kuala Lumpur, Malaysia. Information on risk behaviours for HIV infection were also collected. A total of 84 female and 91 male patients were interviewed and tested for HIV infection; 41.7% of the women reported working as prostitutes, other occupations included masseuses, hairdressers, waitresses, salesgirls, receptionists, factory workers, and others. The most common diagnosis was gonorrhoea. Other diagnoses included non-specific genital infection, pelvic inflammatory disease, genital herpes and syphilis. 58.3% of the women had a hundred or more sex partners during the previous month; 99% had 6 or more sex partners. Only 4.8% of female patients had their male partners using condoms most of the time, 11.9% hardly used condoms at all. Of the males, 93.3% were heterosexual, while 6.7% were bisexuals, 41.1% had between 6-20 different partners in the previous year. 78.0% of them had prostitutes as their sex partners most of the time. 41.8% had experiences in Thailand and the Philippines. 73.6% never used condoms, while 19.8% only used condoms rarely. Although all patients were tested negative for HIV antibodies, lot quality assurance sampling methods indicate that the upper limits of prevalences for females and males were 3.5% and 3.3% respectively, at a 5% type I error. The study has shown that it is feasible to carry out a sentinel surveillance programme among STD patients and provided useful baseline data for future comparisons.(ABSTRACT TRUNCATED AT 250 WORDS)
MeSH terms: Adult; Ambulatory Care Facilities; Cross-Sectional Studies; Feasibility Studies; Female; Health Education; Humans; Malaysia/epidemiology; Male; Pilot Projects; Population Surveillance/methods*; Private Practice; Prostitution; Risk Factors; Risk-Taking*; Sexual Behavior*; Sexually Transmitted Diseases/etiology*; Sexually Transmitted Diseases/epidemiology*; Sexually Transmitted Diseases/prevention & control; Urban Population; HIV Seroprevalence*; HIV Infections/etiology*; HIV Infections/epidemiology*; HIV Infections/prevention & control; Bias (Epidemiology); Prevalence; Condoms/utilization
We report a case of Japanese encephalitis that occurred in a woman who had spent only a few days in an area where she could have been exposed to the virus. The risks and protective efficacy of vaccination against Japanese encephalitis virus for travellers who visit endemic areas for only a short period are discussed.