To examine the accuracy of food composition table (FCT)-based estimation of dietary nutrient element intake in reference to the instrumental measurement by inductively-coupled plasma mass spectrometry (ICP-MS).
To examine the accuracy of food composition table (FCT)-based estimation of dietary nutrient element intake in reference to the instrumental measurement by inductively-coupled plasma mass spectrometry (ICP-MS), as an extension of the first part of this study.
Molecular typing with IS6110 was applied to Mycobacterium tuberculosis isolates from all parts of Malaysia. The degree of clustering increased with patient age, suggesting that reactivation may contribute to clustering. Identical banding patterns were also obtained for isolates from widely separate regions. Therefore, the use of clustering as a measure of recent transmission must be treated with caution. Strains related to the Beijing family were common in Peninsular Malaysia but were less common in Sabah and Sarawak, while a distinct group of strains comprised nearly 40% of isolates from East Malaysia but such strains were rare in Peninsular Malaysia. Single-copy strains, common in South and Southeastern Asia, constituted nearly 20% of isolates from the peninsula but were virtually absent in East Malaysia. The marked geographical difference in the prevailing strains indicates not only a restricted dissemination of M. tuberculosis but also a considerable degree of stability in the banding patterns.
MeSH terms: Adult; Age Factors; DNA Transposable Elements*; Humans; Malaysia; Middle Aged; Mycobacterium tuberculosis/genetics*; Tuberculosis/transmission*; Gene Dosage
The number of dentists in Japan may be too high. The ratio of dentists/population, in China, Indonesia, Thailand, and Malaysia, is less than 1 dentist for every 10,000 people. From this data, it can be seen that there is a shortage of dentists in China, Indonesia, Thailand, and Malaysia. The shortage of pediatric dentists in these Asian countries is serious, particularly in the Philippines where the number of children with dental caries is increasing. There is an urgent need to increase the number of pediatric dentists in these countries. However, one problem is that dental schools in the Philippines and Singapore, do not have a department of pediatric dentistry.
MeSH terms: Asia/epidemiology; Dental Caries/epidemiology; Dentists/supply & distribution*; Health Services Needs and Demand; Humans; Schools, Dental/statistics & numerical data; Prevalence
Controlled release buccal patches were fabricated using Eudragit NE40D and studied. Various bioadhesive polymers, namely hydroxypropylmethyl cellulose, sodium carboxymethyl cellulose and Carbopol of different grades, were incorporated into the patches, to modify their bioadhesive properties as well as the rate of drug release, using metoprolol tartrate as the model drug. The in-vitro drug release was determined using the USP 23 dissolution test apparatus 5 with slight modification, while the bioadhesive properties were evaluated using texture analyzer equipment with chicken pouch as the model tissue. The incorporation of hydrophilic polymers was found to affect the drug release as well as enhance the bioadhesiveness. Although high viscosity polymers can enhance the bioadhesiveness of the patches, they also tend to cause non-homogeneous distribution of the polymers and drug, resulting in non-predictable drug-release rates. Of the various bioadhesive polymers studied, Cekol 700 appeared to be most satisfactory in terms of modifying the drug release and enhancement of the bioadhesive properties.
The Typhidot test, which detects IgM and IgG antibodies to a Salmonella typhi-specific outer membrane protein, is as sensitive as, and more specific than, the Widal test in the diagnosis of enteric fever in Malaysian children. It is easier and quicker to perform. In order to increase diagnostic accuracy in an area of high endemicity, the Typhidot-M test has been developed in which IgG is first removed. This theoretically allows improved detection of IgM, and thus would differentiate new from recent infections. We evaluated both tests in 134 unselected febrile children admitted to the General Hospital Kota Bharu, Malaysia. The children were divided into two groups: (i) those who were blood and/or stool culture positive for S. typhi and/or who had clinical features strongly suggestive of enteric fever (n = 62); and (ii) those who were both culture-negative and had clinical evidence of another diagnosis (n = 72). The sensitivity and specificity of the Typhidot and Typhidot-M tests were identical at 90.3 and 93.1%, respectively. Both tests had comparable sensitivity but greater specificity than those of the Widal test (91.9 and 80.6%, respectively). When used together, a positive result for Typhidot and/or Typhidot-M was more specific than either test alone (95.2%) but specificity was lower (87.5%). We conclude that the Typhidot and Typhidot-M tests have comparatively high diagnostic accuracy, suggesting that IgM can be detected in children who may have a predominant IgG response to S. typhi. Using these tests in combination increases the negative predictive value but at the cost of a lower positive predictive value.
SETTING: An urban university teaching hospital.
OBJECTIVES: To determine patients' attitudes to tuberculosis and their knowledge of the disease, and factors associated with treatment compliance.
