PIP: Morality in Peninsular Malaysia has reached a level that is quite similar to that prevailing in the low mortality countries. This article systematically documents changes in mortality levels and differentials in Malaysia over time and relates these to changes in development indicators and health-related policies. Remedial measures undertaken by the authorities including the expansion of hospital and health services into the estates, together with a comprehensive malaria-eradication program, improvements in sanitation laws, and increased provision of public utilities and education, resulted in beriberi being eliminated and the incidence of malaria, typhus, and smallpox being greatly reduced by the time of World War II. The gain in life expectancy over the period of 1957-1979 was greatest for the Malay, the most significant period being 1957-1967, which saw the introduction of rural health programs. The infant mortality rate and the neonatal and post-neonatal rates declined substantially for all ethnic groups in Peninsular Malaysia for the same time period. Although the lower infant mortality of the Chinese can be explained by their advantageous socioeconomic position the same reason cannot explain the lower decline in infant mortality levels of the Indians. Much still needs to be done to narrow, if not to eliminate, the existing mortality differentials of different groups in the country. Overall, the quality of life of the general population can be further enhanced by reducing the high mortality level of disadvantaged groups.
A study is made of the accuracy and repeatability of the Humphrey autorefractor (HAR) objective refraction for different refractive groups as measured against subjective refraction. The value of the autofogging mechanism in objective refraction for different refractive groupings is assessed.
Scrub typhus is a major cause of febrile illness throughout the Asia-Pacific region. It is commonly undiagnosed, partly because of the lack of a simple, reliable diagnostic test which can be used in clinical laboratories. The indirect immunoperoxidase technique, configured into a test kit, was provided to technicians who were trained in its use. They used the kit during a 2 year field trial in their respective clinical hospital laboratories throughout Malaysia. In an evaluation using 1,722 consecutive sera tested in those laboratories, the kit was found to have a median sensitivity for IgG detection of 0.85 (range 0.33-0.95), a median specificity of 0.94 (range 0.88-1.00), reproducibility of 0.86, and efficiency of 0.92 when compared to the reference laboratory. In a proficiency survey in which 10 laboratories received 3 coded test samples, all but 2 laboratories had results within 1 dilution of the reference laboratory in quantitating specific IgG, whereas 7 laboratories were within 1 dilution in quantitating IgM. The shelf life of the kit was at least 1 year at 4 degrees C.
A filter method for collection and storage of capillary blood spots for glycated haemoglobin (gHb) has been developed. Glass fibre filters (GFB) impregnated with 0.8 M boric acid were used to collect and store capillary blood. Haemoglobin from the dried blood spots was eluted into water and determined by Drabkin's method, while gHb in the eluates was determined by the microcolorimetric method. The intraassay coefficients of variation (CVs) were 4.5, 4.5 and 3.1% at 882, 1101 and 1704 pmol HMF/mg Hb, respectively. The corresponding inter-assay CVs were 8.6, 8.6 and 6.3%, respectively. A total of 63 paired capillary and venous blood samples were measured by both the direct and GFB method. The GFB method showed excellent correlation with the direct method (r = 0.948 and r = 0.994) after 7 and 14 days' storage at room temperature. The GFB method will enable prior collection and postage of blood samples by patients.
Two series of Blood Pressure (BP) measurements were carried out to assess the variability in BP following repeated measurements in normotensive individuals. In one series, measurement of BP on three occasions three and seven days apart revealed a significant drop in BP in unaccustomed subjects ('untrained'). In a second series assessing the significance of time-interval between measurements or the number of measurements, it was found that a significant fall in BP occurred over the first four days in 'untrained' individuals, whose blood pressure was measured repeatedly for five consecutive days. A significant positive correlation was evident between the falls in systolic and diastolic pressures and the pressure at first screening. Assessment of the anxiety status revealed a significantly lower state anxiety in 'trained' subjects. It therefore appears that (a) BP in normotensive individuals previously unaccustomed to BP measurements, drops significantly with repeated measurements, (b) the number of measurements seem more important than the time-interval between measurements, (c) the largest falls occur in individuals with high initial pressures and (d) the fall upon repeated measurements may be due to reduced anxiety as familiarity with the procedure makes the subjects comparatively relaxed and less state anxious.
