An ecologic study on Paragonimus in Malaysia was attempted from May to September 1967. Seven streams located in various directions and distances from Kuala Lumpur were surveyed for the study of intermediate hosts, snail and crab. One Malayan village and one aborigine village where infected crabs were found, and two tuberculosis hospitals in K.L. were surveyed for the study of human population. Intradermal tests along with sputum or stool examination to detect human infection by Paragonimus were employed. Wild animals, only a few, were shot in the vicinity of the aborigine village and several domestic cats from the Malayan village were bought. These animals were autopsied and examined for adult Paragonimus. Among five species of crab collected from the study areas, only two species, Potamon jahorenes and Parathelphusa maculata were found to be infected with Paragonimus. P. maculata seemed to be better crab host for the Paragonimus because this species had higher infection rate and metacercarial density than the other in the very same area. Three out of seven streams had infected crabs and the infection rate as well as the infection intensity varied from one stream to another. Only avilable snail in the streams was identified as Brotia costula. The infection rate of the snail was very low, six snails out of 11,898, which is about the same rate reported from other countries. Infected snail, however, had thousands of rediae uncountable containing about twelve microcercocercariae in each redia, sufficient enough to maintain the life cycle of the parasite even with only a few infected snail, the amplifier. This is the first confirmed report on the snail host of Paragonimus from Malaysia where the existence of Paragonimus had been reported in 1923. The first trial to study human population by means of intradermal test, sputum and/or stool examinations in Malaysia showed no evidence of human infection of Paragonimus. The number of animals, wild and domestic, examined for natural infection was too small to draw any statement. These examined animals were all negative for adult Paragonimus. Even though more extensive studies on wild animals and human population may be necessary for the definite conclusion, the facts that infected crabs from jungle stream where human contacts are extreamely rare, and also highly infected crabs from the area where none of humans or domestic animals were infected, strongly suggest the life cycle of Paragonimus in this area may be maintained by wild animal hosts rather than by human host. The morphology of all stages of the parasite, the pattern of penetrating glands, flame cells and excretroy bladder of cercaria, lancet shaped single cuticular spines and 6 branched ovary of adult worm obtained from experimentally infected cat, and the shape of egg including all measurements agree well with the characteristics of Paragonimus westermani.
A group of 18 male Caucasian workers from the United Kingdom and a further group of 18 male mixed race (mainly Malay) workers from Malaysia employed in the formulation of paraquat-based herbicides were examined for evidence of chronic ill health after long-term exposure to paraquat. Clinical records were examined, medical and occupational histories were obtained and a clinical examination, particularly of the skin, was undertaken. Skin rashes, nail damage and epistaxes were encountered by most workers as a result of direct contact of skin and mucous membranes with paraquat. These conditions subsided rapidly and no worker reported any sequelae. There was no clinical evidence of long-term effects on skin, mucous membranes or general health following exposure to paraquat over several years in these workers.
Nineteen out of 121 consecutive cardiac biopsies from 107 patients were found to contain amyloid deposits on routine Congo red screening. Seventeen were left atrial appendages removed during mitral valvotomy for chronic rheumatic mitral valve disease while the remaining two were right atrial appendages excised during surgical repair of atrial septal defects. The distribution of amyloid deposits within the atria and their tinctorial characteristics are described. The high prevalence of atrial amyloidosis observed could not be attributed to generalized or senile amyloidosis. The possibility that this is a distinctive localized form of amyloidosis secondary to chronic heart disease is discussed.
Sera from one hundred and fifty nine Malaysian individuals were screened for the prevalence of delta markers. These included 15 HBsAg positive homosexuals, 16 acute hepatitis B cases, 9 chronic hepatitis B patients, 13 healthy HBsAg carriers and 106 intravenous (i.v.) drug abusers, of whom 27 were positive for HBsAg only and the rest were anti-HBc IgG positive but HBsAg negative. The prevalence of delta markers in the homosexuals was found to be 6.7%, in the HBsAg positive drug abusers 17.8%, in acute hepatitis B cases 12.5%. No evidence of delta infection was detected in healthy HBsAg carriers, chronic hepatitis B cases and HBsAg negative i.v. drug abusers. With reference to i.v. drug abusers, the prevalence of delta markers was higher in Malays (23%) than in Chinese (7%) although the latter had a higher HBsAg carrier rate. Although the HBsAg carrier rate in the homosexuals was high, their delta prevalence rate was low as compared to drug abusers. In Malaysia, as in other non-endemic regions, hepatitis delta virus transmission appeared to occur mainly via the parenteral and sexual routes. This is the first time in Malaysia that a reservoir of delta infection has been demonstrated in certain groups of the population at high risk for hepatitis B.
