Over 200 strains of respiratory viruses cause a variety of human infections ranging from common cold to life-threatening pneumonia. Respiratory viruses implicated in this study are respiratory syncytial viruses (RSV), adenovirus, influenza viruses and parainfluenza viruses. The objective of this study is to determine the epidemiology of respiratory viruses in paediatric patients with lower respiratory tract infection. The methods used were direct antigen detection method, shell vial culture method and conventional tube culture method. The samples included in this study are paediatric patients seen in Universiti Kebangsaan Malaysia Hospital, Kuala Lumpur with suspected acute viral respiratory infection, presenting with acute laryngotracheobronchitis (croup), bronchiolitis and pneumonia. Nasopharyngeal aspirates were collected and processed almost immediately. A total of 222 specimens were received during February 1999 to January 2000 showing a dual peak pattern in the months of April and December. The mean age of the patients was 13 months. Pneumonia (77.9%) was the most common clinical diagnosis in children with lower respiratory tract infection. This was followed by bronchiolitis (19.4%) and croup (27%). Viral aetiologies were confirmed in 23.4% of the patients. The most common respiratory virus isolated or detected was RSV, followed by parainfluenza viruses, influenza viruses and adenovirus.
The effect of Ramadan fasting on fasting serum glucose (FPG) is still a matter of controversy. One hundred and fifteen healthy volunteers fasted for > or = 25 days during Ramadan. Blood samples were taken 1 week before Ramadan and on the 14th and 28th day of Ramadan. Serum glucose was determined by the glucose oxidase method. FPG decreased from 88.4 + 9.0 mg/dl to 62.9 +/- 7.7 mg/dl (p < 0.001). Men and women both experienced a significant drop in FPG. Calorie intake decreased in all groups (p < 0.001) and was positively correlated with decreasing FPG. FPG decreases with Ramadan fasting and has no serious adverse effect on fasting adults.
Prostate cancer is not common in south-east asia and in particular there are only scarce reports on the characteristics of Malaysian men with prostate cancer. A retrospective study where all prostate specimens sent to the pathology department during the period 1st January 1996 to 30th June 1998 were reviewed. A total of 131 prostate specimens were reviewed and these consisted of prostatectomy specimens, transurethral resection specimens and trucut biopsy specimens. Only 114 patients' case notes were evaluated. Data reviewed were age, race, presenting symptoms, clinical findings and prostate-specific antigen (PSA) level. Overall incidence of carcinoma of the prostate was 19.0%. The incidence of carcinoma of the prostate with serum prostate-specific antigen (PSA) of 4.1 to 20.0 ng/ml was only 10% and 60.5% of patients had evidence of subclinical histological prostatitis. The mean age of men with carcinoma of the prostate was 71.3 years and there was no differences in the incidence of carcinoma of the prostate among the 3 major ethnic groups (Malays, Chinese and Indian). About three-quarter of the patients with carcinoma of the prostate presented with lower urinary tract symptoms, a third had haematuria and about a tenth of patients presented with urinary retention. The majority of patients presented with metastatic disease (66.7%) with a mean PSA of 1476.8 ng/ml. A significant proportion of men with prostatic diseases attending the University of Malaya Medical Center had prostate cancer (19.0%). A small proportion of men with serum PSA in the range of 4.1 to 20.0 ng/ml had prostate cancer and this is thought to be due to the background histological prostatitis. The majority of patients presented late.
We retrospectively studied the records of 6 Malaysian children who were diagnosed with Alagille Syndrome (AGS) according to this criteria from January 1999 to January 2001, at the Institute of Paediatrics, Kuala Lumpur Hospital. Four patients (66%) had a positive family history. Thirteen individuals (6 patients and 7 relatives) were diagnosed with AGS in these 5 families. Only 6/13 (46%) of them presented with liver involvement. All 6 patients presented with typical facies and cholestasis (100%). Three (50%) presented with portal hypertension (PHT) with synthetic liver dysfunction (1 died), 1/6 (17%) have PHT and normal synthetic liver function. Two have cleared their jaundice but have biochemical evidence of hepatitis and hepatomegaly, four have congenital heart disease 5/6 posterior embryotoxon, 2/6 butterfly vertebrae, 4/6 hyperlipidaemia and 4/6 failure to thrive. One patient has a Jagged-1 gene disruption at the translocation breakpoint locus 20p12.3 2n = 46,XX,t(12.20) (q22, p12.3). 5/6 (83%) are still alive. Two-thirds of our patients developed chronic liver disease by 3 years of age. Two-thirds of the index patients have a family history. Only 46% of individuals in these families have clinical evidence of liver involvement. Mortality depends on cardiac/renal disease, end-stage liver failure and intercurrent infection.
