We have recently reported that a dipstick colloidal dye immunoassay (DIA) that detect parasite antigens in human serum is sensitive and specific for the diagnosis of active infection of lymphatic filariasis. Rabbit polyclonal antibodies (RbBmCAg) labelled with a commercial dye, palanil navy blue was used to detect filarial antigenemia among Indonesian and Bangladeshi immigrant workers (N= 630) at oil palm estates at Hulu Trengganu District, Peninsular Malaysia. Microfilaremia with Brugia malayi were detected in 51 (8.10 %) individuals, of which 42 (6.67 %) were among the Indonesians and 9 (1.98 %) among the Bangladeshis. Microfilaremia with Wuchereria bancrofti were detected in 33 (5.24 %) individuals of which 15 (2.38 %) were among the Indonesians and 18 (2.86 %) among the Bangladeshis workers. The DIA detected 96 (15.24 %) antigenemic cases which comprise of all the microfilaremic cases and 15 (2.38 %) amicrofilaremic cases. The amicrofilaremic cases with filarial antigenemia consisted of 9 (1. 43 %) Indonesians and 6 (0.95%) Bangladeshis. We have used 6 ul of the RbBmCAg and diluted (1:10) patients' sera per dipstick which make the DIA reagent conservative. The DIA is a rapid test and can be read in approximate 2 hours.. Additionally, coloured dots developed in the DIA can be qualitatively assessed visually for intensity. The DIA does not require sophisticated equipment or radioactivity, and therefore suitable for field application.
Seven different brands of mouthwashes were assessed for the inhibition of growth of oral micro-organisms. The results showed wide variations in their effectiveness: Those containing cationic surfactants and complex organic nitrogenous compounds were more active than the older formulations based on phenols. A list was compiled ranking the mouthwashes according to their antimicrobial activity, which did not always agree with the manufacturer's claims or indication for use.
The prevalence of sexually transmitted diseases (STD) among female drug abusers was studied by screening 130 new inmates of a rehabilitation centre. Data was collected using a structured questionnaire, physical examination and specimen collection for laboratory investigation at the Community Medicine Clinic of HUSM. The majority (64.6%) were Malays and self-confessed sex workers (77.7%). A high prevalence of syphilis (50.8%), hepatitis B (52.2%), moniliasis (23.8%), trichomoniasis (19.2%) and gonococcal vaginitis (8.5%) was noted. More than half of them harbour 2 or more STDs. Six subjects, of whom 5 were Malays, were HIV positive. The evidence indicates that female drug abusers need a thorough screening for STD followed by an aggressive treatment regimen. Since the majority of them were born Muslims, they should have access to spiritual counselling and rehabilitation, stressing on repentance, and adopting a compassionate and forgiving approach.
Hepatoblastoma is the most common primary liver tumour of childhood. This is a case report of a one-year-old boy who presented with a one-month history of progressive abdominal distension and weight loss. He was cachexic, anaemic, had gross hepatomegaly and ascites. He had been born prematurely with a birth weight of 1.23 kg, and his developmental milestones were delayed. Ultrasound and CT scan demonstrated a large solid tumour in the left lobe of the liver with a smaller superficial nodule in the right lobe. Serum alpha fetoprotein was significantly raised. A left lobe hepatectomy and complete excision of the right sided nodule was performed. There was no evidence of metastatic disease. Histopathological examination confirmed hepatoblastoma of the fetal type. The patient developed features of intestinal obstruction a few days after surgery and he succumbed ten days after re-laparotomy. The clinical presentation and investigation results in this case are characteristic. Recent reports have suggested a strong relationship between very low birth weight (< 1500gm)/prematurity and hepatoblastoma as is present in this case. Surgery is the mainstay of therapy in hepatoblastoma. A brief review of the literature on this tumour is presented.
Milk is a physiological fluid which has high nutritional value and soybean has strong antioxidant characteristics which is believed to inhibit carcinogenesis. The objective of this study was to investigate the effects of administration of soybean and goat's milk on hepatocarcinogenesis in rats (fed with diethylnitrosamine; DEN and acetylaminofluorene; AAF) by determining the activities of plasma gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP). Thirty-six rats from the species Sprague-Dawley were divided into 6 groups : control, DEN/AAF, soybean, DEN/AAF with soybean treatment, goat's milk and DEN/AAF with goat's milk treatment. Soybean and goat's milk administrations were given 5 ml/day. The rats were sacrificed after 8 weeks and the blood was collected. Treatment with DEN/AAF caused an increase in ALP and GGT levels and a decrease in weight significantly (p<0.05). ALP and GGT activities decreased significantly after administration of soybean and goat's milk (p<0.05). Administration of goat's milk and soybean alone did not cause any changes in the enzyme activities. Comparison between the effect of soybean and goat's milk in reducing the enzyme activities (ALP and GGT) did not give significant values (p>0.05). However, a decrease in weight was observed in the rats given soybean as well as goat's milk. The results obtained suggested that soybean and goat's milk may work as anti cancer agents in hepatocarcinogenesis although further studies are required to further elucidate this aspect.