The maxillary casts of 320 Malaysian children were examined for the occurrence of the Carabelli trait on the maxillary first permanent molars. The total trait frequency was observed to be 52.2 per cent. Statistical analysis showed no sex dimorphism in the occurrence of the trait. Bilateral occurrence with a tendency towards concordance of expression between sides was also observed.
The aim of this study is to assess the reliability of computerised reporting of electrocardiograms (ECG). Fifty ECG performed consecutively at the outpatient department of the Penang Adventist Hospital on the Marquette 12SL-SC were studied. Two physicians independently reviewed the ECG and the manual readings were compared with each other and to the computer reports. There was no significant difference in the measurement of rate. The PR and QT intervals measured by the two physicians were similar but each was significantly different from the computer reading. The QRS duration assessed by Physician 1 was similar to the computer reading but each was significantly different from that of Physician 2. The overall diagnosis was the same between the two physicians in 76%, between Physician 1 and the computer in 68%, and between Physician 2 and the computer in 78%. No ECG was reported as normal by the computer and said to be abnormal by either physician. Thus, the computer programme is reasonably reliable in ECG reporting with computer-physician variability being comparable to inter-physician variability.
Study site: outpatient department of the Penang Adventist Hospital
A bilingual version of the Khatena-Torrance Creative Perception Inventory was given to 70 Malaysian students. The two 50-item subscales, 'Something About Myself' and 'What Kind of Person Are You?", require the respondent to choose one of two alternatives. Test-retest reliability and criterion validity indices for this version suggest the bilingual form is suitable to assess the creative perception of these students. Replication with other groups is recommended.
Functional renal reserve is a measure of the capacity of the kidney to increase the glomerular filtration in response to the stimulus of a protein meal or amino acid infusion. The aim of this study was to evaluate the usefulness of protein meal test to measure functional renal reserve in normal subjects and various groups of renal patients. One hundred and twenty five subjects from the Nephrology Clinic, Kuala Lumpur General Hospital were subjected to a protein loading test to measure their renal reserve. Each subject had to eat a 100 gram cooked chicken meat and timed 2 hours urine collections before and after the test meal were done to measure the creatinine clearances. The 62 healthy subjects showed a mean renal reserve (creatinine clearance after protein loading-baseline creatinine clearance) of 31.0 ml/min. The 31 subjects with various kidney diseases showed a mean renal reserve of 13.5 ml/min. The 19 renal transplant recipients showed renal reserve of 13.2 ml/min. The 12 nephrectomised donors showed renal reserve of 5.4ml/min. Renal reserve may be used to assess suitability of living related transplant donor for nephrectomy.
Study site: Nephrology Clinic, Kuala Lumpur General Hospital
A simple, rapid and objective infectivity assay based on an in situ enzyme immunoassay (EIA) was developed for the fast-growing and cytopathic cell culture-adapted hepatitis A virus (HAV) strain HM175A.2. Infectivity titration by EIA correlated well with titration by cytopathic effects. The reliability of this assay was demonstrated by close agreement in virus infectivity titers among different assays of the same virus aliquot and between assays of different virus aliquots. HAV infected cell cultures after fixation could be stored for up to 1 week before testing without decline in virus titer.
A detailed cytomorphologic study was done on fine needle aspiration smears from 651 benign breast lumps. Cytological categorization enabled the distinction of proliferative from non-proliferative and infective lesions in the majority of the cases. Lumpectomy provided the histological diagnosis in 584 cases, most of which were proliferative lesions. Gross cystic disease and fibroadenoma were the most common lesions encountered. Microcysts with apocrine change, sclerosing adenosis, proliferative disease without atypia, atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ were associated with the dominant lesion in many of the cases. In all these cases, retrospective analysis of the cytological smears was done in an attempt to identify cytological features which may indicate these lesions.
Two commercial serological kits, Pylori-set (Orion Diagnostica, Finland) and Helico-G (Cambridge Biomedical Ltd, UK), and an in-house ELISA were evaluated with sera from 24 Helicobacter pylori-positive and 146 H. pylori-negative dyspeptic patients. Sensitivity, specificity, positive and negative predictive values of Pylori-set were lower than that of Helico-G and in-house ELISA. Helico-G was more sensitive (91.7%) than in-house ELISA (83.3%) and both had comparable negative predictive values of 98.3% and 97.3%, respectively. However, specificity (97.9%) and positive predictive value (86.9%) of an in-house ELISA were much higher than specificity (80.1%) and positive predictive value (43.1%) of Helico-G. Kappa index of agreement between the three serological tests (Pylori-set, Helico-G or in-house ELISA) and the presence of H. pylori in antral biopsies was very low (k = 0.13; z = 1.9; p > 0.05), moderate (k = 0.49; z = 7.1; p < 0.0001), or substantial (k = 0.82; z = 10.8; p < 0.0001), respectively. Overall, statistical evaluations demonstrated that both commercial kits were not as reliable as the in-house ELISA for serodiagnosing H. pylori infection.
It has been postulated that subjects with high levels of oral sensory perception and motor ability are able to achieve higher standards of oral hygiene even under different dietary regimes. In this study, eleven dental personnel volunteers were started on a low-sucrose diet for one week, followed by a high-sucrose diet for another week, while eleven others followed a reverse-order dietary regime. Oral sensory perception and motor ability were assessed by the oral stereognosis test and a test for oral motor ability. There was a greater trend for subjects to have more plaque on their teeth when they were on the high-sucrose diet, even when normal oral hygiene procedures were taken. There were no significant correlations between the state of oral hygiene and levels of oral sensory perception and motor ability. These results do not support the hypothesis that subjects with high levels of oral sensory perception and motor ability are likely to achieve better oral hygiene.
Discriminatory typing methods are invaluable in the investigation of outbreaks of infectious diseases. Single primers were used to generate randomly amplified polymorphic DNA (RAPD) profiles from Klebsiella pneumoniae isolates of various serotype and K. pneumoniae isolates from cases of sepsis at a Malaysian hospital and two English hospitals. RAPD profiles of acceptable reproducibility, a maximum of three minor band variations, were produced using a rapid DNA extraction method. RAPD typing of K. pneumoniae was shown to be as discriminatory as restriction fragment length polymorphism analysis using pulsed field gel electrophoresis yet quicker and less costly. The findings suggest that RAPD typing may be a useful tool for the epidemiological typing of K. pneumoniae.
The study was conducted to determine thiocyanate (SCN-) and hypothiocyanite (OSCN-) concentrations in resting (RWS) and stimulated whole saliva (SWS) and stimulated parotid saliva (SPS) of 20 healthy young adults aged 21-29 y. Samples of saliva were collected at 12:30, immediately before lunch. Resting saliva was collected by expectoration, and stimulated saliva was collected during the uniform chewing of paraffin wax. Parotid secretion was collected using a modified Carlsson-Crittenden cup (Carlsson et al., Am, J. Physiol., 26, 169-177, 1910). SCN- concentration was determined by the ferric nitrate method (Betts et al., J. Am. Chem. Soc., 75, 5721-5727, 1953) whilst OSCN- was assayed using 2-mercaptoethanol as a reducing agent (Pruitt et al., Caries Res., 16, 315-323, 1982). In RWS, SWS and SPS, the mean SCN- concentrations (in mM) were 1.48 +/- 0.59(S.D.), 0.90 +/- 0.56(S.D.) and 1.24 +/- 0.65(S.D.) whilst the mean OSCN- concentrations (in microM) were 31.21 +/- 13.54(S.D.), 24.90 +/- 12.61 and 30.19 +/- 23.35(S.D.) in the respective salivas. The presence of OSCN- in the secretion collected from the parotid gland supported previous findings by Tenovuo and Pruitt (Tenovuo et al., J. Oral Path, ol. 13, 573-584, 1984), who suggested an endogenous glandular (eukaryotic) source of hydrogen peroxide (H2O2), since parotid saliva from healthy glands is devoid of bacteria and leukocytes.
