In a prospective study of 50 patients with suspected tear of the meniscus of the knee, the clinical diagnosis, arthrographic and arthroscopic findings were compared at arthro-tomy. The clinical diagnosis was correct in 85%, arthrographic in 54%, and arthroscopy in 91%of the patients.
100 patients were registered at the Diabetic Clinic in 1981, where they were managed by a team of physician, obstetrician and paediatrician, based on a preset protocol. Only 92 patients were eventually analysed. The study showed a 1.3% incidence of pregnancies complicated by diabetes mellitus. The mean birthweights of infants of both gestational and established diabetics were heavier than that of the general population by race and gestation. 25% of the 92 infants of diabetic mothers have birthweight exceeding the 90th centile of population. Further division of the 92 patients into the "true gestational" diabetics, as shown by an oral glucose tolerance test performed 6 weeks post-natally, also showed a 25% incidence of macrosomia. Late antenatal booking, delayed detection of abnormal glucose tolerance and treatment attributed to the high incidence of macrosomia. Only one infant had birthweight below the tenth centile. There were no perinatal mortality in the 92 patients studied. Macrosomia is a common complication in infants of diabetic mothers despite a physician-obstetrician joint-care system. Also, the risk of having macrosomia amongst gestational diabetics is high.
This study presents the demographical characteristics of 271 cases of parasuicide seen at the Psychiatric Clinic, General Hospital, Kuala Lumpur, during 1982. The majority of cases were women in the 20 - 30 year age group, from a lower economic class, with minimal education. About one-half were single and 61.5% were actively religious. The racial breakdown was Indians 55%, Chinese 32% and Malays 13%. Self-poisoning using easily available drugs was the most common method employed and more than one-half intended to die at the time of the suicidal act. Most attempts were impulsive, carried out while alone, inside the
house. The findings are discussed and compared with earlier studies of attempted suicides in Malaysia and Singapore.
This study examines the primary reasons for attempting suicide as described by the 271 parasuicidal patients assessed at the Psychiatric Clinic, General Hospital, Kuala Lumpur during 1982. The reasons in order of frequency were: marital problems; family problems; boyfriend, girlfriend problems; a medical illness; a psychiatric illness; and others, The types of marriage, family, and love problems experienced by each of the three major Malaysian racial groups are discussed. Indians presented with family problems more frequently than the other racial groups and Indian females were more frequently battered before the suicidal attempt. Suggested treatment measures based on the findings include employing a crisis intervention model for suitable patients, interviewing the patients on the Medical Wards, and involving more Psychiatric Social Workers in their management.
One hundred and twenty-four women from a semi-urban area who came for consultation for unplanned pregnancy during an eight month period are analysed. It is found that women with a high risk of unplanned pregnancy are mostly housewives, aged between 20 and 34, who have given birth to one or three children, the last of whom is usually below one or two years old. They belong to the lower socio-economic class and are lowly-educated. Most of them have not completed their families. Although most of them have either used or heard of contraceptives begore, the majority were not using any contraceptive at the time of consultation or were using an ineffective method. Their reasons for non-use or default are identified, many of which are related to the pill. Proper motivation of would-be contraceptive receptors and regular follow-up of acceptors by general practitioners or Family Planning Clinic Staff who are knwoledgable in all available methods of contraception are offered as a solutionto the problem of high rate of defaulting and consequent high rate of unplanned pregnancies.
Study site: private general practice clinic, Perak, Malaysia
In a prospective study performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur, over a period of 14 months from January 1982, we documented 12 new cases of analgesic nephropathy (AN). Since then up to July 1986, we have documented a further 16 cases of AN giving a total of 28 cases over a four-and-a-half-year period.
