Introduction: The flow-volume curves of patients with obstructive sleep apnoea (OSA) obtained during the awake state are frequently abnormal.
Objective: To determine 1) the relationship between the awake respiratory function and the severity of sleep-disordered breathing in a group of Malaysian patients with the OSA syndrome and 2) the frequency of flow-volume curve abnormality in these patients.
Materials and methods: A retrospective analysis of the data from respiratory function tests during wakefulness and nocturnal polysomnography was performed on 48 patients with OSA. The severity of OSA was defined by the apnoea-hypopnoea index (AHI) and the lowest oxygen saturation during sleep (SPO2nadir).
Results: AHI had a significant relationship with alveolar-arterial oxygen gradient (r=0.34, p=0.046) and SPO2nadir (r=0.049, p<0.001) but not with any anthropometric parameter or the other awake respiratory function variables measured SPO2nadir, has a significant relationship with body mass index (r=0.54, P<0.001), neck circumference (r=-0.39, p=0.013), awake room air PaO2 (r=0.61, p<0.001), alveolar-arterial oxygen gradient (r=-0.41, p=0.015) and baseline supine SpO2 (r=0.53, p<0.001). there was no correlation between SPO2nadir and any spirometric or static lung volume parameters. The maximum inspiratory and maximum expiratory flow volume curves of 26 patients (54%) showed a ratio of forced expiratory flow to forced inspiratory flow at mid-vital capacity (FEF50/FIF50) greater than one. In addition, flow oscillations (the ‘sawtooth’ sign) were noted in the inspiratory and/or expiratory flow-volume curves of 21 patients (44%), 9 of who did not have an FEF50/FIF50>1. Altogether, the maximum flow-volume curves during wakefulness of 35 (&3%) of the 48 patients showed variable upper airway obstruction and/or flow oscillations. However, the presence of these two upper airway abnormalities, either occurring alone or together did not have an effect on the severity of OSA as measured by the AHI or SPO2nadir.
Conclusions: Abnormalities of the flow-volume loop consistent with inspiratory flow limitation and/or upper airway instability during wakefulness are common in patients with the OSA syndrome. The degree of oxygen desaturation during sleep in these patients as related to their awake oxygenation status.
MeSH terms: Adult; Aged; Humans; Middle Aged; Neck/anatomy & histology; Respiration*; Retrospective Studies; Body Mass Index; Sleep Apnea, Obstructive/physiopathology*
A young lady who was treated for early squamous cell carcinoma of cervix presented with perforated appendicitis. Appendicectomy was done and the histopathology was reported as metastatic squamous cell carcinoma. Squamous cell carcinoma of the cervix metastasizing to the appendix is extremely rare and we previously unreported.
Sixty-five patients with congenital kyphosis and kyphoscoliosis who underwent spinal arthrodesis are reviewed to determine the factors that influenced the outcome of arthrodesis. Mean follow up after surgery was 6 years and 6 months with all patients having a minimum of 2 years follow up. A satisfactory outcome, or a stable arthrodesis was defined as a loss of correction of less than 10 degrees from the time of surgery till review. An unsatisfactory outcome, or unstable arthrodesis was considered when there was more than 10 degree loss. Type of vertebral anomaly and type of arthrodesis procedure were significantly influenced stability of arthrodesis, whereas age when arthrodesis was performed and size of curve at surgery were not significantly related to stability of arthrodesis.
In 1997, the Ministry of Health Malaysia introduced a surveillance programme for occupational and work-related diseases including poisonings for cases seen in government health facilities. Between June 1997 and November 1998, there were 36 cases of respiratory disease and 95 cases of poisoning by chemicals and pesticides notified while skin diseases were 108 cases. Respiratory diseases reported were predominantly occupational asthma (25%), pneumoconiosis (17%) and infections (39%). The commonest reported skin disease was contact dermatitis (87%). The commonest causes of occupational poisonings were paraquat (19%), organo-phosphates (16%), agro-chemicals excluding pesticides (15%) and gases (10%). The number of cases reported is still relatively few compared to data from other countries, suggesting that there is still considerable under reporting.
