Tuberculosis and malignancy are two common causes of exudative pleural effusions. In this retrospective study of 52 patients with tuberculous pleural effusions and 32 patients with malignant effusions, the median age of patients with malignant effusions (68.5 years) was older than that of patients with tuberculous effusions (34.5 years) (p < 0.001). Both types of effusion occurred more frequently on the right side and there was no difference between them in terms of right-sided dominance. A higher percentage of patients with malignant pleural effusions (44%) presented with large effusions than patients with tuberculous effusions (12%) (x2 = 11.33, p = 0.001). A higher proportion of patients with tuberculous effusion had lymphocyte predominant effusions and tuberculous effusions had higher lymphocyte percentage, lower red cell count, and higher protein content. However, there was considerable overlap of these characteristics of both types of effusions.
A prospective study of patients with acute aortic occlusion (AAO) admitted to the Vascular Unit, Hospital Kuala Lumpur was carried out over a 12 month period. There were a total of 11 patients admitted with a clinical diagnosis of AAO. There was a male preponderance with 10 patients. The median age was 58 years (40-70 years). Hypertension was the commonest underlying medical illness (n = 7). All patients had painful lower limb paraparesis or paraplegia with bilateral absent limb pulses from the groin downwards on admission to the vascular unit. The majority of patients (10 patients) were referred from other hospitals, of which 6 patients came from outside the Klang Valley. Only eight (8) patients underwent an operative procedure with seven (7) having an initial bilateral balloon catheter thromboembolectomy. There was one (1) aorta-bifemoral bypass after failed embolectomy. An aneurysectomy with inlay-graft was done as the initial procedure in one (1) patient. Mortality was 82% (9/11). The two survivors were in the group that had vascular reconstructive surgery. Acute aortic occlusion is an uncommon but catastrophic event with a high mortality. Clinicians must have a high index of suspicion in patients who present with painful paresis or paraplegia. Clinical examination of peripheral pulses in these patients is mandatory. Early diagnosis and treatment is important to improve the outcome of this disease.
Objectives: (a) To examine the intra-observer reliability of the Malay language versions of two international respiratory questionnaires i.e. the International Study of Asthma and Allergy in Children (ISAAC) and the American Thoracic Society (ATS) questionnaires, and (b) using the more reliable of these questionnaires, to estimate the prevalence of asthma and allergy related symptoms in an ethnically homogenous inner city community in Kuala Lumpur.
Methods: The study was conducted among 7 to 12 year old school children of Malay ethnic origin living in an inner city area of Kuala Lumpur. The sample consisted of 787 children attending the only primary school in the area. The Malay versions of both questionnaires were administered twice, one month apart, and were completed by parents. Agreement between the first and second responses to the same questions were assessed by Cohen’s kappa. Kappa values <0.4 were indicative of poor intra-observer reliability, 0.4-0.59 moderate reliability, 0.6-0.79 good reliability and >0.79 excellent reliability.
Results: 77.9% and 36.3% of parents responded to the first and second administrations of the questionnaires respectively. Kappa values of >0.4 were obtained in 15/16 (93.8%) and 17/27 (63.0%) questions of the ISAAC and ATS questionnaires respectively. Excellent kappa values were obtained in 4/16 (25%) questions of the ISAAC questionnaire versus only 1/27 (3.7%) questions of the ATS questionnaire. From the ISAAC questionnaire, all questions on wheeze had good reliability while those on asthma had excellent reliability. Questions on allergic symptoms had poor to moderate reliability. In contrast, from the ATS questionnaire, questions on wheeze had moderate reliability while questions on asthma were excellent reliable. Questions on allergic symptoms had moderate to good reliability while those on cough, phlegm and bronchitis had poor reliability.
According to the ISAAC questionnaire the prevalence of ever wheeze, wheeze in the last 12 months, ever asthma and wheeze with exercise in the last 12 months was 12.5%, 6.6%, 10.3% and 5.9% respectively. The prevalence of ever sneeze or runny nose, sneeze or runny nose in the last 12 months, watery eyes in the last 12 months and ever eczema was 15.2%, 11.1%, 4.4% and 8,5% respectively.
