Oestrone sulphate is a major source of active oestrogens in the breast. It is converted to oestrone by oestrone sulphatase. Breast cyst fluid (BCF) is a rich source of sex hormones and growth factors. BCF obtained from British women has been shown to inhibit oestrone sulphatase activity in the MCF-7 oestrogen-receptor-positive breast cancer cell line. The aim of the present study was to assess whether BCF obtained from Malaysian women inhibited oestrone sulphatase activity in the MCF-7 and MDA-MB-231 breast cancer cell lines. The cell lines were grown in supplemented Dulbecco's Modified Eagle Medium for 3 days, following which a 3-day incubation with sterilised BCF was carried out. At the end of the treatment period the cell monolayers were assayed for oestrone sulphatase activity and the number of cell nuclei counted on a Coulter Counter. BCF was also fractionated on a Bio-Sil SEC 125-5 column by HPLC and the effects of the fractions collected on oestrone sulphatase activity in the MDA-MB-231 cell line were assessed. All 18 samples of BCF tested inhibited cell growth in the MDA-MB-231 cell line while 8 out of 10 samples inhibited MCF-7 cell growth; 15 out of 18 BCF samples inhibited oestrone sulphatase activity in the MDA-MB-231 cell line whereas 5 out of 10 samples stimulated oestrone sulphatase activity in the MCF-7 cell line. HPLC fractions corresponding to molecular weights of > 158 kDa and 28 kDa were found to inhibit oestrone sulphatase activity in the MDA-MB-231 cell line. Further work is required to fully characterise these substances as they may have roles to play in the prevention of breast cancer.
MeSH terms: Breast Neoplasms/enzymology*; Breast Neoplasms/pathology; Cell Division/physiology; Female; Fibrocystic Breast Disease/metabolism*; Humans; Neoplasms, Hormone-Dependent/enzymology*; Neoplasms, Hormone-Dependent/pathology; Sulfatases/antagonists & inhibitors*; Tumor Cells, Cultured; Cyst Fluid/chemistry
A 4-year-old boy presented with metastases in the spermatic cord and ribs 2 years after treatment for a primary medulloblastoma (MB). The testis was free of tumor. A MB presenting with a metastasis to the spermatic cord has not been reported to date. The role of a ventriculo-peritoneal shunt in promoting such spread should be considered in planning management.
A malaria survey was conducted to examine the presence of common clinical features of malaria in individuals living in an endemic area of malaria. The overall infection rate was 11.0% with 7.5% and 3.5% infected with Plasmodium vivax and Plasmodium falciparum respectively. The mean parasitaemia level of both species was 2905.9 parasites/microliter blood, with the mean parasitaemia level of P. vivax and P. falciparum at 682.7 parasites/microliter blood and 6981.7 parasites/microliter blood respectively. The infection rates were higher in the younger age group. Hepatomegaly, hepatosplenomegaly and clinical anaemia were significantly associated with malaria. None of the patients were febrile. In conclusion, in low endemic areas, the presence of clinical anaemia, hepatomegaly and hepatosplenomegaly in afebrile individuals could be considered as useful criteria for the presence of asymptomatic parasitaemia. It is important to carry out laboratory diagnostic investigations, to ensure all the asymptomatic parasitaemia which act as reservoirs are detected and treated.
MeSH terms: Adolescent; Adult; Child; Child, Preschool; Health Surveys; Humans; Infant; Infant, Newborn; Malaria/complications; Malaria/epidemiology*; Malaria/parasitology; Malaysia/epidemiology; Incidence; Prevalence; Age Distribution; Sex Distribution; Parasitemia/parasitology
A study was carried out to determine the pattern of microbiological organisms causing community acquired pneumonia in adult patients admitted to Penang Hospital between November 1999 and August 2000. Altogether, 98 patients (64 males, 34 females) with a mean age (+/- S.D.) of 55.9 (+/- 19.0) (range 15 to 87) years were included in the study. Causative organisms were identified in 42 patients (42.9%). Mycobacterium tuberculosis was the commonest pathogen being identified in 15.3% of cases, followed by Klebsiella pneumoniae (7.2%), Pseudomonas aeruginosa (6.1%) and Staphylococcus aureus (5.1%). Streptococcus pneumoniae and Acinetobacter spp accounted for 3 cases each (3.1%) and Haemophilus influenzae, non-haemolytic Streptococcus, Mycoplasma pneumoniae, Salmonella typhi, Escherichia coli, Klebsiella spp and Pseudomonas spp for 1 case each (1.0%). Four patients (4.1%) had dual infections and no case of legionella pneumonia was found in this series.
