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Urine as a diagnostic specimen for the detection of Chlamydia trachomatis in Malaysia by ligase chain reaction

Gaydos CA, Ngeow YF, Lee HH, Canavaggio M, Welsh LE, Johanson J, et al.

Sex Transm Dis, 1996 9 1;23(5):402-6.
PMID: 8885072

BACKGROUND AND OBJECTIVES: Noninvasive urine screening for Chlamydia trachomatis infections offers a valuable public health tool, which could be of vast importance in chlamydial control programs. The authors evaluated a new DNA amplification method, ligase chain reaction (LCR).
GOALS: The goal was to ascertain whether urine testing could be used as screening method to detect C. trachomatis infections in commercial sex workers, patients at sexually transmitted diseases clinic, and asymptomatic patients in Kuala Lumpur, Malaysia.
METHODS: First-void urine specimens from 300 men and 300 women were tested by LCR, as well as by a commercially available enzyme immunoassay. The LCR assay amplifies specific sequences within the chlamydial plasmid with ligand-labeled probes, and the resultant amplicons are detected by an automated immunoassay. Specimens with discrepant results were confirmed by another LCR of the specimen that targeted the gene for the major outer membrane protein (OMP1).
RESULTS: There were 31 LCR-positive male urine and 37 LCR-positive female urine specimens. The resolved sensitivity and specificity for the LCR of the male urine specimens were 100% and 99.6%, respectively, whereas for female urine specimens, the sensitivity and specificity were 100% and 98.5%, respectively. After resolution of discrepant test results by OMP1 LCR, the prevalence was 10% for men and 11% for women. The urine enzyme immunoassay was not useful in diagnosing C. trachomatis infections in either men or women, as the resolved sensitivities were 10% and 15.2%, respectively. The specificities were 99.6% for men and 98.9% for women.
CONCLUSIONS: Testing first-void urine specimens by LCR is a highly sensitive and specific method to diagnose C. trachomatis infections in men and women, providing health care workers and public health officials with a new molecular amplification assay that uses noninvasive urine specimens for population-based screening purposes.

Matched MeSH terms: Chlamydia Infections/prevention & control
Fulltext Tocotrienols-rich diet decreases advanced glycosylation end-products in non-diabetic rats and improves glycemic control in streptozotocin-induced diabetic rats

Wan Nazaimoon WM, Khalid BA

Malays J Pathol, 2002 Dec;24(2):77-82.
PMID: 12887164

This study determined the effects of palm vitamin E (TRF) diet on the levels of blood glucose, glycated hemoglobin (gHb), serum advanced glycosylation end-products (AGE) and malondialdehyde (MDA) of diabetic Sprague-Dawley rats. The rats received either control (normal rat chow), TRF diet (normal chow fortified with TRF at 1 g/kg) or Vitamin C diet (vitamin E-deficient but contained vitamin C at 45 g/kg). The animals were maintained on the respective diet for 4 weeks, made diabetic with streptozotocin (STZ), then followed-up for a further 8 weeks. At week-4, mean serum AGE levels of rats given TRF diet (0.7 +/- 0.3 units/ml) were significantly lower than those of control or Vitamin C diet rats (p pounds 0.03). The levels increased after STZ and became comparable to the other groups. At week 12, blood glucose (20.9 +/- 6.9 mM) and gHb (10.0 +/- 1.6%) of rats on TRF diet remained significantly low compared to that of control or Vitamin C diet rats (p pounds 0.03). MDA however, was not affected and remained comparable between groups throughout the study. This study showed that TRF may be a useful antioxidant; effectively prevented increase in AGE in normal rats, and caused decrease in blood glucose and gHb in diabetic rats. Further studies are needed to elucidate the mechanisms of action of TRF.

Matched MeSH terms: Hypoglycemia/prevention & control
Fulltext Prevention of type 2 diabetes