A total of 90 cases of pneumococcal infections were identified at a major referral hospital in Kuala Lumpur, Malaysia during a study period of four years. Pneumonia was the most common clinical presentation (41 cases) followed by meningitis (19 cases). Of 48 patients who were followed-up during the microbiology consultation round, 11 died, 9 were children below two years old. Capsular typing was carried out on 57 strains of Streptococcus pneumoniae isolated from blood and body fluids of 43 children and 14 adults. 38 strains isolated from pharyngeal specimens were also typed. Types 6A (11 strains), 6B (7 strains), 14 (8 strains) and 19A (8 strains) predominated in children. The strains from older patients comprised 3 isolates from cerebrospinal fluid (types 18B, 6B and 14), five from blood (4 strains, type 1 and 1 strain, type 4) and six from pus (1 strain, type 14, 3 strains type 23F and 2 strains type 34). The isolates from pharyngeal specimens belonged to capsular type similar to those implicated in infections. 90% of the types reported in this study are included in the 23 valent pneumococcal vaccines. Minimum inhibitory concentrations of penicillin, cefuroxime, chloramphenicol and rifampicin were determined for selected strains. 4.1% of isolates were resistant to penicillin (3/74), 4.5% to cefuroxime (2/44), 6.5% to chloramphenicol (3/46) and 14.6% to rifampicin (6/41).
A prospective clinical study comparing 74 cases of rotavirus-associated diarrhoea and 100 cases of non-rotavirus-associated diarrhoea revealed a higher incidence of vomiting to be the only significant difference in the former. Bloody stools were seen in about 5-10%, fever in about two-thirds and respiratory symptoms in a quarter of cases regardless of aetiology. The overwhelming majority had mild dehydration of the isonatremic type. Hypokalemia was noted in a quarter of the cases in both groups.
Keywords: General Hospital Kuala Lumpur
A prospective study of acute renal failure (ARF) over a three month period showed that 60 out of 22,033 inpatients developed AR"F (Serum creatinine exceeding 0.200 mmol/L). The ARF was oliguric in 22% and nonoliguric in 78%. Poor cardiac output or diminished intravascular volume, nephrotoxins and infections were the main aetiological factors associated with ARF in 85% of cases. Mean peak serum creatinine and blood urea values were higher in the oliguric than the non oliguric group. The oliguric group required dialysis more frequently (53.8% vs 4.3%) and had a higher mortality (53.8% vs 8.5%) than the non oliguric group. Nonoliguric ARF occurs more commonly and has a better prognosis than oliguric ARF. Acute renal failure is a serious condition with significant mortality and remains a frequent occurrence in the setting of large general hospitals. A Previous reports on acute renal failure in Kuala Lumpur comprised patients treated at the Department of Nephrology at the General Hospital Kuala Lumpur, but did not include patients with acute renal failure treated at other departments in the hospital. This report is based on a prospective study of acute renal failure occurring in the General Hospital Kuala Lumpur over a three-month period to evaluate the clinical spectrum of this disease, and its outcome.
A retrospective prospective study of 84 cases of subarachnoid haemorrhage, 24 intracranial aneurysms and 18 arteriovenous malformations (AVM's) treated in the University Hospital, Kuala Lumpur, during the post CT-scan era was carried out to verify the relative frequencies of these clinical entities in the Malaysian population. Our results show that aneurysms are commoner than arteriovenous malformations as a cause of subarachnoid haemorrhage and also the most frequent as a whole, thus refuting the previous claims that AVM's are 4 to 10 times more common than aneurysms in this part of the world. Of interest was the internal carotid artery aneurysms accounted for half of the anterior circulation aneurysms and that 2/3 of the AVM's presented with intracranial haemorrhage.
In a prospective study 84 patients with aphakic retinal detachment were treated either by local scleral buckling alone or combined with an encirclement. The rate of surgical reattachment of the retina was found to be similar with either technique over a minimum follow-up period of one year. Simplicity and a low incidence of serious complications of the local procedure merit its application as the initial method of repairing aphakic detachments.