An open lung biopsy was performed in 12 children with diffuse parenchymal lung disease. A definitive histopathological diagnosis was obtained from all procedures but determined treatment options in only 10 children (83%). Three (25%) children were ventilated for respiratory failure prior to the procedure. Four (44%) of the other 9 children required ventilatory support after the procedure. Three (25%) children developed post-op pneumothorax that resolved fully with chest tube drainage. There were no deaths as a direct result of the procedure. Open lung biopsy is useful in providing a definitive diagnosis in children with diffuse parenchymal lung disease and determining treatment in the majority of cases. The procedure was well-tolerated with minimal complications.
The tumour marker CA19-9 is a sensitive marker for pancreatic, gastric and hepatobiliary malignancies. High CA 19-9 level indicates unresectable lesions and a poor prognosis. The objective of the study was to determine the significance and implications of elevated CA 19-9 levels in the serum. A one-year retrospective review of all patients who had CA19-9 measured in our Medical Centre was undertaken; 69 patients were found to have CA 19-9 level above the cut-off value (37 U/ml). Thirty-six patients had malignant and the remaining 33 had benign lesions. CA 19-9 was found to be elevated in malignancies of pancreas, colorectum, lung, liver and ovary. Benign conditions associated with elevation of CA 19-9 included disease of the hepatobiliary system, pneumonia, pleural effusion, renal failure and SLE. In two individuals, there was no obvious cause for the elevation of this marker. CA 19-9 levels were significantly lower in benign than in malignant conditions. In conclusion, elevated CA 19-9 may be found in patients with benign as well as malignant disease. Therefore, it is important (1) that elevated levels of CA 19-9 are interpreted in the light of the clinical presentation of the patient and (2) to be aware of the benign conditions that can be associated with increased levels of this marker. With these factors in mind, CA 19-9 can be used to assist in the diagnosis of pancreatic cancer and assessment of resection adequacy post-operatively.
A cross-sectional study to determine work-related musculoskeletal problems and ergonomic risk factors was conducted among 529 women semiconductor workers. Overall, 83.4% had musculoskeletal symptoms in the last one year. Pain in the back (57.8%), lower leg (48.4%) and shoulder (44.8%) were the three most common musculoskeletal problems. Significant associations were found between prolonged standing and upper and lower leg pain, between prolonged sitting and neck and shoulder pain and between prolonged bending and shoulder arm, back and upper leg pain. The study therefore showed a clear association between work-related musculoskeletal pain and prolonged hours spent in particular postures and movements.
How people perceive risk influences their behaviour towards these risks. We do not know how workers perceive risk of dying from diseases or accidents. This study was conducted among 198 workers of a security company in Malaysia. The workers were asked to score on a Likert scale of 1 to 5 the perceived risk of death of Malaysians from selected causes of death. The highest perceived risks of death were, in order of ranking, motor vehicle accidents, cancer and diabetes mellitus whereas according to the certified causes of death in Malaysia the highest risks of death among the selected items were cardiovascular disease, cancer and stroke. The difference in perception and mortality data needs be addressed.
Ultrasonographic measurements of the intima-media thickness (IMT) of common carotid arteries (CCA) were taken in 50 patients with familial hypercholesterolaemia (FH) and 57 patients with non-familial hypercholesterolemia (NFH). The lipid profile, body mass index (BMI) and waist-hip ratio (WHR) of each patient were recorded. In FH patients, the IMT was significantly higher in overweight and elevated WHR subgroups compared to the normal with significant correlations between BMI and WHR to the IMT. In NFH patients, the IMT was significantly higher in the elevated WHR compared to the normal subgroup but the correlations between either BMI or WHR to IMT were insignificant. These suggest that the environmentally modified anthropometric indices may have an effect on atherosclerosis in genetically determined hypercholesterolaemia in FH patients.
A retrospective review of all bronchoscopy cases for investigation of lung cancer between January 1997 and December 1999 was done. The cases were included if endobronchial mass was visible (Group A) or when there was an abnormal mucosa and/or bronchial narrowing in the absence of a mass (Group B). All patients in Group A (n = 177) underwent endobronchial biopsy (EB) bronchial brushings (BB) and bronchial washings (BW). All cases in Group B underwent transbronchial biopsy (TBB), BB and BW. Only a small increase in the positive results for cancer was seen when cytology specimens (BB and BW) were added to EB (85.3% vs 88.1%, McNemar's P = 0.06) in Group A but there was a significant increase in Group B (37.3% vs 54.2%. McNemar's, P = 0.001). Therefore although cytology specimens did not significantly add to overall yield of positive results when endobronchial lesions were visible, when mass lesions were not visible, cytology specimens increased the yield by 16.9%.
Study site: Chest clinic, Hospital Sultanah Aminah (HSA), Johor Bahru, Johor, Malaysia
The purpose of this study is to evaluate the use of acoustic rhinometry in assessing surgical outcomes in sinonasal surgery. This prospective study was carried out from January till December 2001. A group of 44 patients who presented with nasal obstruction due to various rhinologic abnormality were examined with acoustic rhinometry pre and post-operatively. They were examined with acoustic rhinometry pre and post decongestion with cocaine and adrenaline. A highly significant correlation existed between minimal cross sectional area (MCA) and the subjective feeling of nasal problem, pre and post surgery. Thus MCA is a valuable parameter to express objectively the nasal patency. The mucovascular component of the nasal cavity plays a major role in the nasal patency as determined in the pre and post-decongestion acoustic rhinometry measurement. Acoustic rhinometry is a good tool to evaluate the nasal patency in cases where sinonasal surgery is considered in correcting the abnormality as well as for the post-operative evaluation.
Population norms for Health Related Quality of Life using SF-36 are described. A national sample was canvassed in 2000 using a self-administered SF-36 in Bahasa Malaysia and English. Response rate was 30.6%, with 3072 usable data. Male: Female ratio was 1.04 and mean age was 39.8 years. Quality of life was affected by age and sex. Older population and women had a poorer quality of life. Population norms for Malaysia differed from those of US, Canada and Australia. The malaysian general population norm described is useful as reference point for studies in Malaysia. Variability in scores by age and sex emphasize the need to use appropriate age- or sex-specific normative data.
Carcinoma of the tongue remain one of the greatest management challenges for the head and neck surgeon because of the adverse effects of treatment on oral and pharyngeal function. In early carcinoma of the base of tongue however, the prognosis is encouraging and function of swallowing and speech is preserved despite surgery. Suprahyoid pharyngotomy is one of the surgical approaches advocated for resection of base of tongue tumours with primary anastomosis.
Penetrating neck trauma present difficult management issues by virtue of their rarity. Undiagnosed laryngotracheal injuries have serious implications, especially in the context of multiple trauma, where other injuries overshadow that of the laryngotracheal complex. This is a case of a schizophrenic patient with multiple self-inflicted cuts on his throat and abdomen. Injuries include open, comminuted laryngeal complex lacerations with vocal cord avulsion, as well as evisceration of small bowel. Adequate assessment using both direct laryngoscopy and rigid endoscopy, coupled with open exploration, allowed optimal exposure and fixation of the larynx in the anatomical configuration. The post-operative outcome of the airway and voice remained satisfactory at follow-up. A high index of suspicion coupled with adequate surgical approach allowed establishment of a functional larynx.
The summary of various studies done looking at size selection of the laryngeal mask airway (LMA) in adults is that, selection based on sex is appropriate, and that both sizes 4 or 5 are adequate for adult females. However, in our local population these sizes may be too large especially the size 5 for adult females.
Medical negligence suits have become an issue of concern for doctors as well as for the health service departments. The main objectives of medical malpractice law are to compensate patients who are injured by negligence and to improve the quality of medical care. The amount of money and time spent on these cases may not be an effective allocation of social resources to minimize patient safety. Though physicians generally win more malpractice suits, much time and money are spent and results in much stress to those concerned. There are certain controllable events in practice that render a physician more or less vulnerable to malpractice claims. Attempts by physicians to understand and prevent unwanted situations that can lead to litigation is important. The risk factors for medical negligence suits are discussed. The practice of good medicine will be the best form of risk management.
While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end and a dislocation at the other. We present two cases; a patient with a bipolar clavicular dislocation, and another with a fracture in both medial and lateral ends of the clavicle with anterior dislocation of the sternoclavicular joint. Both were treated conservatively, with fairly good range of motion and return to normal activity.