Lai LC

Malays J Pathol, 2002 Dec;24(2):71-6.
PMID: 12887163

The prevalence of diabetes is increasing worldwide. The World Health Organisation has estimated that there will be around 300 million diabetics by 2025. The largest increase will occur in Asia. The prevalence of type 2 diabetes is increasing due to a combination of factors: increasing lifespan, sedentary lifestyle, excessive intake of high energy foods, increasing prevalence of overweight/obese people. The Finnish Diabetes Prevention Study Group has clearly shown that changes in the lifestyle of both overweight men and women with impaired glucose tolerance can reduce the incidence of type 2 diabetes by 58%. This finding was confirmed by the Diabetes Prevention Programme which found that lifestyle intervention in individuals with impaired fasting glucose or impaired glucose tolerance reduced the risk of developing type 2 diabetes by 58%, whereas treatment with metformin reduced the risk of type 2 diabetes by only 31%. Both acarbose and troglitazone have also been shown to reduce the progression to diabetes in individuals who are at high risk of developing type 2 diabetes. Since the cure for diabetes remains some way off our concerted efforts should be directed at prevention of diabetes in order to curb the increasing prevalence of diabetes worldwide. Lifestyle changes are more beneficial than long term drug therapy in the prevention of diabetes and should be actively promoted.

Matched MeSH terms: Diabetes Mellitus, Type 2/prevention & control*
Operational issues in the control of the vectors of Brugia

Chang MS

Ann Trop Med Parasitol, 2002 Dec;96 Suppl 2:S71-6.
PMID: 12625920

An estimated 13 million people in the Oriental Region have brugian filariasis. The filarial parasites that cause this disease exist in periodic and sub-periodic forms and are transmitted by four genera of mosquito: Anopheles, Mansonia and, less frequently, Coquillettidia and Ochlerotatus. In most endemic countries, control of the disease has been entirely based on chemotherapy, although house-spraying and use of insecticide-treated bednets can be quite effective against the vectors of nocturnally periodic Brugia malayi and B. timori. The vector-control methods that may be applied against the Mansonia mosquitoes that transmit the parasites causing sub-periodic brugian filariasis are reviewed here. Most of the conventional methods for controlling the immature, aquatic stages of mosquitoes have proved unsatisfactory against Mansonia. The reason is that, unlike the those of other genera, the larvae and pupae of Mansonia spp. are relatively immobile and obtain air not at the water surface but from the underwater roots, stems and leaves of floating plants to which the larvae and pupae attach. Removal of host plants can be very effective in reducing Mansonia productivity, whereas large-scale use of herbicides is restricted by the potential adverse effects on the ecosystem. Environmental management in water-development projects remains the best option.

Matched MeSH terms: Elephantiasis, Filarial/prevention & control*
Contamination of foods by food handlers: experiments on hepatitis A virus transfer to food and its interruption

Bidawid S, Farber JM, Sattar SA

Appl Environ Microbiol, 2000 Jul;66(7):2759-63.
PMID: 10877765

Hepatitis A virus (HAV) is an important pathogen which has been responsible for many food-borne outbreaks. HAV-excreting food handlers, especially those with poor hygienic practices, can contaminate the foods which they handle. Consumption of such foods without further processing has been known to result in cases of infectious hepatitis. Since quantitative data on virus transfer during contact of hands with foods is not available, we investigated the transfer of HAV from artificially contaminated fingerpads of adult volunteers to pieces of fresh lettuce. Touching the lettuce with artificially contaminated fingerpads for 10 s at a pressure of 0.2 to 0.4 kg/cm(2) resulted in transfer of 9.2% +/- 0.9% of the infectious virus. The pretreatments tested to interrupt virus transfer from contaminated fingerpads included (i) hard-water rinsing and towel drying, (ii) application of a domestic or commercial topical agent followed by water rinsing and towel drying, and (iii) exposure to a hand gel containing 62% ethanol or 75% liquid ethanol without water rinsing or towel drying. When the fingerpads were treated with the topical agents or alcohol before the lettuce was touched, the amount of infectious virus transferred to lettuce was reduced from 9.2% to between 0.3 and 0.6% (depending on the topical agent used), which was a reduction in virus transfer of up to 30-fold. Surprisingly, no virus transfer to lettuce was detected when the fingerpads were rinsed with water alone before the lettuce was touched. However, additional experiments with water rinsing in which smaller volumes of water were used (1 ml instead of 15 ml) showed that the rate of virus transfer to lettuce was 0.3% +/- 0.1%. The variability in virus transfer rates following water rinsing may indicate that the volume of water at least in part influences virus removal from the fingerpads differently, a possibility which should be investigated further. This study provided novel information concerning the rate of virus transfer to foods and a model for investigating the transfer of viral and other food-borne pathogens from contaminated hands to foods, as well as techniques for interrupting such transfer to improve food safety.

Matched MeSH terms: Food Contamination/prevention & control*
Multicentre laboratory evaluation of Brugia Rapid dipstick test for detection of brugian filariasis

Rahmah N, Shenoy RK, Nutman TB, Weiss N, Gilmour K, Maizels RM, et al.

Trop Med Int Health, 2003 Oct;8(10):895-900.
PMID: 14516300

A multicentre evaluation of the Brugia Rapid dipstick test was performed using 1263 serum samples in four international laboratories, i.e. T.D. Medical College (TDMC, India), National Institutes of Health (NIH, USA), Swiss Tropical Institute (STI, Switzerland) and Leiden University Medical Centre (LUMC, Netherlands). In comparison with microscopy, the dipstick demonstrated sensitivities of 97.2% (70 of 72) at TDMC, 91.6% (175 of 191) at LUMC and 100% (six of six) at STI. Sera of chronic patients showed a positivity rate of 11.3% (19 of 168) and 61.2% (71of 116) at TDMC and LUMC, respectively. All 266 sera of non-endemic normals from STI, NIH and LUMC tested negative with the dipstick. At LUMC, sera of 'endemic normals' (amicrofilaraemics with no clinical disease) from an area with approximately 35% microfilaria positivity showed 60.8% positive results (31 of 51), thus demonstrating the likelihood of many cryptic infections occurring in this population. Specificities of the test with Onchocerca volvulus sera were 98.8% (80 of 81) and 100% (10 of 10) at the NIH and STI, respectively; while specificity with Loa loa sera at the NIH was 84.6% (44 of 52). At the STI, the dipstick test also demonstrated 100% specificity when tested with 75 sera from various protozoan and helminthic infections.

Matched MeSH terms: Filariasis/prevention & control
Managing emerging diseases borne by fruit bats (flying foxes), with particular reference to henipaviruses and Australian bat lyssavirus

Mackenzie JS, Field HE, Guyatt KJ

J Appl Microbiol, 2003;94 Suppl:59S-69S.
PMID: 12675937

Since 1994, a number of novel viruses have been described from bats in Australia and Malaysia, particularly from fruit bats belonging to the genus Pteropus (flying foxes), and it is probable that related viruses will be found in other countries across the geographical range of other members of the genus. These viruses include Hendra and Nipah viruses, members of a new genus, Henipaviruses, within the family Paramyxoviridae; Menangle and Tioman viruses, new members of the Rubulavirus genus within the Paramyxoviridae; and Australian bat lyssavirus (ABLV), a member of the Lyssavirus genus in the family Rhabdoviridae. All but Tioman virus are known to be associated with human and/or livestock diseases. The isolation, disease associations and biological properties of the viruses are described, and are used as the basis for developing management strategies for disease prevention or control. These strategies are directed largely at disease minimization through good farm management practices, reducing the potential for exposure to flying foxes, and better disease recognition and diagnosis, and for ABLV specifically, the use of rabies vaccine for pre- and post-exposure prophylaxis. Finally, an intriguing and long-term strategy is that of wildlife immunization through plant-derived vaccination.

Matched MeSH terms: Communicable Diseases, Emerging/prevention & control
Fulltext Indirect hemagglutination antibodies against Burkholderia pseudomallei in normal blood donors and suspected cases of melioidosis in Malaysia

Norazah A, Rohani MY, Chang PT, Kamel AG

Southeast Asian J Trop Med Public Health, 1996 Jun;27(2):263-6.
PMID: 9279987

Interpretation of the indirect hemagglutination test (IHA) for melioidosis in endemic areas is difficult because of the presence of antibodies in apparently healthy individuals. Fifty-three out of 200 healthy blood donors in Malaysia showed positive antibody titers (> or = 1 : 40) against Burkholderia pseudomallei. Seven percent had an IHA titer of 1 : 40, 11% had an IHA titer of 1 : 80 while 8.5% had a titer > or = 1 : 160. Out of 258 sera sent for melioidosis serology, 7% of the patients had an IHA titer of 1 : 40, 9% had an IHA titer of 1 : 80 while 20% had an IHA titer of > or = 1 : 160. If a titer of > or = 1 : 80 is taken as cut off point for positivity, 29% of the patients had positive melioidosis serology. Increasing the positivity threshold may jeopardize the sensitivity of the test. A more specific and sensitive test is needed.

Matched MeSH terms: Melioidosis/prevention & control
Prevalence of childhood sexual abuse among Malaysian paramedical students

Singh HS, Yiing WW, Nurani HN

Child Abuse Negl, 1996 Jun;20(6):487-92.
PMID: 8800523

There has been increasing awareness that sexual abuse of children is a problem in Malaysia. Existing data is based on notification of cases. Population based studies are required to plan services for sexually abused children. This study utilized trainee paramedical staff as a community population to determine the prevalence of childhood sexual abuse. An anonymous, self-administered questionnaire was given to student nurses and trainee medical assistants at the Ipoh School of Nursing and Hospital Bahagia Medical Assistant Training School. Questionnaires were distributed directly to all students in a classroom setting and retrieved after a 30-minute interval. Information collected included questions on personal experiences of sexual abuse. Sexual abuse was defined as rape, sodomy, molestation, or exhibitionism occurring to a child less than 18 years of age. Six hundred and sixteen students participated in the study; 6.8% of the students admitted to having been sexually abused in their childhood, 2.1% of males and 8.3% of females. Of those abused, 69% reported sexual abuse involving physical contact, 9.5% of whom experienced sexual intercourse. The age at first abuse was < 10 years in 38.1% of the cases; 59.5% were repeatedly abused and 33.3% had more than one abuser. Of the abusers, 71.4% were known to the respondent, 14.2% of whom were brothers, 24.5% relatives, and 24.5% a family friend. Further, 28.9% of all students knew of an individual who had been sexually abused as a child. While this population may not be entirely reflective of the community, this study does provide an indication of the prevalence of sexual abuse in Malaysian children. The prevalence figures in this study are lower than those reported in industrialized countries and this may reflect local sociocultural limitations in reporting abuse.

Matched MeSH terms: Child Abuse, Sexual/prevention & control
Fulltext The use of surgical antibiotic prophylaxis in seven Malaysian hospitals

Lim VK, Cheong YM, Suleiman AB

Southeast Asian J Trop Med Public Health, 1994 Dec;25(4):698-701.
PMID: 7667716

A survey on the use of antibiotics in surgical prophylaxis was carried out in seven Malaysian hospitals. Details of antibiotic prescriptions were obtained through questionnaires completed by the prescriber. A total of 430 such prescriptions was analysed. A large number of different antibiotic regimens were used for a variety of surgical procedures. The majority of prescriptions (70%) were issued for procedures where such prophylaxis was probably not necessary. Antibiotics were also often prescribed for durations that were longer than necessary. There is an urgent need to educate surgeons and standardize surgical prophylactic regimens in order to reduce cost and combat the emergence of antibiotic resistance.

Matched MeSH terms: Surgical Wound Infection/prevention & control*
Fulltext Evaluation of the bacteriological contamination of a closed feeding system for enteral nutrition

Chan L, Yasmin AH, Ngeow YF, Ong GS

Med J Malaysia, 1994 Mar;49(1):62-7.
PMID: 8057993

A closed enteral delivery system consisting of a cardboard tetrapack containing the sterile ready-to-use liquid feed and an independent sterile administration set, has been devised. We found bacterial contamination within 24 hours in this system in patients on ventilatory support in intensive care. This emphasises the need for meticulous care in handling enteral feeding systems to prevent environmental contamination.

Matched MeSH terms: Equipment Contamination/prevention & control
Obesity in preschool children: an intervention programme in primary health care in Singapore

Ray R, Lim LH, Ling SL

Ann Acad Med Singap, 1994 May;23(3):335-41.
PMID: 7944246

The Programme on Prevention and Management of Obesity in Preschool Children, aged three to six years, was implemented in 17 Primary Health Clinics in November 1991. The study sample comprised 1128 preschool children who qualified to enter the obesity register, using the defined criteria for obesity of 2 standard deviations above the normal weight for height and age. This group was divided into three categories, namely, mildly overweight (120% to below 140%), moderately overweight (140% to below 160%), and severely overweight (above 160%). The severely overweight category was referred to dietitians for follow-up management, while the other two categories were managed by the clinic staff through pre-planned nurse-conducted counselling sessions. In this paper, we analysed the first 1128 preschool children aged three to six years on the Programme with respect to their demographic characteristics; medical conditions; family history of obesity, diabetes, hypertension and ischaemic heart disease; number of siblings and parents' educational and occupational status. The Malay children showed significantly more severe grades of obesity compared to the Chinese and Indian children. A family history of obesity and hypertension among the three groups were significant (P < 0.001). After one year of follow-up with the intervention programme, the following were found: 40.4% (456) of the children improved in their obesity status and 20.2% (228) reached normal status. The severe, moderate and mild categories reduced from 6.3% to 5.9%, 29.3% to 23.2% and 64.4% to 50.7% respectively and was found to be statistically significant (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Matched MeSH terms: Obesity/prevention & control*
Fulltext Malaria and Anopheles mosquitos in Malaysia

Rahman WA, Che'Rus A, Ahmad AH

Southeast Asian J Trop Med Public Health, 1997 Sep;28(3):599-605.
PMID: 9561615

Until today, malaria is still one of the most important diseases in Malaysia. This is because Malaysia is located within the equatorial zone with high temperatures and humidities, usually important for the transmission of malaria. The number of malaria cases were estimated to be around 300,000 before the launching of the Malaria Eradication Program (MEP). The program was successful in reducing the numbers progressively during the 1967-1982 period. During the period 1980-1991, the highest number of malaria cases recorded for the country was 65,283 in 1989 (16,902 in Peninsular Malaysia, 47,545 in Sabah and 836 in Sarawak) whilst the lowest was 22,218 (10,069 in Peninsular Malaysia, 11,290 in Sabah and 859 in Sarawak) in 1983. In Malaysia, there are 434 species of mosquitos, representing 20 genera. Of these, 75 species are Anopheles that comprise of 2 subgenus, i.e. Anopheles and Cellia. Of the 75 species, only 9 have been reported as vectors: An. maculatus, An balabacensis, An. dirus, An. letifer An. campestris, An. sundaicus, An. donaldi, An. leucophyrus and An. flavirostris. The behavior, seasonal abundance, biting activities and breeding sites of these species are discussed.

Matched MeSH terms: Malaria/prevention & control*
Susceptibility pattern of Streptococcus pneumoniae among pre-school children in Kota Bharu, Malaysia

Malik AS, Ismail A, Pennie RA, Naidu JV

J Trop Pediatr, 1998 02;44(1):10-4.
PMID: 9538599 DOI: 10.1093/tropej/44.1.10

Streptococcus pneumoniae (S. pneumoniae) is the most common bacterial cause of pneumonia, meningitis, and otitis media, with the highest incidence among young children and the elderly. S. pneumoniae was once routinely susceptible to penicillin, but since the mid-1980s the incidence of resistance to penicillin and other antimicrobial agents has been increasing all over the world. To optimize empirical regimens and initial therapy for S. pneumoniae infections, clinical healthcare providers must be informed about the prevalence and pattern of drug resistance among the isolates in their communities. No such data are available for the Malaysian population. Therefore, this study was designed to determine the antibiotic susceptibility pattern of S. pneumoniae among colonized pre-school children in Kota Bharu, Malaysia. Pharyngeal swabs were collected from children 1 month to 6 years of age. S. pneumoniae isolates were identified according to the standard and tested for penicillin resistance with a 1-microgram oxacillin disk by the Kirby-Bauer disk diffusion methods. Of 355 nasopharyngeal specimens obtained from kindergarten students, in-patients and pediatric clinics over a period of 1 year, S. pneumoniae was isolated from 36 (10 per cent). All isolates, except one, were susceptible to penicillin. The resistant isolates was susceptible to erythromycin, chloramphenicol and cephalosporins.
Study site: kindergarten, schools, pediatric outpatients clinics, and in-patient wards of Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia.

Matched MeSH terms: Pneumococcal Infections/prevention & control*
Typhoid fever--important issues still remain

Pang T, Levine MM, Ivanoff B, Wain J, Finlay BB

Trends Microbiol, 1998 Apr;6(4):131-3.
PMID: 9587187
Matched MeSH terms: Typhoid Fever/prevention & control
The partograph in community obstetrics

Lennox CE, Kwast BE

Trop Doct, 1995 Apr;25(2):56-63.
PMID: 7778195
Matched MeSH terms: Obstetric Labor Complications/prevention & control*
Fulltext Knowledge and attitudes of parents of children with nursing bottle syndrome in Serdang, Malaysia

Syahrial D, Abdul-Kadir R, Yassin Z, Jali NM

J Nihon Univ Sch Dent, 1995 Sep;37(3):146-51.
PMID: 7490607 DOI: 10.2334/josnusd1959.37.146

A study was conducted to investigate the relationship between the parents' level of knowledge, and their attitudes to nursing bottle syndrome. Of 284 children aged 2-6 years clinically examined, 153 were diagnosed as having nursing bottle syndrome based on the criterion that at least one upper maxillary incisor was affected by caries. The parents of the 153 affected children were then interviewed by questionnaire. The findings suggested that parents had adequate knowledge and a positive attitude towards maintaining satisfactory dental care for their children. However, these attitudes were not reflected in the dental health of their children. The implications of these findings are discussed.