Samples of stimulated whole saliva were obtained from ninety-four 12-14-year-old school children living in inner London to evaluate if there was a correlation between Streptococcus mutans counts in saliva with plaque amount, gingival inflammation and caries experience. S. mutans counts were obtained by a dip-slide method (Dentocult 'Strip Mutans') in which the count was expressed as 0, 1, 2, 3, or 4 based on visual estimation of the colony density. There was no association between counts' of S. mutans in saliva with plaque amount and gingival inflammation. However, there was a significant trend of increased decayed, missing, filled surfaces (DMFS) with increasing S. mutans counts.
We compared a commercially available dot-blot immunoassay system with the indirect immunofluorescence assay (IFA) in tests of known negative and known positive sera from scrub typhus cases. Using a panel of 100 sera from patients with various rickettsial and nonrickettsial infections, we observed that the IFA was 99% specific and the dipstick assay was 98% specific. In tests of 91 sera (30 negative and 61 positive for scrub typhus antibodies) from a study of febrile patients in Malaysia, using the standard of an IFA titer < 1:64 as negative, an IFA titer > 1:128 as positive, and an IFA titer = 1:64 as either positive or negative (supported by clinical records), dipsticks were 83% specific and 90% sensitive. The quantitative correlation of the dipsticks to IFA titers was confirmed by significant differences in geometric means of inverse IFA titers corresponding to the number of positive dipstick spots (no dots = 8.5, one dot = 43.3, two dots = 206.7, and three dots = 676.9). The assay would enable physicians and public health workers who deal with patients to quickly diagnose and appropriately treat most cases of the disease, especially in areas of high prevalence where the proportion of false-positive results to true-positive results would be low.
A selective reproducible high-performance liquid chromatographic assay for the simultaneous quantitative determination of the antimalarial compound artemether (ARM), dihydroartemisinin (DQHS) and artemisinin (QHS), as internal standard, is described. After extraction from plasma, ARM and DQHS were analysed using a Lichrocart/Lichrosphere 100 CN stainless-steel column and a mobile phase of acetonitrile-0.05 M acetic acid (15:85, v/v) adjusted to pH 5.0, and electrochemical detection in the reductive mode. The mean recovery of ARM and DQHS over a concentration range of 30-120 ng/ml was 81.6% and 93.4%, respectively. The within-day coefficients of variation were 0.89-7.01% for ARM and 3.45-8.11% for DQHS. The day-to-day coefficients of variation were 2.06-8.43% and 3.22-6.33%, respectively. The minimum detectable concentration for ARM and DQHS in plasma was 2.5 and 1.25 ng/ml for both compounds. The method was found to be suitable for use in clinical pharmacological studies.
Chrome azurol S immobilised on XAD-2 has been used in this study as a reagent phase for the development of an optical fibre Al(III) sensor. Using a kinetic approach, this sensor was able to give a linear response in the Al(III) concentration range of 1.3 x 10(-5)-2.0 x 10(-4) M with a limit of detection of 1.0 x 10(-4) M. The optimum responses were obtained at pH 6.0 and when the solution was stirred. The sensor response was found to have a repeatability and reproducibility of 1.6% and 5.8%, respectively. The results obtained for Al(III) determination in aqueous sample were in good agreement with those obtained using graphite furnace-atomic absorption spectrometry.