Three East Timorese immigrants presented with signs and symptoms of heart failure in early December 1992. One of them also had features of peripheral neuropathy. Another collapsed within 24 hours of admission and attempts at resuscitation failed. The other two showed dramatic response to oral thiamine therapy. An investigation into their dietary history established gross deficiency in fresh vegetables.
Since dengue was first documented in Malaysia in 1902 and made notifiable in 1973, the disease pattern has changed from major outbreaks every four years to one of increasing trend yearly. The largest outbreak was seen in 1996 with 14,255 dengue cases reported and 32 deaths. The case fatality rate varied from a high of 10.43% in 1985 when dengue type 3 was the predominant type to a low of 1.29% when dengue type 1 predominated. Severe disease patterns have been observed with dengue 2 and 3 serotypes in the country. The clinical spectrum has also been changing and multisystem involvement with more severe manifestations are being seen. Liver involvement has been documented since 1987. Fulminant hepatitis with encephalopathy can resemble Reye's syndrome. Dengue type 3 has been isolated from liver biopsy specimens. Neurological manifestations can very from irritability, convulsions, coma to peripheral neuritis. The isolation of dengue viruses from cerebrospinal fluids recently strongly suggests that dengue viruses can be neurovirulent. Adult respiratory distress syndrome was seen in three children admitted with shock. Deaths were more frequent in children in the early period but since 1982, over 50% of deaths have occurred in patients over the age of 15 years.
Several sizes of plastic cap were designed and made to fit the vertex of the penile glans. The foreskin is prepared in the usual manner, the glans capped with the specially made plastic cap and the foreskin pulled forwards over the cap. A crushing or non-crushing forceps is applied across the foreskin. The plastic cap separates the glans from the clamp, and its unwanted portion is cut with a knife without fear of injuries in the glans. We find this method to be safe even if it is used by a surgeon with limited experience.
Knowledge of local antimicrobial resistance patterns of bacteria is a valuable guide to empirical antimicrobial therapy. This paper reports the resistance patterns of more than 36,000 bacteria isolated between August 1991 and July 1992 in six Malaysian hospitals and discusses the implications of the results. A customized menu driven software programme was developed to analyse the results. Generally, resistance to the commonly used antibiotics like ampicillin, cloxacillin, cephalosporins, gentamicin, cotrimoxazole and tetracycline was high. Some differences in resistance rate amongst the six hospitals were also noted. Continuous surveillance of antimicrobial resistance in hospitals is encouraged for the effective control of the emergence of antimicrobial resistance.
There are significant differences in the food consumption patterns of countries. In the lower income countries, most of the energy intake is derived from cereals and starchy roots. On the other hand, the intake of these carbohydrate foods is much lower in the economically developed countries and more of the energy is derived from added fats, alcohol, meat, dairy products and sweeteners. The contribution of energy from various food groups has changed markedly over the past three decades. With increasing national wealth there is a general tendency for the consumption of cereal foods to decline, whereas the consumption of added fats, alcohol, meat and dairy products has increased over the years. Similar changes have also been observed for Malaysia. These dietary alterations, as well as other lifestyle changes, have brought about a new nutrition scenario in many developing countries. These countries are now faced with the twin problems of malnutrition, that is, undernutrition among some segments of the population and diet-related chronic diseases in other groups; for example, obesity, hypertension, coronary heart disease, diabetes and various cancers. In Malaysia, deaths due to diseases of the circulatory system and neoplasms have been on the rise since the 1960s. The former has been the most important cause of death in the country for more than 15 years, with cancer ranking third for almost 10 years. Epidemiological data collected from different community groups showed increased prevalences of various risk factors amongst Malaysians. In view of the changed nutrition scenario in the country, intervention programmes have been reviewed accordingly. The Healthy Lifestyle (HLS) Programme was launched in 1991 as a comprehensive, long-term approach to combating the emerging diet-related chronic diseases. For six consecutive years one thematic campaign per year was carried out; namely, coronary heart disease (1991), sexually transmitted diseases (1992), food safety (1993), childhood diseases (1994), cancers (1995) and diabetes mellitus (1996). To further strengthen health promotion among the community, another series of activities to be carried out under the second phase of the HLS programme from 1997 to 2002 was launched within the framework of the National Plan of Action on Nutrition (NPAN) for Malaysia. In view of the importance of diet and nutrition in the causation and prevention of chronic diseases, the theme for the first year of this phase was Healthy Eating. It is clear that nutrition education for the community in order to inculcate a culture of healthy eating is the long-term solution. A series of guidelines have been prepared for dissemination to the public via a variety of media and approaches, and with the collaboration of various government and non-governmental organisations. The implementation of the programme is, however, a challenge to health and nutrition workers. There is a need to examine the strategies for nutrition education to ensure more effective dissemination of information. The challenge is to determine how best to promote healthy eating within the present scenerio of rapid urbanisation, 'western' dietary pattern influence, a whole barrage of convenience and 'health' foods, and nutrition misinformation. We would like to share our experiences in the approaches taken and our concerns with other countries in the region given that various opportunities exist for collaboration.
Delivering a drug direct to the site of disease has several advantages. In the case of aerosols, it only requires about one-twentieth of the oral dose of the drug to exert its effect, thus resulting in less or minimal systemic side-effects. The onset of action is fast and the efficacy is superior to the oral drug. Because of the anatomy of the airways which are protective against the inhalation of foreign substances, the aerosol particles must be inhaled in an optimal way in order to reach the sites of action which are the peripheral airways. The particle size must be small and the aerosol must be inhaled in a coordinated manner, especially when a pressurised metered dose inhaler is used. Because of the high pressure of the propellants used in the canister, the particles will travel at a rapid speed upon actuating, causing great impaction in the throat. Only a small percentage reaches the peripheral airways and this percentage is even smaller if the coordination between actuation and inhalation is poor. Spacers have been shown to be able to overcome this problem of incoordination and to reduce throat impaction. Alternatively, the breath-actuated dry powder inhaler can be effectively used. The nebuliser, which is another aerosol delivery system, needs proper setting of the flow rate of compressed air and an appropriate volume of solution in order to optimise the drug delivery.
Preliminary analysis of the short-term impact of a running headlights intervention revealed that there has been a significant drop in conspicuity-related motorcycle accidents in the pilot areas, Seremban and Shah Alam, Malaysia. This paper attempts to look in more detail at conspicuity-related accidents involving motorcycles. The aim of the analysis was to establish a statistical model to describe the relationship between the frequency of conspicuity-related motorcycle accidents and a range of explanatory variables so that new insights can be obtained into the effects of introducing a running headlight campaign and regulation. The exogenous variables in this analysis include the influence of time trends, changes in the recording and analysis system, the effect of fasting activities during Ramadhan and the "Balik Kampong" culture, a seasonal cultural-religious holiday activity unique to Malaysia. The model developed revealed that the running headlight intervention reduced the conspicuity-related motorcycle accidents by about 29%. It is concluded that the intervention has been successful in improving conspicuity-related motorcycle accidents in Malaysia.
A case of non-fatal strangulation of the neck by rigging lines of a parachute during military training is presented. It is an unusual but potentially life-threatening injury. Probable factors leading to such injury are discussed.
A teenage male was admitted to a hospital in the United Kingdom following the ingestion of strychnine. The typical spasms of strychnine poisoning were observed and he died during the fourth convulsion. The post mortem findings are presented, and strychnine poisoning is discussed.