This study aimed to validate the Beck Depression Inventory (BDI) in the Malaysian urological population. Reliability and internal consistency were evaluated using the test-retest method and internal consistency was assessed using Cronbach's alpha. Responsiveness was expressed as the effect size. Internal consistency was high (Cronbach's alpha value = 0.56 to 0.87). Test-retest correlation coefficient and intraclass correlation coefficient were significant (ICC = 0.56 to 0.87) and a high degree of sensitivity and specificity. The BDI is thus a reliable and a valid instrument to be used in Malaysia.
Main objective of this study is to validate the Health-Related Quality of Life (HRQOL-20) in the Malaysian population. Reliability and internal consistency were evaluated using the test-retest method and Cronbach's alpha. Responsiveness was expressed as the effect size. Internal consistency was excellent (Cronbach's alpha value = 0.68 to 0.87). Test-retest correlation coefficients and intraclass correlation coefficient were significant (ICC = 0.58 and 0.91) as well as the high degree of sensitivity and specificity. The HRQOL-20 is a reliable, valid and sensitive to clinical changes in the Malaysian urological population.
MeSH terms: Aged; Health Status*; Humans; Malaysia; Middle Aged; Quality of Life*; Surveys and Questionnaires/standards*; Sensitivity and Specificity; Urologic Diseases/physiopathology*
An analysis of the clinical and serological features of 12 male and 122 female patients with SLE was done to determine whether sex related differences exist. We found a lower incidence of mucocutaneous symptoms and arthritis but an increased incidence of discoid lesions, pleuritis and pericarditis in males at disease onset. During the disease course, there was a lower incidence of arthritis, a similar prevalence of mucocutaneous symptoms but an increased incidence of pleuritis in males with a trend towards renal involvement. These findings were however not statistically significant except for the higher incidence of thrombosis among males. Serologically, both groups showed similar frequencies of autoantibodies and hypocomplementaemia. Although the study was small, it was shown that several sex-related differences in the clinical and serological features exist in Malaysian SLE patients.
Study site: SLE Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
A retrospective analysis of the case records of 494 systemic lupus erythematosus (SLE) patients under follow-up at University Hospital, Kuala Lumpur during 1976-1990 was performed. Overall mortality was 20.2% (100 patients). The causes of death were infection (30%), renal (15%), respiratory (14%), neurological (5%), cardiovascular (7%), other causes (2%) and unknown (27%). Active SLE was a contributing factor in 19% of the deaths. The patients who died had significantly more renal disease, neurological disease, serositis or thrombocytopenia by the end of the first year of disease compared to the survivors. As in other series, infection and active SLE remain important causes of death.
MeSH terms: Adult; Cause of Death; Female; Humans; Kidney Diseases/complications; Longitudinal Studies; Lupus Erythematosus, Systemic/complications; Lupus Erythematosus, Systemic/mortality*; Malaysia/epidemiology; Male; Nervous System Diseases/complications; Serositis/complications; Thrombocytopenia/complications
This is a prospective study with the objective of comparing Three Dimensional (3D) Dynamic Subtraction Contrast Enhanced Magnetic Resonance Angiography (3DDSCEMRA) with Conventional Catheter Arteriography (CCA) as the gold standard, in the diagnosis of peripheral occlusive disease. Three patients scheduled for CCA in this hospital in between September and October 2000 were included in this study. Patients underwent 3DDSCEMRA before proceeding to CCA on the same day. The 3DDSCEMRA reader was blinded to the CCA results. The results showed good correlation in iliofemoral segment and poor correlation in the infrapopliteal segment due to artifacts in 3DDSCEMRA images. 3DDSCEMRA is a new, non-invasive and promising technique in the diagnosis of peripheral occlusive disease.
