A seroepidemiological study was carried out on Orang Asli (Aborigines) children who lead a semi-nomadic life in the deep jungles of Ulu Kelantan, Malaysia. Out of a total of about 190 children below 14 years, 143 were studied. Blood was collected from finger pricks on standard "strip type" filter papers for indirect fluorescent antibody (IFA) tests with Plasmodium falciparum antigen. A positive reaction at 1:10 dilution in infants and young children was considered positive and the reasons are given. The P. falciparum antibody prevalence rate was 84.6% compared to 81.8% spleen and 43.4% parasite rates. Both P. Falciparum and P. vivax were present in children. The age-specific patterns of antibody, spleen and parasite rates were those of a hyperendemic community. There was a positive correlation between antibody and spleen rates up to the age of 9 years. In older children, the antibody rates increased while the spleen and the parasite rates dropped.
This study evaluates the safety and results of surgery usingTaraKlamp Circumcision Device during a group circumcision. Atotal of 64 circumcisions of Muslim boys were performed by Medical Assistants supervised by Medical Doctors in a hall in Kuala Lumpur, Malaysia. A new type disposable clamp was used, which was removed 4 days after the operation. No major complications occurred and the boys experienced in general mild pain postoperatively. Mostly good cosmetic results were obtained and 90% of the parents would recommend this new clamp to others. Group circumcisions withTaraKlamp Circumcision Device (Kuala Lumpur, Malaysia) are safe, although proper patient selection and adequate training in using the device are mandatory.
An uncommon and late complication of side-to-side choledochoduodenostomy (CDD), the 'sump syndrome', developed in a patient 4 years after surgery. Recurrent right upper abdominal pain, fever with chills and rigors and latterly, mild jaundice made her seek repeated hospital admissions which were treated successfully with antibiotics. During the last admission, ultrasonography, endoscopic retrograde cholangiography (ERC), computerized scanning (CT) and hepatic iminodiacetic acid (HIDA) scan using Tc99m confirmed multiple intrahepatic calculi with proximal dilatation, debris in the distal blind segment and delayed excretion through the CDD. At surgery, the choledochoduodenostomy was taken down and a Rouxen-Y hepaticojejunostomy (RHJ) was fashioned after ductal clearance. The closed end of the Roux loop was placed subcutaneously for subsequent percutaneous access for cholangiography and removal of calculi. She is asymptomatic and well 28 months after surgery.
Dengue infection can cause various effects on the central and peripheral nervous systems. Direct neurotropism and immunological mechanisms are responsible for most such neurological manifestations. We present the case of a 64-year-old woman with rapidly progressive dementia with seizures following dengue infection.
Rapid participatory research and project development is possible within a tightly controlled social context such as a prison. Having gained access, based on trust and mutual respect, external agents may then facilitate significant change. Given adequate support, incarcerated people with HIV/AIDS and limited medical access may be able to develop mutual care, social support and income-generating activities. In the Malaysian context, we estimated in 1998 that up to one-quarter of prisoners with HIV had indicators of significant disease. We estimated that significant indicators remained unrevealed among between one-half and two-thirds of these. Given prevailing conditions, these would probably only be amenable to peer-based care.
Nationally-representative evidence is limited on factors affecting uptake of cataract surgery in Malaysia. We found the prevalence of cataract among older persons to be 26.8%. The two most common barriers were 'need not felt' (43.5%) and 'fear of surgery or poor result' (16.2%). Reluctance for surgical intervention was greater outside the Central zone.
Severe pulmonary involvement in malaria has been frequently reported in cases of Plasmodium falciparum infection but rarely in vivax malaria. We look at a case of a 38-year-old man living in a malaria endemic area who presented with acute respiratory distress syndrome (ARDS) caused by P. vivax. DNA polymerase chain reaction (PCR) confirmed that it was not a mixed infection. After specific antimalarial therapy and intensive supportive care, the patient was discharged from the hospital. This case illustrates that P. vivax-induced ARDS is not uncommon and should be readily recognized by the treating physicians. A confirmatory test with PCR is required in order to exclude P. falciparum co-infection.
The prevalence of HIV/AIDS among drug addicts in Malaysia is high, especially among intravenous drug users. The present treatment and rehabilitation of drug addiction is considered as a failure. The government finally decided to start on Drug Substitution Therapy in early 2005 as an effort to prevent the spread of HIV/AIDS in the country.