In dengue shock syndrome, an acute increase in capillary permeability results in leakage of plasma into the interstitial space. Pleural effusion is commonly seen in dengue shock syndrome. We report three cases of dengue-associated adult respiratory distress syndrome (ARDS) in children, in all of whom dengue haemorrhagic fever, presenting with grade 3 or grade 4 dengue shock syndrome with disseminated intravascular coagulopathy, was confirmed. The criteria for the diagnosis of ARDS were based on the expanded definition of ARDS by Murray et al. Treatment consisted of fluid resuscitation, correction of coagulopathy and mechanical ventilation. All three children had multi-organ impairment, but it was more severe in the two who died. The one survivor was well at discharge.
The purpose of the study is as a preliminary outline of the effectiveness of initiating high-risk individuals into the Health Farm concept in the primary prevention of coronary artery disease (CAD). Thirty-five (35) Army personnel, all male, with risk-factors for CAD were brought together on a Health Farm concept to go through a predesigned ten-day Farm programme comprising CAD risk-assessment, comprehensive medical examination, relevant blood chemistry analysis, physical fitness evaluation, individualised weekly exercise routine, physical fitness workouts, individualised diet, lectures, group discussion and individual counselling. Description of the participants (as measurements of various relevant parameters) are made at the start and as participant-achievement. The results show general participant-compliance to the programme which was reflected by significant changes in weight (p < 0.005), percentile VO2Max (p < 0.005), percentile push-ups (p < 0.005) and girth-difference (p < 0.005). The study showed that the Health Farm concept is effective in initiating high-risk individuals into lifestyles conducive to the primary prevention of CAD. Sustained results towards primary prevention of CAD can be expected with compliance to a long-term follow-up that has been identified and to which participants have been made aware of. Other previous intervention studies are briefly discussed.
MeSH terms: Adult; Coronary Disease/etiology; Coronary Disease/prevention & control*; Health Education; Health Resorts*; Humans; Life Style; Malaysia; Male; Military Personnel*; Risk Factors
Omeprazole has been shown to have a suppressive effect on Helicobacter pylori. The aim of this study was to determine if prolonged treatment with omeprazole would result in a higher eradication rate than short course treatment. Twenty patients with endoscopy proven duodenal ulcers and unequivocal evidence of Helicobacter pylori (HP) infection based on culture, histology, urease test and Gram's stain of a fresh tissue smear were treated with omeprazole 40 mg om for 2-4 weeks. Following ulcer healing, patients received either maintenance omeprazole 20 mg om or placebo for up to one year. All 20 patients had healed ulcers following a 2-4 week course of omeprazole 40 mg om.. All were negative for HP at the end of treatment. Thirteen patients received short course therapy with omeprazole only, followed by placebo. On follow-up endoscopy at 3 months, only one of 13 (7.7%) had eradicated the bacteria. Seven patients received maintenance treatment with omeprazole 20mg om for one year. Following completion of treatment, patients were followed up at 1, 3 and 6 months. Only one of 7 (14.3%) patients had eradicated the infection on long term follow-up. The eradication rates of HP with both short and long course omeprazole monotherapy were low.
Determinations of total calcium, total magnesium, calcium ion, parathyroid hormone and 6-keto-prostaglandin-F1 alpha levels were carried out on 84 blood samples from 4 groups of women categorised as non-pregnant normotensive (NNP), pregnant normotensive (NP), pregnancy-induced hypertension (PIH) and pre-eclampsia (PE). PIH was clinically diagnosed when the diastolic pressure was more than 90 mmHg and was only hypertensive during pregnancy while PE was with additional proteinuria after 20 weeks of gestation. Compared to NNP women, total calcium and parathyroid hormone levels were of lower levels (p < 0.05) in NP women while in PIH women, total calcium and 6-keto-prostaglandin-F1 alpha levels were also lowered (p < 0.05). Compared to NNP women, PE women's levels of total calcium, calcium ion and 6-keto-prostaglandin-F1 alpha decreased (p < 0.05) while parathyroid hormone level increased (p < 0.05). When compared to the NP women, PE women had decreased levels (p < 0.05) of total calcium as well as calcium ion and increased level (p < 0.05) of parathyroid hormone. Calcium ion was found to be negatively correlated (NNP : r = -0.883, p = 0.008/NP : r = -0.931, p = 0.000) while parathyroid hormone was positively correlated (NNP : r = 0.904, p = 0.013/NP : r = 0.913, p = 0.000) with mean arterial pressure.
Asperger's Syndrome is a distinct variant of autism, with a prevalence rate of 10 to 26 per 10,000 of normal intelligence, and 0.4 per 10,000 in those with mild mental retardation. The syndrome now has its own clinical entity and diagnostic criteria. It is being officially listed in the ICD-10 under pervasive developmental disorder. Two such cases are described in this article. Case One lacked the ability to relate to others, was excessively preoccupied with the late actor P. Ramlee and demonstrated a peculiar behaviour of holding on to toothbrushes in his early childhood. Cognitively, he was unable to synthesise words into meaningful sentences. Similarly, Case Two was unable to relate well to others and was preoccupied with the planets and its constellations. Though he appeared intelligent with an IQ score of 101, he was unable to follow instructions at school. Both children had motor clumsiness and fulfilled the criteria for the diagnosis of Asperger's Syndrome.
MeSH terms: Autistic Disorder/classification; Autistic Disorder/diagnosis*; Autistic Disorder/psychology; Child; Child Development Disorders, Pervasive/classification; Child Development Disorders, Pervasive/diagnosis*; Child Development Disorders, Pervasive/psychology; Humans; Language Development Disorders/classification; Language Development Disorders/diagnosis; Language Development Disorders/psychology; Malaysia; Male; Psychiatric Status Rating Scales; Social Behavior; Stereotyped Behavior; Syndrome
We describe here a case of cryptococcal empyema thoracis and periauricular pyogenic abscess in a child with Bruton's agammaglobulinaemia. The cryptococcal empyema thoracis was treated with intravenous amphotericin B and intravenous fluconazole for six weeks followed by oral fluconazole. The pyogenic periauricular abscess was surgically drained and treated with intravenous ceftazidime and cloxacillin for two weeks. He also received monthly intravenous immunoglobulin.
OBJECTIVE: This study examines the extent to which preventive and promotive advice is integrated into the clinical practice of doctors.
STUDY DESIGN: Using a cross-sectional descriptive survey design, the study compares the performance of doctors in giving healthy lifestyle advice for five clinical conditions, their perceived practice and their rating on the importance of disseminating selected key lifestyle messages.
DATA EXTRACTION METHODS: A total of 28 volunteers were trained to simulate the five clinical conditions which required related health advice and to rate the doctors' performance with the use of a prepared checklist. Simulated patient ratings of 343 doctor-patient encounters provided the data on doctors' health promotion efforts for the selected clinical conditions. A post-visit self-administered questionnaire survey of a sub-sample of 100 doctors gave an insight into their opinions and perceived practice.
PRINCIPAL FINDINGS: Only in 49% of the instances was a health promotion message given. The doctors' encouraging interest in health education and health promotion and their positive perceptions of their volume of healthy lifestyle counselling were not borne out in actual clinical practice.
CONCLUSIONS: The results indicate that the extent of preventive and promotive health education in both the public and private health sectors is unacceptably low. The matter needs to be addressed through training programmes as well as the formulation of clear health promotion priorities and strategies in Malaysia.
MeSH terms: Cross-Sectional Studies; Humans; Life Style; Malaysia; Practice Patterns, Physicians'/statistics & numerical data*; Prospective Studies; Surveys and Questionnaires; Chi-Square Distribution; Patient Simulation*
Levels of serum IgG against Porphyromonas gingivalis cell sonicate were determined in patients with rheumatoid arthritis (RA) (n = 25), rapidly progressive periodontitis (RPP)(n = 25) and adult periodontitis (AP)(n = 15) and controls (HP)(n = 10) utilizing the ELISA technique. Comparison between groups showed no significant differences between the HP and RA groups and also between the RPP and AP groups. The increased levels of IgG in the RPP and AP groups were comparable. Significant differences in IgG levels were noted between HP and RPP (p<0.05) and between HP and AP (p<0.01). The differences between RA and RPP and between RA and AP were highly significant (p<0.0001). Thus it was revealed that the serum levels of IgG against P. gingivalis in RPP and AP patients were elevated, whereas the levels in RA patients were comparable to those in controls.
A novel Bacillus thuringiensis strain highly toxic to mosquitoes was isolated from soil samples in Malaysia. This strain was shown to display a new subfraction of the H-28 flagellar antigen determining a new serovar H28a28c, which was designated serovar jegathesan. Bioassays indicated that Culex quinquefasciatus larvae are the most susceptible to this new isolate, whereas toxicity to Anopheles maculatus and Aedes aegypti larvae was 10 times lower. The potency of this new serotype is also comparable to most of the Malaysian B. thuringiensis H-14 isolates.
Thirteen strains among 3 species of entomopathogenic bacteria were tested against 3 medically important mosquito species in French Polynesia. Two strains of Bacillus thuringiensis were highly toxic to Aedes polynesiensis, Aedes aegypti, and Culex quinquefasciatus. Six of 7 strains of Bacillus sphaericus tested were highly toxic to Cx. quinquefasciatus but not to the Aedes spp. Clostridium bifermentans serovar. malaysia was more toxic to Ae. polynesiensis than to the other 2 species. Entomopathogenic bacteria merit field testing for larval mosquito control in French Polynesia.