A baby milk market was created in the late nineteenth and early twentieth centuries and was conceived through the mutual attraction of the manufacturers and doctors. This has partly attributed to the change from breast to artificial feeding. This study was conducted to determine whether marketing had any effect on infant feeding practices. Fifty Malay mothers whose last child was aged less than five years were asked, by questionnaire and by interview, to identify whether several marketing methods influenced their decision on the selection of infant feeding practice. It was found that these mothers felt milk advertisements on television were attractive (72%), were influenced by others to buy a particular brand of formula (38.4%), were influenced by free milk samples to buy a particular brand of milk formula (65.2%) and were not influenced by their doctors on the chosen method of feeding (68%). More studies should be conducted on a bigger sample in other settings and targeting other methods of marketing to substantiate the above results. Further, similar studies among Chinese and Indian mothers are also required.
A total of 356 doctors responded to a survey on the timing and stability of choice of medical specialty. The majority of doctors made their final decision while working as a medical officer. One hundred (48.5%) of the doctors had made an earlier choice as medical students, 63 (30.6%) during their internship and 43 (20.9%) made their final choice while they were medical officers. Working experience in the specialty was the most important factor in determining final choice of specialty. Advice from consultants/seniors, better financial prospects and parental influence were more important for the male doctors while marriage and family considerations were more important for the female doctors in making their final choice.
MeSH terms: Career Choice*; Data Collection; Decision Making; Female; Humans; Male; Medicine*; Specialization*; Students, Medical*; Time Factors
The Griffiths Scales for Mental Development were used to assess a group of 60 normal 2-year old Malaysian children (25 Indian, 23 Malay and 12 Chinese). The mean GQ was 104.2 (SD 9.3). This was significantly higher than the test mean of 100, p < 0.001. The mean score for Malaysian children was significantly higher on the locomotor, personal social, performance and practical reasoning subscales while they were significantly lower on the hand eye subscale and did not differ from the test mean on the hearing and speech subscale. There was a significant correlation between GQ and social class, r = -0.39, p < 0.05. Scores were lower than those currently obtained on British children, p < 0.001. Minor difficulties due to language and cultural factors arose over the interpretation of several items but with standardisation of these items the test is useful in Malaysian children.
MeSH terms: Child Development*; Child, Preschool; Female; Humans; Intelligence Tests*; Malaysia; Male; Reference Values; Social Class
Inhaled nitric oxide (iNO) improves oxygenation in term and near-term infants with persistent pulmonary hypertension of the newborn (PPHN) and decreases the need for treatment with extracorporeal membrane oxygenation (ECMO). This mode of treatment is currently being introduced in Malaysia. We report our preliminary experience using low dose inhaled nitric oxide (20 parts per million) in three newborn infants (meconium aspiration syndrome, primary PPHN and congenital diaphragmatic hernia) with severe PPHN who fulfilled criteria for ECMO with a mean oxygenation index (OI) of 40. Two of the infants showed rapid and sustained improvement in oxygenation with a reduction in oxygenation index (OI) over 24 hours. The infant with diaphragmatic hernia showed an initial improvement in OI, which was unsustained and subsequently died. All three infants did not show significant elevation of methemoglobin or nitrogen dioxide (NO2). Inhaled nitric oxide is an effective and safe treatment for severe PPHN that can be used in a developing country like Malaysia.
Thirty-seven consecutive patients (41 eyes) diagnosed with primary angle closure glaucoma (PACG) attending the Glaucoma Clinic in University Malaya Medical Centre, over a period of 6 months were categorized into acute, subacute and chronic PACG from their clinical presentation. Each case was subjected to automated refraction, A-scan biometry for anterior chamber depth, axial length and lens thickness, keratometry and corneal diameter measurement. Calculations for the relative lens position and the lens thickness: axial length index were performed. The data collected was analysed by the nonparametric test (Kruskal-Wallis), one way analysis of variance (ANOVA), chi-square test, Spearman's nonparametric correlations and regression analysis. For controls 15 eyes from 15 normal subjects matched for age, sex, refractive error and race were chosen and subjected to the same examinations. Chronic PACG was the predominant subtype (53.6% of patients and 58.5% of eyes). The ocular biometric measurements of acute PACG eyes deviated most from normals in having the shallowest anterior chamber depth, shortest axial length, smallest corneal diameter, steepest corneal radius, thickest and most anteriorly situated lens, and the greatest lens thickness: axial length index. The subacute subtype was closest to normal and chronic PACG subtype fell in between in most of the biometric characteristics. These findings were not statistically significant. All PACG eyes as a group however showed statistically significant shallower anterior chamber depth (p < 0.05), and a more anterior relative lens position (p < 0.05) compared to normals.
