In a prospective study of 300 infants with acute gastroenteritis 150 infants had enteropathogens in the stools, 58 being due to rotavirus, 130 to adenovirus, 32 to Sahnonella, 18 Shigella and 29 E. coli. Hypernatraemic dehydration was present in 11% and acquired carbohydrate intolerance in 30% of the infants. Protracted diarrhoea was observed in 8% of infants and was commoner in the bacterial than viral group. The study shows that clinical features and simple blood tests cannot be used as reliable indices of predicting the aetiology of AGE. Despite the diverse aetiology of acute gastroenteritis, rehydration by the oral or intravenous route remained the mainstay of therapy.
Keywords: Kuala Lumpur, university hospital,
The diagnosis and management of brain death is discussed in this paper. Criteria recommended by the Conference of Medical Royal Colleges and their Faculties in U.K. were used in the diagnosis of brain death. It is felt that brain death should be considered as death of the individual and a plea is made to draw up guidelines on management of patients with brain death.
Two Malaysian boys of Chinese origin who satisfy the necessary criteria of subacute sclerosing panencephalitis are reported. A brief description of the symptomatology, epidemiology, laboratory finding, pathology, pathogenesis and treatment of the illness was also given.
Concerned by the alarming decline in breast feeding in the urban and rural areas of Malaysia, we conducted a critical review of infant feeding practices among nursing personnel from representative centres using questionnaires. It was found that although 75% of mothers breast-fed their babies at birth only 19% did so at 2 months and 5% at 6 months respectively. Chinese mothers initiated breast feeding less frequently compared with Indian or Malay mothers. The prevalence of breast feeding was higher among lower category nurses, lower income groups and those from health centres. Decision for breast feeding was based in most instances on conviction derived from reading, lectures or advice from relatives. The vast majority of mothers listed "work' as the main reason for termination of breast feeding followed by "insufficient breast milk' and satisfactory past experience with bottle feeding. The ramifications of these findings and measures to improve the prevalence and duration of breast feeding are discussed.
A report of 25 cases of neurosyphilis seen in University Hospital, Kuala Lumpur since 1970. Classical form of the disease still constitute the majority of the patients with often long delay before diagnosis.
Thirty girls who had been detained in a remand home on suspicion of prostitution were examined in the University Hospital, Kuala Lumpur. All except two were below 21 years old. Endocervical and high vaginal swabs were taken for cultures. A sample of blood was taken for serology. Eleven of the girls [37%] had no evidence of a sexually transmitted disease. The others [63%] had one or more of the following: 5 with positive serology for syphilis, 3 had gonorrhoea, 6 with trichomonas, 2 with candidiasis.rl with Chlamydia trachomatls, 2 with Ureaplasma urealyticum and 1 with C. vaginale. With such a high incidence of STD in these young girls with a history of prostitution, it is recommended that a more regular and comprehensive screening be carried out on such high risk women.
Study site: University Malaya Medical Centre (UMMC)
Two hundred and nineteen patients with skeletal tuberculosis have been reviewed analysing the site of the lesion and the treatment given. Operative management is advocated since the results of this approach are encouraging.
A review of all cases of nephroblastoma admitted to the University Hospital over a 10 year period reveals that its incidence relative to the other childhood tumours and epidemiological features are similar to other centres. The majority of patients presented with either stage III or IV disease. During the period 1968·1972 the number of defaulters was high and survival was poor. Following the introduction of treatment protocol, default rate has fallen and 5 of 7 patients have survived more than 2 years. Earlier referral and education of the parents should help improve the outcome for children with Wilms' tumour in Malaysia.
A review of rhabdomyosarcoma in childhood reveals that the pattern and results of treatment have changed with the introduction of multimodal therapy. Outcome in our series have been poor due to advanced disease, poor compliance to follow up resulting from poor socio-economics and educational levels of our patients and their faith in traditional medicine. Improvement in the prognosis can only be anticipated with earlier diagnosis and reduction in defaulter rate.
A 13 year review at the University Hospital, Kuala Lumpur reveals that chronic myeloid leukaemia (CML) constitutes 4.3% of all childhood leukaemia. Adult type of CML occurs in older children and is associated with marked splenomegaly, leukocytosis and thrombocytosis and the presence of Philadelphia chromosome. Although the initial response to busulphan was encouraging most of the patients succumbed; 2 patients underwent acute lymphoblastic transformation. Juvenile CML occurs in younger children and is associated with less marked splenomegaly, leukocytosis and thrombocytopenia and the presence of elevated fetal haemoglobin levels. The disease is characterised by an acute fulminating course. Despite improved survival in acute lymphoblastic leukaemia, the outlook for chronic myeloid leukaemia in childhood remains poor and treatment needs re-evaluation.