A biotin-avidin-linked immunosorbent assay was developed to detect Aspergillus antigens in sera of immunocompromised patients. The assay was based on a double antibody sandwich ELISA using polyclonal antibodies raised against water-soluble antigens of Aspergillus fumigatus. Aspergillus antigens were positive in sera of 9 of 16 (56%) patients who were studied prospectively and in 13 of 73 (19%) patients studied retrospectively. The 9 prospectively studied patients who were antigen positive were febrile neutropenic hematological malignancy patients who exhibited a high risk of acquiring invasive aspergillosis.
A retrospective epidemiological study was done on 41 deaths among patients treated for TB in the Klang Chest Clinic for the year 1999. The findings revealed a male preponderance of TB deaths with Indians having the highest case fatality rate (8.6%). The majority of deaths occurred within the 25-44 year age group. Of those cases diagnosed as Pulmonary TB, 69% were diagnosed as far-advanced, at presentation, based on chest x-rays reported. Eighty three percent of these patients were still on treatment when they died. HIV was the most common co-existing disease condition and was implicated in 14.6% of the deaths. The recommendations include implementation of clinical guidelines on TB screening for HIV patients, a study to evaluate the effectiveness of the current TB surveillance programme and for chest x-rays of all sputum smear negative patients to be reported by the radiologist to reduce the risk of misdiagnosis.
Study site: Chest clinic, Kelang, Selangor, Malaysia
MeSH terms: Ambulatory Care Facilities; Humans; Malaysia; Retrospective Studies; Time Factors; Tuberculosis/mortality*; Tuberculosis/therapy
The detection of Vibrio cholerae 01 from the aquatic environment of Daro and Bintulu in Sarawak was carried out following an outbreak of cholera. Conventional culture methods and detection of ctx gene by polymerase chain reaction technique were carried out on 80 water samples. Only one sample was positive by culture methods while 8 were positive by PCR. DNA finger printing by pulsed-field gel electrophoresis showed that the clinical isolates in Daro and Bintulu were genetically identical while the environmental isolate was closely related. Recovery of Vibrio cholerae by culture method is poor and newer methods of detection should be developed.
A review was carried out in 21 cases of bone transport in the tibia done between May 1995 and December 1997. These were done for the treatment of compound (Grade IIIB) fractures with extensive bone and soft tissue loss and in infective non-unions of the tibia using the Ilizarov technique and ring fixator. In 5 cases, 2 or 3 additional procedures were needed such as tendo achilles (TA) lengthening, bone grafting, revision of construct or revision of scar at the docking site. Average resection of infected bone was 5.2 cms in the infective non-union group and average bone and soft tissue loss was 8 cms in the compound Grade IIIB fracture group. The defect was bridged and regenerate bone occurred in all the cases except one. Union was achieved in all the cases although 10 needed bone grafting. Infection was eradicated in all the cases. Limb length discrepancy was corrected in all the cases except three. Mean duration of treatment was 12 months.
The prevalence rate of trichuriasis in children in certain areas of Kelantan is high. However the Trichuris Dysentery Syndrome (TDS), a condition in children characterized by chronic diarrhoea, stunting and anaemia is said to be rare. A recent change in policy at our institution to lower the threshold for undertaking colonoscopy in children with chronic diarrhoea resulted in the detection of 6 cases of TDS in less than a year. The median age was 7 years (range 3-13) and the median duration of symptoms before diagnosis was 2 years (range 1-8). The insidious nature of TDS and the low level of awareness of this condition even among health care workers may result in considerable underdiagnosis.
Ambulatory or day care surgery is still in its infancy in this part of the world. Our newly built university affiliated hospital started its Day Surgery Centre in February 1998. It is the first multidisciplinary ambulatory surgery centre in a teaching hospital in the country. It caters for Orthopaedic surgery, Urology, Plastic surgery, Otorhinolaryngology, General surgery, Paediatric surgery and Ophthalmology. We have done 2,604 cases and our unanticipated admission rate is less than 2%. There has been no major morbidity or mortality. The problems of setting up a multidisciplinary ambulatory centre in a teaching hospital are discussed.
A prospective observational study of feeding in low birth weight (LBW) infants with birth weight (BW) of at least 1.8 kg admitted to the Neonatal Intensive Care Unit (NICU) showed that nearly 80% of mothers provided expressed breastmilk (EBM) and a further 14% breastfed their infants before discharge. Weight gain was overall poor at a mean of 9.48 +/- 7.82 grams per kg per day with those on predominant EBM feeding (EBM > 70%) doing worse than those on predominant preterm formula (PTF) feeding (EBM < 31%), weight gain being 5.40 +/- 6.88 and 11.10 +/- 8.15 grams per kg per day respectively (p < 0.01). Weight gain was also poorer (7.72 +/- 5.55 grams per kg per day) in patients with respiratory distress syndrome (RDS) compared to those who did not have RDS (12.02 +/- 9.58 grams per kg per day). p < 0.05. Incidence of infants < 10th centile body weight at birth was 16.8% and at discharge was 69.1%.
A study on infant feeding practices was conducted during the implementation of the Baby Friendly Hospital Initiative (BFHI) in a district hospital. The aim was to identify which population subgroups had lower breastfeeding rates at 4 months and the effect of attendance of antenatal breastfeeding education on breastfeeding practices. All infants delivered in May 1996 were followed-up. 204 respondents were analyzed. This study demonstrated a higher exclusive and any breastfeeding rates at 4 months than some other studies. (48% and 76% respectively). It was found that the Malays were more likely to be breastfeeding exclusively at 4 months (72%) than the Indians (32%) and the Chinese (4%). (P < 0.01). There were more non-working mothers breastfeeding exclusively at 4 months than working mothers. (60% versus 26%) P < 0.01. Antenatal breastfeeding education in the form that was given appeared to improve breastfeeding rates at 4 months. Future efforts to promote breastfeeding should target the Chinese mothers and the working mothers.
MeSH terms: Breast Feeding*; China/ethnology; Female; Humans; India/ethnology; Infant, Newborn; Patient Education as Topic; Pregnancy
Lower limb injuries are the main cause of temporary and permanent disability among motorcyclists in Malaysia. They cause non-fatal but serious injuries requiring hospitalisation. Detailed studies on factors influencing lower limb injuries are justified in an attempt to reduce the occurrence of these injuries. This study presents a computer simulation of the crash behaviour of the basket of a small-engined motorcycle with the lower limb using finite element (FE) methods. The results suggest that the extensive deformation of the motorcycle basket may reduce the risk of injury to the lower limb. The behaviour of the basket during collision is analogous to the crumple zone of automobiles.
MeSH terms: Accidents, Traffic*; Humans; Leg Injuries/etiology*; Motorcycles*
Retrospective analysis was done on 235 recipients, 133 males and 102 females, who were transplanted between 25th September 1979 and 25th June 1999. 85.1% were Chinese, 7.7% were Indians and 7.2% Malays. 23% (54) were living related renal transplants (LRRT) all except 5 done at Hospital Kuala Lumpur. 60% (141) were living unrelated donor renal transplants (LURT) done in India. 17% (40) were cadaveric transplants (CADT) (all done in China except 2 at Hospital Kuala Lumpur and one in London). 97% (228) were first transplants. Primary renal disease was unknown in 69.4%, 17% (40) glomerulonephritis, 5.5% diabetic nephropathy and 8.1% 19 others. All were on prednisolone, 93.2% were on azathioprine and 96.6% were on cyclosporin A. The acute rejection rate was 23.4% (55 episodes). Patient survival was 88% at five years and patients alive with functioning graft was 84% at 5 years. LRRT had significantly better survival compared to LURT. 34 grafts were lost to chronic allograft nephropathy. 46 recipients died (33 died with functioning graft).
The EEC syndrome (ectrodactyly, ectodermal dysplasia and cleft lip-palate) is a rare disorder inherited as an autosomal dominant trait or can occur sporadically. We describe a case of this syndrome with chronic ocular surface disorder secondary to abnormalities of ocular adnexia.