A cross-sectional study, comparing the nature of services in 15 private clinics and 6 public health facilities, was undertaken in a rural district of Malaysia. Semi-structured interviews and observations using check-lists were employed. Public health facilities were run by younger doctors (mean age = 31.1 years), supported mostly by trained staff. The private clinics were run by older doctors (mean age = 41.2 years) who had served the district for much longer (8.9 years vs 1.5 years) but were supported by less well trained staff. The curative services were the main strength of the private clinics but their provision of preventive care was less comprehensive and of inferior quality. Private clinics were inclined to provide more expensive diagnostic services than the public facilities. 'Short hours' private clinics had very restricted opening hours and offered limited range of services.
Comment in: Hee HW. Differences in public and private health services in a rural district of Malaysia. Med J Malaysia. 1997 Sep;52(3):296-8
MeSH terms: Health Services*; Malaysia; National Health Programs*; Rural Health*
In Peninsular Malaysia ten species of lycaenid butterflies use leaf flushes or inflorescences of the legume tree Saraca thaipingensis as larval hostplant. Resource partitioning among these species is regulated by a complex mixture of patterns of interaction with ants. Females of obligately myrmecophilous species lay their eggs exclusively on trees colonized by their specific host ants. On trees colonized by weaver ants, only specialist mutualists adapted to these territorial ants are able to survive, while larvae of other species are killed. The formicine ant Cladomyrma petalae, which inhabits hollow twigs of the myrmecophytic hostplant, likewise precludes oviposition by female butterflies. Lycaenid larvae confronted with this ant species never survive, but one concealed feeding species (Jamides caeruleus) escapes removal due to the cryptic life-habits of the larvae. Two facultative myrmecophiles associate in a mutualistic way with a wide and largely overlapping range of ant genera which forage at the extrafloral nectaries of leaf flushes. One species (Cheritra freja) is not myrmecophilous, but is tolerated by all but the most territorial ants. Ant-dependent hostplant selection and egg-clustering characterize the obligate mutualists, whereas facultative myrmecophiles and the non-myrmecophile distribute their eggs singly over appropriate hostplants. Signals mediating caterpillar-ant communication are highly specialized in one obligate myrmecophile (Drupadia theda), but rather unspecific in four other species tested. Altogether our observations indicate that colonization and establishment of lycaenid butterflies on S. thaipingensis trees are governed by specializations as well as opportunistic use of resources (ants and hostplant parts). Therefore, the diversity of this species assemblage is maintained by deterministic as well as stochastic factors.
Mangroves, woody halophytes restricted to protected tropical coasts, form some of the most productive ecosystems in the world, but their capacity to act as a carbon source or sink under climate change is unknown. Their ability to adjust growth or to function as potential carbon sinks under conditions of rising atmospheric CO2 during global change may affect global carbon cycling, but as yet has not been investigated experimentally. Halophyte responses to CO2 doubling may be constrained by the need to use carbon conservatively under water-limited conditions, but data are lacking to issue general predictions. We describe the growth, architecture, biomass allocation, anatomy, and photosynthetic physiology of the predominant neotropical mangrove tree, Rhizophora mangle L., grown solitarily in ambient (350 μll(-1)) and double-ambient (700 μll(-1)) CO2 concentrations for over 1 year. Mangrove seedlings exhibited significantly increased biomass, total stem length, branching activity, and total leaf area in elevated CO2. Enhanced total plant biomass under high CO2 was associated with higher root:shoot ratios, relative growth rates, and net assimilation rates, but few allometric shifts were attributable to CO2 treatment independent of plant size. Maximal photosynthetic rates were enhanced among high-CO2 plants while stomatal conductances were lower, but the magnitude of the treatment difference declined over time, and high-CO2 seedlings showed a lower Pmax at 700 μll(-1) CO2 than low-CO2 plants transferred to 700 μll(-1) CO2: possible evidence of downregulation. The relative thicknesses of leaf cell layers were not affected by treatment. Stomatal density decreased as epidermal cells enlarged in elevated CO2. Foliar chlorophyll, nitrogen, and sodium concentrations were lower in high CO2. Mangroves grown in high CO2 were reproductive after only 1 year of growth (fully 2 years before they typically reproduce in the field), produced aerial roots, and showed extensive lignification of the main stem; hence, elevated CO2 appeared to accelerate maturation as well as growth. Data from this long-term study suggest that certain mangrove growth characters will change flexibly as atmospheric CO2 increases, and accord with responses previously shown in Rhizophora apiculata. Such results must be integrated with data from sea-level rise studies to yield predictions of mangrove performance under changing climate.