A review of 20 cases of neuroblastoma at the University Hospital, Kuala Lumpur from 1967 to 1980 reveals six infants aged 2 to 13 months with stage IV·S disease, associated with an unusually good prognosis. Four of the six patients presented with hepatomegaly, one had skin nodules and another paresis of the lower limbs. The primary tumour was located infra-diaphragmatically in all cases, four had disease in the bone marrow but none had radiological evidence of bone involvement. Although not systematic, with limited treatment of low dose radiation and mild chemotherapy, four patients are alive and well, one absconded and one died of septicaemia. It is important to define this special category as an unexpectedly good survival is possible with minimal therapy. Death is more likely to result from over-zealous treatment than from the disease itself.
A descriptive study of 1,945 cancer cases discharged from the University Hospital, Kuala Lumpur, during the three-year period from 1972 to 1974, was carried out to analyse cancer patterns and frequency in the various age, sex and ethnic groups, The highest frequency of cancers occurred among the Chinese (68.8 percent) in excess of that expected from their utilization rate of the hospital (50.5 percent). The jive leading cancers in males were lung, liver, stomach, nasopharynx and rectum. In the females, the five leading cancers were cervix uteri, breast, stomach, lung and ovary. This was the pattern reflected among the Chinese, the patterns for the Malays and Indians were different. In addition, the Chinese constituted the highest proportions in most of the selected individual cancers analysed (including cancer of the nasopharynx, lung, liver, stomach, cervix, breast, rectum and colon). However, there was a high proportion of Indians in laryngeal and skin cancer. The age distribution of the patients showed that cancers of the oesophagus, stomach, colon, rectum, liver, lung, skin and bladder, were predominant in the older age groups (55 years and above). Carcinoma of the cervix uteri, ovary and breast were more common in the 45-54 years age group, while leukaemia, thyroid and nasopharyngeal carcinoma were more common in the younger age groups. Comparisons with other studies showed strikingly similar patterns to those found in Singapore, 1968-70.
A retrospective study of intraocular foreign bodies treated at the University Hospital over 10 years from 1970 - 1979 was carried out. Of the 48 cases reviewed, nine were anterior chamber foreign bodies while the rest were posterior segment foreign bodies. The anterior chamber foreign bodies had better visual prognosis as compared to the posterior segment foreign bodies. Most of the patients were young Chinese males and most of the injuries were due to accidents at work involving the 'hand hammer' (includes other implements used as a hammer).
A young Chinese female presented with severe bilateral chemosis without any other systemic evidence ofoedema or systemic lupus erythematosus (SLE). Investigations confirmed the diagnosis of SLE with early diffuse proliferative glomerulonephritis. The condition improved with steroid therapy.
Patients attending a referral Skin Clinic were studied to identify the spectrum of drug eruptions and the offending drugs. There were 51 patients with an incidence of five per thousand and equal sex incidence. Though the pattern of eruption was broadly similar to other reports, unusual reactions were observed. In addition to the skin manifestation, fever and lymphadenopathy were present in most patients. Raised erythrocyte sedimentation rate and eosinopoenia were commonly observed. Clinical acumen and the list of drugs ingested are still the best clues to the diagnosis ofdrug eruption.
Study site: Skin clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The results of this study indicate that the important viral agents associated with lower respiratory tract infections in young children are respiratory syncytial virus, rhinovirus, and parainfluenza virus, particularly in those under 2 years of age. This is in close agreement with studies done in temperate climates. Influenza A virus is seasonal and plays an important role in upper respiratory tract infections in older children.
Study site: Inpatients and outpatients, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
A study of 50 healthy nurses from the University Hospital showed that 72% had chronic headache. Among those who had chronic headache, 33% were due to migraine. Another 30% were probable migraine subjects and 33% suffered from tension headache. Twenty two nurses had headache more than once a month and 18 nurses described the headache as moderate to severe. The common precipitating factors mentioned were tension, exposure to the sun, lack of sleep and menstruation.
One hundred and forty-five diabetic patients attending diabetic clinic over a four week period were fully examined in an adjacent eye clinic. The fundi were examined with a Halogen light direct ophthalmoscope and the Binocular Indirect Ophthalmoscope after mydriasis to assess the presence of retinopathy. 44.1 percent of patients examined had Opbthalmoscopicaliy detectable retinopathy while 11 percent were found to have 'serious diabetic eye disease'. The prevalence of diabetic retinopathy in Malaysia is comparable to those of Western countries and Japan.
Study site: Diabetic clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia