A prospective study was performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur. Over a period of 14 months from 1 January 1982, 12 new cases of analgesic nephropathy (AN) were documented. Contrary to the experience in the West and in Australia, AN in Malaysia tends to have a male preponderance and occurs even in the younger age groups. The common analgesics abused are paracetamol, Chap Kaki Tiga and Chap Harimau. The main reasons for analgesic abuse are headache and arthritis. In addition to radiological features of renal papillary necrosis patients have the other manifestations of the disease such as peptic ulceration, anaemia, neuro-psychiatric disorders and ischaemic heart disease.
Serum prolactin (hPRL) levels in nonpregnant, pregnant and postpartum women during sleep were investigated. The study showed that in non-pregnant women, there is an immediate shift of hPRL release with reversal of sleeping period. Thus, the nocturnal surge for prolactin is sleep related. In pregnant women, however, while there is an increase in hPRL level during pregnancy, the nocturnal rise of this hormone is not detected and this is observed as early as the first trimester of pregnancy.
A clinical isolate of Salmonella typhi (Vi phage type 25), resistant to chloramphenicol, streptomycin and tetracycline, was examined for the presence of R plasmids. Results from conjugation, agarose gel electrophoresis and transformation experiments indicated that it harboured a single large self-transmissible R plasmid which coded for both the chloramphenicol and tetracycline resistance traits.
200 doctors are gazetted as practising in Sarawak in 1982. 88% are males and only 12% are females. Of the 200, 65.5% are Chinese and the natives of Sarawak and Indians form 15.5% each. Nearly 30% are graduates from local universities, 44% from universities in Commonwealth countries and a few from universities in other countries. The majority of the doctors are under 40 years of age. 55 % are in government service, while 45% are in the private sector. All private practices are solo practices except three-one each in Kuching, Sibu and Miri which are based on partnership. The number of doctors with specialist qualifications is not known as it is not essential for these qualifications to be entered in the Register. The doctor-to-population ratio in Sarawak has improved from 1:14000 in 1964 to 1:6856 in 1982. To reach the Ministry of Health's target of 1:2500 by 1990, a yearly recruitment of 58 doctors would be needed from 1983 to 1990. This would be feasible if either an admission quota to the local medical faculties for Sarawakians is implemented or more doctors are posted to serve in Sarawak.
An epidemiological investigation was carried out on a food borne outbreak in a National Type Primary School (Chinese). The findings of the outbreak are reported. Of the 495 Chinese students (ages between 7-12 years) interviewed, 321 were exposed to one or more of the food items sold at the school canteen. The median incubation period was one hour for the outbreak. The main symptoms were related to the upper gastro-intestinal tract (nausea and vomiting). Fried meehoon (rice vermicelli) was suspected as being the responsible vehicle. The causative organism was Staphylococcus aureus. 48 cases were treated in the Main Health Centre, Kapar.
Eight infants between the ages of one and three months with prolonged conjugated hyperbilirubinaemia had duodenal aspirations performed to differentiate between biliary atresia and neonatal hepatitis. Four infants had bile-stained aspirates and in all of them the jaundice subsided completely by eight months of age. We have found duodenal aspiration a safe, inexpensive and simple procedure to undertake in helping us make a rapid differentiation between patients with conjugated hyperbilirubinaemia requiring urgent laparotomy and those that do not require surgery. This approach appears to be reliable although further studies need to be undertaken.
A survey on the incidence of Salmonellae in soil was conducted on 12 kindergartens in the Klang District, The organism. was isolated from five (three urban and two rural) kindergartens from one or more soil samples tested. Ten isolates comprising six serotypes, namely, Salmonella bareilly, S. haifa, S. abony, S. weltevreden, S. agona and S. stanley, were encountered. The possible role that these soil isolates may play in the transmission. of salmonellae is discussed. The need to use more than one media in the detection of salmonellae is emphasised.
One-hundred-and-four patients unth. hand eczema were studied. The female to male ratio was 1.9:1 and peak incidence was in young adulthood. In females, housewives constituted the biggest group while in males, mechanics/engineers was the biggest group. 30% of the patients had contact sensitivity on patch testing to a standard series. Balsams, medicaments, rubber ingredients, nickel and formaldehyde were the common allergens. The contact sensitivity was considered relevant in 65% of cases.
Infants, one to 56-weeks-old, presenting with persistent diarrhoea were placed on a diet free of cow's milk protein which improved their clinical condition. Six weeks later, 67 infants were challenged with a low-lactose cow's milk formula and jejunal biopsy was taken before and 24-hours after challenge. On the basis of histological changes in the intestinal mucosa and development of clinical symptoms the infants were categorised into three groups: Group 1 (n = 16) with no clinical or mucosal abnormality, Group 2 (n = 20) with mucosal abnormality but lacking clinical symptoms, and Group 3 (n 31) with manifestation of mucosal abnormality and clinical symptoms. In addition to the total IgE the radioallergosorbent test (RAST) was performed on sera from the infants taken before and after milk provocation. The mean total serum IgE level ranged from 288 to 560 IU/ml. In Groups 2 and 3 the prechallenge serum IgE levels were significantly higher than the postchallenge levels but in Group 1 the levels remained unchanged on challenge. A positive RAST to milk proteins was observed in five infants (7.4%), that is, one in Group 2 and four in Group 3, of 67 infants studied. In a survey of 405 consecutive paediatric-age patients admitted for a variety of symptoms, 90 were positive for RAST specific for milk proteins. Interestingly the majority of the patients positive for RAST presented with gastrointestinal ailments. The measurement of specific IgE appears not to be a useful adjunct in the diagnosis of CMPSE in Malaysian children.