Pulmonary tuberculosis (TB) in the AIDS population has a variable chest radiographic presentation. The association between the chest radiographic presentation of pulmonary TB and CD4 T-lymphocyte count in the HIV-infected patient was investigated in order to provide an empirical approach for early diagnosis, treatment, and isolation of these patients. A retrospective analysis of chest radiographs, CD4 T-lymphocyte counts, and clinical history of 80 patients from Hospital Kota Bharu, was performed. All patients were HIV-seropositive and had culture and /or cytology-proven pulmonary tuberculosis. Radiographs were evaluated for the presence of atypical or typical patterns of pulmonary TB. Thirteen (16.2%) patients had typical postprimary pattern, where opacities were distributed at the upper zones, with or without cavitation. Sixty-seven (83.8%) patients had atypical patterns, consisting of normal chest radiograph, middle and/or lower zones parenchymal opacities, mediastinal lymphadenopathy, pleural effusion and miliary TB. Of these, 18 (22.5%) patients demonstrated normal chest radiographs, 36 (45%) patients showed parenchymal opacities at the middle and/or lower zones of the lungs, 30 (37.5%) had mediastinal lymphadenopathy, 18 (22.5%) revealed pleural effusion and 6 (7.5%) presented with miliary TB. Sixty-two (77.5%) patients had CD4 T-lymphocytes count less than 200 cells/ul. Of these patients, only 1 (1.6%) had typical pattern. Eighteen (22.5%) patients had CD4 T-lymphocyte count more than 200 cells/ul, where 12 (66.7%) of them showed typical pattern. Patients with CD4 T-lymphocytes count of less than 200 cells/ul, were more likely to produce normal chest radiographs, middle and /or lower zones parenchymal opacities and mediastinal lymphadenopathy. The mean CD4 T-lymphocytes count were also found significantly lower. AIDS patients with pulmonary TB can present with both typical and atypical chest radiograph patterns. An AIDS patient who had CD4 T-lymphocytes count less than 200 cells/ul were more likely to present with atypical radiographic appearance of pulmonary TB. They required appropriate treatment and isolation until the diagnosis of pulmonary TB was confirmed.
Helicobacter pylori-associated gastric carcinoma is generally more common in the antrum/body and is of the intestinal type. The aim of this study was to determine the pattern of gastric carcinoma in an area known to have a low prevalence of H. pylori. Pathology records of gastric carcinoma diagnosed at Hospital University Sains Malaysia between 1995 and 1999 were retrieved and studied. There were a total of 23 cases. The median age was 60 years. Eighteen patients were Malay and 5 were Chinese. The most common location of the tumour was the cardia/gastrooesophageal junction (61%, 14/23 patients). The majority was of the intestinal type (69.6%, 16/23). The frequency of gastric carcinoma appears to be exceptionally low in the area of study. The Chinese population was over-represented. The higher frequency of tumour in the cardia/gastro-oesophageal junction as compared to the antrum and body is in sharp contrast to most other studies. This reaffirms the notion that Helicobacter pylori infection is a causative agent for non-cardia gastric carcinomas.
ERCP (Endoscopic Retrograde Cholangiopancreaticography) was introduced in this hospital in late 1995. Since then, a lot of improvement have been achieved in the management of biliary tract diseases. Various general surgeons posted to this hospital have been trained in this procedure. A study was done to include all patients admitted for ERCP from August 1998 to July 1999. A total of 322 new patients with a mean of 26.9 cases a month had underwent this procedure. The duration of cannulation varied from 2 minutes to 45 minutes with a mean of 12 minutes. Cannulation rate by various surgeons differed. Overall success rate was 80%. Mortality was 0.6 % and morbidity was 0.9%. ERCP is safe and it takes at least 6 months of regular duodenoscopy before one can master the technique. Achieving 80% cannulation rate, has definitely reduced unnecessary common bile duct (CBD) explorations. During this study we have trained various surgeons in this procedure and at least 2 surgeons could be credentialled according to the guidelines provided by the Malaysian Society of Gastroenterology and Hepatology. During this study we have identified various reasons for the failure of cannulation which are useful for future training of endoscopists.
