The serious health hazards posed by adverse drug reactions have long been recognised, but the application of epidemiological principles to their studies is only a recent development. A total of 3160 patients admitted into Medical Unit I, General Hospital, Singapore were kept under surveillance for adverse reactions to drugs for six months in 1972. Fifty three of them (1.7%) were admitted with adverse drug reactions as the sole reason for admission. There were 25 males and 28 females. There were two deaths and ten life-threatening reactions, and hypersensitivity was the most common type of reaction encountered. Among the chief offending drugs were Chinese herbal medicines, digoxin, corticosteroids, antibiotics, phenothiazines, and hypoglycaemic agents. All doctors especially the general practitioners must be fully aware of these hazards so that they can help prevent un- necessary morbidity and mortality and also to avoid taxing heavily on the already over-burdened hospital service in a developing country.
The Physics Interviewing Project assists graduate physics departments in evaluating foreign applicants. Supported by some 20 universities, two interviewers, both working scientists, travel abroad and interview students individually for about 1 hour each. Prospective teaching assistants are rated on physics knowledge, problem-solving ability, and English language proficiency. Ratings on all interviewees are sent to all supporting schools and other schools as requested. The Project aids able students from countries that have no physics Ph.D. programs (Indonesia, Malaysia, Thailand) to obtain assistantships and Ph.D.'s abroad, assists in the technological development of those countries, and helps U.S. schools in selecting the most promising foreign candidates. A similar program should be beneficial in other sciences.
Stool samples from healthy children mainly of the low income group aged 0 to 7 years of age from five Maternal and Child Health Centres in Kuala Lumpur were obtained for isolation of enteroviruses. The specimens were collected before and after the mass vaccination given in the face of polio type 1 epidemic which started in October, 1971. The prevelance rate of enteroviruses was 11.9% (3.0% polioviruses, 8.9% non-polio enteroviruses) before the vaccination and essentially the same after. Coxsackie A viruses predominated over the other enteroviruses in the pre- and post-vaccination phases. The highest isolation rate of enteroviruses was observed in children 0 to 2 years age. No significant differences in distribution by sex, race and month were noted. A sharp fall in the prevalence rates of total enteroviruses and polioviruses was noted shortly after the mass vaccination campaign However, the rates reverted to the pre-vaccination state during the next successive years.
Following the opening of the University Hospital of the University of Malaya in 1967, over 126,000 patients (excluding obstetric patients) have been admitted. A retrospective review, run concurrently with a prospective study, of over 200 patients thought to have suffered from systemic lupus erythematosus (SLE) revealed that, up until the 31st December 1975, 175 patients fulfilled the criteria for the diagnosis of SLE. There was a highly significant increase in the diagnosis of SLE over this period among Chinese patients compared to all other races, and no significant differencein the diagnosis of SLE among Indian and Malay patients. A review of the literature revealed that SLE appears to be a worldwide disease, reported frequently from Chinese communities but infrequently from tropical Africa. It is concluded that SLE is more common in the Chinese from Peninsular Malaysia than the other races, and that a careful study of geographical and racial factors in SLE may contribute to further understanding of its pathogenesis.
Merital is a recently introduced antidepressant agent which is structurally unrelated to the traditional antidepressant agents and which is reported to have minimal side effects. This study aimed to establish the olerance of a single compared to a spaced dose .schedule of Merital. It was found that a single morrung dose of Merital 100 mgs compared to a similar dose of the drug given in two divided doses did not appreciably increase the frequency or severity of side effects.
We evaluated 3,066 consecutive women admitted during 1 year to two major hospitals of Kuala Lumpur and the adjacent urban area of Malaysia. Indicators of acute pelvic inflammatory disease were more common among patients with induced abortions. PID was thought to be a major contributor to the higher costs associated with management of patients with induced abortions.
One hundred and eight consecutive previously untreated males with gonococcal urethritis were treated with single-dose oral ampicillin under supervision. A high failure-rate of 41.5 percent was obtained. The main cause of failure was the high incidence of penicillinase-producing Neisseria gonorrhoeae - an overall incidence of 37.2 percent was obtained.