DESIGN: All adult patients commenced on treatment for tuberculosis from September 1994 to February 1996 were interviewed on initiation of treatment. To assess patient compliance with treatment, hospital clinical records were reviewed retrospectively.
RESULTS: A total of 135 patients with a mean age (±SD) of 41.9 (±17.4) years (range 15–84 years) were interviewed. The patients had limited understanding and knowledge about tuberculosis. There was a negative correlation between patient age and tuberculosis knowledge score (r = −0.18, P = 0.038). Patients with tertiary education had better knowledge than the others. Of 118 patients who were followed-up in our chest clinic, 80 (67.8%) completed the prescribed treatment. Compliance with treatment and follow-up was not affected by age, sex, ethnic group, educational level, occupation, extent of knowledge, tuberculosis symptoms, hospitalisation for tuberculosis or duration of the prescribed treatment regimen. There was a trend toward poorer compliance among patients who equated disappearance of tuberculosis symptoms with cure of the disease.
CONCLUSIONS: Malaysian patients with newly diagnosed tuberculosis attending a university teaching hospital had misconceptions and limited knowledge about the disease and its treatment. Educational background was an important determinant of a patient's level of knowledge about tuberculosis. Compliance was not affected by patient characteristics. Adequate counselling and education of patients and close relatives on tuberculosis and the necessity for prolonged treatment may help to improve treatment compliance.
Study site: Chest clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Drug Therapy, Combination; Female; Hospitals, Teaching; Hospitals, University; Hospitals, Urban; Humans; Health Knowledge, Attitudes, Practice*; Malaysia/epidemiology; Male; Middle Aged; Outpatient Clinics, Hospital; Patient Compliance*; Surveys and Questionnaires; Retrospective Studies; Tuberculosis/drug therapy*; Tuberculosis/epidemiology; Tuberculosis/psychology*; Chi-Square Distribution; Statistics, Nonparametric
OBJECTIVES—To compare the modes of death and factors leading to withdrawal or limitation of life support in a paediatric intensive care unit (PICU) in a developing country.
METHODS—Retrospective analysis of all children (< 12 years) dying in the PICU from January 1995 to December 1995 and January 1997to June 1998 (n = 148).
RESULTS—The main mode of death was by limitation of treatment in 68 of 148 patients, failure of active treatment including cardiopulmonary resuscitation in 61, brain death in 12, and withdrawal of life support with removal of endotracheal tube in seven. There was no significant variation in the proportion of limitation of treatment, failure of active treatment, and brain death between the two periods; however, there was an increase in withdrawal of life support from 0% in 1995 to 8% in 1997-98. Justification for limitation was based predominantly on expectation of imminent death (71 of 75). Ethnic variability was noted among the 14 of 21 patients who refused withdrawal. Discussions for care restrictions were initiated almost exclusively by paediatricians (70 of 75). Diagnostic uncertainty (36% v 4.6%) and presentation as an acute illness were associated with the use of active treatment.
CONCLUSIONS—Limitation of treatment is the most common mode of death in a developing country's PICU and active withdrawal is still not widely practised. Paediatricians in developing countries are becoming more proactive in managing death and dying but have to consider sociocultural and religious factors when making such decisions.
MeSH terms: Cause of Death; Child; Child, Preschool; Critical Care/methods*; Developing Countries*; Ethnic Groups; Euthanasia, Passive*; Female; Humans; Infant; Infant, Newborn; Life Support Care/methods*; Malaysia; Male; Retrospective Studies
Socio-cultural perspectives on the image of nursing: The Hong Kong dimension¶Using structured interviews a study was undertaken with 19 high school students in Hong Kong to elicit their perceptions of nursing as a profession. The study also sought to gauge the extent of the students' intentions on pursuing a career in nursing. Responses were content analysed to determine the extent of knowledge and understanding held, intentions on choosing nursing as a career and their reasons. Findings suggest the image of nursing to be poor and that nursing as a career is far from desirable amongst the teenagers of Hong Kong. The reasons appear to be related to the notion of monetary rewards and status within the Hong Kong community. There is also a lack of knowledge as to what nurses do. The implications of such findings include the lost potential for recruitment of candidates of high calibre with a lot to offer the profession and their society. It suggests the need for the profession to find ways of publicizing and marketing the positive aspects with elements of realism which the general population in that part of the world could relate to more readily.
Congenital diaphragmatic hernia through the foramen of Bochdalek may present after infancy. A 21/2-year-old Malay girl presented with acute respiratory distress. Chest examination showed reduced chest expansion and decreased breath sounds on the left side. Chest radiograph showed a large "cyst" in the left chest, which was thought to be a lung cyst under tension. Tube thoracostomy resulted in clinical improvement. Results of a barium study showed that the cyst perforated by the thoracostomy tube was the stomach, which had herniated through a Bochdalek diaphragmatic defect. Surgical repair of the diaphragmatic defect and closure of the perforated stomach was performed successfully. Congenital diaphragmatic hernia should be included in the differential diagnosis of respiratory distress in young children. Nasogastric tube placement must be considered as an early diagnostic or therapeutic intervention when the diagnosis is suspected.