A bnormal variants of plasma cholinesterase (ChE, EC. 3.1.1.8) are a rarity in this region and to date there is no reported case of suxamethonium sensitivity in the Malaysian population. We now report a case of a Malaysian Indian patient who received suxamethonium, developed prolonged apnoea and on investigation was found to be a homozygote for the silent gene. His family was screened for abnormal variants of plasma cholinesterase. The results are discussed.
The results of a 10-year study of intussusception seen in the General Hospital Kuala Lumpur is presented. Incidence among Indians was found to be the lowest in comparison to the other two major racial groups. In 63.5 percent of infants there was no pain. A large number of patients presented with diarrhoea (21.8 percent), constipation (31 percent) and abdominal distension. (43.7 percent). Overall mortality rate was high (14.4 percent). This could be attributed to late presentation (only 30.8 percent) of cases were seen within 24 hours of onset of symptoms) which also accounted for a higher resection rate. A high incidence of lead points (28.7 percent) was also seen. The usefulness of barium enema reduction in this country is discussed. Mainstay of management in the majority of cases is operation with adequate pre and postoperative care.
A country-wide diabetic survey of the population (age 15 years and above) of Singapore shows that the prevalence of diabetes mellitus in Singapore is 1.99 percent. It is commoner in males (2.36 percent) than in females (1.64 percent). The prevalence of diabetes in the age group 15-39 years is only 0.40 percent and in the age group 40 years and older it is 5.08 percent. The prevalence of diabetes in Indians (6.07 percent) is significantly higher than that in Malays (2.43 percent) and Chinese (1.55 percent). Indian diabetics have an insignifi"cantly higher incidence of positive family of diabetes (12.7 percent) than Malays (10.9 percent) and Chinese (6.5 percent). Obesity was commoner in Malay diabetics (67.4 percent) than in Chinese diabetics (41.6 percent) and Indian diabetics (35.7 percent). The survey shows that 40.4 percent of the diabetics are known while 59.6 percent of the diabetics are newly diagnosed. The majority of the diabetics are treated with oral hypoglycaemic drugs (71.5 percent) and only 4.8 percent are receiving insulin injections. A mong the female diabetics, 63.0 percent have 4 or more pregnancies and large babies at birth are recorded in 12.3 percent. In the newly diagnosed diabetics, 64.3 percent have no symptoms. The complications of the diabetics are hypertension (26.8 percent), nephropathy (9.8 percent), retinopathy (8.5 percent), coronary heart disease (6.1 percent), skin infection (4.6 percent) and neuropathy (3.3 percent). The high prevalence of diabetes among the Indians is likely to be due to a genetic predisposition coupled with an environmental factor (obesity), although this hypothesis is not conclusively demonstrated by the present study.
Folate and vitamin B 12 status in pregnancy was studied in a group of 190 Malaysian mothers belonging to the three major ethnic origins. Cord blood was also analysed for the same vitamins. Ethnic variations with regard to deficiency in these two vitamins was determined. About 58.5 percent of the pregnant mothers suffered from lowered serum folate levels and 32.4 percent had lowered RBC folate levels. In contrast vitamin B 12 levels were within normal limits. Cord blood levels of these vitamins were significantly higher than. the corresponding levels in the maternal blood, suggesting the possible involvement of an active process in the transfer of folates and vitamin B 12 to the fetus.
To our knowledge, meningitis due to Listeria monocytogenes has not previously been reported in Malaysia. We describe here two infants with meningitis due to Listeria monocytogenes occurring within a month of each other in the Universiti Kebangsaan Malaysia Paediatric Unit. The incidence of listeriosis in Malaysia is unknown and it is possible that this infection may have been missed in the past.
Health, including nuirition is not independent but is closely associated with the social and economic environment. Malnutrition itself can cause death, but more commonly, it can cause considerable ill-health, physical retardation, impaired mental performance, loss in productivity and a decline in the quality of life. The effects of malnutrition as obstacles to socio-economic development are now well recognised. In a rapidly developing country like Malaysia, the nutritional and nutritionally-related problems present themselves with contrasting features. While population indicators such as toddler mortality, incidence of low birthweight and food balance sheet studies suggest an improving nutritional situation, methods of direct assessment have shown that chronic protein-energy malnutrition and anaemia are sWI common amongst pre-school children in both the rural and urban disadvantaged sectors. Moderate anaemia also affects a significant proportion of older children and women of childbearing age. Intestinal parasites, another indicator of under development at the local level, are ubiquitous in the rural setting and urban slums owing to unsatisfactory waste disposal. In striking contrast, diseases associated with dietary excesses and increasing affluence have now emerged as the major killers. This changing pattern of mortality and morbidity along the lines encountered by the industrialised societies is now dramatised by the fact that road accidents are now claiming a large number of victims. It is clear that while continued efforts should be given to the improvement of the nutritional health of both rural and urban poverty communities, little time should be wasted in considering the adoption of public health measures aimed at stemming the rising number of deaths associated with our increasing affluence, particularly those diseases that are nutritionally linked, such as coronary heart disease, hypertension and diabetes mellitus, not forgetting the increasing road toll afflicted by the motor vehicle.