The effect of soy protein on the small bowel mucosa of 18 infants with acute gastroenteritis was studied. The infants were maintained on a protein hydrolysate formula for 6-8 weeks, following which they were readmitted for soy protein challenge studies. Jejunal biopsy was performed before and 24 h after challenge. On the basis of the clinical and histological reaction to soy protein challenge, three groups were identified. Group 1 consisted of three infants who had clinical and histological reaction. There was associated depletion of mucosal enzymes, lactase, sucrase, malatase, alkaline phosphatase, and blood xylose levels. Group 2 consisted of seven infants who had histological reaction but no clinical symptoms. Two of these seven infants, however, developed clinical reaction when rechallenged with soy protein 2 and 90 days later. Following challenge, mucosal enzymes and blood xylose levels were depressed in five of the seven infants tested. Group 3 consisted of eight infants who did not have either a clinical or a histological reaction. The mucosal enzymes and blood xylose levels were not depressed in four infants tested. The present study shows that the small bowel mucosa of some young infants recovering from acute gastroenteritis remains sensitive to soy protein for a variable period of time. The feeding of soy protein to these infants may result in the persistence of mucosal damage and perpetuation of diarrhea.(ABSTRACT TRUNCATED AT 250 WORDS)
A prospective study was carried out in the Maternity Hospital, Kuala Lumpur over a 2-year period. During this time, 52,379 deliveries took place. 36 neonates (0.7 per 1000 births) were found to have congenital dislocation of the hips (CDH) by both the Ortolani and Barlow's manoeuvre. CDH was most common in the females (female to male ratio was 2.3:1), the first borns (50% of the affected cases) and babies who had breech delivery (10.7 per 1000 births). In 21 (58.3%) of the affected neonates, CDH occurred in both hips. According to the classification of newborn infants' hips by Finlay et al, 88.9% of the neonates had unstable hips while 8.3% had pathological hips. Family history of CDH was present in 5% of the patients. 8 (22.2%) of the neonates had other associated congenital abnormalities.
In a prospective case-control study over a two-year period involving 1006 women, 264 women with acute myocardial infarction (AMI), 305 with non-infarct acute coronary syndromes (CAD) were compared with 437 women with no coronary heart disease (Controls), to determine the relationship between cigarette smoking and other risks factors with coronary heart disease. A history of current cigarette smoking was strongly associated with the risk of coronary events for both AMI And CAD (p less than 0.001). 23.9% of patients with acute coronary syndromes were current smokers, compared with only 12.8% among controls. Overall, women smokers had about a two-fold increase in risk for all coronary events. Younger women smokers (less than 40 years) and those between 61-70 years had particularly higher risks (10.3 and 2.7 times respectively (p less than 0.01, p less than 0.02). A dose-response pattern of increased AMI risks (from 2.0 to 2.9 times) among women smokers was also found, corresponding to the number of cigarettes smoked per day (p less than 0.05). Other significant coronary risk factors established were: postmenopausal status (OR 6.5), diabetes mellitus (OR 5.1), hypertension (OR 1.6), family history of premature coronary heart disease less than 50 years (OR 1.3) and use of oral contraceptive pills (OR 1.4). Our results thus emphasize that cigarette smoking is an important determinant of acute coronary events even among Malaysian women.
Over a 12 months period, out of 25,411 livebirths, 155 neonates (6.1 per 1000 livebirths) had proven septicemia by blood culture. The mortality rate was 26.5%. Septicemia was more common among the very low birthweight and preterm neonates of gestation of 30 weeks or less. 45.8% of the septicemia occurred during the first 48 hours of life. Staphylococcus epidermidis was the most common causative organism. However, mortality was highest among neonates who acquired multiresistant nosocomial infection during the later part of neonatal life.
The objective of the study was to determine whether discriminant analysis of characteristics of dyspepsia can differentiate peptic ulcer from non-ulcer dyspepsia in a Malaysian population. Two hundred and twenty six patients with dyspepsia were interviewed using a standard history questionnaire before undergoing upper gastrointestinal endoscopy. Forty seven patients had peptic ulcer while 149 others were classified as having non-ulcer dyspepsia. Stepwise logistic regression analysis was done on 25 variables. The study showed that only five of these variables could differentiate peptic ulcer from non-ulcer dyspepsia, namely, nocturnal pain, pain before meals or when hungry, absence of nausea, age and sex. A scoring system was devised based on these discriminant symptoms. At a sensitivity of 51%, the specificity for peptic ulcer was 83%, but only prospective studies will determine if this scoring system is of actual clinical value.
Over an 18 month period, 34,495 livebirths were delivered in the Kuala Lumpur Maternity Hospital. 36 neonates (1.044 per 1000 livebirths) had Down's syndrome. The observed rates of Down's syndrome per 1000 livebirths by single year intervals of maternal age were calculated. By using the discontinuous slope model, our study showed that the incidence of Down's syndrome among the Malaysian liveborns increased markedly when the maternal age exceeded 35 years. This study also suggested that the Malay mothers had increased risk of producing babies with Down's syndrome at a later age than the Chinese and the Indians. However, a larger number of babies in each racial group needs to be studied to confirm this.