G6PD deficiency is the most common human enzymopathy and affects 200 million people worldwide. To date more than 400 biochemical variants and at least 60 different point mutations in the G6PD locus have been discovered. In Malaysia the overall incidence of G6PD deficiency among males is 3.1%, being more prevalent among the Chinese and Malays and less common among the Indians. As part of our initial effort to characterise G6PD deficiency in the Malaysian population, we investigated 18 G6PD deficient Chinese male neonates for the G6PD mutation G-->T at nt 1376, a common mutation seen among the Chinese in Taiwan and mainland China. The mutation was detected by a PCR-based technique using primers that artificially create a site for restriction enzyme Xho I. We found 61% (11 out of 18) of the Chinese G6PD deficient male neonates positive for this mutation. Study of enzyme electrophoretic mobility in 7 of the cases positive for this mutation revealed three different patterns of mobility. 107% (5 out of 7), 103% (1 out of 7) and 100% (1 out of 7). This study shows that mutation G-->T at nt 1376 is a common allele causing G6PD deficiency in Malaysians of Chinese origin. The finding of different patterns of electrophoretic mobility among the 7 cases positive for 1376 G-->T mutation supports the notion that diverse biochemical variants may share the same mutation.
The diagnostic value of adenosine deaminase (ADA) activity was studied to evaluate its use in the differential diagnosis of tuberculous meningitis in the local setting. Cerebrospinal fluid (CSF) from 119 patients with meningitis and other conditions with central nervous system symptoms were collected and ADA activity determined by the colorimetric method of Guisti read at 628 nm. The CSF was also subjected to other laboratory examinations so as to provide the aetiological diagnosis. All 14 tuberculous meningitis patients had ADA activity greater than the cut off value of 9.0 IU/L. High ADA activity was also seen in 13 of 105 non-tuberculous cases giving a specificity of 87.6%. Even though the ADA activity determination is sensitive for tuberculosis, it was not specific enough to be used as a rapid diagnostic test. However when interpreted together with clinical signs and symptoms and other laboratory tests, it is a useful adjunctive rapid marker for tuberculosis.
Beta-lactamase production is one of the major mechanisms of resistance amongst bacteria especially the enteric bacilli. The purpose of this study is to assess the in-vitro activity of Sulperazon, a combination of cefoperazone and an irreversible beta-lactamase inhibitor, sulbactam, against the cefoperazone resistant isolates of aerobic gram-negative bacilli. A total of 92 such strains were tested. It was found that at a concentration of < or = 8 mg/l of sulbactam added to cefoperazone 82% of Klebsiella spp, 100% of E. coli, 100% of Enterobacter spp, 33% of Pseudomonas aeruginosa, 67% of Pseudomonas spp and 62% of Acinetobacter spp that were resistant to cefoperazone alone were susceptible to the combination. Hence it is concluded that the addition of sulbactam to cefoperazone does expand the spectrum of the in-vitro activity of cefoperazone.
A system for computerising full blood picture reporting developed in-house using dBASE IV on IBM-compatible microcomputers in a local area network environment is described. The software package has a user-friendly interface which consists of a horizontal main menu bar with associated pull-down submenus. The package captures data directly from an automatic blood cell counter and provides options to modify or delete records, search for records, print interim, final or cumulative reports, record differential counts with an emulator, facilitate house-keeping activities which include backing-up databases and repairing corrupted indices. The implementation of this system has helped to improve the efficiency of reporting full blood picture in the haematology laboratory.
MeSH terms: Automatic Data Processing*; Blood Cell Count/instrumentation*; Blood Cell Count/methods*; Computer Communication Networks*; Humans; Microcomputers; Software
A study of 101 sera from 69 Malay, 14 Chinese and 18 Indian healthy adult Malaysians was undertaken to determine the frequency of antinuclear antibodies (ANA), antimitochondrial antibodies (AMA), antismooth muscle antibodies (SMA) and antiparietal cell antibodies (APCA). There were 67 females and 34 males with a mean age of 31.7 years (+/-8.6). ANA was assayed by immunofluorescence (IF) using both mouse liver and HEp-2 cell substrates. AMA, SMA and APCA were also tested by IF using composite sections from mouse liver, kidney and stomach substrates. Analysis showed 6.9% were positive for ANA at a titre of 1:40 with HEp-2 while only 1.9% were detected using mouse liver. 9.9% had detectable AMA from titres 1:10 to 1:90. None of them had detectable SMA and only 1 (0.09%) had APCA at a titre of 1:80. This study suggests that a diagnosis of an autoimmune disorder has to be cautiously made taking into consideration that autoantibodies are present in low titres in the healthy population.
