A case of tetanus occurring after induced abortion is reported. The patient gave a history of low grade fever with chill and rigors, headache, neck pain and Trismus. She subsequently developed respiratory distress. However, incorrect information from the patient resulted in the delay to locate and eradicate the source of infection. Early referral to an intensive care unit for ventilatory assistance was the most appropriate step to save the patient. Complications which occurred during the course of the disease were sometimes difficult to overcome. These complications were probably related to the duration of stay in the intensive care unit. Their incidence could be reduced by more meticulous patient care.
Parotid abscess is uncommon in neonates. It is frequently related to prematurity, prolonged gavage feeding and dehydration. We report a case of a late preterm infant who developed the classical manifestation of unilateral acute Staphylococcus aureus suppurative parotitis progressing to formation of abscess which responded to surgical drainage and antibiotic therapy.
Dapsone syndrome is a potentially fatal hypersensitivity reaction to sulphone. We report a 12-year-old girl who developed high grade fever associated with intense jaundice, exfoliative skin rash and hepatomegaly after five weeks of starting the multidrug regimen for the treatment of Hansen's disease. Laboratory investigations revealed presence of leucocytosis with eosinophilia, deranged liver enzymes and an abnormal coagulation profile. Immediate cessation of the offending drug and administration of steroid proved successful. A high level of clinical awareness is fundamental for early diagnosis of dapsone syndrome as initiation of a prompt treatment may lead to rapid recovery.
Group B Streptococcus (GBS) is a predominant causative pathogen of neonatal meningitis that is associated with a high rate of mortality and morbidity. The establishment of antenatal screening and intrapartum chemoprophylaxis has led to a significant reduction in the incidence rate of invasive GBS disease in developed countries. However, these strategies are not routinely practiced in most developing countries. To ensure good recovery of infants affected with GBS, a prompt diagnostic strategy and appropriate therapy are essential. We highlight here the case of a preterm male infant diagnosed with early-onset of GBS meningitis diagnosed by using polymerase chain reaction (PCR) method on the cerebrospinal fluid (CSF) of the infant. Initially the pathogen was not isolated in both blood and CSF cultures as sampling was performed after the administration of antibiotics. Hence, PCR was a crucial diagnostic test in facilitating the detection of the pathogen in CSF. We believe that PCR is a potentially fast and precise diagnostic method for infection in a newborn.
This retrospective study examined the G/P type of rotavirus in RNA samples that have previously been e-typed by RNA-PAGE in 1996. The results were then compared to 2007 samples to ascertain the extent of changes that may have occurred in this 11-years time interval. The G and P genotypes were determined by hemi-nested PCR and further analysed by phylogenetic study. In 1996, the G/P combination G1P, G(UT)P and G1P(UT) prevalence rate were 81%, 9% and 7%, respectively. As expected, the G9 genotype which has already emerged worldwide was identified in 42% of the 2007 samples with the remaining 33% G1P and 25% G1P(UT) Analysis of the RNA pattern showed that majority of the isolates were long e-type in both series, nevertheless minor differences within electropherotypes were observed. Genetic diversity in some strains of the human group A rotaviruses was analysed by phylogenetic methods. These findings will help in the decision to introduce rotavirus vaccines within the next decade.
A total of 157 stool samples were examined for Group A rotaviruses in diarrheic children admitted to 8 different major hospitals in Malaysia. The overall incidence rate in this study was 19.7% (31 of 157) with a variation of 9.5% to 39.1% in different locations. Majority of the infections detected were in those under 2 years of age and there were fewer admissions in the older age group. The stool samples were initially screened for rotavirus Group A by latex agglutination method and followed by RNA electrophoresis. The size and the characteristics wheel-shaped morphology of the viral preparations when examined by electron-microscopy further confirmed the presence of rotaviruses in the positive stool samples. Analysis of the RNA pattern showed that majority of the isolates, 51.6% (16 of 31) were Type IIC ('long' with comigration of RNA segments 7 and 8), 35.5% (11 of 31) with Type IIG ('long' with comigration of segments 7, 8, 9), 9.7% (3 of 31) with Type IG ('short' with comigration of RNA segments 7, 8, 9) and 3.2% (1 of 31) of mixed or atypical pattern. It appeared that over a 12 year interval, only one new or unusual rotavirus electropherotype was found. This is the first comprehensive report on the electropherotypes of rotaviruses covering eight different geographical locations in Malaysia and the data obtained is useful for understanding the geographic distribution and types of rotaviruses transmitting in Malaysia.
Findings on knowledge, attitudes and beliefs related to HIV/AIDS among 520 Malaysian adolescents, aged 15 to 21 years, based on a survey conducted in Peninsular Malaysia showed that the average score for knowledge on HIV/AIDS was high, and majority showed a positive attitude towards the disease. However, misconceptions regarding transmission and gender bias related to sexual behaviour and contracting the disease prevailed. Although 72 percent of the sexually-experienced did not use protection at first sexual intercourse, 80 percent did not perceive themselves to be at risk of contracting HIV/AIDS. A critical review of existing HIV/AIDS prevention programmes to focus on adolescent risk-taking behaviour and sexuality issues, including male-female negotiation skills, is warranted.
