The Malaysian people consist of several ethnic groups including the Malay, the Chinese, the Indian and the Orang Asli (aboriginal Malaysians). We collected blood samples from outpatients of 2 hospitals in the State of Selangor and identified 27 glucose-6-phosphate dehydrogenase (G6PD)-deficient subjects among these ethnic groups. In the Malay, G6PD Viangchan (871GA, 1311CT, IVS11 nt93TC) and G6PD Mahidol (487GA) types, which are common in Cambodia and Myanmar, respectively, were detected. The Malay also had both subtypes of G6PD Mediterranean:the Mediterranean subtype (563CT, 1311CT, IVS11 nt93TC) and the Indo-Pakistan subtype (563CT, 1311C, IVS11 nt93T). In Malaysians of Chinese background, G6PD Kaiping (1388GA), G6PD Canton (1376GT) and G6PD Gaohe (95AG), which are common in China, were detected. Indian Malaysians possessed G6PD Mediterranean (Indo-Pakistan subtype) and G6PD Namoru (208TC), a few cases of which had been reported in Vanuatu and many in India. Our findings indicate that G6PD Namoru occurs in India and flows to Malaysia up to Vanuatu. We also discovered 5 G6PD-deficient cases with 2 nucleotide substitutions of 1311CT and IVS11 nt93TC, but without amino-acid substitution in the G6PD molecule. These results indicate that the Malaysian people have incorporated many ancestors in terms of G6PD variants.
A 62-year-old man presented with continuous, persistent backache shortly after completion of antituberculosis medication for tuberculosis (TB) of the spine. Computed tomography scan revealed a pseudoaneurysm involving the infrarenal aorta. He was restarted on anti-TB medication and underwent repair of the pseudoaneurysm with an in situ silver-coated bifurcated Dacron graft. His postoperative recovery was uneventful and he remained well up to 12 months of follow up. To our knowledge, this is the first case in the literature where an in situ silver-impregnated vascular graft has been successfully used in treating a tuberculous pseudoaneurysm.
Hepatitis C virus infection is a major health problem worldwide. The current study estimated seroprevalence of Hepatitis C virus (HCV) and evaluated associated factors among volunteer blood donors of the Northwest Frontier Province (NWFP), Pakistan. Of 1,131 volunteer blood donors enrolled, 46 (4.1%) were positive for anti-HCV antibodies. Multivariate logistic regression analysis revealed that positive donors were more likely to be 27-32 years old or >32 years old, have had 1-2 injections or >2 injections in the past year, or 1-5 intravenous (IV) drips or >5 I/V drips in the past 5 years. Positive donors had a family history of jaundice and were more likely to have been shaved (facial and armpit) by barbers. There was high prevalence of anti-HCV antibodies among blood donors of the NWFP. Public awareness programs should target the identified risk factors to prevent HCV transmission. We highlight the weakness of the health care system for blood donation, as it does not offer any record management for donors.
Nipah encephalitis is a particular dangerous disease that affects animals and man. Fatal cases of the disease have been identified in the persons looking after pigs in the villages of Malaysia. The causative agent is presumably referred to as morbilliviruses of the Paramixoviridae family. Two hundred persons died among the ill patients with the signs of encephalitis. The principal hosts of the virus were fox-bats (Megaschiroptera) inhabiting in the surrounding forests. The present paper descries the epidemiological features of the disease, its clinical manifestations, abnormal anatomic changes, diagnosis, and implemented controlling measures.
The clinical outcome of bacteraemic patients is influenced by many factors. It is vital to know one's own local hospital epidemiological data so as to provide optimal care to the affected patients. This was a prospective, observational study carried out in the said patient population over a period of four months in the year 2005. One hundred and ninety one patients presented with bacteraemia over the study period. Fifty-two (27%) of the patients died. Mechanical ventilation, inappropriate empirical antibiotic usage, Chinese ethnicity and low serum albumin levels independently affected prognosis. These factors should alert physicians to those patients who require more intensive monitoring and care.
KEY WORDS:
Bacteraemia, Blood Culture Positive, Outcome, Risk factors, Kuala Lumpur, Malaysia
A mathematical model to describe the oscillatory bursting activity of pancreatic beta-cells is combined with a model of glucose regulation system in this work to study the bursting pattern under regulated extracellular glucose stimulation. The bursting electrical activity in beta-cells is crucial for the release of insulin, which acts to regulate the blood glucose level. Different types of bursting pattern have been observed experimentally in glucose-stimulated islets both in vivo and in vitro, and the variations in these patterns have been linked to changes in glucose level. The combined model in this study enables us to have a deeper understanding on the regime change of bursting pattern when glucose level changes due to hormonal regulation, especially in the postprandial state. This is especially important as the oscillatory components of electrical activity play significant physiological roles in insulin secretion and some components have been found to be lost in type 2 diabetic patients.