Conclusions: The translated ISAAC questionnaire was more reliable than the translated ATS questionnaire. Asthma and related symptoms were common among Malay school children in inner city Kuala Lumpur.
MeSH terms: Asthma/epidemiology*; Child; Female; Humans; Hypersensitivity/epidemiology*; International Cooperation; Malaysia; Male; Poverty Areas*; Surveys and Questionnaires; Observer Variation; Prevalence
Motorcyclists make up the largest group of fatalities on Malaysian roads, majority succumbing to head injuries despite the compulsory safety helmet laws in the country. One possible reason for this high fatality is improper usage of safety helmets. This study examines the compliance of proper safety helmet use in motorcyclists in a typical Malaysian town. Five hundred motorcyclists were studied. Only 54.4% of motorcyclists used helmets properly, 21.4% used them improperly; and 24.2% did not wear helmets. Six variables were found to be significant in improper safety helmet use. They were age, gender, race, formal education level, prior accident experience and type of license held. Marital status and riding experience were not significant. Efforts promoting proper use of safety helmets should focus on the young, male, less formally educated, unlicensed rider, who has had a prior accident.
MeSH terms: Adult; Age Factors; Education; Ethnic Groups; Female; Head Protective Devices/utilization*; Head Protective Devices/statistics & numerical data; Humans; Malaysia; Male; Motorcycles*; Sex Factors
This study examines the accident characteristics of injured motorcyclists in Malaysia. The aim of this study is to identify the characteristics of motorcyclists who are at higher fatality risk and subsequently be the targeted group for the fatality-reduction countermeasures. A total of 412 motorcycle crash victims with serious or fatal injuries were analysed. The results showed that the injured motorcyclists were predominant young, novice riders of less than 3 years licensure and male. A fatal outcome was more likely to be associated with a larger engine capacity motorcycle, collision with a heavy vehicle, head on collision, and collision at a non-junction road. In contrast, a non-fatal outcome was more likely to be associated with a small engine capacity motorcycle, collision with another motorcycle or passenger car, junction accidents, and side or rear collisions.
MeSH terms: Accidents, Traffic/statistics & numerical data*; Adolescent; Adult; Female; Humans; Malaysia; Male; Motorcycles*; Age Distribution; Sex Distribution
Exposure to Portland cement dust has long been associated with the prevalence of respiratory symptoms and varying degrees of airway obstruction in man. Apart from respiratory diseases, it was also found to be the cause of lung and laryngeal cancer, gastrointestinal tumours and also dermatitis. This study was done to investigate the effect of dust exposure on ventilatory lung function of Portland cement factory workers in Rawang, Selangor. Spirometry tests of 62 male workers (exposed to total dust concentration of 10,180 micrograms/m3 and PM10 of 8049 micrograms/m3) and 70 subjects from UPM (exposed to mean total dust of 192 micrograms/m3 and PM10 of 177 micrograms/m3--controls) revealed significant differences in spirometry values between the groups. The workers showed i) significantly lower FEV1% and FEF25-75%, and higher FMFT, ii) reduced FEV1% with increasing level of dust exposure and iii) higher prevalence of respiratory symptoms. Therefore, we suggest that exposure to dust in the cement factory leads to higher incidence of respiratory symptoms and impaired lung function.
Hepatitis E virus (HEV) is a RNA virus transmitted enterically. A study of anti-HEV antibodies in 145 human immunodeficiency virus type 1 (HIV-1) infected subjects found that 14.4% of them were reactive to anti-HEV antibodies. Anti-HEV IgG and anti-HEV IgM was detected in 10.3% and 4.1% of the subjects respectively. Prevalence of anti-HEV (either IgG or IgM) was similar across all adult ages (p = 0.154), between the three ethnic groups (p = 0.378), and across risk groups (p = 0.120). The results showed that HEV infection in subjects recruited in this study was most likely transmitted via faecal-route.