The spectrophotometric method of Ellman was used to determine cholinesterase (ChE) levels in plasma and whole blood in elderly patients and umbilical cord blood of newborn infants. The mean +/- SD for plasma and whole blood ChE levels were 2.24 +/- 0.58 micromol/min/ml and 4.38 +/- 0.65 micromol/min/ml respectively in a group of healthy elderly patients (n = 25). The mean +/- SD for plasma and whole blood ChE levels were 2.23 +/- 0.77 and 3.31 +/- 0.56 respectively in cord blood of healthy full term newborn infants (n = 25). In a group of healthy adult blood donors the general mean +/- SD for plasma and whole blood ChE have been shown to be 2.71 +/- 0.75 and 4.87 +/- 0.73 micromol/min/ml respectively. Statistical analysis revealed that the mean levels of plasma and whole blood ChE in elderly, newborn infants and adults were different (p < 0.001). However, there was no statistical difference between the mean level of plasma ChE in elderly and cord blood but each shared statistically significant difference when compared to the mean level in adults. The mean activity of whole blood ChE in the 3 groups was different from one another. Theoretically, decreased levels of ChE would suggest a careful assessment of drugs that are hydrolysed by ChE.
An in-house enzyme-linked immunoabsorbant assay (ELISA) for SP-A was successfully developed using in-house polyclonal anti SP-A and a commercial polyclonal anti-rabbit immunoglobulin horseradish peroxidase conjugate system. The standard curve, generated by using 50 ng of SP-A to coat the plate and 1:500 dilution of polyclonal anti SP-A as a primary antibody, was linear for concentrations of SP-A ranging from 4 micrograms/l to 4000 micrograms/l and reproducible. Results of recovery study of SP-A from a known sample of tracheal aspirate ranged from 94%-114%. Intra- and inter-assay coefficients of variations were 2.7% and 5.6% respectively for a known sample of tracheal aspirate. Interference study showed that tracheal aspirate did not interfere with the assay. The assay developed was intended to be used for SP-A measurement in tracheal aspirates obtained from neonates with and without respiratory distress syndrome.
Surfactant protein A (SP-A) is one of the four known surfactant-associated proteins found in human lungs. It plays a major role in determining regulation of surfactant uptake and resecretion. Qualitative and quantitative deficiencies of SP-A may contribute to neonatal respiratory distress syndrome. The measurement of its level in amniotic fluid or neonatal tracheal aspirate may be useful in the assessment of replacement therapy using natural or synthetic surfactants. In order to develop an in-house immunoassay to detect the level of SP-A, we used a discontinuous sucrose density gradient to isolate SP-A from amniotic fluid. Polyacrylamide gel electrophoresis was carried out on the isolates with low molecular weight markers. We successfully isolated SP-A from 12 out of 31 samples of amniotic fluid. The isolates were found to be relatively pure and have a molecular weight of about 35 kD. The isolated SP-A were used as immunogens to raise antibodies in rabbits for the immunoassay.
A case of true enteric myiasis in a 7-year-old girl is reported. Two larvae were obtained from the vomitus of the patient. After processing and identification, the larvae were found to be those of Hermetia illucens (Soldier Fly). This is the first case of true enteric myiasis due to these larvae in Malaysia.
Typhoid fever remains a common problem in Malaysia, but for its diagnosis both blood culture and the Widal test have drawbacks. A dot enzyme immunoassay (EIA) has been developed which detects IgM and IgG antibodies to a specific 50 kDa outer membrane protein on Salmonella typhi. This study was performed among outpatients attending the university hospital in Kelantan, a state on the east coast of Peninsular Malaysia where typhoid is endemic. The dot EIA was done on 149 outpatients of all ages in whom typhoid was suspected. Of these, 60 were not analysable due to insufficient data. The other 89 were retrospectively classed as typhoid (total = 21), or not typhoid (total = 68). The criteria for diagnosis of typhoid was either, blood culture was positive, or with blood culture negative, temperature was at least 38 degrees C and Widal O and/or H titer greater than or equal to 1/160. We then compared the diagnosis with the EIA result. For the result where either IgM or IgG was positive, sensitivity was 90%, specificity 91% and negative predictive value 97%. For IgM positive, specificity was 100%. But the specificity of IgG positive alone was reduced by six false positives, which were probably due to persistence of IgG after acute infection. Other cases were found where IgG positive alone appeared in the first week of typhoid fever, probably due to rapid response in a second or subsequent infection. We also found that IgM-producing patients were significantly younger than those showing IgG alone positive.
Study site: Community Medicine clinic, Accident & emergency department, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia