As Malaysia ages its health and social care systems will have to adapt to a changing pattern of disease and dependency. Improved public health measures extend life expectancy at the relative expense of increased prevalence of currently incurable conditions such as dementia and Parkinson's disease. In this article we discuss how these demographic changes will impact and suggest possible means of coping with the altered epidemiology of disease and disability. Malaysia will need to swiftly develop sufficient expertise in acute Geriatric Medicine, rehabilitation of older people; the management of long-term conditions in older people with multiple complex problems within Primary Care; as well as an infrastructure for home and institutional care.
Recent advances in neuroimaging have allowed the detection and characterization of focal malformations of cortical developmental in a significant proportion of patients with epilepsy, many of whom were previously labelled as cryptogenic, allowing a better description of the associated electroencephalogram (EEG) features. Alpha activity is usually preserved, although superficial gyral abnormalities are often associated with overlying localized polymorphic delta activity, and occasionally abnormal fast activity. Most affected patients with epilepsy show interictal spikes. These are often broadly concordant with the structural abnormality but may show a wider anatomic distribution and be multifocal, or occasionally appear only in anatomically distant sites. In many patients the spikes are frequent and sometimes they occur continuously or in long trains. EEG findings are often stable over time, but some patients only show the development of slow wave changes or interictal spikes when followed serially for several years. A small proportion of patients with focal malformations of cortical development have EEG features mimicking idiopathic generalized epilepsy, and occasionally patients exhibit continuous generalized spike and slow wave activity in sleep. Electrocorticography studies confirm the often widespread nature of interictal spiking, but may also show highly epileptogenic patterns recorded directly from dysplastic cortex. The intrinsic epileptogenicity of areas of cortical developmental abnormalities has also been demonstrated by chronic intracranial studies and in vitro recordings of slices obtained from resected human dysplastic cortex. In this regard such developmental abnormalities are fundamentally different from acquired lesions such as tumors/vascular anomalies that usually exert their effects through changes in adjacent cortex.
The rapid increase in the use of helicopters for hospital transport during the 1980s is the culmination of several hundred years of military medical innovation. Mass battefield casualties spurred both technologic and medical changes necessary for today's sophisticated helicopter systems in use worldwide, particularly in the United States. The Napoleonic Era and the American Civil War provided the framework for the evolution of today's state-of-the-art emergency medical techniques. The use of airplanes to evacuate the wounded eventually led to using helicopters for rescue missions in World War II. The combat experiences of the United States in Korea, the British in Malaya, and the French in Indochina proved that rotary-wing aircraft were invaluable in reducing battlefield death rates. Any skepticism about the efficacy of helicopter medical evacuation was erased during the Vietnam conflict. As an integral part of the modern battlefield, these specialized aircraft became a necessity. The observations and experience of American servicemen and medical personnel in Vietnam established the foundation for the acceptance of helicopter transport in modern hospital systems.
Thirteen strains among 3 species of entomopathogenic bacteria were tested against 3 medically important mosquito species in French Polynesia. Two strains of Bacillus thuringiensis were highly toxic to Aedes polynesiensis, Aedes aegypti, and Culex quinquefasciatus. Six of 7 strains of Bacillus sphaericus tested were highly toxic to Cx. quinquefasciatus but not to the Aedes spp. Clostridium bifermentans serovar. malaysia was more toxic to Ae. polynesiensis than to the other 2 species. Entomopathogenic bacteria merit field testing for larval mosquito control in French Polynesia.
Paradistomoidella cerberi n.g., n.sp. and Paracanthostomum cerberi from Cerberus rhynchops, Xenopharynx pyriformis and Allopharynx mehrai from Ptyas korros, Neopronocephalus orientalis from Geoemyda spinosa, and Duthiersia expansa from Varanus salvator are all reported from the area of Kuala Lumpur, Malaysia. Paradistomoidella cerberi most closely resembles members of Paradistomoides but is characterized by relatively short caeca, a cirrus sac containing a bipartite rather than sinous internal seminal vesicle, and unevenly-sized suckers. Kuala Lumpur is a new locality for Paracanthostomum cerberi, X. pyriformis, A. mehrai, and D. expansa. Ptyas korros is a new host for X. pyriformis and G. spinosa is a new host for N. orientalis.
T-agglutination patterns of 190 strains of group A streptococci isolated between January 1989 and December 1993 from body fluids (10), throat culture (56), pus (51) and skin lesions (73) were determined. Mucoid colonial morphology was exhibited by 6.3% (12/190) of the strains on initial isolation. Type T-5,11,27,44 comprised 23.7%, followed by T-1,3,13,B3264 (11.1%), T-4,6 (8.4%) and T-8,25, Imp 19 (7.9%). About 42% (80/190) strains could not be characterized by T agglutination pattern. T-typing of 71 selected strains at WHO Collaborating Center, Minneapolis yielded similar results. Nineteen selected strains were further characterized by M-typing; only three strains were M-typeable. These strains were isolated from throat (M1), sputum (M5) and pus (M12). About 68% (48/71) isolates produced serum opacity factor. These data support the existence of as yet uncharacterized group A streptococcal serotypes in this region.
Slurry acidification has been shown to be effective in reducing environmentally damaging gases. However, this involved the use of concentrated acids on farms. Therefore, due to the health and safety concerns, there is an interest in self-acidification of slurry technique. This study was designed to determine the microbial dynamics leading to self-acidification of slurry. A fresh cattle slurry was amended 10% brewing sugar and stored over 30 days. This fermentable carbon source promoted self-acidification of the slurry from pH 7.0 to 4.7 within four days, and was associated with the accumulation of lactic acid and a reduction in methane and relative ammonia emissions. A metagenomics approach through next generation sequencing (NGS) using an Illumina MiSeq platform was used to determine the microbial diversity and dynamics (bacteria and archaea) in the stored amended slurry. 16S ribosomal ribonucleic acid (rRNA) sequence data revealed the presence of the Order of Lactobacillales was associated with the lactic acid production. The operational taxonomic units (OTUs) abundance indicates that the methanogenic community was dominated by hydrogenotrophic methanogens from the member Order of Methanobacteriales, Methanomicrobiales, and Methanosarcinales. The decrease in tolerance by the methanogens in the self-acidified slurry was probably the main reason for the reduced methane emission. These results confirm, at the microbial level, the mechanism of inhibiting methane production via self-acidification during storage period.
A 41-year-old patient with hepatolenticular degeneration (Wilson disease), who had been treated for 15 years with penicillamine, developed small white papules at sites of venipuncture in the antecubital fossae and at surgical suture sites. Histologically, these papules showed focal areas of connective tissue degeneration in the dermis, but there was no evidence of inclusion cysts. The changes most likely resulted from the effect of penicillamine on new connective tissue formation at the sites of injury. The patient also developed crinkling of the skin of her face and neck while on the penicillamine regimen, and these changes were attributed, at least in part, to the effects of this drug on connective tissue.
Chloroquine pressure was applied over a 22 month period on a somewhat isolated, malarious rubber estate by examination of residents at 4-week intervals and treatment of parasitaemias with chloroquine. During this time the monthly attack rate for P. falciparum rose four-fold to an average of nearly 18% per month, while that of P. vivax remained relatively constant at about 8%. Eight in vivo chloroquine resistance studies, which allowed both detection of late recrudescing R-I resistance and estimation of the risk of reinfection, showed an apparent rise in the drug resistance rate, from 12% to 20% prior to the study to the range of 40-50%. Virtually all resistance encountered was R-I in nature. There was no convincing evidence of chloroquine resistance among 148 tested P. vivax infections.