Life (QOL) of patients with childhood leukaemias presenting at the Hospital Universiti Kebangsaan Malaysia (HUKM). The objectives of this pilot study were 1) To assess the feasibility and applicability of assessing quality of life in leukaemia patients using the adult-based SF-36 questionnaire. 2) To compare the differences of QOL scores among patients based on gender and treatment status. The Short-Form-36 Health Survey (SF36) was used. The items in SF-36 were drawn from the original 245-item MOS questionnaire, which includes multi-item scales that measured the eight dimensions of quality of life namely physical function, role limitations (physical problems), bodily pain, general health, vitality, social functioning, role limitations (emotional problems) and mental health. Patients with acute leukaemias were chosen to participate in the study. Twenty-eight patients were recruited, twelve were males and 16 were females. Ten patients had completed therapy whilst 18 others were still undergoing treatment. The results showed that those patients off treatment have a better quality of life than those on chemotherapy. However, this was only significant with respect to the role limitation pertaining to physical problems. Although the use of the SF-36 was feasible, there were limitations especially in the younger age group.
MeSH terms: Adult; Female; Health Surveys; Humans; Leukemia; Malaysia; Male; Mental Health; Pain; Physical Examination; Pilot Projects; Quality of Life; Surveys and Questionnaires
The medical education should be tailored to deal with the diseases the physician is most likely to see.' With expectations that all the graduates from Malaysian Medical Schools should be able to serve anywhere in the country, the need for a national curriculum is self-evident. It may be argued that the public must have confidence in the competence of the practitioners they depend upon irrespective of the school from which they had graduated. In smaller countries in which health needs are uniform the graduates of any school should have been trained to meet those needs. In larger countries and those with geographic diversities and distances (e.g. Malaysia), the curriculum should cover the commonly encountered diverse ailments. If not dealt with care, we may end up with huge load of ever expanding, unmanageable curriculum.
A retrospective study was conducted to evaluate the magnitude, clinical course and risk factors of cholestasis in surviving very low birth weight (VLBW) infants who received parenteral nutrition at the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia. Cholestasis was defined as direct hyperbilirubinaemia of >34 mmol/L. Between 1St July 2000 to 31St March 2001, 58 VLBW infants received parenteral nutrition (PN). Forty seven infants survived to discharge. Complete data was obtained from 43 (90.1%) infants. Thirteen (30.2%) of these infants developed cholestasis. The cholestasis persisted beyond the age of 6 weeks in 8 infants and they underwent hepato imino diacetic acid (HIDA) scan. The HIDA scan was reported as normal in 2 infants and inconclusive in 6 infants. Operative cholangiography. (OTC) was then performed in these infants and were all normal. The cholestasis finally resolved in all infants. Analysis of risk factors revealed that duration of assisted ventilation and PN and the presence of patent ductus arteriosus (PDA) had significant correlation with the development of cholestasis. These factors together with lower mean gestational age increased the likelihood of persistent cholestasis beyond 6 weeks of life in these infants. In conclusion cholestasis is common in VLBW infants who received parenteral nutrition. Although the clinical course seems benign, in a significant proportion of these infants it may persist longer and put them at increased risk of requiring invasive investigations.
Dengue haemorrhagic fever (DHF) is a severe viral illness with significant morbidity and mortality especially among children in Southeast Asia. The tourniquet test is recommended by the World Health Organisation (WHO) as an initial clinical screening procedure for patients suspected to have DHF, particularly in patients with DHF grade I. The aim of this study was to evaluate the validity of the tourniquet test as a predictor of DHF and also to assess the usefulness of repeated, serial tourniquet testing as a diagnostic indicator of DHF. Individuals included into this study were children from the Institute of Paediatrics, Kuala Lumpur who were admitted on a clinical suspicion of DHF based on the WHO criteria and who had serology for Dengue IgM performed. A standard method of tourniquet was performed on these patients on a daily basis following admission. A total number of 60 patients were considered for analysis and of these the tourniquet test was positive in 50 patients and negative in the remaining 10 patients. Sensitivity of the test was found to be 85.4% and the specificity was 25%. Further assessment of the predictive value of the test showed that the positive predictive value (PPV) was 82% while the negative predictive value (NPV) was 30%. In conclusion, a positive tourniquet test, serially performed on a daily basis was found clinically to be a useful preliminary screening tool for DHF as recommended by WHO. However its specificity was low and consequently led to a high false positive rate.
