A survey of 25,246 Malay, Chinese and Indian children and adults ranging from birth to over 60 years of age, of both sexes, from 4 types of communities with different conditions of environmental sanitation and socio-economic status revealed an overall incidence of infection with soil-transmitted helminths of 39.6 percent. The incidence of soil-transmitted helminthiasis was highest among rural rubber estates, followed closely by the urban slums or squatter areas and incidence of infection was low in the semi-rural new villages and the urban flats. The commonest helminth in all these areas was Trichuris trichiura and the commonest type of helminthic infection was mixed infections with Ascaris and Trichuris. Infection was most prevalent among Indians, followed closely by Malays. Chinese generally had lower incidences of infection. Soil-transmitted helminthiasis was also more prevalent among the younger age groups, starting from toddlers to 9 years and rising to a peak in the 10-19 years age group. Elderly people (60 years and above) from the squatter areas and some ofthe estates, new villages andflats also had a higher incidence of infection than the older adults (30-59 years). Malay and Indian children (under 15 years of age) having a higher overall incidence of injection also tended to have higher degrees of infection, as estimated by egg counts. There was no significant differences in the distribution of infection between males and females in most of the study areas. However, females in the squatter areas had a higher incidence of infection than males. Conversely, females in some of the flats (Sri Melati and Shaw Road) had a lower incidence of infection than males.
Morphological and neuroelectrical changes of the skeletal muscle fibres after various types of injury to the nerve was studied in monkey. The percentage of normal and atrophic muscle fibres after various types of injury to the nerve was compared with the proportion of innervated and denervated muscle as shown by the position of the bend (kink) on the I.D. at corresponding stages. It was found that the pattern and the position of the I.D. curve when considered together only gave an approximate estimation of the proportion of all innervated and denervated muscle fibres as well as the condition ofthe muscle after denervation.
Two cases of Syndromes of Ophthalmoplegia , Ataxia and Areflexia were reported. A brief discussion on its clinical feature and differential diagnosis was made.
A retrospective study of 62 cases of myasthenia gravis in Malaysia is reviewed. It shows an apparent prevalence among the ethnic Chinese compared with the Malay and Indian. The incidence of male and female and their average age of onset are similar. Unlike the western figure, among those with age of onset less than 20 years. both sexes are equally affected. The symptomatology, morbidity and mortality and incidence of thymoma are the same as those
reported elsewhere.
This study was proposed to identify specific radiological appearances in Malaysian patients with bronchial asthma. All consecutive patients, seen in the Medical Unit, Universiti Kebangsaan Malaysia between 1976 and 1979, satisfying the American Thoracic Society [1962] criteria for bronchial asthma formed the subjects of this study. Analysis of 207 patients led to the following conclusion. There are specific radiological changes present in a proportion of bronchial asthmatics during the acute episode. These changes are more frequent in the younger age group and in those in which the age of onset are early, The duration of asthma seems to have some bearing to the radiological changes.
A 103 year old patient was admitted with pain in the right iliac fossa. There was no response to conservative treatment. Subsequent laparatomy showed the presence of a perforated ulcer in the pyloric region. The condition improved gradually after the surgical management.
A 17 year old male with ataxia telangiectasia [Louis-Bar Syndrome] is presented here with a review of the literature with regards to the mode of inheritance, clinical manifestations, diagnosis and treatment of this disorder.
An Indian family with four members having hereditary ataxia was presented. The inheritance was most likely autosomal dominant. The onset was at adult life. The main disability was cerebellar ataxia with pyramidal tract sign found at physical examination. Electroencephalography and nerve conduction study were abnormal in two cases where they were done. The clinical feature correspond to an intermediate form of hereditary ataxia.
A pilot study was conducted based on a questionnaire sent to Malaysian physicians surveying their opinions on 1) the value of traditional Malay medicine and 2) the role of auxiliary cosmopolitan health care practitioners-- Hospital Assistants (HA), in rural health care. The 98 responses (23%) can not be held representative of all Malaysian physicians, but emphasize the need for a more thorough survey. Three-fourths of the responding physicians found it of potential value to have their patients see a traditional Malay healer (bomoh) in certain circumstances and a majority supported closer contact between traditional Malay and cosmopolitan medical systems, particularly in the area of mental health care. The majority of physician respondants did not see the role of the HA as permanent and stated. that HAs should gradually be replaced by physicians. More general practitioners and physicians now practicing in rural areas held this opinion than physicians in other specialties. The issues of the appropriate roles and interrelationships of HAs and tradtional Malay folk healers within an overall health care system are complex, yet pertinent to the future of rural health care in Malaysia and warrant further study and consideration.