Absorbed dose to water was measured with ionisation chambers NE 2561 (#267), NE 2581 (#334), NE 2571 (#1028), using the IAEA standard water phantom. The ionisation chamber was inserted in the water phantom at a reference depth dependent on the type of the radiation quality used. Three radiation qualities were used namely 1.25 MeV gamma ray, 6 MV x-rays and 10 MV x-rays. The values of the absorbed dose to water were determined by the N(K)- and N(X)- based methods, i.e with the use of IAEA, HPA, NACP, AAPM, NCRP and ICRU protocols. The aim of this study was to make an intercomparison of the results, by taking the IAEA protocol as a standard. The largest deviation contributed by any of these protocols was recorded for each quality. It was found that AAPM, NCRP and ICRU protocols contributed 0.94% for 1.25 MeV gamma ray, NACP contributed 2.12% for the 6 MV x-rays, and NACP contributed 2.35% for 10 MV x-rays. Since the acceptable limit of deviation set by the IAEA for this absorbed dose work is ± 3%, it is clear that the overall deviations obtained were all satisfactory.
Nosocomial infection is a common problem in the Neonatal Intensive Care Unit (NICU) and a knowledge of the pattern of nosocomial infection will contribute greatly to the intensification of infection control measures and the development of antibiotic policies in the NICU. This study aims to compare the incidence and clinical characteristics of neonates with nosocomial infection in NICU of both Kuala Terengganu Hospital (HKT) and Universiti Sains Malaysia Hospital (HUSM). Neonates who had both clinical signs of sepsis and positive blood cultures, 48 hours after admission to NICU, from 1(st) January to 31(st) December 1998, in both hospitals were retrospectively studied. Among neonates admitted to NICU, 30 (5.4%) in HKT and 65 (3.6%) in HUSM had nosocomial infection (p = 0.07). The mean duration of hospitalisation was shorter (HUSM 37 days, HKT 49 days; p = 0.02), and the number of neonates with predisposing factors for infection is higher (HUSM 100%, HKT 73.3%; p < 0.001) in HUSM compared with HKT. There were no differences in gestation, mean age of onset of infection and mortality between both hospitals. The most common organism isolated from the blood in HKT was Klebsiella pneumoniae (33.3%), and in HUSM Klebsiella aerogenes (24.6%). Half of Klebsiella pneumoniae isolates were resistant to cephalosporins and aminoglycosides in HKT and a similar number of Klebsiella aerogenes isolates were resistant to piperacillin and aminoglycosides in HUSM. In conclusion nosocomial infection is a common problem in both hospitals. Except for more frequent predisposing factors for infection in HUSM, and a longer duration of hospital stay among neonates in HKT, the clinical characteristics of neonates with nosocomial infection in both hospitals were similar.
Experience of acute medical, surgical conditions, and clinical procedures of undergraduate students were assessed via a questionnaire survey during the final week of the 1993/1998 programme at the School of Medical Sciences, Univestiti Sains Malaysia. Individual performances were assessed by a scoring system. One hundred and twenty four students responded, (response rate 97%). More than 90% had seen myocardial infarction, cerebrovascular accident, pneumonia, respiratory distress, gastroenteritis, coma, and snake bite. Less than 33% had witnessed acute psychosis, diabetic ketoacidosis, acute hepatic failure, status epilepticus, near drowning, hypertensive encephalopathy, acute haemolysis or child abuse.Acute surgical/obstetrics cases, seen by >90% students, included fracture of long bones, head injury, acute abdominal pain, malpresentation and foetal distress. Less than 33% had observed epistaxis, sudden loss of vision, peritonitis or burns. Among operations only herniorrhaphy, Caesarian section, internal fixation of fracture and cataract extraction were seen by >80% students. The main deficits in clinical procedures are in rectal and vaginal examinations, urine collection and microscopic examinations. The performance of individual students, assessed by a scoring system, showed 15 students had unacceptably low scores (<149/230, 50%), 37 had good scores (>181.4/230, 70%) and 5 had superior scores (197.6/230, 80%).
The objective of the study was to determine the prevalence of H. pylori in functional dyspepsia among the three main races in Malaysia. Gastric antral biopsies from 233 (98 males, 135 females; age range: 17-75 years, mean age 39.5 years) patients attending the Universiti Kebangsaan Malaysia (UKM) gastroenterology clinic were assessed for the presence of H. pylori by culture and histology. About a third of the cases (79 of 233 (34%); 34 males, 45 females; mean age 42.6 yrs) were positive for H. pylori. The presence of H. pylori was always associated with antral gastritis. Malay patients were least likely to be positive for H. pylori (10 of 88 (11.4%); 5 males, 5 females; mean age 35.7 yrs) compared to the Chinese (43 of 95 (45%); 19 males; 24 females; mean age 40.2 yrs) and Indian patients (23 of 41 (56%); 10 males, 13 females; mean age 48.1 yrs). We found that H. pylori were most common among Chinese followed by Indians. However, the relative risk for the Indians was 8.58 and 6.29 for the Chinese compared to Malays. We conclude that the prevalence of H. pylori in patients with functional dyspepsia differs considerably with respect to ethnic groups.