MeSH terms: Asia, Southeastern; Capillary Fragility; Child; Dengue; Humans; Immunoglobulin M; Pediatrics; Sensitivity and Specificity; Tourniquets; World Health Organization; Severe Dengue
Heralded by the revelation of the double helical structure of the DNA molecule in 1953, the 21st century is aptly designated the biotechnology century. The 20th century of physics, which saw the transformation of silicon into computing magic, was embraced with enthusiasm by virtually every household. However, unlike her predecessor, the same cannot be said about the advancements in biomedicine.
Even though vaccines are effective for prevention of diseases, compliance with recommended schedules of immunisation in early childhood is not always complete. Identification of potential risk factors associated with under-immunisation may help increase vaccination uptake. The objectives of this study were to determine the prevalence and risk factors of under-immunisation in hospitalised preschool children in Universiti Sains Malaysia Hospital (HUSM). Children aged 1 month to 2 years admitted between December 1998 and December 2000 in medical paediatric wards at HUSM were studied. Parents/guardians were interviewed during admission regarding immunisation status and potential risk factors. Children who did not have home-based cards during admission were excluded. Among 401 children, 37.9% had complete immunisation, 43.4% had delayed immunisation and 34.9% had incomplete immunisation. The uptake of BCG, DPT/OPV 1, DPT/OPV2, Hepatitis B3, DPT/OPV3, and measles were 98.5%, 90.7%, 83.2%, 81.4%,79.2% and 72.9% respectively. Vaccines scheduled to be given at later ages were significantly less likely to be taken (p=0.002) compared with vaccines scheduled to be given at an earlier age. Significant independent risk factors for under-immunisation were elderly mothers (3 40 years old) (OR 3.0, 95% CI: 1.2-8.0), low birth weight £2.0 kg (OR 6.2; 95% CI: 1.8-21.4) and presence of chronic illness in the child (OR 4.5; 95% CI: 2.5-7.9). In children whose father's education was low (primary school or no education), low maternal education was significantly associated with lower rate of under-immunisation (p = 0.005, OR 0.11 95%CI 0.02-0.51).
In conclusion this study showed that a large proportion of hospitalised preschool children were under-immunised, and vaccines scheduled to be given at a later age had lower uptakes. The situation can be rectified if every opportunity is taken to immunise all children, who have lapsed in their immunisation schedule.
An eight-year-old Chinese girl presented with a slowly progressive generalized muscle weakness and wasting, complicated by respiratory failure. She had many hospital admissions requiring ventilator support. Eventually tracheostomy tube was inserted. Initial investigations failed to elicit a diagnosis but a muscle biopsy and histological study confirmed the diagnosis of juvenile acid maltase deficiency.
Introduction: Parents play an important role in the management of their asthmatic children. Thus the ability of parents to recognise asthma trigger factors are very important.
Objectives: The objectives of this study were to identify the trigger factors that were recognised by parents to cause acute exacerbation in their children and analyse the association of these factors with severity of asthma and parental asthma knowledge.
Methods: Sixty-seven parents were interviewed to identify factors that can exacerbate acute asthmatic attack in their asthmatic children. The factors were then categorised as: infection, exercise, allergen, irritant, emotion and weather. The profiles of children were asthma severity status, duration of asthma, age, frequency of admission and steroid dosage. Parents' profiles were their age, number of asthmatic children and the level of asthma knowledge.
Result: Fifty-six (83.5%) parents identified more than one trigger factor for their children's exacerbation. The commonest frequency was two trigger factors (31.3%). Upper respiratory tract infection (77.6%) was the commonest trigger factor. There was no association between the number of trigger factors with the severity of asthma and level of parental asthma knowledge. The number of trigger factors significantly correlated with asthma duration (r = 0.33, p = 0.006). The asthma severity was associated significantly with weather (p = 0.042) but not with other trigger factors.
Conclusion: The majority of parents recognised more than one trigger factors to cause asthma exacerbation.
MeSH terms: Asthma; Child; Emotions; Humans; Irritants; Parents; Play and Playthings; Respiratory Tract Infections; Weather; Disease Management
OBJECTIVE: To assess a better strategy to implement oral iron supplementation in preschool Orang Asli children with high prevalence of iron deficiency, as opposed to the current practice, yet inefficient, of daily oral iron supplementation regime.
METHODS: A randomized controlled trial was conducted in preschool children presenting to a remote health center (Klinik Desa Kenang, Sungai Siput, Perak) with iron deficiency state. Oral iron prescribed as a daily unsupervised dose (group A) was compared to a weekly supervised administration (group B) over eight weeks.
