A prevalence study for intestinal parasites among 305 infants and young children was conducted at the Paediatric wards of the General Hospital Kuala Lum.pur, Malaysia. 40.8 percent of children were infected with at least one type of intestinal parasites: 39 percent were found to be infected with intestinal helminths and 4.26 percent with intestinal protozoa. Ascaris formed 17.38 percent of the infestation followed by Trichuris (14.75 percent) and hookworm (2.95 percent); 0.3 percent of the cases had Strongyloides stercoralis; 2.30 percent and 2.62 percent of the children had Entamoeba histolytica and Giardia lamblia respectively. Indian children were the predominant group found infected, followed by the Chinese and Ma lays. A significant drop in infestation rate of soil-transmitted helminths was detected among the Malays. The significance of the changing pattern in the epidemiology of soil-transmitted helminths is
discussed. A brief review of literature is also presented.
A case of the Hutchinson-Gilford progeria syndrome (HGPS) in Malaysia is described. A brief discussion of this rare condition and its differential diagnosis follows.
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.
In the outbreak of cholera in Perak in 1978, a study on 179 cholera patients (cases) from 8 health districts in the state indicated that those afflicted with the disease were from the rural areas, belonged to the lower socio-economic class and had little or no formal education. Under such conditions, it is expected that personal hygiene may not be satisfactory and person to person contact could play an important role in the transmission of the disease especially among those living in close contact. 34.2 percent of the 164 households of the cholera patients contained injected household contacts. From 1 to 6 infected household contacts per household were found for household size ranging from 2 to 18. Ninetyjive (8.6 percent) of the total 1101 household contacts were injected. Only 8 of these 95 infected household contacts developed clinical symptoms giving a ratio of 1:12 symptomatic to inapparent injections. While most of the contacts probably acquired their infection from the patient who constitutes the index case, the role of the asymptomatic carrier in the transmission ofinjection cannot be underestimated.
Thirty-four case notes of patients in acute renal failure on whom intravenous urograms (IVU) were performed, were reviewed. All patients received high doses of Conray 420 or Urotrast. Delayed films up to 48 hours were routinely done in patients suspected of having obstruction. There were no side effects of the intravenous urogram examination. IVU with high dose contrast material and nephrogram are helpful in differentiating the cause of the acute renal failure, and in excluding outflow obstruction.
The sugar content of twenty-four liquid medicines commonly prescribed for infants and young children were measured and the type of sugars present were also identified in four randomly selected samples. All the liquid medicines tested contained sugar, in the range of 29.4% to 61.2%. Sucrose appeared to be the most commonly used sugar. Whilst it is agreed that sucrose makes the medicine more acceptable to children, its continual use by the pharmaceutical industry should be discontinued due to its harmful effect on the dental health of children, particularly those taking these syrup-based medicines on prolonged basis. Sugar-free alternatives such as sorbitol or saccharin should be used instead.
Yaws was detected in a six-member family in the southern Malaysia state of Johor. This stresses the need to be vigilant against a long-forgotten disease of childhood which was of great public health concern in the past.
One hundred and seventy five patients treated for burns during 1983 and 1984 were reviewed. The majority of these patients were below eight years of age. These injuries were mainly sustained at home (83.4%) and were usually caused by hot liquids (41.7%). The infection rate was 57.1% and many developed septicaemia (21.7%). Mortality in patients sustaining burns involving greater than 30% of the body surface area was high at 52%.
Barium enema hydrostatic reduction was carried out for eight patients with Intussusception over a six-month period. There were five successes (62%) and three failures. There were no mortality or complications arising out of this procedure. The technique is discussed. This procedure offers many advantages over surgical reduction. However, it is not a substitute for surgery which is still indicated in the sick infants and in those where hydrostatic reduction failed.
An anthropometric study and dietary investigations were conducted in an Iban community in the Sixth Division of Sarawak. 140 children aged 0 to 6 years, were assessed anthropometrically. Their mean weights and heights were much lower than those of their counterparts in Singapore. 7% of the children were nutritional dwarfs while about 68% were either wasted or wasted as well as stunted. Rice was the staple food in the community while other foods were considered unnecessary. Child feeding practices also reflected this dependancy on rice leading to a toddler diet which is mainly carbohydrate in nature. The dietary assessment showed a quantitative adequacy of energy as well as protein, a [inding whicn does not reflect the seasonal fluctuations with periods of hunger. The predominant contribution from rice resulted in protein intakes which were qualitatively deficient.
Between January 1974 and June 1980, 85 cases of cryptococcosis were diagnosed in the University Hospital, Kuala Lumpur, Malaysia. The diagnosis was based on positive culture of the organism in 81 cases; the remaining four were diagnosed on histopathological findings. Cerebral cryptococcosis was the most common presentation and Chinese are particularly susceptible (72% of cases). The incidence of the disease is shown to be far greater than previously suspected. Association with compromised host status is uncommon (14%). The local literature is briefly reviewed and the findings discussed.
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.
Surgery for the persistent ductus arteriosus (PDA) is almost 50-years-old. It started with Robert Gross in 1938 who successfully ligated the PDA in a seven-year-old girl.! Incomplete obliteration, ligatures cutting through the ductus and recanalisation of the ductus remained troublesome possibilities with this method of dealing with the PDA. Dividing the ductus and suturing each divided end separately would eliminate these possibilities. Gross was quick to recognise this and advocated division in all cases to remove any doubt of incomplete obliteration. 2 Jones supported this concept but also stressed that division and suture of the PDA was not to be taken lightly for the fatal consequence that could arise from inexperience.f There were those who continued to have satisfactory results with ligation of the PDA and persisted with this method (Blalock." Clagett, Kirklin, Ellis and Coolev.' Panagopoulos, Tatooles, Aberdeen, Waterston and Bonham Carter"}, The debate continues between ligation on one hand, and division and suture on the other and it appears currently to favour the latter. This paper reviews our experience with surgery for the PDA over the past five years.
This is the first report in which a marine mollusc, Oliva vidua fulminans (olives), generally not known to be poisonous, was responsible for death in five children after consuming boiled olives with tamarind. The onset of symptoms was rapid 10 to 20 min after consumption of the olives. Signs and symptoms included nausea, vomiting, abdominal pain, tingling sensation around the lips, numbness around the mouth, drowsiness, lethargy and generalized weakness with paraesthesia in the limbs. The five deaths occurred within 3 to 4 hours after eating the poisoned olives and resulted from respiratory failure. Left-over olives from the affected household and freshly collected live olives had a toxicity of 14,200 mouse units (M.U.) and 15,000 M.U. per 100 g meat respectively. No other common chemical poison and organophosphorus insecticides were detected. The neurotoxic agent was acid and heat stable and was toxic at pH less than 4. Its action was similar to that of paralytic shellfish poisoning which was caused by toxins from certain dinoflagellates.