Matched MeSH terms: Dental Caries/prevention & control
Fulltext Case-finding for pulmonary tuberculosis in Penang

Hooi LN

Med J Malaysia, 1994 Sep;49(3):223-30.
PMID: 7845270

The process of case-finding was studied in 100 consecutive patients with pulmonary tuberculosis treated by the Chest Clinic, Penang Hospital. The median time from the onset of the illness until the initial medical consultation was two weeks (patient's delay). This delay was longer in males, patients with lower than secondary education and drug abusers. Only 47% of patients were put on treatment with a correct diagnosis within one month of the first consultation (doctor's delay). Almost all patients had at least one symptom suggestive of tuberculosis at presentation and the mean number of consultations before diagnosis was three. Patients who first visited government medical facilities had shorter doctor's delay than those who first saw private practitioners, and patients who first consulted a private practitioner were the least likely to be appropriately investigated by sputum examination and chest radiography. The median total delay was three months and at the time of diagnosis, 95% of patients had moderate or far advanced disease radiologically. In order to shorten doctor's delay, all medical practitioners, especially those in the private sector, should be made aware of the importance of early diagnosis and the proper management of tuberculosis. Health education campaigns for the public should also be undertaken to shorten patient's delay.
Study site: Chest clinic, Hospital Pulau Pinang, Malaysia

Matched MeSH terms: Tuberculosis, Pulmonary/prevention & control*
Relationship between active protection in vaccinated buffaloes against haemorrhagic septicaemia and passive mouse protection test or serum antibody titres

Chandrasekaran S, Kennett L, Yeap PC, Muniandy N, Rani B, Mukkur TK

Vet Microbiol, 1994 Aug 15;41(4):303-9.
PMID: 7801530

The relationship between the standard passive mouse protection test or serum antibody titres measured by indirect haemagglutination or enzyme-linked immunosorbent assays and active protection in buffaloes immunized with different types of haemorrhagic septicaemia bacterins was investigated. Groups of 2-3 buffaloes were immunized with the bacterins currently in use in Asia, viz., broth bacterin (BB), alum precipitated vaccine (APV) and oil adjuvant vaccine (OAV) either subcutaneously (BB, APV) or intramuscularly (OAV) and challenged subcutaneously with virulent organisms at different periods post-immunization. Although the passive mouse protection and indirect haemagglutination tests carried out with the pre-challenge sera from vaccinated buffaloes revealed no relationship with active protection in buffaloes, a relationship was observed between the ELISA antibody titres and protection. In contrast, a dose-response relationship was observed between the homologous active and passive mouse protection test.

Matched MeSH terms: Hemorrhagic Septicemia/prevention & control
Severe head injury management in a general surgical department

Visvanathan R

Aust N Z J Surg, 1994 Aug;64(8):527-9.
PMID: 8048888

Sixty-nine severely head-injured patients treated by general surgeons over a 28 month period with admission Glasgow Coma Scale motor scores of 3 to 8 were reviewed retrospectively. Fifty-one patients were comatose on admission with periods from injury to admission exceeding 4 h in 34 patients who were referred from peripheral hospitals. Forty patients with acute intracranial bleeding underwent emergency decompressive surgery with 13 good recoveries and 18 deaths; good recoveries were observed in 11 of 20 patients with extradural haemorrhages, one out of eight patients with subdural haemorrhages, and one of 12 patients with intracerebral and/or combined haemorrhages. Twenty-nine patients with no evidence of acute mass lesions were treated medically with sedation, mechanical ventilation and mannitol infusion for cerebral decompression with seven good recoveries and 16 deaths. There were 15 good outcomes in 40 patients with admission motor scores of 6, 7 or 8 and five good outcomes in 29 patients with scores of 3, 4 or 5. A good outcome of 29% in the study may be improved by (i) better neurosurgical training of surgical and nursing staff; (ii) provision of technologically advanced diagnostic and treatment modalities; (iii) an efficient referral system; and (iv) provision of effective long-term rehabilitation.

Matched MeSH terms: Brain Edema/prevention & control

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