Serum prolactin (hPRL) levels in nonpregnant, pregnant and postpartum women during sleep were investigated. The study showed that in non-pregnant women, there is an immediate shift of hPRL release with reversal of sleeping period. Thus, the nocturnal surge for prolactin is sleep related. In pregnant women, however, while there is an increase in hPRL level during pregnancy, the nocturnal rise of this hormone is not detected and this is observed as early as the first trimester of pregnancy.
One-hundred-and-four patients unth. hand eczema were studied. The female to male ratio was 1.9:1 and peak incidence was in young adulthood. In females, housewives constituted the biggest group while in males, mechanics/engineers was the biggest group. 30% of the patients had contact sensitivity on patch testing to a standard series. Balsams, medicaments, rubber ingredients, nickel and formaldehyde were the common allergens. The contact sensitivity was considered relevant in 65% of cases.
The causal explanation given by a 24-year-old Malay woman from a low socioeconomic class for her epilepsy is described. This case illustrates how cultural explanations can protect an individual from the stigma of illness. The Malay concept of the supernatural and the causation of illness is discussed.
Folate and vitamin B 12 status in pregnancy was studied in a group of 190 Malaysian mothers belonging to the three major ethnic origins. Cord blood was also analysed for the same vitamins. Ethnic variations with regard to deficiency in these two vitamins was determined. About 58.5 percent of the pregnant mothers suffered from lowered serum folate levels and 32.4 percent had lowered RBC folate levels. In contrast vitamin B 12 levels were within normal limits. Cord blood levels of these vitamins were significantly higher than. the corresponding levels in the maternal blood, suggesting the possible involvement of an active process in the transfer of folates and vitamin B 12 to the fetus.
This report describes a case of Behcet's syndrome in which there was involvement of both the intracranial and systemic veins. The pathogenesis of Behcet's syndrome is discussed.
A cohort of90 infants born in March 1979 in Kedah, Pahang and Malacca were followed up to find out the feeding practices, preventive health care and medical care practices during infancy. A high proportion of infants were breastfed compared to the urban population. However, early introduction of solids was very common. Parents were well aware of the immunisation schedule and attended government clinics for immunisation. However, attendance for health appraisal was not made according to schedule. Cough and cold,fever, diarrhoea, measles and skin conditions were the common ailments. Medical care for cough and cold, fever and diarrhoea was sought from general practitioners, clinics, and hospitals. Practice of buying analgesics and penicillin cream for self treatment for fever and sores was a common practice. Help was soughtfrom traditional healers for measles. Fever and diarrhoea were thought to be signs of health by some and nothing was done. Mothers were well educated on the importance of breast feeding but were not aware that introduction ofearly solids is not satisfactory. Education with regards to introduction of solids by health staff was not done timely. Health staff were mentioned as injluentials for feeding practices and immunisation, but were not mentioned for medical care. Some recommendations for infant care are also mentioned in the paper.
Demographic characteristics of all patients with a diagnosis of alcoholism or alcoholic psychoses admitted between 1975 and 1978 to the Psychiatry Department, General Hospital, Kuala Lumpur, were examined. The diagnosis of alcoholism or alcoholic psychoses accounted for 2% of the total psychiatric admissions. Males greatly predominated over females and Indians greatly predominated over Malays and Chinese. Reasons for these differences are discussed.
This was a retrospective study of 177 patients above the age of 45 who were admitted to the Psychiatric Unit, University Hospital Petaling Jaya during the period October 1975 to October 1978. The available socio-demographic and clinical data from the case files were studied. The patients were divided into two groups - those with effective illnesses and those with non-affective illnesses. The differences in socio-demographic background and clinical symptomatology between the two groups and how the data compares with that in other studies was reported. The sick elderly person is an economic and psychological liagility to .his family and society. Absence of illness in the elderly not only fosters their continued independence but also improves the quality of their individual life. Though no definite correlations or conclusions could be arrived at, this study has sought to bring into awareness the necessity of delineating possible illness precipitating stress factors in the social and domestic environment of patients in later life.
We report here a case of a kidney transplant recipient in whom the ureter was initially implanted into the peritoneum. Excessive ultrafiltration volume and reversal of serum vs dialysate creatinine ratio when the patient was recommenced on continuous ambulatory peritoneal dialysis first suggested the diagnosis which was subsequently confirmed by a plain abdominal x-ray demonstrating placement of ureteric stent in the peritoneum. This rare complication was successfully corrected with surgical re-implantation of ureter into the bladder and 5 years later, the patient remains well with good graft function.
We report the case of an infant who was found dead in the toilet of a nursery. Examination of the scene revealed an element of neglect in the care of the child. Postmortem showed evidence of drowning. Her blood sample showed a toxicologic evidence of alcohol exposure.
A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.