Forty-eight patients treated surgically for chronic subdural hematoma in General Hospital Kuala Lumpur were studied retrospectively. The clinical presentations were insidious and nonspecific. A high clinical index of suspicion for this disease is required. Diagnosis is confirmed by CAT Scan of the brain with or without cerebralangiography. Treatment consists or burr-holes and drainage
The author describes a new operative method for treating chronic recurrent subdural hematoma. The subdural pocket is exteriorized so that it is in continuity with the subgaleal space through a limited extradural pocket and an L-shaped linear craniectomy. This procedure has been carried out in two patients with recurrent chronic subdural hematoma, both of whom made complete recoveries despite initial recurrence of the subdural hematoma.
Anthropometric and parasitological data from cross-sectional studies of two groups of primary school children (Group I of Indian origin, 325 boys and 259 girls, age = 7 years; Group II of Malay origin, 284 boys and 335 girls, age = 7-9 years) from two different ecological settings in Peninsular Malaysia were examined for epidemiological evidence of an association between hookworm infection and protein-energy malnutrition. In both ecological groups, significant weight, height and haemoglobin deficits were observed in children with hookworm infection after adjustment for covariables including Ascaris and Trichuris infection intensities and other child and family characteristics. The deficits were related to the intensity of infection based on egg counts. These findings suggest that hookworm may be an important determinant of chronic protein-energy malnutrition, as well as anaemia, in areas where diets are generally inadequate in protein, energy, and iron. Well-controlled intervention studies are needed to confirm these observations.
A 51-year old man presented with a persistent tongue ulcer, fever, cervical lymphadenopathy and hepatomegaly. The diagnosis was initially thought to be tuberculosis. This led to the initiation of antituberculous chemotherapy to which the patient failed to respond. The correct diagnosis of histoplasmosis was made after the detection of Histoplasma capsulatum on further review of the tongue ulcer biopsy specimen. He responded to treatment with amphotericin B.
This study was undertaken to analyse the clinical spectrum of chronic liver disease (cirrhosis, and others with portal hypertension) in Kuala Lumpur. Eighty patients were diagnosed over a 6-year period. Twenty-two had biopsy proven cirrhosis while 58 others had portal hypertension with clinical and biochemical evidence of chronic liver disease. The commonest aetiology was alcohol (36%), followed by the idiopathic variety and hepatitis B. The male to female ratio was 4.4:1. Indians had a high prevalence of alcohol-associated chronic liver disease. Overall, ascites was the commonest presentation. Eight patients presented with hepatocellular carcinoma. Spontaneous bacterial peritonitis was diagnosed in 13% of patients undergoing abdominal paracentesis. Gallstones were detected in 37% of patients who underwent ultrasonography. Diabetes mellitus and peptic ulcer disease were noted in 22% and 31% of patients respectively.
A good overall assessment of the severity of illnesses of patients admitted to a general intensive care unit (ICU) is not without problems. The APACHE (acute physiology and chronic health evaluation) prognostic scoring system enables us to stratify acutely ill patients and compare efficiency of ICU therapy in different hospitals. This preliminary study carried out on 100 consecutive admissions to the ICU in University Hospital, Kuala Lumpur showed the spectrum of ICU admissions and the direct relationship between APACHE II score and mortality.