Crosses were made between four varieties ('Mahsuri', 'Setanjung", 'MR84" and 'MR103") of Oryza sativa L. (2n=24, AA) and one accession of O. minuta (2n= 8, BBCC). The seed set obtained ranged between 9.5% and 25.1% depending on the rice variety used. By rescuing 14-day-old embryos and culturing them on 25%-strength MS medium we obtained a total of 414 F1 hybrids. The F1s were vigorous, tillered profusely, were perennial and male-sterile. The hybrids were triploid (ABC) with 36 chromosomes and showed irregular meiosis. The average frequency and range of chromosome associations at metaphase I or early anaphase I pollen mother cells of F1 plants were 29.31(16-36) Is +3.32(0-10) IIs+0.016(0-1) IIIs+0.002(0-1) IVs. Upon backcrossing the original triploid hybrids and colchicine-treated hybrids to their respective recurrent parents, and further embryo rescue, 17 backcross-1 (BC1) plants were obtained. Of all the crosses using MR84, no BC1 plant was obtained even after pollinating 13 894 spikelets of the triploid hybrid. The BC1s were similar in appearence to the F1s and were male-sterile, their chromosome number ranged from 44 to 48. By backcrossing these BC1s and nurturing them through embryo rescue, we obtained 32 BC2 plants. Of these, however, only 18 plants grew vigorously. One of these plants has 24 chromosomes and the other 17 have chromosome numbers ranging between 30 and 37. The 24-chromosome plant was morphologically similar to the O. sativa parent and was partially fertile with a pollen and spikelet fertility of 58.8% and 12.5% respectively. All of the F1 and BC1 plants were found to be resistant to five Malaysian isolates (XO66, XO99, XO100, XO257 and XO319) of Xanthomonas campestris pv oryzae. Amongst the BC2s, the reaction varied from resistant to moderately susceptible. The 24-chromosome BC2 plant was resistant to the four isolates and moderately resistant to isolate XO100 to which the O. sativa parent was susceptible.
A previously healthy eleven month old male Malay infant presented with fever, upper respiratory tract infection and right knee swelling. Pallor, bilateral proptosis, hepatosplenomegaly, multiple scalp swellings and a right cheek swelling were observed. Investigations revealed that he had acute monoblastic leukemia or FAB M5a. Immunophenotyping by flow cytometry showed that the blast cells were positive for CD45, CD13, CD33, HLA-DR, CDllc, CD71, EMA, and Cytokeratin. They were negative for CD34, CD19, CD10, CD22, CD2, CD3, CD4, CD7, CD8, CD61, NK, Glycophorin A, and CD14. The monoblasts were used to evaluate anti-EMA and anti-cytokeratin. They were unexpectedly found to be positive. Acute monoblastic leukaemias are well known to show extramedullary infiltration and this may be their primary mode of presentation. Thus, in immunochemostry, when using EMA and cytokeratin expression in the differential diagnosis of neoplastic diseases, it is important to consider that monoblasts may express these markers as illustrated by this case.
Three primary schools with three different food service managements in Kuala Selangor were selected for this study. Food samples served for five school days were taken and analyzed for calories, protein, fat and carbohydrate. It was observed that most of the food served was rice-based such as nasi lemak, chicken rice, noodles and traditional cakes. The amount of calories and protein per serving ranged from 77-274 kcal and 0.9-3.6 g respectively. Food served under the Supplementary School Feeding Programme contained higher calories than those sold by these school canteens. However, the amounts of protein and calories were still short of the expected amounts recommended by the Ministry of Education, which according to menu should provide at least 10 g protein and 290-390 kcal. The percentage contributions of energy from protein in foods served at school canteens were also lower than the recommended.
Supernumerarypremolars have been reported to occur in 0.29% of the general populationand to represent about 9.1% of all supernumerary teeth. Most of the supernumerary teeth reported in the literature were detected by radiographsas most of them were unerupted or impacted.Asearch of the literature revealed not many cases of fully erupted and well aligned supernumerary premolars being reported. A case of a unilateral transposed supernumery premolarthat had erupted into alignment is presented here. The remarkable featureof this case is that the supernumery premolar is transposed between the first and second permanent maxillary molars. The etiology of supernumeraryteeth is also reviewed.
A case of mucosal burn during the placement of fissure sealant on the first permanent molars of a 9-year-old Malay boy is presented. The erythematous lesion with accompanying burning sensation appeared a few minutes after the etching liquid, containing 37% by weight phosphoric acid, had accidentally come into contact with the buccal mucosa on the right side of the angle of the mouth. The mucosa showed complete healing after one week. The use of rubber dam for tooth isolation while doing fissure sealant is essential to avoid accidental contact of potentially caustic chemicals, such as the phosphoric acid etchant, with the oral mucosa as it can result in mucosal burns.