Gastric cancer is an important cause of death among patients with malignancies in Malaysia. Survival of patients with gastric cancer is dependent on the stage at which diagnosis is made. We report our experience in dealing with gastric cancer in a major Ministry of Health Hospitals in Malaysia. A retrospective review of two hundred and fifty consecutive histologically proven gastric adenocarcinoma at Hospital Ipoh for the period January 1988 to 1998 was performed. The study confirms that gastric cancer is a disease of the elderly and has a male preponderance. It is also identifies the Chinese and Indians to be at increased risk of gastric cancer when compared to the Malays. The most striking finding in this study was the very late stage of disease at time of presentation. Eighty-two percent of the patients presented with stage IV disease and curative surgery was offered only to a 16% of them. In a substantial number of patients not even a palliative procedure was offered. Early detection is the key to improving survival in gastric cancer patients. There is an urgent need for clinicians to change their approach to the management of the disease. Patients with dyspeptic symptoms should be investigated early rather then wait for classical symptoms of gastric cancer.
The effect of Ramadan fasting on fasting serum glucose (FPG) is still a matter of controversy. One hundred and fifteen healthy volunteers fasted for > or = 25 days during Ramadan. Blood samples were taken 1 week before Ramadan and on the 14th and 28th day of Ramadan. Serum glucose was determined by the glucose oxidase method. FPG decreased from 88.4 + 9.0 mg/dl to 62.9 +/- 7.7 mg/dl (p < 0.001). Men and women both experienced a significant drop in FPG. Calorie intake decreased in all groups (p < 0.001) and was positively correlated with decreasing FPG. FPG decreases with Ramadan fasting and has no serious adverse effect on fasting adults.
We retrospectively studied the records of 6 Malaysian children who were diagnosed with Alagille Syndrome (AGS) according to this criteria from January 1999 to January 2001, at the Institute of Paediatrics, Kuala Lumpur Hospital. Four patients (66%) had a positive family history. Thirteen individuals (6 patients and 7 relatives) were diagnosed with AGS in these 5 families. Only 6/13 (46%) of them presented with liver involvement. All 6 patients presented with typical facies and cholestasis (100%). Three (50%) presented with portal hypertension (PHT) with synthetic liver dysfunction (1 died), 1/6 (17%) have PHT and normal synthetic liver function. Two have cleared their jaundice but have biochemical evidence of hepatitis and hepatomegaly, four have congenital heart disease 5/6 posterior embryotoxon, 2/6 butterfly vertebrae, 4/6 hyperlipidaemia and 4/6 failure to thrive. One patient has a Jagged-1 gene disruption at the translocation breakpoint locus 20p12.3 2n = 46,XX,t(12.20) (q22, p12.3). 5/6 (83%) are still alive. Two-thirds of our patients developed chronic liver disease by 3 years of age. Two-thirds of the index patients have a family history. Only 46% of individuals in these families have clinical evidence of liver involvement. Mortality depends on cardiac/renal disease, end-stage liver failure and intercurrent infection.
How people perceive risk influences their behaviour towards these risks. We do not know how workers perceive risk of dying from diseases or accidents. This study was conducted among 198 workers of a security company in Malaysia. The workers were asked to score on a Likert scale of 1 to 5 the perceived risk of death of Malaysians from selected causes of death. The highest perceived risks of death were, in order of ranking, motor vehicle accidents, cancer and diabetes mellitus whereas according to the certified causes of death in Malaysia the highest risks of death among the selected items were cardiovascular disease, cancer and stroke. The difference in perception and mortality data needs be addressed.
The purpose of this study is to evaluate the use of acoustic rhinometry in assessing surgical outcomes in sinonasal surgery. This prospective study was carried out from January till December 2001. A group of 44 patients who presented with nasal obstruction due to various rhinologic abnormality were examined with acoustic rhinometry pre and post-operatively. They were examined with acoustic rhinometry pre and post decongestion with cocaine and adrenaline. A highly significant correlation existed between minimal cross sectional area (MCA) and the subjective feeling of nasal problem, pre and post surgery. Thus MCA is a valuable parameter to express objectively the nasal patency. The mucovascular component of the nasal cavity plays a major role in the nasal patency as determined in the pre and post-decongestion acoustic rhinometry measurement. Acoustic rhinometry is a good tool to evaluate the nasal patency in cases where sinonasal surgery is considered in correcting the abnormality as well as for the post-operative evaluation.
Population norms for Health Related Quality of Life using SF-36 are described. A national sample was canvassed in 2000 using a self-administered SF-36 in Bahasa Malaysia and English. Response rate was 30.6%, with 3072 usable data. Male: Female ratio was 1.04 and mean age was 39.8 years. Quality of life was affected by age and sex. Older population and women had a poorer quality of life. Population norms for Malaysia differed from those of US, Canada and Australia. The malaysian general population norm described is useful as reference point for studies in Malaysia. Variability in scores by age and sex emphasize the need to use appropriate age- or sex-specific normative data.
We report two patients, who have used Pneumostat to replace the conventional underwater seal drainage system for recurrent pneumothorax. Both patients had required repeated chest tube insertion for recurrent pneumothorax and needed a longer hospital stay. Both patients were able to be discharged with the Pneumostat device and were reviewed in outpatient clinic. Both patients had optimal clinical improvement and chest X-ray showed no residual pneumothorax.