Hypertension complicates chronic pyelonephritis. Since arterial narrowing is common in the damaged kidney, activation of the renin-angiotensin system due to renal ischaemia has been suggested as a pathogenetic mechanism. We used an antiserum to human renin and an immunoperoxidase technique to study the anatomy of renin-containing cells (RCC) in 18 kidneys removed for pyeloneophritis. We independently assessed the degree of arterial narrowing and correlated these variables with the clinical findings. There was histological evidence of hyperplasia of RCC in 5 of the 6 hypertensive patients and in 7 of the 12 non-hypertensive cases. There was no difference in the apparent number or distribution of RCC between the hypertensive and the non-hypertensive cases. Also, the degree of arterial narrowing did not correlate with either the hyperplasia of RCC or the blood pressure of the patients. Our results do not support the hypothesis that narrowing of the intrarenal arteries is important in the pathogenesis of hypertension in pyelonephritis. In our cases, the renal veins were more severely damaged than the arteries and their lumina were often obliterated by organized thrombus. We suggest that such widespread obliteration of the renal venous tree could impair blood flow and contribute to the tissue damage in the pyelonephritic kidney.
We report a case of total occlusion of the left main coronary artery (LMCA) in a patient with chronic, stable angina. Total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, there is usually also disease in other parts of the coronary arterial tree.
Identifying the nutrition problems of Asia and the Pacific is made difficult by the enormous geographic, socioeconomic and cultural diversity that exists in these areas. With increasing longevity and reduced infant mortality, the more chronic diseases are becoming increasingly important. For almost 90% of the countries that keep such data in the Western Pacific Region of WHO, at least three of the five leading causes of death are noncommunicable diseases. Nevertheless undernutrition is still the most important nutritional problem in the Region. Even though there have been some encouraging declines in the proportion of malnourished under 5-year-olds, increasing populations have meant the actual numbers have not declined. Vitamin A deficiency, iodine deficiency disorders and iron deficiency anaemia remain major public health problems in many countries. There is evidence that vitamin A deficiency is appearing in countries in which it has not previously been a problem. New challenges are occurring, such as childhood obesity, the susceptibility of undernourished populations to the human immunodeficiency virus and the increase in noncommunicable diseases. The three arms of clinical nutrition: therapeutic, research and public health will need to work closely to meet the considerable and continuing threat posed by the nutrition-related diseases.
The identification of the Hepatitis C virus using molecular cloning techniques, besides making the term Non-A Non-B Hepatitis obsolete, enables the development of specific assays for the detection of antibodies in HCV-infected individuals, thus making it possible to obtain sero-epidemiological data of the disease. The carriage of Hepatitis C antibody varies worldwide. The disease is most prevalent in intravenous drug abusers or haemophiliacs. Parenteral transmission is the most important route of transmission. Sexual, intra-familial and perinatal transmissions are uncommon. About 40% could be community-acquired (sporadic). Diagnostic tests include enzyme-linked immunosorbant (ELISA) anti-HCV assay, recombinant immunoblot assay, HCV-RNA by polymerase chain reaction and HCV-Ag. More than 50% of acute cases becomes chronic and runs a benign and indolent course. About 20% progress to cirrhosis and some of these develop hepatocellular carcinoma. Several published trials have consistently shown that treatment with interferon in some patients is useful. There is however a relapse rate of 50%. Further trials with interferon and other anti-viral agents like ribavirin are awaited for more effective treatment.
Intestinal protozoa are found in all communities in Malaysia and among all ethnic groups. Prevalence of intestinal protozoa is not affected by ethnicity but by living conditions. Communities with both basic amenities of safe water supply and proper toilets have lower prevalence than those with one or none of the amenity. Cryptosporidium is an important intestinal protozoon in Malaysia and should be included in future field and laboratory studies and also in laboratory diagnosis for pathogens. Much interest will be centered on Blastocystis hominis in future studies in view that it may be a cause of diarrhea.
A case of chronic disseminated histiocytosis X (Hand-Schuller-Christian Disease) of the mandible is presented. Multi-modal approach to management is discussed.
A five-week-old infant presented with infantile acute lymphoblastic leukaemia. He devel-oped an early CNS and bone marrow relapse despite intensive treatment. This paper discusses infantile leukaemia and its treatment.
The association of arsenical poisoning with the development of skin cancer is well-known. In Malaysia, arsenic has been shown to coexist with tin in tin-mining land. Our preliminary investigation has shown that the level of arsenic in well water from a tin-mining area is high. We report 3 patients with cutaneous lesions typical of chronic arsenical poisoning such as hyperpigmentation, keratoses and skin cancer. These patients have positive histories of previous domicility in tin-mining areas. We conclude that these patients developed chronic arsenical poisoning from drinking well water polluted with arsenic from the tin-mining soil.