Severe gingival recession caused by dehiscence usually present a challenging task to the clinician as any mucogingival surgery without bony regeneration will not 'prevent the condition from recurring. The procedures of guided tissue regeneration ( GTR ) which allow regeneration of the lost periodontium may offer some solution to the condition. This paper reports on the use of a non-resorbable GTR membrane to treat an isolated lower incisor gingival recession associated with dehiscence.
Fixed-removable appliance is frequently used to extrude a tooth but the idea of incorporating an acrylic capping or stop has not been documented in the literature. This article reports on a case treated with this new approach and describes the technique used.
The current standard of managing facial bone fractures is the use of rigid internal fixation. This method provides good stabilization and repair for mid-face fractures such as the zygomatico-orbitalfracture. Nowadays, for the young and old, patients want not only rapid bone healing, but also good facial aesthetics after surgical treatment following maxillofacial trauma. Therefore, osteosynthesis of fractures and inconspicuous post-operative scars are considered essential. The lower eyelid approach or modified blepharoplasty provides rapid access to the infraorbital rim as well as the orbital floor, while the lateral eyebrow incision gives direct access for fixation at the fronto-zygomatic suture. Combining the Gillies' approach and a single form of rigid internal fixation, good cosmetic results and function can be achieved. Cases using the micro-plate-system for thin infraorbital bones and the miniplate- system for thicker facial bones involving zygomatico-orbital fractures are described.
In recent years, dental evidence has played an important role in the positive identification of unknown deceased victims of catastrophies. To improve further dental identification techniques, there is an urgent need to adopt a national policy on denture marking as a compulsory procedure in the fabrication of dentures. The favoured scheme of marking which provides the most information for the identity of the denture wearer is proposed here.
The canine teeth of the mature ferret have closed apices. They are easily accessible for operating purposes and are sufficiently large, allowing conventional cavity preparation techniques to be prepared using ordinary dental instruments. Handling of the ferret is relatively easy since it becomes quite tame after a period of time. The body weight in male is greater and the teeth larger than those of the female. The cost of purchase and maintenance of the ferret is also inexpensive. For all these reasons, the ferret male is animal of choice in dental experiments.
MeSH terms: Animals; Body Weight; Cuspid; Dental Caries; Dental Cavity Preparation; Dental Instruments; Female; Ferrets; Male
The Combined Cleft Clinic at the University Hospital, Kuala Lumpur was organised in 1992. The team consists of Plastic Surgeon, Orthodontists, Speech therapist, Ear, Nose and Throat Surgeon, Audiologist, medical officers and the nurses. We attend the clinic on a regular basis. Specialists from other medical and dental disciplines as well as the members of the Cleft Lip and Palate Association of Malaysia (CLAPAM) do occasionally participate in this set-up.The team members formulate treatment plans for each cleft patient, monitor the patient's growth and development and manage the patient at different stages according to the individual needs. To date, the idea of team approach and an establishment of a centre towards management of cleft patients seem to be the most ideal as the patients are benefiting total treatment and care from various specialists from only one place. The experience of University Hospital as a centre for cleft patients is discussed.
Side effects such as abrasion of the dental hard tissue have been frequently observed following the extensive use of mechanical cleansing. As promising antiseptics like chlorhexidine produces extrinsic dental staining on long term usage, there has been increasing interest and research generated towards chemically based stain removing agents. This invitro studyexamined whether some commercial oral hygiene products could inhibit chlorhexidine derived stain independent of any mechanical cleansing action. Perspex blocks were soaked in triplicate in chlorhexidine solution for 2 minutesand stain inhibition by these products was determined by further soaking the blocks in productl water slurries for 2 minutes and finally in tea solution for I hourly periods. The optical density (OD) of each specimen was determined at each hourly interval by spectrophotometry at 395 nm and the mean values obtained. At the end of the study, most of the products inhibited stain compared to water control and there was a variation in the stain inhibitingefficacyof the products. It is thus concluded that oral hygiene products like dentifricesand mouthrinses can inhibit chlorhexidine derived extrinsic dental stain to a variable degree through a chemical action by contained ingredients.
