Four cases of puffer fish poisoning with one death in a family are described. Acute respiratory cessation probably resulted from both depression of the medullary centres and muscular paralysis by the neurotoxin. Artificial ventilation is the single most effective therapeutic measure and should be considered in all severe cases. Delay in treatment may result in death. Anticholinesterases are not known to confer any benefit. Medical staff in coastal hospitals should familiarise themselves with the management of puffer fish poisoning.
Two children with Juvenile Rheumatoid Arthritis (JRA) and severe growth suppression from corticosteroid therapy are described. Prolonged 'tailing-off' of steroids occurred during outpatients follow-up and this may be related to the high turnover of doctors involved. Suggestions for improving such follow-ups and caution against the continuous use of steroids are made.
Study site: Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
Coronary atheroma is the principal cause of ischaemic heart disease. Among the factors considered to predispose to atheroma formation is raised plasma cholesterol and although it is regarded as a minor risk factor by some, others see its contribution as one of major importance. Whichever the view, the debate on plasma cholesterol and coronary heart disease (CHD) has long moved out of the exclusive domain of the scientific journal to the public arena and is reflected in the increasing frequency with which doctors are consulted by patients on the subject. The incidence of CHD in South-East Asian countries is also rising. For the practising clinician, the problem resolves itself into deciding if the evidence incriminating plasma cholesterol as a predisposing factor is strong enough, and if it is, what prophylactic and therapeutic steps are of value in reducing the incidence of CH D. An updated and brief review of lipid metabolism and the relationship of lipids to CHD is now necessary in view of the rapid accumulation of data from recent trials and prospective studies.
This paper is based on the beta-thalassaemia programme at the Duchess of Kent Hospital, Sandakan, Sabah. It seeks to show that a hypertransfusion regimen which improves the quality of life of children with thalassaemia major can be practised in district and general hospitals if there is an organised blood recruitment programme, at least at departmental level. Such a programme reduces the demand on the hardpressed hospitals' blood banks. Frequent and regular transfusions can be given with minimal interference with the school and family life of affected children and reduces immeasurably the social, emotional and financial strain on the affected families. There is also an urgent need to define the magnitude of the problem of beta-thalassaemia through population studies so that genetic counselling can be given and adequate resources can be allocated to improve the quality of life of affected patients.