Asthma can place considerable restrictions on the physical, emotional and social aspects of the lives of patients. The assessment of quality of life aims to provide a means of measuring the impact of this disease on patients' lives, from the patients' perspective. A cross sectional multi-centre study was conducted in six government hospitals throughout the country. Self-administered SF-36 was used, and clinical information obtained through interviews and examination. 1612 asthmatics responded. Females constituted 63% of the respondents; mean age was 40.9 years; Malays were the majority ethnic group, while 70.8% had secondary level education and 53.7% were employed. Half had suffered from asthma for at least 13 years, while 46.8% and 23.6% have moderate and severe disease respectively. Quality of life was affected by severity of disease. Asthmatics, had a significantly poorer quality of life than the general US population. Severe asthma disease was associated with a compromised quality of life, similar to that of COPD.
MeSH terms: Adult; Aged; Asthma/physiopathology*; Female; Health Status; Humans; Malaysia; Male; Middle Aged; Quality of Life*; Surveys and Questionnaires
An observational study of all children with intractable epilepsy at the Paediatric Institute prescribed Lamotrigine as an add-on therapy between January 1994 and November 1998 was conducted. A total of 30 children were recruited. Three had adverse effects to the drug and it was withdrawn. Of the remaining 27, there were 20 boys and 7 girls, ranging from 2 to 17 years. Fifteen children had generalised epilepsy, 6 had partial epilepsy, 2 had West syndrome and 4 had Lennox Gastaut syndrome. Six children (20%) became seizure free, and 14 (54%) had a greater than 50% reduction in seizure frequency. However 7 children (23%) did not respond and 3 experienced a deterioration in seizure severity. Nine children were noted to have an improvement in alertness and behaviour. Our small series suggests that Lamotrigine is useful as add-on therapy in childhood intractable epilepsy.
The in vitro activity of sulperazon (cefoperazone/sulbactam) was tested against 94 ceftazidime-resistant strains of bacteria isolated from mostly seriously ill patients in critical care units. Acinetobacter baumanii, Pseudomonas aeruginosa and Klebsiella pneumoniae made up 80% of the pathogens studied; 90% of the Klebsiella strains were producers of extended-spectrum beta-lactamases (ESBL). The MIC90 of sulperazon for Klebsiella was 12 mg/l (range 1.5-16 mg/l), indicating that this drug may be a useful alternative for the treatment of ceftazidime-resistant, ESBL-producing Klebsiella.
MeSH terms: Acinetobacter/drug effects; Bacteria/drug effects*; Cefoperazone/pharmacology*; Ceftazidime/pharmacology*; Drug Combinations; Drug Resistance, Microbial; Humans; Klebsiella pneumoniae/drug effects; Microbial Sensitivity Tests; Pseudomonas aeruginosa/drug effects; Sulbactam/pharmacology*; In Vitro Techniques
A 45 years old Chinese housewife presented with menorrhagia and dysmenorrhoea due to adenomyosis failed to respond to various medical treatments. She was treated with balloon thermoablation. The total menstrual blood loss (MBL) decreased from 96.94 ml before to 37.57 ml, six months after thermoablation. The pictorial blood loss chart (PBLC) showed similar decrease in blood loss. Dysmenorrhoea was also cured. At three year follow up, there was no recurrence. This is the first report which shows thermoablation decreases MBL objectively and can be tried to treat adenomyosis.
A 16 year-old man presented with fracture of both his femurs after a road traffic accident. Chest radiograph revealed mediastinal widening. Subsequent CT scan and arch aortogram confirmed the findings of traumatic aortic arch transection at the isthmus. He underwent successful surgical repair. High index of suspicion and prompt actions are important in managing this potentially fatal but treatable condition.