RESULTS: Before intervention, iron deficiency was prevalent in these children (91.2%). The mean baseline haemoglobin and ferritin levels of group A were 9.9 (+/- 1.1) g/dL and 8.9 (+/- 1.3) mg/L respectively, and that of group B were 9.9 (+/-1.2) g/dL and 9.7 (+/- 1.9) mg/L respectively. After eight weeks of treatment, the mean rise in haemoglobin and ferritin levels of group A were 1.2 (+/- 0.6) g/dL and 18.1 (+/- 15.1) mg/ L respectively, as compared to group B, where the mean rise in haemoglobin and ferritin levels were 1.8 (+/- 0.7) g/dL and 35.2 (+/- 21.8) mg/ L respectively. The differences in the rise of haemoglobin and ferritin levels of the two groups were statistically significant (p<0.025). Both regimes were however effective in improving the iron status in a short term (88% in group A and 100% in group B), but group B had a better iron improvement (35.2 +/- 21.8 versus 18.1 +/-15.1 mg/L).
CONCLUSION: It was concluded that the supervised weekly oral iron supplementation regime was more effective than the unsupervised daily supplementation for treating iron deficiency in preschool Orang Asli children. Since iron deficiency is so common in these children and in view of the possibility of poor compliance with the unsupervised regime, an intermittent supervised treatment is proposed as the most effective strategy to address this nutritional problem.
The main objective of this study was to compare protein profiles of whole
mosquitoes of Malaysian Aedes aegypti and Aedes albopictus after infection with virus and to investigate whether dengue virus would induce protein secretion in Ae. aegypti and Ae. albopictus. Using SDS -PAGE, it was shown that in uninfected Ae. aegypti and Ae. albopictus, the protein bands were within the range of 14 - 80 kDa with most of the bands overlapping for the two species. Comparison of the protein profile of infected and uninfected Ae. aegypti and Ae. albopictus showed five distinct molecular weight grouping at 73 - 76 kDa (Group 1), 44 - 50 kDa (Group 2), 28 - 31 kDa (Group 3), 20 – 25 kDa (Group 4) and 14 - 17 kDa (Group 5). Predominant bands for both species (infected and uninfected) were between 21 - 25 kDa and 44 - 50 kDa. Protein bands having a molecular weight of 70 kDa were only present in infected Ae. albopictus and those bands having molecular weight of 21 kDa were observed only in infected Ae. aegypti. The rate of digestion of blood meals was more rapid in Ae. albopictus than Ae. aegypti. Uninfected Ae. albopictus completed the blood digestion 2 days after ingestion of a blood meal whereas Ae. aegypti needed 3 days to complete the digestion. The rate of digestion for blood meals was slower for both mosquito species when fed with dengue virus infected blood. The digestion processes were completed 3 and 4 days after blood ingestion for Ae. albopictus and Ae. aegypti, respectively. This could be due to the presence of dengue virus in the blood, which slow down the digestion process. Appearance and disappearance of new protein bands was also observed even after the digestion has completed
for both infected mosquito species. In conclusion, dengue virus was shown to induce specific proteins in both Ae. aegypti and Ae. albopictus. INTRODUCTION
Dengue is a notorious mosquito-borne disease in the world and is transmitted in
cities as well as in densely populated areas. This viral disease was said to occur
more frequently compared to malaria (Scott, 1993). In Malaysia, dengue was
first documented in 1902 (Skae, 1902). In 1990, the number of cases increased
dramatically (Lam, 1993). Therefore, to date dengue is the most important human
mosquito-borne viral pathogen. The appearance of dengue is caused by the presence of dengue virus in the blood, which slow down the digestion process. Appearance and
disappearance of new protein bands was also observed even after the digestion has completed for both infected mosquito species. In conclusion, dengue virus was shown to induce specific proteins in both Ae. aegypti and Ae. albopictus.
MeSH terms: Aedes; Animals; Cities; Dengue; Dengue Virus; Humans; Malaria; Malaysia; Molecular Weight; Population Density
Plaque assay procedure was carried out to determine the infectivity titration of
dengue virus using Aedes albopictus C6/36 mosquito cell line. Cells were seeded in 6 wells
plates and incubated until monolayer C6/36 cell lines were formed. Each well was exposed
to a different dilution of dengue infected culture fluid, followed by addition of first and second
overlay medium. Cells were observed under an inverted microscope and plaque staining was carried out. The results showed that countable plaques were not achieved and plaques formed were restricted to the central section due to the significant partial lysis of the C6/36 cells in the plates. However, the plaque assay technique using C6/36 cell line reported here appears to be promising and merits further detailed studies.