MeSH terms: Adult; Child; Child, Preschool; Humans; Infant; Malaysia; HIV-1*; HIV Infections/immunology*; HIV Infections/virology*; Seroepidemiologic Studies; Hepatitis E/immunology*
We describe the distribution of capillary blood glucose (BG) by age, sex and ethnicity in Malaysian adults. A national sample of 20,041 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BG was measured using reflectance photometer. Percentile tables and curves by age, sex and ethnicity are presented. The BG distribution was right skewed and showed the expected increase with age. Except in Indian, women had higher BG than men. There were also marked ethnic differences. Indian had the highest BG concentration, followed by Chinese, Malay and other indigenous ethnic group.
Study name: National Health and Morbidity Survey (NHMS-1996)
We describe the distribution of capillary blood total cholesterol (BC) by age, sex and ethnicity in Malaysian adults. A national sample of 20,041 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BC was measured using reflectance photometer. Percentile tables and curves by age, sex and ethnicity are presented. The BC distribution was right skewed and showed the expected increase with age. There were ethnic differences. Malay had the highest BC concentration, followed by Indian, Chinese and other indigenous ethnic group. However, for all ethnic groups, BC concentrations were low in comparison those prevailing in Western populations.
Study name: National Health and Morbidity Survey (NHMS-1996)
MeSH terms: Adult; Aged; Aging/blood; China/ethnology; Cholesterol/blood*; Female; Health Surveys; Humans; India/ethnology; Malaysia; Male; Middle Aged; Sex Characteristics
We describe the distribution of blood pressure (BP) by age, sex and ethnicity in Malaysian adults. A national sample of 21,391 individuals aged 30 or older had usable data. They were selected by stratified 2-stage cluster sampling. BP was measured using an automated oscillometric device, Visomat. Percentile tables and curves by age, sex and ethnicity are presented. The systolic and diastolic BP distribution was right skewed and showed the expected increase with age. This was markedly so in Malay and other indigenous women; as a result they had most severe hypertension.
Study name: National Health and Morbidity Survey (NHMS-1996)
MeSH terms: Adult; Aged; Aging/physiology; Blood Pressure*; China/ethnology; Cross-Sectional Studies; Female; Health Surveys; Humans; Hypertension/epidemiology; India/ethnology; Malaysia; Male; Middle Aged; Sex Characteristics; Age Distribution; Sex Distribution
We describe the distribution of body weight, height and body mass index (BMI) by age, sex and ethnicity in Malaysian adults. A national sample of 28,737 individuals aged 20 or older had usable data. They were selected by stratified 2-stage cluster sampling. Percentile tables and curves by age, sex and ethnicity are presented. The body weight and BMI distributions were right skewed, while that of height was symmetrical. BMI distribution showed the expected increase with age, while that of height decrease with age. Differences in BMI between the 2 sexes and among the 4 ethnic groups were observed. Indian had the highest BMI, followed by Malay, Chinese and other indigenous ethnic group.
Study name: National Health and Morbidity Survey (NHMS-1996)
MeSH terms: Adult; Aged; Aging/physiology; Body Height*; Body Weight*; China/ethnology; Cross-Sectional Studies; Female; Health Surveys; Humans; India/ethnology; Malaysia; Male; Middle Aged; Sex Characteristics; Body Mass Index*
A young man presented with primary multi-drug resistant tuberculosis. The institution of second-line regimes with insufficient efficacy due to clinical inexperience, unreliable sensitivity reports and the inavailability of second-line drugs led to the development of an organism that was resistant to ten anti-tuberculous drugs. Accurate sensitivity testing done in an overseas laboratory enabled the institution of a six-drug regimen that has resulted in clinical cure.
Hungry bone syndrome (HBS) following successful parathyroid surgery is a well described phenomenon. However, few studies have clearly addressed this syndrome or looked at the outcome of perioperative management. We report a case of HBS following successful parathyroid surgery. The perioperative management is discussed and literature pertaining to this interesting case is reviewed.
