A strain of streptomycin-resistant Listeria monocytogenes LM35 isolated from imported frozen beef was examined in this study. In conjugation studies, the L. monocytogenes LM35 strain harbouring two plasmids of 54, 3.0, 2.8 and 2.7 kilobase was used as the donor and streptomycin-sensitive and plasmidless L. monocytogenes LM65 and LM100 strains as the recipients. Streptomycin resistance was transferred to L. monocytogenes LM65 and LM100 strains at frequencies of 3.3 x 10-8 and 1.2 x 10-9 per input donor cells, respectively. In both occasions, we also observed the concomitant transfer of the donor’s 54 kilobase plasmid. These results suggest that streptomycin resistance in L. monocytogenes LM35 was mediated by the 54 kilobase plasmid.
Twenty-eight isolates of E. faecalis and 5 isolates of E. hirae were isolated from chicken samples obtained from markets in Sri Serdang, Selangor. They were tested for susceptibility to vancomycin and other antimicrobial agents. All of the isolates showed multiple resistance to the antibiotic tested. All Enterococcus spp. were resistant (100%) to ceftaxidime, cephalothin, erythromycin, gentamicin, kanamycin, nalidixic acid and streptomycin. Resistance was also observed to norfloxacin (97%), tetracycline (91%), penicillin (85%), bacitracin (82%), chloramphenicol (61%) and the least resistance was to ampicillin (27%). High prevalence to vancomycin resistance was detected among the E. faecalis (27of 28) and E. hirae (4 of 5) isolates. The multiple antibiotic resistance index ranging between 0.64 to 1.0 showed that all strains tested originated from high-risk contamination. Plasmid profile analysis of Enterococcus spp. revealed plasmid DNA bands ranging in size from 1.3 to 35.8 megadalton but some isolates were plasmidless. No correlation could be made between plasmid patterns and antibiotic resistance.
µ-Lipoic acid (ALA) is a naturally occuring cofactor that serves as an acyl carrier in oxidative decarboxylation of _-keto acids in carbohydrate metabolism. Current findings suggest that _-lipoic acid and its reduced form, dihydrolipoic acid (DHLA) may act as antioxidants and are able to quench free radicals in vitro and in vivo. However, the mechanism underlying the process is still unknown. In this study, atherosclerotic lesions were induced in six groups of adult male NZW rabbits labelled as group K, A, B, C, D, E (n=6) by giving 100g/head/day of 2% cholesterolrich diet for ten weeks. While group K acted as a control, the rest were supplemented with ALA orally (1.4, 2.8, 4.2, 8.0 and 10mg/kg, respectively). In week ten, venous blood samples drawn from ear lobes were analysed for complete lipid profile and peroxidation index. The results showed a significant reduction of total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) levels in most of the treated groups as compared to the control whereas apo-A levels showed a significant increase in group C and D. However, microsomal lipid peroxidation index, malondialdehyde (MDA) was found to be not significantly different. These findings suggest that µ-lipoic acid may act as a lipid lowering agent in dose dependent manner in premature stage of atherosclerosis but was unable to inhibit lipid peroxidation processes in matured stage of atherosclerosis in rabbits fed a high cholesterol diet.
