A study was done on 638 infants with BCG related lymphadenitis seen between August 1990 and December 1993. Most infants (86.5%) had developed symptoms by six months after vaccination and the nodes became suppurative in 317. Surgical procedures were carried out in 82 cases and the rest were managed conservatively. The mean duration to resolution was 6.6 months (range 1 to 29 months). This outbreak was related to a change from the Japan to the Pasteur strain of BCG. The incidence remained high ( > 15 per 1000 live births) despite a dose reduction from 0.1 ml to 0.05 ml, but declined when the Japan strain was reintroduced in April 1992.
Study site: Chest Clinic, Hospital Pulau Pinang, Malaysia
A prospective study was carried out in the Maternity Hospital, Kuala Lumpur in 1989 to determine the morbidity and mortality of infants of diabetic mothers. Out of 24,856 neonates born during the study period, 54 neonates (2.2 per 1000 livebirths) were born to mothers who were diagnosed to have diabetes mellitus before the current pregnancy or who had impaired glucose tolerance test during the current pregnancy. Almost a third (29.6 percent) of these infants of diabetic mothers had birthweight of 4000 grams and above, and 37.0 percent of the 54 babies were large-for-gestational age. Hypoglycemia occurred in 9/54 (16.7 percent) of the neonates, respiratory distress syndrome in 5/54 (9.3 percent), shoulder dystocia in 7/54 (13.0 percent), and congenital abnormalities in 4/54 (7.4 percent). Three (5.6 percent) neonates died during the neonatal period. The results of this study suggest a need to intensify control of maternal diabetes mellitus during pregnancy in order to reduce the rates of morbidity and mortality of their infants.
Beta-lactamase production is one of the major mechanisms of resistance amongst bacteria especially the enteric bacilli. The purpose of this study is to assess the in-vitro activity of Sulperazon, a combination of cefoperazone and an irreversible beta-lactamase inhibitor, sulbactam, against the cefoperazone resistant isolates of aerobic gram-negative bacilli. A total of 92 such strains were tested. It was found that at a concentration of < or = 8 mg/l of sulbactam added to cefoperazone 82% of Klebsiella spp, 100% of E. coli, 100% of Enterobacter spp, 33% of Pseudomonas aeruginosa, 67% of Pseudomonas spp and 62% of Acinetobacter spp that were resistant to cefoperazone alone were susceptible to the combination. Hence it is concluded that the addition of sulbactam to cefoperazone does expand the spectrum of the in-vitro activity of cefoperazone.
BACKGROUND: The benefit of adding theophylline to beta 2 agonists in acute asthmatic attacks has been debated frequently.
METHODS: In an open randomised study 25 patients with severe acute asthma who presented to the emergency department were treated with either a combined nebulised salbutamol (5 mg/dose) and aminophylline infusion (0.6-0.9 mg/kg/hour), or nebulised salbutamol alone.
RESULTS: The responses to treatment as measured by peak expiratory flow (PEF) and the time taken to achieve maximum PEF were similar in both groups. Side effects were observed more commonly in patients receiving the combined treatment.
CONCLUSIONS: Nebulised salbutamol is equally efficacious in acute asthma when given alone or in combination with aminophylline.
Study site: Emergency department, Hospital Kuala Lumpur, Malaysia
Between January 1990 and December 1991, 100 cases of extrapulmonary tuberculosis were identified at the General Hospital Kota Bharu representing 11% of all the newly diagnosed tuberculosis. It was commonest in the third decade of life and the sites involved were the lymph nodes (34%), osteoarticular (14%), miliary (12%) and pleura (10%). Tuberculous lymphadenitis appears to be more common in females and younger patients. Fourteen patients had concurrent active pulmonary tuberculosis and in 36 others the chest X-rays showed satisfactory response to standard chemotherapy. Six patients died and six were lost to follow-up.