We report a 7 year old girl who developed ipsilateral left facial swelling immediately
after lignocaine injection. Skin prick test showed positive reaction to pure 2% lignocaine
hydrochloride and to lignocaine oral dental gel. Specific Immunoglobulin E (Ig E) to
lignocaine was detected. Lignocaine is a commonly used anaesthetic agent mainly as local
anaesthesia. However type I hypersensitivity to lignocaine is rare and there have been very
few cases reported in the literature.
Phosphoglucomutase was studied by polyacrylamide gel electrophoresis in the Thailand and Hawaii isolates of Parastrongylus cantonensis (also known as Angiostrongylus cantonensis). Two loci were present. The faster-moving locus (PGM-1) was polymorphic in the Hawaii isolate, represented by two alleles – the faster-moving, less common Pgm-1A and
the slower-moving, more common Pgm-1B. It was monomorphic for the faster-moving allele
Pgm-1A in the Thailand isolate. The slower-moving locus (PGM-2) was invariant, with a single band of enzyme activity, in the female worms of both the Thailand and Hawaii isolates. There was no detectable enzyme activity at this PGM-2 locus in the male worms of both isolates. The non-expression or ‘null’ PGM-2 phenotype in the male worms was presumed to be sexlimited. The present findings differ significantly in several aspects (polymorphic locus,proportion of polymorphic loci, heterozygosity, deviations from Hardy-Weinberg expectations, sex-limited expression) from the Japan isolate of P. cantonensis reported in the literature.
The present study aims to explore the possible mechanisms underlying the multidrug resistance characteristic of Cryptosporidium parvum by detecting the presence of ATP-binding cassette (ABC) protein encoding genes, especially one that shows high similarity to members belonging to the multidrug resistance protein (MDR) and multidrug
resistance associated protein (MRP) subfamilies. PCR using ABC-specific degenerate primers successfully amplified two unique fragments, designated Cpnbd1 and Cpnbd2, from C. parvum genomic DNA. Cpnbd1 exhibited high degree of homology (99-100%) with the nucleotidebinding domains (NBDs) at the NH2-terminal halves of two previously reported ABC proteins (CpABC and CpABC1) of human and bovine origin C. parvum isolates. It is likely that CpABC, CpABC1 and Cpnbd1 were encoded by homologous genes of a type of ABC transporter protein found in different C. parvum isolates. However, Cpnbd2 showed moderate levels of similarities (28-49%) to the NBDs of four ABC proteins characterised in C. parvum to date. Therefore, Cpnbd2 could be a novel member of an ABC superfamily of proteins in C. parvum. Phylogenetic analyses on a list of ABC transporters known to associate with MDR phenotype has significantly linked Cpnbd1 and Cpnbd2 to these transporters, thus suggesting that Cpnbd1 and Cpnbd2 proteins may contribute to the intrinsic multidrug resistance phenotype of C. parvum.
To determine resistance level and characterize malathion and permethrin resistance
in Culex quinquefasciatus, two methods were used namely: WHO procedures of larval
bioassay to determine the susceptibility of lethal concentration (LC) and adult bioassay to
determine the lethal time (LT) which are resistant to malathion and permethrin. These
mosquito strains were bred in the Insectarium, Division of Medical Entomology, IMR.
Thousands of late fourth instar larvae which survived the selection pressure to yield 50%
mortality of malathion and permethrin were reared and colonies were established from adults that emerged. Larvae from these colonies were then subjected to the subsequent 10 generations in the test undertaken for malathion resistant strain (F61 – F70) and permethrin resistant strain (F54 – F63). Selection pressure at 50% - 70% mortality level was applied to the larvae of each successive generation. The rate of resistance development and resistance ratio (RR) were calculated by LC50 for larval bioassay and LT50 value for adult bioassay. The lab bred Cx. quinquefasciatus was used as a susceptible strain for comparison purpose. The adult bioassay test was carried out by using diagnostic dosages of malathion 5.0%, permethrin 0.75% and with propoxur 0.1%. All bioassay results were subjected to probit analysis. The results showed that LC50 for both malathion (F61 – F70) and permethrin (F54 – F63) resistant Cx. quinquefasciatus increased steadily to the subsequent 10 generations indicating a marked development of resistance. The adult female malathion resistant strain have developed high resistance level to malathion diagnostic dosage with resistance ratio 9.3 to 9.6 folds of resistance. Permethrin resistance ratio remained as 1.0 folds of resistance at every generation.
It was obvious that malathion resistance developing at a higher rate in adult females compared to permethrin. Female adults exposed to 2 hours of exposure period for propoxur 0.1% showed presence of cross-resistance among the both strains of mosquitoes towards propoxur and it was indicated by 70%–100% mortality at 24 hours post-recovery period.
Detail chemical investigations on the stem bark of Mesua daphnifolia gave three triterpenoids and four xanthones. They are friedelin (1), friedelan-1,3-dione (2), lup-20(29)-
en-3β-ol (3), cudraxanthone G (4), ananixanthone (5), 1,3,5-trihydroxy-4-methoxyxanthone
(6) and euxanthone (7). These chemical constituents were tested in vitro for their cytotoxic
activities against four cell lines, MDA-MB-231 (human estrogen receptor negative breast
cancer), HeLa (cervical carcinoma), CEM-SS (T-lymphoblastic leukemia) and CaOV3 (human
ovarian cancer). Compound 4 showed a broad spectrum of activity against the MDA-MB-231,
HeLa and CEM-SS cell lines with IC50 values of 1.3, 4.0 and 6.7 μg/ml respectively. Meanwhile, the other compounds 1, 2, 3, 5, 6 and 7 gave only selective activities against the cell lines.
Myiasis is a pathogenic condition found in
live humans and animals caused by various
species of dipteran larvae (Zumpt, 1965).
The first human case of myiasis in
Malaysia was reported by Reid (1953) from
a great toe of a patient in Malacca. Later
Cheong et al. (1973) reported a cause of
intestinal myiasis. Since then myiasis cases
in Malaysia have been reported
sporadically. Generally, myiasis can be
classified according to the site of
infestation, as nasopharyngeal or nasal,
urogenital, cutaneous, intestinal (enteric),
aural (ear) myiasis (Oothuman & Jeffery
1984; Lee & Cheong, 1985; Lee & Young,
1991; Lee, & Yong, 1991; Lee et al., 1995;
Lee, 1996). Recently Roszalina & Rosalan
(2002) reported on two cases of oral
myiasis in cerebral palsy patients.
However, reports on human myiasis in
Malaysia is generally considered relatively
few, probably due to a lack of awareness
of the importance of flies in inducing
myiasis. We report here a case of
nasopharyngeal myiasis from a patient in
Malaysia for the first time.
Unidentified mermithid nematodes were found in the abdominal cavity of three species of Anopheles mosquitoes from LAO PDR. This is a first record of mermithid nematodes in adult mosquitoes from Lao PDR. Two worms were found in each adult host and the infection was more prevalent in the northern region compared to the south.
The rapid detection of dengue infection in mosquito vectors is important for early
warning to forestall an outbreak. Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR)
provides a rapid method for dengue detect ion in man and mosqui toes . An RT-PCR ki t
developed by the Medical Entomology Unit, Institute for Medical Research to detect dengue
infect ion in mosqui toes , was tes ted for i t s shel f l i fe at 3 s torage temperatures : room
temperature, refrigerator and freezer. Test kits were tested once every 3 days for kits stored
at room temperature, and once every week for those stored at refrigerator and freezer
temperatures. The results showed that the test kit could only be stored above its recommended
storage temperature of -20ºC for not more than 3 days. DNA 100bp markers in the kits appeared
to be stable at the tested temperatures and were usable up to the 20th day when stored at 2ºC and below.
In order to control any pest it is essential to study the life cycle, biology and
bionomics of the target pest under control. With this respect, we have studied the flight range
of the house fly Musca domestica (L.). The flight range of the house fly from two sites i.e,
the poultry farm and a stable farm has been studied. The flight range study was conducted
using a mark release technique. The approach we used in this study was that the flies collected
from the respective farms were marked and released at different distances from the farms.
The flies were then re-captured from the poultry farm and the stable farm. Studies conducted
elsewhere use the technique of releasing the insect species at one spot and recapturing the
insect species with the help of baited traps placed at various locations from the release
point. The advantage of the approach used in this study was that the flight range as well as
the homing effect was determined. From this study, the flight range of house flies released at
the poultry farm was 7 km whereas flight range for flies release from stable farm was 5 km.
The recovery rate of house flies at the poultry and stable farm was 0.05% and 0.016%, In this
study, marked specimens has been detected up to 8 days in field conditions indicating that
under field condition the life expectancy could be in the range of 1-2 weeks.
MeSH terms: Agriculture; Animals; Diptera; Ecology; Houseflies; Insects; Life Expectancy; Life Cycle Stages; Poultry