Milk is a physiological fluid which has high nutritional value and soybean has strong antioxidant characteristics which is believed to inhibit carcinogenesis. The objective of this study was to investigate the effects of administration of soybean and goat’s milk on hepatocarcinogenesis in rats (fed with diethylnitrosamine; DEN and acetylaminofluorene; AAF) by determining the activities of plasma gammaglutamyl transpeptidase (GGT) and alkaline phosphatase (ALP). Thirty-six rats from the species Sprague-Dawley were divided into 6 groups: control, DEN/AAF, soybean, DEN/AAF with soybean treatment, goat’s milk and DEN/AAF with goat’s milk treatment. Soybean and goat’s milk administrations were given 5 ml/day. The rats were sacrificed after 8 weeks and the blood was collected. Treatment with DEN/AAF caused an increase in ALP and GGT levels and a decrease in weight significantly (p
Pulmonary tuberculosis (TB) in the AIDS population has a variable chest radiographic presentation. The association between the chest radiographic presentation of pulmonary TB and CD4 T-lymphocyte count in the HIV-infected patient was investigated in order to provide an empirical approach for early diagnosis, treatment, and isolation of these patients. A retrospective analysis of chest radiographs, CD4 T-lymphocyte counts, and clinical history of 80 patients from Hospital Kota Bharu, was performed. All patients were HIV-seropositive and had culture and /or cytology-proven pulmonary tuberculosis. Radiographs were evaluated for the presence of atypical or typical patterns of pulmonary TB. Thirteen (16.2%) patients had typical postprimary pattern, where opacities were distributed at the upper zones, with or without cavitation. Sixty-seven (83.8%)patients had atypical patterns, consisting of normal chest radiograph, middle and/or lower zones parenchymal opacities, mediastinal lymphadenopathy, pleural effusion and miliary TB. Of these, 18 (22.5%) patients demonstrated normal chest radiographs, 36 (45%) patients showed parenchymal opacities at the middle and/or lower zones of the lungs, 30 (37.5%) had mediastinal lymphadenopathy, 18 (22.5%) revealed pleural effusion and 6 (7.5%) presented with miliary TB. Sixtytwo (77.5%) patients had CD4 T-lymphocytes count less than 200 cells/ul. Of these patients, only 1 (1.6%) had typical pattern. Eighteen (22.5%) patients had CD4 Tlymphocyte count more than 200 cells/ul, where 12 (66.7%) of them showed typical pattern. Patients with CD4 T-lymphocytes count of less than 200 cells/ul, were more likely to produce normal chest radiographs, middle and /or lower zones parenchymal opacities and mediastinal lymphadenopathy. The mean CD4 Tlymphocytes count were also found significantly lower. AIDS patients with pulmonary TB can present with both typical and atypical chest radiograph patterns. An AIDS patient who had CD4 T-lymphocytes count less than 200 cells/ul were more likely to present with atypical radiographic appearance of pulmonary TB. They required appropriate treatment and isolation until the diagnosis of pulmonary TB was confirmed.
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Seropositivity; Humans; Lymphatic Diseases; Lymphocytes; Pleural Effusion; Retrospective Studies; Tuberculosis, Miliary; Tuberculosis, Pulmonary; HIV Infections; Lymphocyte Count; Early Diagnosis
A total of 190 secondary four male school students from three schools in Kota Bharu were surveyed on their smoking habits and their attitudes towards the health warning messages on cigarette packs. There were 57 (30.0%) students who were current smokers, 45 (23.7%) students who were ex-smokers and 88 (46.3%) students who have never smoked cigarettes. Nearly all current and ex-smokers (95.1%) as well as non-smokers (94.3%) knew the wording of the health warning message currently displayed on cigarette packs. Almost all the students (95.3%) also knew where the warning message was placed. There were more ex-smokers and nonsmokers (70.5%) compared to current smokers (50.0%) who felt that there should be different health warning messages and each should be displayed concurrently on different cigarette packs. The students felt that the current health message was not effective to motivate smokers to quit (score=2.25). Alternative messages which the students felt may be more effective were ‘Smoking is dangerous for pregnancy’ (score = 3.3), ‘Cigarette smoke is dangerous for your child’ (score=3.11) and ‘Smoking can kill you’ (score=3.08). The current health message “ Smoking is dangerous for your health’ is eighth with a score of only 2.64. The students felt that the least effective message was ‘Cigarettes are drugs’ (score=2.22). Most of the students (80.0%) felt that the health warning message should be placed at the front instead of on the side of the cigarette pack to be more effective.