Chronic venous disorders are conditions of increasing prevalence in the developing world, and venous ulceration is the terminal sequel. Currently there are only limited data on all aspects of this from Southeast Asia. The aim of the present study was to assess differences in the demography and outcome between varicose vein surgery (VVS) and the relatively new endovenous laser therapy (EVT) in patients from Penang, Malaysia.
Prevention of cardiovascular disease by modifying its major risk factors, including serum cholesterol levels, is an important strategy. Regular intake of garlic has been suggested, but its impact on cholesterol levels has been inconsistent.
A study was undertaken to assess the accuracy of the Omron HEM-907 blood pressure measuring device for use in community studies. A modified version of the British Hypertension Society (BHS) and American Association for the Advancement Medical Instrumentation (AAMI) protocol for measuring the accuracy of a blood pressure measuring device was used. A total of 104 subjects were recruited from two clinics. Observer-observer agreement for readings within the 5 mmHg was good; 80.8% and 84.6% of systolic blood pressure (SBP) and diastolic blood pressure (DBP) agreement respectively. Of the two, the better observer-device agreement readings within the 5 mmHg were 66.4% and 50.0% for SBP and DBP respectively, giving an overall grade B. The mean differences and standard deviation of the differences were within < or =5 mmHg with a standard deviation (SD) of < or =8 mmHg. The Omron HEM-907 satisfied both the AAMI and BHS protocols for accuracy for a non-invasive blood pressure monitoring device using single observer readings.
Study site: Klinik Kesihatan Shah Alam, Selangor; Hypertension clinic, Hospital Kuala Lumpur, Malaysia
Device: Standard device: mercury sphygmomanometer (brand?); test device: oscillometric automated electronic BP monitor (Omron HEM-907).
Health care workers (HCW) are at high risk of acquiring blood-borne diseases. This study compared the risk of infection among HCW in different hospital units and also between HCW and students in medical fields. This cross-sectional study involved pre-tested questionnaires that were completed by 625 HCW and undergraduate students undergoing clinical attachments from February to August 2001. The respondents were separated into two groups: i) HCW from Hospital Kuala Lumpur, HKL (n=241) and Hospital Universiti Kebangsaan Malaysia, HUKM (n=153) ii) Medical students from Universiti Kebangsaan Malaysia, UKM (n=171) and HUKM student nurses (n=60). The results obtained showed that the risk of transmission of blood-borne infections varied significantly according to professional ranks (p<0.05) and to hospital units (p<0.05). The medical intensive care (ICU), haemodialysis, and nephrology and urology units had the highest scores for the risk of infection while the diagnostic laboratory had the lowest risk of infection (p<0.05). Preventive measures taken by the subjects in this study were not satisfactory especially with reference to the use of personal protective equipment and the practice of universal precautions.
Antibodies to the protozoan parasite, Toxoplasma gondii were assayed in sera of 200 goats, 100 pigs, 126 cattle from various states of Malaysia, and 135 dogs and 55 cats around Ipoh region using an indirect fluorescence antibody test (IFAT, cut-off titer 1:200); antibodies were found in 35.5% of goats, 14.5% cats, 9.6% dogs, 7.9% local cattle and 4% yellow cattle but not in pigs. Results indicate that infection is most prevalent in goats.
INTRODUCTION:
This study aimed to compare the detection rates of glucose-6-phosphate dehydrogenase (G6PD) deficiency in neonates by fluorescent spot test (FST), enzyme assay and molecular methods, and to identify which method was a significant predictor of severe hyperbilirubinaemia.
METHODS:
74 term infants of Chinese descent admitted with severe hyperbilirubinaemia (total serum bilirubin equal or greater than 300 micromol/L) and 125 healthy term infants born in the hospital without severe hyperbilirubinaemia were recruited into the study. Specimens of blood were collected from each infant for FST, G6PD enzyme assay and TaqMan minor groove binder single nucleotide polymorphism genotyping assay.
RESULTS:
26 (13.1 percent) infants were diagnosed to have G6PD deficiency by FST. They had significantly lower median enzyme levels (0.8 IU/g Hb, interquartile range [IQR] 0.4-4.3) than those diagnosed to be normal (12.0 IU/g Hb, IQR 10.3-15.8) (p-value is less than 0.0001). Based on the enzyme assay, 39 (19.6 percent) infants had G6PD deficiency at an enzyme cut-off level of less than 8.5 IU/g Hb. G6PD mutation was detected in 27 (13.6 percent) infants. Logistic regression analysis showed that the only significant predictors of severe hyperbilirubinaemia were G6PD deficiency based on a cut-off level of less than 8.5 IU/g Hb (adjusted odds ratio [OR] 5.3, 95 percent confidence interval [CI] 2.4-11.4; p-value is less than 0.0001) and exclusive breast-feeding (adjusted OR 11.4, 95 percent CI 3.1-42.4; p-value is less than 0.0001). The gender and birth weight of infants, FST results, G6PD mutation and the actual G6PD enzyme levels were not significant predictors.