Two identical groups of females underwent caesarean operations. One group was induced with propofol 2.04 (SD 0.023) mg per kilogram and the other group induced with methohexitone 1.05 (SD 0.15) mg per kilogram body weight. Maintenance of anaesthesia was identical in both groups. Post-intubation blood pressure in the methohexitone group was significantly raised whereas with propofol the changes were not significant. There were no significant differences in the Apgar scores, uterine contractility and umbilical venous or arterial blood gases. There was a significant difference in the analgesic requirement in the first hour of the post-operative period; in the propofol group, patients needed less analgesia compared to the methohexitone group. There was no maternal awareness in both groups.
A prospective randomised controlled study was conducted over a 6 month period on the value of administering prophylactic antibiotics in patients undergoing emergency caesarean section at the Ipoh General Hospital. A total of 222 patients were randomised to receive 24 hours of ampicillin (500 mg per dose), cefoperazone (1 gm per dose) or no antibiotics. In all parameters of patient morbidity, the group receiving cefoperazone showed significantly better results as compared to the group not receiving antibiotics. The ampicillin group also had favourable results but generally not achieving statistical significance. Prophylactic antibiotics appear to be beneficial and consideration should be given to make it a routine in all emergency caesarean sections.
The reactions of 117 parents to the febrile seizure experienced by their children; and their fears and worries were investigated. A standard questionnaire was used and clinical information was abstracted from the notes. In 88.9% of the cases, the adult present at the seizure was one of the parents usually the mother. Most of the parents (66.7%) did tepid sponging to bring the fever down but a third tried to open the clenched teeth of the child. The adults present placed the child supine in 62.9%, on the side in 9.5% and prone in 6.0%. Over half of the parents brought the child to a private clinic first before bringing to hospital. A fifth of the children were given antipyretics by the parent or the doctor and an anticonvulsant was given in 7.7% of cases. Interestingly, in 12% of children traditional treatment was given for the seizure. Three quarters of the parents knew that the febrile seizure was caused by high fever (which we have taken as the correct knowledge of febrile seizure). However "ghosts" and "spirits" were blamed as the cause of the seizure by 7% of parents. Factors significantly associated with correct knowledge were higher parental education and higher family income. The most common fear expressed was that the child might be dead or might die from the seizure (70.9%). Fear of death was associated with low paternal education. We concluded that the majority of our parents had reacted appropriately to a febrile seizure and their knowledge of the cause of febrile seizure was generally correct. Their fears and worries were similar to those elsewhere. However, traditional beliefs and practices may have to be taken into consideration during counselling.
First six cases of neonatal group B beta-haemolytic streptococcal sepsis in GHKL & Maternity Hospital K.L. were reported and in one third, it was fatal. Five of the cases were 'early - onset' type and one was 'late - onset' type. While maternal infant transmission of the disease is important in the 'early - onset' type, environmental sources of infection are also significant. No gestational age or birthweight is spared from the disease. Finally, there are cases of 'early - onset' GBS sepsis presenting like hyaline membrane disease of the newborn and it is important to find ways to distinguish them which so far has not been satisfactory.
Previous studies in Malaysia and in Singapore report a higher schizophrenic admission rate for males than for females and this is in contrast to findings in Western societies. Characteristics by age, sex and race of 5% and 619 first schizophrenic admissions during 1977 and 1978 respectively to the Psychiatric Department, General Hospital, Kuala Lumpur were examined. It was found that the male to female sex ratio for Malay schizophrenic admissions was significantly higher than male to female sex ratio for Malays to other departments of the hospital. A similar trend for the Chinese did not reach significance. Possible reasons for these findings are discussed.
Two-hundred and sixty-five patients with asymptomatic proteinuria and/or haematuria were studied at the Department of Medicine, Universiti Kebangsaan Malaysia and Department of Nephrology, General Hospital Kuala Lumpur. They represented 25.4% of all the renal biopsies performed during the period 1980-88. All the three races were affected with 71.3% occurring between the ages of 20-39 years and 41.1% were detected during routine medical examination. Excluding those patients with lupus nephritis, IgA nephropathy was the commonest histological diagnosis (51.7%). The presence of severe and advanced histological changes in a significant number of biopsies emphasises the need for more effective screening and early referral of this group of patients.