Random amplification of polymorphic DNA (RAPD) was used to analyse genomic DNA from virgin females and males of Brugia malayi, with a view to identifying sex-specific differences predicted by an XX/XY system of chromosomal sex determination. A product of 2338 bp, amplified with the arbitrary primer 5' GTTGCGATCC 3', was obtained exclusively from males. Primers based on the sequence of this product amplified a DNA fragment of the expected size from each of two independent isolates of B. malayi (from Malaysia and Indonesia) by PCR. No reaction product was obtained from the closely related species Brugia pahangi. In a genetic cross between B. malayi males and B. pahangi females, F1 hybrid microfilariae were PCR-positive, indicating that the locus is paternally-inherited. Southern blotting demonstrated that the target sequence resides in the high molecular weight fraction of genomic DNA, confirming that it is of chromosomal, rather than mitochondrial, origin. Sequencing of the locus revealed significant similarity with members of a family of reverse transcriptase-like genes in Caenorhabditis elegans. In-frame stops indicate that the gene is non-functional, but multiple bands of hybridisation in Southern blots suggest that the RT sequence may be the relic of a transposable element. Multiple repeats of the dinucleotide AT occurred in another region of the sequence. These varied in number between the two isolates of B. malayi in the manner of a microsatellite, surprisingly the first to be described from the B. malayi genome. Because of its association with the Y chromosome, we have given the locus the acronym TOY (Tag On Y). Identification of this chromosome-specific marker confirms the XX/XY heterogametic karyotype in B. malayi and opens the way to elucidation of the role of Y in sex determination.
MeSH terms: Amino Acid Sequence; Animals; Crosses, Genetic; Female; Genetic Markers/genetics*; Male; Molecular Sequence Data; RNA-Directed DNA Polymerase/genetics; Species Specificity; Y Chromosome/genetics*; Blotting, Southern; Brugia malayi/genetics*; Brugia malayi/physiology; DNA, Helminth/analysis; DNA, Helminth/isolation & purification; Microsatellite Repeats/genetics; Random Amplified Polymorphic DNA Technique; Sex Determination Processes
This study was conducted to compare the bioavailability of two controlled-release metformin preparations (Diabetmin Retard and Glucophage Retard) and also to correlate the in vitro and in vivo data obtained with the two preparations. Twelve healthy volunteers participated in the study, conducted according to a completely randomized, two-way crossover design. The preparations were compared using area under the plasma concentration-time curve AUC0-infinity, time to reach peak plasma concentration Tmax, and peak plasma concentration Cmax, while correlation was determined between in vitro release and in vivo absorption. Diabetmin Retard demonstrated a slower rate of in vitro release, but a faster rate of in vivo absorption than Glucophage Retard. However, the in vivo absorption of both products was found to be slower than that of drug released in vitro. A satisfactory relationship could be established between the in vitro and in vivo results, but there was no rank order correlation. No statistically significant difference was observed between the two preparations in the parameters AUC0-infinity and Cmax. However, a slight but statistically significant difference was observed between the Tmax values, but it may not be therapeutically significant. Moreover, the 90% confidence interval for the ratio of the logarithmic transformed AUC0-infinity values, as well as the logarithmic transformed Cmax values, of Diabetmin Retard over those of Glucophage Retard was within the acceptance criteria of 0.80-1.25.
Two children with Tetralogy of Fallot presented for dental extraction. Anaesthesia was induced rapidly and smoothly by inhalation of sevoflurane. We discussed the advantages of sevoflurane as an induction agent as compared to halothane in these children.
Early identification of a syndrome at birth is of paramount importance for genetic counselling and possible prevention. Often malformation of the hands and fingers are cardinal manifestations of recognizable syndromes. As there are no published standards for hand and finger size for Malay newborn infants, this study was undertaken to establish normal values for hand, middle finger and palmar lengths, and their indices. A cross-sectional study was done on 509 consecutive newborn Malay babies between 34 and 42 weeks of gestation. Measurements were made on the right hand according to the recommended guidelines of Bergsma & Feingold (1975). The mean values for the measurements did not differ significantly between boys and girls, or change with gestation. For the whole group the mean value for total hand length was 64.4 +/- 3.42 mm, middle finger length 37.1 +/- 2.91 mm, palmar length 27.4 +/- 2.15 mm, finger index 0.425 +/- 0.03 and palmar index 0.58 +/- 0.03. A comparison with published measurements for newborns of different racial origin shows significant differences for the total hand length, middle finger length and palm length from Indian and Jewish infants, but not from Japanese infants. The indices were similar in Malay, Indian, Jewish and Japanese newborn infants.