If they lived in households without piped water or a toilet, Malaysian infants who did not breast-feed were five times more likely to die after 1 week of age than those who breast-fed, when other significant factors affecting infant mortality were taken into account. This is double the relative risk associated with not breast-feeding for infants born into households with toilets, whether or not they had piped water. Analogously, improvements in toilet sanitation appear to have reduced mortality twice as much among infants who did not breast-feed as among those who did. These findings, from a retrospective survey of infants born to a probability sample of 1,262 women in peninsular Malaysia, confirm the pernicious synergistic effect of poor sanitation and nonbreastfeeding that was postulated previously on theoretical grounds. Promoting and maintaining high initiation of breast-feeding is thus particularly important where poor sanitation is prevalent. Even more affluent areas should not be neglected, however, because socioeconomic improvement, including improved environmental sanitation, is often accompanied by decreased breast-feeding. Although the risk to each nonbreast-fed infant was less in those areas, infants there were less likely to breast-feed in Malaysia, and hence they made up a significant proportion of lives that could be saved by breast-feeding.
Foreign bodies in the laryngotracheobronchial tree are not uncommon. Their clinical presentations, the radiological and endoscopic findings in sixteen cases that presented to the Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia were reviewed. The technique of removal is also discussed.
Study site: Hospital Kuala Lumpur, Malaysia (UKM unit)
The left atrial myxoma is important not only because of its relative frequency and diagnostic difficulty but because it can be successfully removed by surgery. However, if untreated, it invariably leads to death. We report three cases seen at the Cardiology Department, General Hospital, Kuala Lumpur in 1985.
An alarm about suspected toxic gas leakage was raised in a primary school. All the students were evacuated by the staff and the community to a district hospital in Teluk Intan, Perak, about 8 km from the school. Sixty-four primary students from the school, four secondary school students and a student’s mother, who was near the school were all examined by a team of medical officers: Perceptions and records of the incidence from the students, staff and medical officers were recorded and examined by the author who visited the school and the hospital after the incidence. Psychosomatic symptoms related to anxiety attack were predominant There was no evidence of any gas leak. Symptomatic management was given by the medical officers. The psychogenic aetiology of the subsequent physical symptoms and behaviour, and the difference from epidemic hysteria are discussed.
Infantile or developmental coxa vara is a relatively infrequent localised dysplasia of unknown etiology which usually presents in the second or third year of life soon after the child begins walking. The clinical and radiological picture is usually characteristic especially when seen early. Early surgery leads to a satisfactory outcome. However, difficulty arises in diagnosis and treatment when patients present late, three cases diagnosed in adolescence at the University Hospital, Kuala Lumpur over the last 10 years are presented to increase awareness of this condition, which may be underdiagnosed, and the difficulties in diagnosis and treatment with late presentation are stressed.
A detailed account and definition is given of the previously inadequately described "giant reactions" to tuberculin occasionally seen in leprosy patients. The reaction is an accelerated and exaggerated response to species-specific antigens of Mycobacterium tuberculosis found in both PPD and New tuberculin. Our studies were performed in Malaysia, Uganda, Spain, and England. There was a significantly higher incidence of the phenomenon in Malaysia than in the other centers, but this may have been because there alone previously untreated lepromatous (LL and BL) patients were serially tested for up to three years after starting chemotherapy. Of the 28 patients exhibiting giant reactions, 27 occurred among lepromatous patients (24 LL and 3 BL), of which only 3 (1 LL and 2 BL) were untreated. One treated BL patient had developed, and one untreated BL patient was a family contact of, active tuberculosis. Giant reactions are uncommon in untreated and in very long-term treated LL patients, but may occur in up to a fifth of those receiving their first 1-3 years of chemotherapy. Although the mechanism is not yet understood, it appears to be a coincidence of delayed hypersensitivity of the tuberculin type and a less-delayed phenomenon of excessive local edema associated with local lymphadenopathy and short-lasting symptoms of malaise and pyrexia. It is suggested that the majority of giant reactions occur during a period of temporary lack of immune regulation associated with changing levels of antigenic load.
The right heart pressures and saturations at different sites were measured in 87 normal individuals over a 16-year period during heart cardiac catheterisation. The right heart pressure measurements were comparable with normal values reported in Caucasian subjects. However, the total pulmonary vascular resistance and systemic vascular resistance were significantly different, though the pulmonary vascular resistance was comparable.
Neonatal epiphyseal separatton of the head of femur is a rare obstetrical injury. This is confused with the more common proximal femoral metaphysical fracture, dislocation of hip or even an infection. Such a case is reported in this paper. Management was conservative, with abduction splint for three weeks and the outcome was satisfactory.
This paper deals with our experience of two cases of retropharyngeal abscess due to foreign body. A briefaccount ofthe anatomy. pathology, complications and treatment ofthis condition is given
19 cases of Kawasaki Syndrome were seen at the University Hospital, Kuala Lumpur between June 1979 and August 1984. The clinical features of the cases are reviewed in this paper. Kawasaki Syndrome is not an uncommon disease in Malaysia and clinicians should be aware of its presentation.
A survey of a total of 1,157 Indian primary school children from eight schools from urban and rural areas in and around Kuala Lumpur showed an overall
prevalence of infection with soil-transmitted helminthiasis of 89.02%. The prevalence and intensity of infection were consistently high among both school boys and girls throughout the six years of primary school. The predominant helminth was Trichuris trichiura - both as single and mixed infections. The commonest type of helminthic infection among urban primary school children was mixed infections with Trichuris trichiura and Ascaris lumbricoides. Hookworm infections, both as single or mixed infections, were more common among school children from rubber and oil palm estates in the rural areas.
A food poisoning outbreak affected 114 female Malay students staying in a religious secondary school hostel in Klang. The students developed an illness mainly characterized by abdominal pain, nausea, vomiting and giddiness. The median incubation period in this outbreak was 2.5 hours. Laboratory examination of suspected food revealed 2.3 X10^6 Bacillus cereus organisms per gram of fried noodles. B. cereus was determined as the probable cause of this outbreak and the fried. noodles the most likely vehicle for the organism. An outbreak of B. cereus food poisoning is being reported in Malaysia for the first time.
Edesonfilaria cynocephali n. sp., a parasite of Cynocephalus variegatus taylori (Thomas) in Malaysia, is described. Makifilaria Krishnasamy et coll., 1981 is placed in synonymy with Edesonfilaria and the new combination E. inderi (Krishnasamy et coll., 1981) n. comb. is proposed. Edesonfilaria and the closely related genus Macacanema constitute a small evolutionary line of Filariae with a hyperspecialized oesophagus (the glandular portion lacks lumen); the line is restricted to the Indo-Malaysian region and occurs in arboreal Dermopterans, Chiropterans and Primates.
A case of perforation of the uterus by the Multiload CU250 Device is described. To date no perforation of the uterus by this device has been reported. The device was successfully removed under laparoscopic control.