The use of pressurised metered dose inhalers was assessed among 93 asthmatic patients attending the respiratory out patient clinic between January to October 1989. They were regular users of the inhalers prior to the assessment. 62.4% of the patients were found to use the inhalers incorrectly. Forty three percent made more than one error. The commonest error observed was the failure to actuate and inhale the aerosol together in 41.9%. There was no difference in the occurrence of incorrect performance between different sexes, age groups, duration of inhaler used and previous supervision or no supervision by the doctors.
Study site: Respiratory clinic, Hospital Kuala Lumpur (UKM), Malaysia
A six-month survey of 828 patients admitted to the Coronary Care Unit (CCU) of the General Hospital, Kuala Lumpur was carried out to ascertain whether the smoking habits of the patients predisposed them to definite coronary events and its immediate outcome i.e. early mortality (within seven days). The various ethnic groups were also screened to determine if they were at increased risk to coronary events in relation to other known risk factors. Three hundred and eleven patients - 239 males, and 72 females - had confirmed acute myocardial infarctions of whom 190 were smokers (172 males, and 18 females). Sixty-nine infarct patients died within the first seven days post-Ml: 35 were smokers (50.7%). Two-hundred and eighty other patients had non-infarct coronary events. Of these, 167 were smokers. In contrast, only 99 out of 237 patients admitted for non-coronary events, were smokers. It thus appeared that patients admitted to the CCU for suspected cardiac events had a greater incidence of confirmed acute myocardial infarction or acute coronary events if they were smokers (p < 0.001). Mortality from these coronary events was not seen to increase among smokers in this population sample. Women who smoked as a whole, were not found to be at increased risk to coronary events, but women smokers 60 years and older were shown to be at increased risk to developing confirmed coronary events (p < 0.01).
We report a case of systemic lupus erythematosus complicated by transverse myelopathy and hyperphagia. To our knowledge the latter has not been reported before.
A case of paranoid psychosis in myxoedema is described. Though depression is commonly encountered in myxoedema, the disorder can also manifest itself with schizophrenic features; this can lead to problems in diagnosis and management.
The clinical presentation of patients with bilateral stones is discussed. The majority of patients presenting to the Nephrology Unit were in renal failure. Aggressive medical treatment allowed
diagnostic procedures and definitive surgery to be performed in uraemic patients. Most patients presenting in uraemia benefitted from treatment.
Study Site: Urology Unit, General Hospital, Kuala Lumpur, Malaysia
Between 1980-1986, 219 renal biopsies were performed on patients with lupus nephritis (LN) presenting at the General Hospital, Kuala Lumpur. There were 172 (78.5%) females and 47 (21.5%) males. The ethnic distribution of 48.4% Malays, 46.1% Chinese and 5.5% Indians reflected their proportional composition in the general population. Peak incidence (40.6%) of cases occurred in the third decade of life (20-29 group) followed by 26.5% and 20.1% in the second and fourth decades respectively. The median age was 24 for females and 27 for males. In both sexes, nephrotic syndrome was the commonest mode of presentation (62.2%) followed by proteinuria (20.5%). Acute oliguric renal failure occurred in 11 patients (5%) and 8 of these showed crescentic glomerulonephritis with more than 50% crescents. The commonest histological picture was diffuse proliferative LN (WHO Stage IV-44.7%) which included 70% (19/27) of those with crescentic disease. This was followed by membranous LN (28.8%) of which 6 (all males) had crescentic disease. 7 (12.3%) of our patients had crescentic nephritis with a female to male distribution of 14: 13, suggesting either more aggressive disease or delayed diagnosis in males.
Key words - Renal biopsies, lupus nephritis, nephrotic syndrome, proteinuria.
We present four cases of polymyalgia rheumatica who recently came under our care. The dramatic response of this disorder to low dose corticosteroids is well illustrated by our patients. The pertinent features of diagnostic value in this condition are highlighted.