Gastric cancer in the young adult is rare and has been said to be more aggressive than gastric cancers of the older age group. Its unique association with pregnancy is even rarer. However, they have similar complications of haemorrhage, obstruction and perforation. We report a 27 year old lady at 16 weeks gestation who presented with a perforated malignant gastric ulcer and carcinomatosis peritonei. Reviewing the literature, we realised that such complication of a gastric cancer occurring in a pregnant young adult has not been previously documented.
We report a case of cervical pregnancy complicated by life threatening hemorrhage. An initial diagnosis of molar pregnancy was made preoperatively. During uterine evacuation she developed profuse hemorrhage which required an emergency hysterectomy for uncontrolled bleeding. Histopathological examination confirmed a cervical pregnancy. The clinical and pathological criteria for the diagnosis and the etiology of cervical pregnancy are discussed.
A method for securing closed suction drains in the neck is described where it serves to prevent leakage, slippage and accidental removal. This method involves passing a stay suture through the most proximal holes of the drain and suturing it to the skin and an overlying short length of the tube externally. Drains secured in this manner can be left in the wound for up to fourteen days with no associated complications from our experience in sixty-two patients following head and neck surgery.
Sensitivity testing on Vibrio cholerae isolates during an epidemic in 1998 in Kelantan identified strains resistant to tetracycline. This prompted a change in the usual management of cholera in Kelantan. The antibiotic of choice was changed from tetracycline to erythromycin.
The number of women in the workforce in increasing. A substantial proportion are in the reproductive age which brings to attention the problem of work exposures that adversely affect reproductive outcome. These exposures include chemicals, radiation, strenuous physical activity and infections. They affect reproduction by effect on the germ cells, through hormonal distribution which in turn affects transport of germ cells or zygote, implantation and development. Some of these exposures are teratogenic. At present, some regulations and policies seem to be directed at women workers while there is evidence to show that women are not the only victims. Paternal exposures have also been reported to be associated with infertility, spontaneous abortions and other adverse outcomes. There is insufficient information about reproductive effects of work exposures and hence further research is required in this area.
MeSH terms: Developing Countries*; Health Services Accessibility; Humans; International Cooperation; Global Health*; Women's Health; Rural Health Services*; Oceanic Ancestry Group; Continental Population Groups
Breast cancer is the most common cancer in women worldwide. The growth of breast cancer cells is either hormone-dependent or hormone-independent. Both types are represented in vitro by the estrogen-receptor positive (ER+) MCF-7 and the estrogen-receptor negative (ER-) MDA-MB-231 cell lines, respectively. The pS2 gene is an estrogen-regulated gene and serves as a marker for the ER+ tumours. Carotenoids are pigments with anti-cancer properties besides having pro-vitamin A, antioxidant and free-radical quenching effects. This study was designed firstly, to compare the effect of palm oil carotene concentrate with retinoic acid on the growth of the ER+ MCF-7 and the ER- MDA-MB-231 cells; and secondly to evaluate the effect of the palm oil carotene concentrate on the regulation of pS2 mRNA. The growth experiments were performed with monolayer cells seeded in phenol red free RPMI 1640 culture media and subsequently treated with varying concentrations of either retinoic acid or palm oil carotenoids. The cell numbers were determined at the start of each experiment and then at successive time intervals. The results showed that the palm oil carotene concentrate caused dose-dependent inhibition of estradiol-stimulated growth of MCF-7 cells but did not affect the proliferation of MDA-MB-231 cells. Retinoic acid caused similar, albeit more potent effects, as significant inhibition was observed at lower concentrations than the palm oil carotenoids. In the pS2 gene expression experiment, cell monolayers were treated with the carotene concentrate (10(-6) M), either with or without supplemented estradiol (10(-8) M), and subsequently the RNA was extracted. Northern blotting was performed and the regulation of pS2 mRNA determined using a 32P-labelled pS2 cDNA probe. The results showed that the palm oil carotene concentrate did not affect the expression of pS2 mRNA and are therefore independent of the estrogen-regulated pathway.