The menstrual patterns of 281 women undergoing laparoscopic sterilization with silastic rings were studied prospectively. A significant increase in dysmenorrhea and irregular periods was seen soon after sterilization but this was transient, returning to presterilization levels by 12 months. Menorrhagia was not observed and the amount of menstrual blood loss showed a trend towards normal following sterilization. No permanent adverse effects on menstrual patterns were seen in the 1st year after sterilization. It is suggested that factors other than the sterilization procedure may be responsible for the high prevalence of menstrual dysfunction that has been reported following sterilization.
Patients attending a referral Skin Clinic were studied to identify the spectrum of drug eruptions and the offending drugs. There were 51 patients with an incidence of five per thousand and equal sex incidence. Though the pattern of eruption was broadly similar to other reports, unusual reactions were observed. In addition to the skin manifestation, fever and lymphadenopathy were present in most patients. Raised erythrocyte sedimentation rate and eosinopoenia were commonly observed. Clinical acumen and the list of drugs ingested are still the best clues to the diagnosis ofdrug eruption.
Study site: Skin clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Fifty-six living related renal transplants were performed between December 1975 and December 1980. All except eight of the recipients were male. The mean age was 29.5 years. Patient and graft survival were 86 percent and 73 percent at 1 year and 83 percent and 68 percent at 2 years respectively. Infection was the main cause of death and acute and chronic rejection were the main causes of graft failure. The donors were aged between 18 and 72 years old. There were 21 parent and 35 sibling donors. Donor nephrectomies were performed without mortality and our experience so far with the transplantation of kidneys from elderly donors has been encouraging.
Women who conceived within 4 months of cessation of oral contraceptives have five times more postdatism (term plus 14 days or more) compared to the non pal users. Also postdatism is severe if they conceive within 4 months of cessation of oral contraceptives. In pill users, routine induction. at term plus 14 days would result in unacceptably high induction rate, iatrogenic prematurity and possibly high caesarean rates. This is the conclusion of a prospective study of 186 pill users of which 37 were postdate out of 1496 pregnancies.
A prospective study of 77 consecutive patients with bullous diseases was done to study the pattern and natural history. Pemphigus was the commonest with 45 patients (59%) followed by pemphigoid with 21 patients (27%). Pemphigoid was more common in Indians than in other ethnic groups and its age of onset was a decade later than pemphigus. Unusual immunofluorescent findings in both diseases are discussed. Six of the 7 patients with dermatitis herpetiformis had linear IgA in the dermo-epidermal junction and the classical papillary IgA deposits were absent. Ultrastructural findings of pemphigoid and dermatitis herpetiformis confirmed earlier reports. Chronic bullous dermatoses of childhood was seen in 4 patients, all of whom had total remission within one year of onset disease.
A prospective study was performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur. Over a period of 14 months from 1 January 1982, 12 new cases of analgesic nephropathy (AN) were documented. Contrary to the experience in the West and in Australia, AN in Malaysia tends to have a male preponderance and occurs even in the younger age groups. The common analgesics abused are paracetamol, Chap Kaki Tiga and Chap Harimau. The main reasons for analgesic abuse are headache and arthritis. In addition to radiological features of renal papillary necrosis patients have the other manifestations of the disease such as peptic ulceration, anaemia, neuro-psychiatric disorders and ischaemic heart disease.
The severity of pulmonary aspiration depends mainly on the acidity of the aspirate. Mist magnesium trisilicate (MMT) has been used for many years at the maternity unit in General Hospital, Kuala Lumpur, to neutralise the acidic gastric contents in all obstetric patients requiring caesarian section. This preliminary study shows that a single dose of 15 mls of MMT before general anaesthesia raises the intragastric pH to above the critical level of 2.5 in 80% of the patients. Recently there have been doubts over the protective role of MMT. Sodium citrate which is the other antacid available may be a better alternative.
Sixty patients with uncomplicated gonococcal urethritis were treated with a single dose oral regime comprising 3 g of cefaclor and 1 g of probenecid. Forty-eight patients (80%) returned for follow-up and the overall cure rate among them was 91.6%. Among the isolates, 25 (41.7%) showed penicillinase producing Neisseria gonorrhoeae (PPNG) strains. The cure rate for patients infected with PPNG was 85% while the cure rate for non-PPNG was 96.4%. Further work is required to establish the optimum dosage for this particular regimen.