The high incidence of primary liver cancer in Malaysian males is not observed in childhood, where it constitutes 0.16 per 1000 paediatric hospital admissions and 3.20/0 of all childhood malignancies at the University Hospital, Kuala Lumpur. This frequency is comparable to that reported from several developed countries. The commonest liver tumour in children is the hepatoblastoma which is probably of embryonal origin and has a similar world wide "incidence. The relative infrequency of hepatocellular carcinoma in childhood and its association with cirrhosis, the hepatitis B antigen and its prevalence in the older age group helps to substantiate an acquired environmental aetiology.
279 cases of pulmonary tuberculosis were diagnosed during a 10 year period from 1969 to 1978. 60% as a result of self-referral and 40% from mass miniature radiography of the chest. For every case of pulmonary tuberculosis picked up, the number of MMRs required has been steadily rising from 1 in 1900 to 1 in 6700. Using South Korea study figures, it costs US$42600 for a case of pulmonary tuberculosis detected by MMR. Besides being not cost effective, there is little advantage in early detection with regard to prognosis, in preventing subsequent cases and in picking up other lung or cardiac abnormalities. Unnecessary radiation results from frequent MMR whose dosage is 10 or more times greater than standard chest X-rays. MMR should be limited to. contact tracing, prior to overseas courses and on termination of service.
Study site: medical boards submitted to Medical Directorate, Ministry of Defence, Malaysia
The presence, in the fruit of Averrhoa carambola (star fruit), of a depressant agent with properties similar to those of tranquilizers was demonstrated.
An audit of diabetes care was done in a hospital to assess its effectiveness. The results revealed that diabetic patients received less than adequate care. Only 9% of the patients achieved good glycaemic control; 39% had hypertriglyceridemia and 65% had undesirable weight gain while on treatment. The average duration of diabetes in this group of young diabetic patients under study was only 4.5 years, yet 12% of them had evidence of diabetic retinopathy. Few patients possessed adequate knowledge and skills of diabetes self-care. No patients could draw up and mix insulin adequately. Only one patient could self-inject insulin correctly. Few understood the nature of hypoglycaemia, hence few took adequate precaution against it. Patients had frequent hypoglycaemia; 61% had at least one episode per week and 56% of the diabetic drivers admitted to occurrence of hypoglycaemia while driving. No patient understood the principle of diabetic diet therapy, nor did they carry out regular home-monitoring of their diabetes. Good diabetes care requires organisation with supportive patient education. The less than adequate standard of care achieved by the hospital under study is probably explained by the absence of both.
Study site: Outpatient clinic, Hospital Mentakab, Pahang, Malaysia
Twenty two Muslim diabetic patients on oral hypoglycaemic agents were studied during the fasting month of Ramadan to determine the effect of fasting on their diabetic control. All the patients completed their fast during the month. Their mean (+/- standard deviation) blood glucose, serum fructosamine and body weight before the fasting month were 10.7 +/- 4.6 mmol/l, 6.64 +/- 3.64 mmol/l and 60.5 +/- 12.6 kg and by the end of the fasting month were 10.9 +/- 4.4 mmol/1,4.34 +/- 1.08 mmol/l and 59.8 +/- 12.3 kg respectively. There was no significant difference between the blood glucose levels but there were significant reductions in the mean body weight and fructosamine values (p = 0.01 and p = 0.03 respectively). The mean decrease in body weight and fructosamine were 0.7 +/- 1.3 kg and 2.29 +/- 3.09 mmol/l respectively. There were also statistically significant differences between the mean daily calorie content before the fasting and during the fasting month (1480 +/- 326 vs 1193 +/- 378 Cal/day - p less than 0.005) and between the mean daily carbohydrate content (389 +/- 298 vs 187 +/- 46 gm/day - p less than 0.005). In conclusion, fasting was safe for diabetic patients on oral hypoglycaemic agents and it was associated with weight reduction and improvement in the overall diabetic control. This was most likely due to decrease in food intake.