This paper examines data on the sexual activities of 1,200 Malaysian adolescents aged 15-21 years based on a probability household sampled survey carried out in Kuala Lumpur in 1986. Sexual behaviours like premarital sexual intercourse, contraceptive usage and masturbation were presented. Of the 1,181 unmarried respondents, 9% (105) reported having had sexual intercourse; males were significantly more experienced compared to females. Older age groups were also found to be more sexually active than the younger ones. Among those who had experience dating (n = 521), 20% (105) have experienced sexual intercourse, 44% (228) have kissed and necked, and 35% (183) have experienced petting, while 24% (130) have had no physical intimacies. Poor use of contraception was also revealed. The most commonly used were condoms, oral contraceptives and withdrawal. With regard to masturbation, males begin this practice relatively earlier than females. Almost half of those who indulged in masturbation were worried by the act, especially the females. Implications of the findings are discussed.
A 70 million population for Malaysia by the year 2010 has been officially targetted for in the Mid-Term Review of the Fourth Malaysia Plan, 1981-1985. In response to this, a preliminary investigation was undertaken into the health aspects of population growth. For this exercise, infant mortality rate was used as the health indicator. From trends seen vis-a-vis population growth, it appears that thus far, population growth has not been associated negatively with health (as measured by IMR). In recognition of the relevance of the medical, economic and education factors to health, trends in Malaysia's population ratio, per capita GNP and rates of school enrolment were also drawn; the selection of these as proxies being based on completeness of time-serial records. Although statistical regressions established the high correlation between medical doctors.population ratio and school enrolment rate with IMR, the limitations in this analysis did not permit any reliable inferences. In view of the difficulties in projections of trends, a comparison of health and related variables was carried out for several countries with high populations as near to 70 million as were available. The characteristics associated with low mortality and high life expectancy (health indices) were identified as low population growth, high literacy and high per capita GNP; this being stated with explicit qualifications. Other determinants of health were also discussed in brief, and the need for careful planning in the distribution of human and material resources was noted.
This paper describes the findings of a survey on perinatal cases in Kuala Lumpur. Information on the deceased infants and their deliveries were documented as well as selected social, demographic and anthropometric data on the mothers. This includes quality of the home environment in terms of presence of basic amenities. It was evident that the lower classes were better represented in the sample.
This paper also highlights a major problem in retrospective studies, that of successfully tracing eligible respondents. There were also cases of non-cooperation. Another problem which emerged, and one common to many developing countries, was the incompleteness of birth weight records.
A survey of specialisation choices was conducted for two batches of medical officers applying to the local medical schools for specialisation in Malaysia. A total of 359 doctors responded, giving a response rate of 71%, with 169 male (44.4%) and 187 female (55.6%) respondents. Surgery ranked highest among the male doctors followed by orthopaedic surgery and internal medicine. Family medicine ranked highest among female doctors followed by public health and anaesthesiology. Among the other specialties, the male doctors preferred otorhinolaryngology while female doctors preferred Pathology. Both male and female doctors chose to be a clinical consultant in a general hospital as the first choice. They prefer to work in or near their hometowns.
A study of the prevalence and intensity of soil-transmitted helminthiasis among pre-school children aged 0 to 7 years from an Orang Asli village resettlement scheme in Gua Musang, Kelantan was undertaken. The overall prevalence of soil transmitted helminthic (STH) infections was 56.0%. The predominant helminth found was Ascaris lumbricoides while the commonest type of infection was a mixed infection with Ascaris lumbricoides and Trichuris trichiura. The prevalence rates of Ascaris, Trichuris and hookworm infections were 47.5%, 33.9% and 6.2% respectively. The intensity of Ascaris infections were 64.5% light, 27.3% moderate and 8.3% heavy whilst the intensity of Trichuris infections were 80.5% light, 18.3% moderate and 1.2% heavy. However, the intensity of hookworm infections were 86.7% light, 13.3% moderate and no heavy infection. The prevalence of helminthiasis (STH) shows an-age dependent relationship, with the lowest prevalence in 0-< 1 year age group and highest in the 6-< 7 year age group.
A demographic and obstetric profile of pregnant mothers attending antenatal clinics in Kelantan over period of one year was determined by a retrospective study of 10,032 registered pregnant mothers. The prevalence of risk factors related to the age of the mother, parity, weight, haemoglobin level, bad obstetric history and pregnancy related diseases were determined. Prevalence of teenage pregnancy and primigravida accounted for 4.3 and 17.2 percent respectively. Nearly 3.9 percent of the mothers weighed less than 40 kg and 44.5 percent of mothers were found to be anaemic (Hb less than 11g/d) at the first antenatal visit. Only 3.2 percent of the mothers did not have any designated risk factor. Previous bad obstetric history and pregnancy related disease accounted for 17.1 and 3.5 percent of mothers respectively.
Study site: Antenatal clinics, klinik kesihatan, Kelantan, Malaysia
A survey of career choices were conducted for three batches of final year medical students at Universiti Sains Malaysia. A total of 241 students responded, giving a response rate of 76%, with 107 males (44.4%) and 134 females (55.6%). Surgery ranked highest among the male students while obstetrics and gynaecology ranked highest among female students. Internal medicine was the second choice for both males and females. Among the other specialties, the male students shows preferred Hospital Administration and Radiology while female students preferred Community Medicine, Psychiatry and Pathology. Both male and female students chose to be a clinical consultant in a general hospital as the first choice. They prefer to work in or near their hometowns.
This study was proposed to identify specific radiological appearances in Malaysian patients with bronchial asthma. All consecutive patients, seen in the Medical Unit, Universiti Kebangsaan Malaysia between 1976 and 1979, satisfying the American Thoracic Society  criteria for bronchial asthma formed the subjects of this study. Analysis of 207 patients led to the following conclusion. There are specific radiological changes present in a proportion of bronchial asthmatics during the acute episode. These changes are more frequent in the younger age group and in those in which the age of onset are early, The duration of asthma seems to have some bearing to the radiological changes.