The effect of filler content and storage conditions such as drying, storing in water and thermal cycling on linear dimensional changes were investigated and evaluated. The dimensional accuracy studies were performed using a specific designed mould and a coordinate measuring machine. The findings gave support to the view that tiller content is an important factor influencing the physical and mechanical properties of the composite inlay material. The higher tiller content gave less polymerization shrinkage. The greatest linear shrinkage recorded was 0.79 %. The average linear shrinkage (in air, water and thermal cycling) for 79 % filler Prisma AP.H was 0.33 %, for 65 % tiller Prisma AP.H was 0.35 % and for 50 % filler Prisma AP.H was 0.42 %. Generally, dimensional changes was greatest when stored dry. This was followed by materials which were thermal cycled. The least dimensional change recorded was when the materials were stored in water.
In Malaysia the School Dental Service (SDS) provides comprehensive dental treatment with the aim of rendering the child dentally fit before leaving primary school at 12 years. Hence the purpose of this study was to investigate I) the prevalence and treatment needs of traumatised permanent incisors and 2) to assess their relationship to the degree of incisor overjet amongst 12-13 year-old schoolchildren. The sample comprised of 1519 schoolchildren attending 20 secondary government and government-aided schools in Klang district. There were 772 boys and 747 girls. The sampling procedure involved a multistage, clustered and stratified random sampling. The prevalence of traumatic injuries in permanent incisors was 2.6% which confirmed the results of a previous local study. Boys suffered more trauma than girls with a ratio of about 1.5:I. A majority (77.5% ) of the children had one tooth affected. The most commonly affected teeth were the upper central incisors (91.8%) followed by the lower central incisors (4.1%). A high percentage (57.5%) of children with traumatised anterior teeth had increased overjet (>3mm). Almost all cases (93.9%) required two or more surface fillings. However the majority of affected children (56%) were satisfied with their appearance. It is concluded that traumatic dental injuries should be incorporated as part of the treatment plan for the SDS and appropriately managed soon after occurrence or not later than 12 years after which they leave the SDS. Future epidemiological studies should also give due emphasis to the relative importance of traumatised teeth in children.
The diagnosis of oral cancer have been variously reported as being due to delay by clinicians, patients or both. The purpose of this study was to evaluate the referral pattern of 65 patients eventually diagnosed as having oral squamous cell carcinoma. The results showed that 50% of the patients delayed seeking professional help for more than 3 months after being aware of the lesion. The majority of the patients consulted medical practitioners as the first source of help. The mean clinicians' and patients' delay were 10.3 weeks and 28.9 weeks respectively. Dental practitioners showed a tendency to refer on more advanced lesions compared to the medical practitioners. The findings raise the concern that lack of patients' awareness, misdiagnosis by clinicians and late detection by dental practitioners prevail thus calling for urgent measures towards early detection of the disease.
MeSH terms: Carcinoma, Squamous Cell; Dentists; Diagnostic Errors; Humans; Mouth Neoplasms; Referral and Consultation; Early Detection of Cancer
Molecular characterization of a total of 54 isolates of Salmonella typhi from Santiago, Chile, was performed by pulsed-field gel electrophoresis (PFGE) after digestion of chromosomal DNA with three restriction endonucleases: XbaI (5'-TCTAGA-3'), AvrII (5'-CCTAGG-3'), and SpeI (5'-ACTAGT-3'). Thirteen of the 54 isolates were obtained from environmental sources (sewage and river water), and the rest were isolates from clinical cases of typhoid fever. Considerable genetic diversity was detected among the human isolates obtained in 1994, as evidenced by the presence of 14 to 19 different PFGE patterns among 20 human isolates, with F (coefficient of similarity) values ranging from 0.69 to 1.0 (XbaI), 0.61 to 1.0 (AvrII), and 0.70 to 1.0 (SpeI). A total of eight phage types were detected among these 20 isolates, with 50% possessing the E1 or 46 phage type. There was no correlation between PFGE pattern and phage types. Similar diversity was seen among 21 isolates obtained in 1983, with 17 to 19 PFGE patterns detected and F values of 0.56 to 1.0 (XbaI), 0.55 to 1.0 (AvrII), and 0.67 to 1.0 (SpeI). Comparison of these two groups of human isolates obtained 11 years apart indicated that certain molecular types of S. typhi are shared and are able to persist for considerable periods. A similar degree of genetic diversity was also detected among the environmental isolates of S. typhi, for which 10 to 12 different PFGE patterns were detected among the 13 isolates analyzed, with F values ranging from 0.56 to 1.0 (XbaI), 0.52 to 1.0 (AvrII), and 0.69 to 1.0 (SpeI). Certain molecular types present among the environmental isolates of S. typhi were also found among the human isolates from the same time period, providing evidence for the epidemiological link between environmental reservoirs and human infection.