The prevalence of Enterotoxigenic Escherichia coli (ETEC) in 433 stool samples from diarrhoeal cases of all ages was studied using two commercially available test kits for the detection of heat labile toxin (LT) and the infant mouse assay for the heat stable toxin (ST). 16 samples (3.7%) were positive for ETEC, of which nine were producing ST alone, six LT alone and only one was producing both LT and ST. Although the percentage of isolation rate was low, its occurrence was almost as common as the Shigella spp and Salmonella spp in the same study. Of the two test kits examined, the Phadebact ETEC-LT Test 50 (Pharmacia Diagnostics, Uppsala, Sweden) was found to be more suitable for use in a routine diagnostic laboratory. Ten out of 12 (83%) of the strains tested were resistant to one or more antibiotics.
This report deals with the use of a relatively new investigative technique (Doppler ultrasound) in the management of a case of early onset pre-eclampsia and discusses the benefit of this new technique over conventional methods of fetal monitoring.
Existing criteria for admission of newborns to the special care nursery, Sarawak General Hospital, resulted in the admission of many neonates with certain risk factors ("at risk" neonates). To test whether such babies could be safely and better cared for in postnatal wards, 392 of these babies were randomly allocated into two groups. One group of 196 was admitted to the special care nursery and the other group of 196 was cared for with their mothers in the postnatal wards. The two groups were compared for mortality, morbidity and breastfeeding. There was no significant difference in mortality and morbidity between the two groups. While in hospital a larger proportion of babies cared for in postnatal wards were breastfed, compared to babies admitted to the special care nursery. In addition, they initiated their breastfeeding earlier. Babies with these risk factors should therefore be cared for with their mothers in the postnatal wards.
Chronic lymphocytic leukaemia (CLL) is rare locally. Seven CLL patients which constituted 0.9% of the total 747 cases of leukaemic patients were diagnosed over a 5 year period. They had similar haematological profiles as Western patients though most of them had advanced disease at presentation. Treatment of CLL patients was palliative and should be reserved for symptomatic patients and/or patients with progressive disease.
The presenting features of 236 thyrotoxic patients seen in the thyroid clinic were reviewed. 18.65% of these patterns had one or more dermatological complaints at presentation. There was no specific difference in this group of patients when compared with the general hyperthyroid population with regard to age, race, sex, duration of hyperthyroidism or biochemical indices of thyrotoxicosis. The two major complaints were itching and alopecia. The prevalence of pruritus at 6.4% in our series was identical to that of other workers, but we had a much lower occurrence of alopecia at 2.6%. The diagnosis of thyrotoxicosis was delayed in two patients in whom the only major complaint was pruritus. These symptoms cleared quickly when these patients became euthyroid. However there were other patients who noted hair loss with anti-thyroid medications. The incidence of vitiligo, eczema, onycholysis in our series was much lower those quoted in the Western literature The occurrence of pretibial myoxoedema in our series is similar to that of other workers from this region. The other miscellaneous manifestations include urticaria, xanthelasma and systemic lupus erythematosis. In conclusion we feel the cutaneous manifestations of hyperthyroidism are common in our patients.
On the basis of a questionnaire on smoking behaviour, knowledge and attitudes administered to medical students in the University of Malaya in July 1987, the prevalence of smoking was found to be low (10%) among medical students. Smokers and non-smokers were equally well informed about common smoking complications. Most students, irrespective of smoking status, felt that they would as future doctors, often advise sick smokers against smoking. In contrast, less than half would do so for healthy smokers who do not themselves raise the question of smoking. The students' personal smoking behaviour also influenced their view of their professional role. Appropriate values, attitudes and a preventive approach towards smoking need to be further developed in the medical students' thinking and behaviour.
A survey was conducted to investigate the prevalence of Enterobius vermicularis in 1352 Chinese children between the ages of 6-12 years from the three National Type Chinese Primary Schools in Pulau Ketam in 1988, using the scotch-tape technique on three successive days. The overall prevalence was high (56.88%). The prevalence in Sin Bin School was significantly lower (50.86%) compared to the other two schools (56.60% and 61.04%). Prevalence was significantly higher amongst the 6-7 years age group (61.61%-70.18%) compared to other age groups (47.9%-59.29%). There was no difference in the prevalence between the boys and girls being 56.15% and 57.55% respectively.
Four cases of acute viral myocarditis were diagnosed within three weeks. The clinical features, electrocardiography, cardiac enzymes and other laboratory investigations are described.
Nasopharyngeal carcinoma (NPC) is one of the commonest presentation of head and neck cancers in Malaysia, especially in the Chinese. The standard treatment is radical radiotherapy to the post-nasal space and the neck. Chemotherapy is given to patients with primary advanced disease and to patients with recurrence. The study reviews results of chemotherapy given to 33 patients at the University Hospital, Kuala Lumpur, over the last four years.
A prospective study to correlate clinical digoxin toxicity with serum digoxin levels was carried out in 67 patients of whom 24 were clinically toxic and 43 were asymptomatic. The patients were clinically diagnosed to be toxic based on typical cardiac arrhythmias (n = 11) or non-cardiac symptoms (n = 13). Blood samples were collected at least six hours after the last digoxin dose and the sera assayed for digoxin using a radioimmunoassay method. The mean serum digoxin level in the toxic group (x1 = 2.09 +/- 1.28 ng/ml) was significantly higher than in the non-toxic group (x2 = 1.20 +/- 0.75 ng/ml), p less than 0.01. All the non-toxic patients had serum digoxin levels below 3 ng/ml. However, there was a considerable overlap of serum digoxin levels between the two groups of patients. Serum level cannot be the sole criterion in diagnosing digoxin toxicity. Nevertheless, raised serum digoxin levels especially above 3 ng/ml, in the presence of suggestive clinical features is strongly suggestive of toxicity.
Twenty patients undergoing various surgical procedures were anaesthetised using hypotensive anaesthesia using labetalol and halothane. The technique is safe, predictable and cheap. This technique also offers the advantage of usage of less blood, thus minimising the complications of transfusion induced diseases like hepatitis and AIDS.
The severity of anxiety and depression in 72 patients presenting with somatic complaints to the psychiatric clinic were assessed after excluding organic illnesses. Majority of the patients were females, between 15 to 34 years of age and came from lower socio-economic background. A high percentage of patients were brought up by dominant mothers and the married patients had passive husbands or active wives controlling the family. Generally the severity of depression was correlated with the severity of anxiety (C.C = 0.704, P less than 0.01). Majority of the patients were found to have both mixed anxiety depressive symptoms and the anxiety symptoms masking the underlying depressive symptomatology.
Study site: Psychiatric Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
An outbreak of yaws consisting of ten active cases in Baling is described. Yaws should be suspected and considered in the differential diagnosis of sores in the limbs of children living in rural areas. The clinical features of yaws are highlighted to help in the recognition of the condition for those unfamiliar with the condition.
62 cases of polycystic ovary syndrome (PCO) were reviewed with regards to their clinical and endocrine features. The subgroup of patients with acanthosis nigricans (AN) was further studied in detail. The prevalence of the syndrome was significantly higher in the Indian (35.5% of cases). Obesity, AN, hirsutism, non-insulin dependent diabetes mellitus (NIDDM) and raised level of serum testosterone were present in 77.1%, 74%, 79%, 21% and 48% of the cases respectively. Patients with AN was associated with higher body mass index, serum testosterone level, and prevalence of hirsutism and NIDDM than patients without AN. These observations are in keeping with the hypothesis that hyperinsulinemia may be of importance in the pathogenesis of a sub-group of PCO associated with insulin resistant states.
Ludwig's angina is a potentially lethal oro-facial cellulitis due to oro-dental infection. The aetiology and management of a case of Ludwig's angina are briefly discussed.
A 44 year old lady with primary hypothyroidism presented with massive pericardial effusion without cardiac tamponade. Pericardial tap was done twice and the effusion resolved as the hypothyroid state improved. She remained hypertensive despite the euthyroid state. She was discharged well with L-thyroxine and anti-hypertensive therapy.
The use of tissue adhesives has been widely studied since the 1960s. Since then they have found use in specialties like plastic surgery, neurosurgery, ENT surgery and dental surgery. Several papers have reported their safe use, both clinically and experimentally, particularly of the newer homologue n-butyl/2-cyanoacrylate (Histoacryl). In this study 43 patients (46 wounds) whose operations involved a groin incision were randomised into two groups for skin closure either with Dexon subcuticular suture (23 wounds) or Histoacryl glue (23 wounds). We found that both sets of wounds healed well with no wound infections or excessive inflammation when assessed at one week and four weeks. However the glued wounds had consistently better cosmesis scores (mean score 4.71 at four weeks) compared to the subcuticular Dexon wounds (mean score 4.00 at four weeks) and P value of less than 0.05. We feel that there is a place for tissue adhesives in skin closure for some general surgical wounds.
This paper discusses the spectrum of rheumatic diseases seen over a 24-month period from January 1986 to December 1987. Rheumatoid arthritis was the commonest rheumatic disorder seen, comprising of 47.1 % of all cases and ankylosing spondylitis was among the least frequent (0.9%). Most of the rheumatic diseases reported in the West are also seen in Malaysia. However, results of this study which is based on the hospital population may not be representative of the spectrum of rheumatic diseases in the our population.
Key words: Epidemiology, occurence, rheumatic diseases, Malaysia
Study site: Rheumatology clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia