A 69-year-old lady who was referred by her general practitioner with a diagnosis of food poisoning developed cardiorespiratory arrest shortly after arriving at the Casualty Department. Cardiac output was successfully restored with resuscitation but she had to be mechanically ventilated due to the absence of any spontaneous respiratory effort. Assessment 24 hours after admission, showed fixed and dilated pupils with brain stem areflexia. Her family was told that the prognosis was hopeless. Surprisingly, her condition rapidly improved a day later and she eventually had a good recovery. Her condition was actually due to severe tetrodotoxin poisoning after eating roe of the puffer fish and it was fortunate that appropriate aggressive resuscitation was instituted to revive the patient from her critical state.
Two cases of carbon monoxide poisoning involving 3 victims occurred in Cameron Highlands in the months of August and September 1995. Two of the victims were found dead in the bathrooms where they were taking a bath while the other one survived. Blood toxicology from the post mortems revealed high levels of carbon monoxide. The only significant source of carbon monoxide in both cases were the gas water heaters which were installed in the bathrooms. A multigas detector was used to monitor the level of carbon monoxide in one of the bathrooms and carbon monoxide was found to be produced to 1200 ppm in 16 minutes during operation of the heater. Carbon monoxide poisoning from gas water heaters installed in bathroom is a significant hazard.
The link between Helicobacter. pylori and peptic ulcer disease in 1997 is an irrefutable one. The association between infection and ulcerogenesis has been shown to be biologically plausible with induction of epithelial inflammation and cell damage and its effect on gastrin/acid homeostasis. The association of H. pylori infection and peptic ulcer disease is a close and consistent one. There is ample evidence indicating that H. pylori eradication results in virtual abolition of ulcer relapse. Several studies have demonstrated that eradication of H. pylori results in ulcer healing and there is evidence showing a temporal relationship between infection and development of peptic ulcer disease.
A 46-year-old Indian man was admitted with unstable angina (Braunwald's class IIIB1)--the chest pain at rest was associated with inferolateral ischaemia on the ECG at admission. His serial total creatine kinase levels were elevated but CKMB was not detected. Serial serum troponin T levels were significantly raised suggesting the presence of significant acute myocardial injury.
Infection from the wisdom teeth usually causes severe swelling at the region of the angle and body of the mandible. Occasionally, it tracts outward to form a cervicofacial sinus. This paper demonstrates the use of gutta-percha point to locate the origin of a cervicofacial sinus due to an asymptomatic impacted wisdom tooth. The advantage of using gutta-percha point is discussed.
Recto-prostatic fistula is a rare complication of prostatic surgery, occurring usually because surgical planes are not appreciated. We describe a combined abdomino-perineal approach for the repair of a large recto-prostatic fistula with the interposition of omentum and gracilis without formally closing the fistula in layers.
A female patient presenting with post-prandial epigastric pain and weight loss was diagnosed to have oesophageal tuberculosis by endoscopic biopsy. She responded well to standard anti-tuberculosis treatment.
An audit was done on 54 tuberculosis patients presenting to Penang Hospital who died during 1993. Active tuberculosis was the cause of death in 29 (53.7%) and 48.3% were aged under 50 years. Tuberculosis was a contributory cause of death in 8 patients and in 17 patients tuberculosis was irrelevant to the cause of death. The diagnosis of tuberculosis was made after death in 17 patients (31.5%). Late diagnosis was the most important factor resulting in death. Only 41.4% of the deaths from active tuberculosis were correctly certified in government hospitals. Medically inspected and certified deaths from tuberculosis is an unreliable indicator of tuberculosis mortality because of inaccuracies in death certification, tuberculosis deaths occurring outside hospital and tuberculosis patients undiagnosed until after death.
Anti-HCV antibody was detected in 1.9% of the blood donors in University Hospital. Among the risk groups, 33.3% of the patients with post-transfusion hepatitis were tested positive for anti-HCV antibody. The anti-HCV antibody was detected in 30% of the IDU. Haemodialysis patients, patients with acute and chronic hepatitis and patients with liver cirrhosis appeared to have increased risk of Hepatitis C virus infection. The results indicate that the frequency of HCV infection increases with the exposure to blood or blood products.
The spread of HIV infection into Malaysia is estimated to have occurred in the early 1980's. The first case of AIDS was reported here in 1986. As of March 31, 1994, the numbers have increased to 8049 HIV positive individuals detected in the country. The risk behaviours among those tested positive were intravenous drug use in 77.2%, sexual transmission in 4.5%, while the remainder are still under investigation. Pediatric AIDS constitutes 0.2% of positives. The high prevalence among intravenous drug users (IVDU) is likely to be due to mandatory testing for HIV upon entry to rehabilitation centres. The trend of HIV infection in this country seems to be highest amongst the intravenous drug users. The increasing number of HIV infected prostitutes and heterosexuals in our population is worrying. Since 1986, a total of 104 HIV positive individuals have been treated at the University Hospital, Kuala Lumpur, Malaysia. Of these, 25 have died and of those still alive, 5 have symptomatic disease. The most common AIDS-defining illness is Pneumocystis carinii pneumonia. Education programmes have been developed targeting the various high risk groups and the general population.
To examine the risk factors of HIV type-I infection among male drug addicts in Malaysia, a case-control study was conducted on inmates, aged 20-40 years, at a drug rehabilitation centre in January, 1994. Stratified random sampling was performed. A total of 87 cases and 261 controls, chosen by frequency matching for age and ethnicity, answered self-administered questionnaires. About 59.8% of the subjects administered drugs intravenously and of these, 71.2% shared needles. Practices significantly associated with HIV infection were needle-sharing (OR = 8.53; 95% CI = 3.36-5.52), sexual relationship with prostitutes (OR = 3.70; 95% CI = 2.10-6.56), homosexuality (OR = 4.05; 95% CI = 1.49-11.11) and non-condom use while having sex with prostitutes (OR = 2.27; 95% CI = 1.05-4.97).
In hookworm endemic areas where sanitation is often wanting, reinfection of treated children is a problem. This study was conducted to enumerate the prevalence and the reinfection rate of hookworm in 193 Orang Asli children following treatment with stat dose of 400mg of albendazole at 2 and 4 months post-treatment. All samples were examined using the Kato-Katz and Harada Mori techniques. The overall initial prevalence was 31.0%, with 27.0% in males and 34.0% in females although there was no statistical difference. Only 7.0% of the children had moderate intensity of infection. The overall infection rate at 2 and 4 months post-treatment was 11.0% and 8.0%. New cases were detected at 1.0% and 5.0% at 2 and 4 months post-treatment period. Reinfection rate 2 months post-treatment was 24.0%, and it was 30.0%, 4 months after treatment. All infection at 2 and 4 months post-treatment were light. Long-term strategies incorporating health education on personal hygiene, provision of toilets and safe water supply need to be adopted in these Orang Asli villages to control rapid reinfection.
The management of abdominal aortic aneurysms (AAA) at a private medical centre was reviewed. The criteria for surgery were AAA more than or equal to five centimeters in diameter, symptomatic AAA even if less than five centimeters and ruptured AAA. A total of 67 patients were seen between October 1991 to September 1994. The age range was 48 to 94 years, mean = 69.8. There were 58 males to nine females. Twelve patients presented with ruptured AAA. There were three suprarenal AAA and three mycotic AAA. Aneurysmectomies were performed on 50 patients. This include all patients with ruptured AAA. There was no mortality in the elective cases. One patient with ruptured AAA died, ie. an operative mortality of eight per cent. It was concluded that a very low operative mortality can be achieved in this group of high risk patients. Our results were comparable to those reported by other centres in the developed countries. Important factors contributing to these results include a team approach in a unit interested in this disease, careful pre-operative preparation and a rigid post-operative regime. For ruptured AAA, survival of the patient depended on a successful and timely operation. It was also concluded that no patient should be deemed unfit for surgery or denied an operation if they needed to have one and it was safe to transport patients with ruptured AAA to a centre where the operation can be performed.
The aim of this study was to examine the relationship between the level of stress experienced by rescue workers after the collapse of a 13 story condominium in Kuala Lumpur, and other probable risk factors. Within a month of the incident, 123 firefighters filled up the Impact of Life Event score (Horowitz) and the General Health Questionnaire (GHQ). The results indicated that 7 (6%) firemen could be classified as possible 'cases' on the GHQ, and significantly 5 from this group also scored highly on the impact of events score. No other risk factors were identified in the firemen. On conclusion, the GHQ can be used to screen those with high impact scores to pick up possible cases early enough, so that intervention can be successful.
A demographic and obstetric profile of pregnant mothers attending antenatal clinics in Kelantan over period of one year was determined by a retrospective study of 10,032 registered pregnant mothers. The prevalence of risk factors related to the age of the mother, parity, weight, haemoglobin level, bad obstetric history and pregnancy related diseases were determined. Prevalence of teenage pregnancy and primigravida accounted for 4.3 and 17.2 percent respectively. Nearly 3.9 percent of the mothers weighed less than 40 kg and 44.5 percent of mothers were found to be anaemic (Hb less than 11g/d) at the first antenatal visit. Only 3.2 percent of the mothers did not have any designated risk factor. Previous bad obstetric history and pregnancy related disease accounted for 17.1 and 3.5 percent of mothers respectively.
Study site: Antenatal clinics, klinik kesihatan, Kelantan, Malaysia