CONCLUSION:
A G6PD enzyme level of less than 8.5 IU/g Hb is a significant predictor of severe hyperbilirubinaemia
Controversy surrounds the acceptance of hypertension as an independent risk factor for anaesthesia. In an attempt to identify variables that are associated with increased haemodynamic instability during surgery, the blood pressure profiles of 128 patients were analysed. The two variables that contributed most to the instability were pre-operative control of blood pressure and anaesthetic technique. To reduce the fluctuation in blood pressure, it is advisable for patients to be given a regional anaesthetic. Current therapy for hypertension appears to exaggerate the depressant effects of anaesthetic drugs. Care must be taken not only to prevent hypertensive episodes during surgery, but also hypotension.
An abnormal communication between an artery and a vein is known as arteriovenous malformation (AVM) or arteriovenous fistula (AVF). The AVM or the AVF might be congenital in origin or even acquired. The arteriovenous communications are usually surgically made in patients undergoing repeated hemodialysis, while suffering from any chronic renal disease. The abnormal arteriovenous communications may be asymptomatic in nature. The arteriovenous communications might be an incidental finding during any anatomical dissections or medico-legal autopsies. The present study reports the presence of BBC on both sides of a 54-year-old male cadaver who died of road traffic accident. There was a communication between the brachial artery and the brachial vein, 11.5 cm above the medial epicondyle. The oblique communicating channel measured 1.5 cm in length and connected the brachial artery to the brachial vein. A detailed histological study of the communication showed the presence of thick tunica media. Knowledge of arteriovenous communications may be beneficial for any academic studies and equally important for vascular surgeons and radiologists performing angiographic studies.
We report a case of a young hypertensive male who was first seen in 1998 with a right thalamic haemorrhage and uncontrolled hypertension. CT abdomen showed a right adrenal tumour and a hyperplastic left adrenal gland. Laparoscopic adrenalectomy performed followed by histopathological examination confirmed the diagnosis of adrenal adenoma. He subsequently presented to us again a year later with persistent hyperkalaemia and asymptomatic hyponatraemia. Further investigations strongly suggested the presence of isolated mineralocorticoid deficiency with normal cortisol levels. This was confirmed to be due to partial or late-onset congenital adrenal hyperplasia (CAH). We discuss the association of partial CAH and adrenal tumours and the unmasking of the mineralocorticoid deficiency following adrenalectomy.
A six year retrospective study of the demography, clinical and laboratory features of patients with systemic sclerosis (SSc) was carried out in Selayang Hospital. There were 61 cases seen between January 2000 and December 2005. Of these, 55 (90.2%) were females and 6 (9.8%) were males. Twenty-eight (45.9%) were Malays, 24 (39.3%) were Chinese and 9 (14.8%) were Indians. The mean age of onset was 38.8 years. Thirty-nine (64.0%) had limited cutaneous SSc, 21 (34.4%) had diffuse cutaneous SSc and one had localized morphoea. Raynaud's phenomenon was present in 82.6%, telangiectasia in 45.9%, calcinosis in 11.5%, sclerodactyly in 83.6%, digital pitting scars in 42.6%, digital infarcts/ulcers/gangrene in 23.0%, arthralgia/arthritis in 49.2% and gastroesophageal reflux disease (GERD) in 47.5%. Forty-three (70.5%) patients had interstitial lung disease. Seven patients had associated myositis, 7 systemic lupus erythematosus and 2 rheumatoid arthritis. Three had two other connective tissue diseases. Antinuclear antibodies were positive in 83.6% and anti-Scl 70 antibodies in 34.4%. This study demonstrates that limited cutaneous SSc is more common and there is a high incidence of interstitial lung disease in our population.
Study site: Selayang Hospital, Kuala Lumpur, Malaysia
Chikungunya infections were detected in Singapore among returning travelers who had visited friends and relatives (VFR) in India and Malaysia. These sporadic imported cases occurred over a year before the 2008 chikungunya outbreaks in Singapore, demonstrating the potential for introducing this emerging viral infection into new areas via VFR travel.
The management of epistaxis remains to be a challenging problem for most ENT surgeon especially posterior epistaxis. Most cases are managed by placement of posterior nasal packs or balloons and failure leads to more invasive techniques, involving ligation of the internal maxillary artery. The above management is associated with significant patient complication and morbidity. Endoscopic ligation or cauterization of the sphenopalatine artery has emerged as a viable and minimally invasive alternative. We have performed endoscopic cauterization of nine sphenopalatine arteries in eight patients with no further episodes of epistaxis and complications, with an average follow-up of 25 months. The mean age of the patients was 52.75 years. Fifty percent of the patients had a history of hypertension.
Mediastinal irradiation for various malignancies can cause radiation injury to mediastinal structures, most importantly the cardiovascular system. This article reviews the effect of radiation on cardiovascular structures and the manifestations of various radiation-induced heart diseases.