MeSH terms: Attitude; Dangerous Behavior; Habits; Male; Motivation; Smoking; Students
Hepatoblastoma is the most common primary liver tumour of childhood. This is a case report of a one-year-old boy who presented with a one-month history of progressive abdominal distension and weight loss. He was cachexic, anaemic, had gross hepatomegaly and ascites. He had been born prematurely with a birth weight of 1.23 kg, and his developmental milestones were delayed. Ultrasound and CT scan demonstrated a large solid tumour in the left lobe of the liver with a smaller superficial nodule in the right lobe. Serum alpha fetoprotein was significantly raised. A left lobe hepatectomy and complete excision of the right sided nodule was performed. There was no evidence of metastatic disease. Histopathological examination confirmed hepatoblastoma of the fetal type. The patient developed features of intestinal obstruction a few days after surgery and he succumbed ten days after re-aparotomy. The clinical presentation and investigation results in this case are characteristic. Recent reports have suggested a strong relationship between very low birth weight (< 1500gm)/prematurity and hepatoblastoma as is present in this case. Surgery is the mainstay of therapy in hepatoblastoma. A brief review of the literature on this tumour is presented.
Osteoporosis is recognised as a public health problem the world over. There is increasing awareness about this problem in Malaysia and this is particularly important, as our population gets older. This brief review aims to highlight the important aspects of history taking as well as the investigative approach to the diagnosis of osteoporosis. The modalities of bone mineral density measurements particularly with regards to the diagnosis and the monitoring of the disease are also discussed.
MeSH terms: Awareness; Malaysia; Medical History Taking; Osteoporosis; Public Health; Absorptiometry, Photon; Bone Density
The forearm fracture is a fracture of the upper limb between the elbow and the wrist. It is a common injury in children, accounting for more than half of all children’s fractures, and mostly occur when a child falls on the outstretched arm. A difficult clinical problem that often arises is how much angulation can be accepted in the child and how much remodeling will occur. One hundred consecutive cases of forearm fractures that were admitted at Childrens Orthopaedic Ward, Institute of Paediatrics at Hospital Kuala Lumpur between 1st January 1997 to 31st December 1998 were studied. We found that all fractures united 3 to 6 weeks, with a remodeling rate of about 2.5 degrees/month; the proximal fractures having the most potential to remodel. We conclude that the early remodeling potential of forearm fractures in children is 1.5 degrees/month in midshaft fractures and 2.5 degrees/month in distal and proximal fractures. We recommend accepting a 10 - 20 degree angulation in midshaft fractures, and a 20 - 30 degree angulation in metaphyseal fractures; based on our study of early remodeling potential.
Ewing’s sarcoma is a rare malignant tumor of the foot in children. We report a case of Ewing’s sarcoma of the talus in a four-year-old Chinese girl to highlight the initial difficulty in diagnosis and the clinical course of the disease. She was initially diagnosed as osteomyelitis of the talus and died eight months after presentation with pleural and spinal metastases. To the best of our knowledge, Ewing’s sarcoma of the talus in a young child has never been reported in Malaysia.
We studied the curve progression of untreated curves presenting to the Scoliosis Service of Hospital Kuala Lumpur. One hundred and fifty-two (152) patients were included in this study. The median rate of curve progression of idiopathic scoliosis curves was 7.03 degrees per year, for neuromuscular scoliosis curves as 17.39 degrees per year; and congenital scoliosis curves were 3.67 degrees per year. These rates are similar to the reported rates in the literature. Data for sixty-one (61) surgically treated patients were reviewed to determine the early curve correction of the curves of different aetiology. The mean age of surgery was 14.15 years old, the mean preoperative curve size was 71.61 degrees; and the mean postoperative curve size was 43.78 degrees. The mean duration of follow up after surgery was 2.44 years. The revision and removal of instrumentation rate was 8.3%.
Over a seven-year period, 170 cases of humerus fractures were plated in Hospital Melaka. Of these, 131 cases were successfully traced for this study. Besides looking at fracture epidemiology, its relationship with radial nerve injury was examined. The incidence of post-traumatic wrist drop in closed and compound fractures were 14.9% and 35.3% respectively. In relation to the site of fracture, lower third fracture had the highest incidence of wrist drop (29%). The recovery from post-traumatic wrist drop was 83%. The average duration taken for recovery was 11.8 weeks. The incidence of post-operative wrist drop was high at 17.6% but all recovered during follow-up.
Inborn errors of metabolism (IEM) are a group of disorders that causes abnormal function of biochemical pathways. Archibald Garrod des-cribed the first inborn error of metabolism in 1893. He described alkaptonuria in a patient whose urine turned black on standing and the development of arthritis in adult life.' Subse-quently, Garrod encapsulated the idea of IEM in 1908 with the concept of 'chemical indivi-duality'. Beadle and Tatum proposed the concept of one gene - one enzyme in 1945.2 Phenyl-ketonuria (PKU) was described in 1934 and amongst the first to be recognised as a cause of mental handicap with a biochemical basis.' Effective treatment for PKU with low pheny-lalanine diet was introduced in 1955. Molecular characterisation of genetic defects localised to alleles in various chromosomes were performed in the last two decades
The problem-based learning (PBL) curriculum, which originated primarily from the Faculty of Health Sciences at McMaster University in 1969, has had a major impact on the thinking and practice in medical education. It is one of the most important developments in the health profession's education in the latter part of the twentieth century) The PBL process incorpo-rates fundamental educational principles such as those derived from adult learning theory' and this gives the PBL approach a greater effective-ness for the acquisition of basic knowledge and clinical skills.
Significant advances in perinatology and neonatology in the last decade have resulted in increased survival of extremely premature infants.' Survival rates at 25 and 26 weeks of gestation age ranging from 60% to 82% and from 75% to 93%, respectively, have been reported.' In Malaysia, the survival rates among premature very low birth weight infants (< 1500 g) were reported to be between 69% and 78%.2,3 Such improvements of survival have been attributed to the advances in the management of respiratory disease and intra-ventricular haemorrahge in the premature infants.',2 Thus, attention have recently been focused on the need to secure adequate nutrient intake of these premature infants. Parenteral nutrition has often been used to manage the transition between transplacental nutrition in-utero and post-natal enteral nutrition, but is associated with cholestasis and sepsis.4 However, the ability to deliver nutrition is limited not only by immature absorptive or digestive function but by inadequate motor activity. Gastroesophageal efflux (GER) and feeding intolerance are the major gastro-enterological problems of the premature neonates.
Vaccines, used appropriately and efficiently, have changed the landscape of infectious diseases. Poliomyelitis is almost completely eliminated globally. In many industrialised countries, there has been over 99 percent reduction in incidence of diphtheria, tetanus, measles, mumps, rubella, Haemophilus in-fluenzae b meningitis and over 97 percent reduction in whooping cough.',2Unlike anti-biotics, most vaccines have remained equally effective despite years of continuous usage.
Respiratory syncytial virus (RSV) is isolated in 15-25% of young Malaysian children with bronchiolitis.',2 Although this observation is consistent with experience reported in other developing nations in the tropics,3•4 it is lower than that of temperate developed nations where RSV is isolated in 60 - 80% of young children with viral bronchiolitis.5,6 The majority of infections are mild, easily cared for at home and only 1% of children with RSV bronchiolitis require in-hospital care.' However, several categories of children have been identified to develop severe RSV bronchiolitis that is asso-ciated with an increased risk of mortality and significant morbidity. This 'high-risk' group includes children who are very young, ex-premature (gestation less than 36 weeks), children with chronic lung disease, congenital heart disease and immunodeficiency, namely, haematological transplant recipients.8'9 It is for this category of children in whom effective therapeutic strategies for the treatment of RSV bronchiolitis are most important.
Dengue and dengue hemorrhagic jiever are still a serious public health problem among people in developing countries. The study was conducted to assess the knowledge, attitude and practice among students in University Technology of MARA in Shah Alam Selangor, Malaysia, and to determine its association withprevious infection. A total of 218 students were selected randomly fom several residential colleges within the university main campus. They were interviewed for their perception of risk to dengue and their blood were taken for serological examination (Dengue IgG). It was found that 49.1% of students have had previous infection, however onlv 0.9% had history of symptomatic dengue infection. Males students originating fom urban areas were more at risk of being infected. The perception of risk to dengue was good among students but this factor is
unable to explain the magnitude of infection among them. Further study should look at the interaction between behaviour and environment among students who are sero negative.
MeSH terms: Dengue; Developing Countries; Fibrinogen; Immunoglobulin G; Malaysia; Male; Perception; Public Health; Students; Universities; Severe Dengue
Diabetes mellitus and its main complication, nephropathy, ajjbcts the economic wellbeing and quality of Iife of the sufferers and the population. A matched case control study was conducted in September 1998 to investigate the factors involved with nephropathy such as diabetic control, smoking, hypertension, familv history of diabetes and diabetic duration. Respondents were classyied based on the presence of microalbuminuria or macroalbuminuria, Seventy-two pairs of case and control were studied Duration of diabetes Q2 = 0.005), presence of lethargy and weakness prior to diabetes diagnosis @7 = 0.019), duration of smoking @7 = 0.014), duration of hypertension @2: 0.000), systolic hypertension Qu= 0e 025), uncontrolled diabetes with poor HbA1c level (v= 0.02Q and lack of diabetes knowledge Q2 = 0.037) were jbctors which related signyicantlv to nephropathy by univariate anahrsis. In multivariate anahrsis, systolic hypertension (p = 0.0015), lack of diabetes knowledge (17 = 0.0197), presence of lethargy symptom Q7 = 0.0027), prolonged diabetic duration @ = 0.0301) and higher body mass indices (p = 0. 0213) were predictors to diabetic nephropathy.
MeSH terms: Albuminuria; Ambulatory Care Facilities; Diabetic Nephropathies; Humans; Hypertension; Health Knowledge, Attitudes, Practice; Malaysia; Surveys and Questionnaires; Smoking; Body Mass Index; Case-Control Studies; Lethargy
A study was undertaken amongst private primary care providers in three urban centres of Malaysia to understand the organizational structure of the facilities and to assess the cost of running such services. A total of 150 clinics were involved in the study. Data was collected through interviews with owners of the clinics using semi-structured questionnaires. Solo-practitioners owned 64.7% of the clinics while 35.3% of them were owned by group practice. This study showed that the mean number of patients visited the clinics daily was 49.3 with the average operating hours of 79.4 hours/week (range 28.0 - 168.0 hours/week). Group practice clinics operates 23.9 hours longer than solo-practice clinics. Group practice clinics were more likely to offer 24 hours service than solo-practice clinics. Most of the clinics were manned by a single doctor (57.3%), 30.0 % had two doctors and only 12.7% were run by more than two doctors. On average, group practice employed greater number of supporting staff than solo-practice clinics (6.0 vs 4.3 people). The mean annual cost to run each facility was found to be RM 444,698. The mean cost per patient was found to be RM 32.09 for solo-practice clinics and RM 38.55 for group practice. Wages represented the highest proportion in the recurrent cost (61.1%) followed by drugs (29.2%) and consumables (2.7%). Building cost (67.9%) and equipment cost (25.9%) were the major capital costs for the clinics. This study could serve as a basis to reimburse private primary care providers in the future health financing scheme in Malaysia. To improve efficiency and contain cost in primary care settings, efforts should be targeted towards cost of wages and drugs utilised by the providers in their daily practice.
Key words: Private practice; primary care; costs; Malaysia.
MeSH terms: Ambulatory Care Facilities; Costs and Cost Analysis*; Cross-Sectional Studies; Group Practice; Humans; Malaysia; Physicians; Primary Health Care; Private Practice; Surveys and Questionnaires; Running; Salaries and Fringe Benefits