Familial defective apolipoprotein B-100 (FDB) is an autosomal dominant genetic disorder associated with hypercholesterolaemia and premature coronary heart disease. FDB is caused by mutations in and around the codon 3500 of the apolipoprotein B (apo B) gene. Apo B R3500Q mutation is the first apo B mutation known to be associated with FDB and it is the most frequently reported apo B mutation in several different populations. The objective of the present study was to determine the association of apo B R3500Q mutation with elevated plasma cholesterol concentration in Kelantanese population in which both hypercholesterolaemia and coronary heart disease are common. Sixty-two Malay subjects with hyperlipidaemia, attending the lipid clinic at Hospital Universiti Sains Malaysia, Kelantan, were selected for this study. The DNA samples were analysed for the presence of apo B R3500Q mutation by polymerase chain reaction-based restriction fragment analysis method using mutagenic primers. This mutation was not detected in the subjects selected for this study. Apo B R3500Q mutation does not appear to be a common cause of hypercholesterolaemia in Kelantanese Malays.
In direct age-adjustment, a common age-structured population is used as standard. This population may actually exist (e.g., United States population, 1999) or may be fictitious (e.g., two populations may be combined to create a standard). In indirect age-adjustment, a common set of age-specific rates is applied to the populations whose rates are to be standardized. The simplest and most useful form of indirect adjustment is the standardized mortality ratio (SMR) (5).
Munchausen syndrome by proxy is a rare disorder in child psychiatric practice. A case of Munchausen syndrome by proxy that was managed in the Child Psychiatric clinic, Universiti Sains Malaysia Hospital is reported. Factors that suggest the diagnosis are discussed. Multidisciplinary approach to the management of such cases is warranted.
In confronting the advances in the new treatment for incurable illnesses there is an increasing need for doctors to be aware of their patients' cognition and feeling related to their quality of life (QOL). Recognizing this need the authors translated and pilot tested the WHOQOL-100, a genuinely international measure of QOL by the World Health Organization (quality of life group). The WHOQOL-100 Malay version was pilot tested on 50 healthy controls and 250 ill subjects, suffering from hypertension, diabetes mellitus, those suffering from both hypertension and ischaemic heart disease, epilepsy and schizophrenia. The results showed several unique features of the QOL, which were influenced by different types of illnesses. The information obtained is different and probably not observable from clinical consultations. This study will be an impetus for further studies using the WHOQOL-100 assessment tool in the local population.
Previous studies have shown that stress on the vergence and accommodation systems, either artificially induced or naturally occurring, results in small misalignment of the visual axes, reduces binocular visual acuity and produces symptoms of ocular discomfort. This study examines the effect of artificially induced visual stress using ophthalmic prisms on three dimensional perception on 30 optometry students ages ranging from 19 to 29 years old. 6D base-in prisms, equally divided between the eyes (3D base-in each) was used to induce stress on the visual system producing misalignment of visual axes known as fixation disparity. The fixation disparity is quantified using near vision Mallett Unit and an enlarged scaled diagram. Stereoscopic perception was measured with the TNO test, with and without the presence of stress and the results was compared. Wilcoxon's matched pair ranked tests show statistically significant difference in the stereo thresholds of both conditions, p = 0.01 for advancing stereopsis and p = 0.01 for receding stereopsis, respectively. The study concludes that visual stress induced by prisms, produce misalignment of the visual axes and thus reduces three dimensional performance.
A cross sectional study was carried out to evaluate the extent of occupational health problems focusing on some aspects of musculoskeletal symptoms among batik workers in Kelantan, Malaysia. The workers selected must have been in that industry for at least one year. Using cluster sampling, 202 workers were selected from 21 factories. More than half (60.2%) of the workers had been troubled with musculoskeletal symptoms at work. The most common symptoms were pain over the shoulders (41.0%), lower back (34.4%) and ankle (34.4%). Duration of employment, younger age group, prolonged standing and awkward working task were among contributing factors. It is therefore necessary to improve on both ergonomic and psychosocial environments of batik workers in order to prevent these musculoskeletal symptoms.
To aid future curriculum revision and planning, a batch of newly graduated medical students were surveyed using a questionnaire containing items representing possible areas of concern during house-officership. Students rated items representing communication issues as areas of concern. They did not agree that areas concerning responsibilities as a doctor, continuing medical education, theoretical and practical skills and potentially stressful working conditions were problem areas. Communication skills should remain among the priority areas for undergraduate training. Students should also be given more information about the house-officership period prior to graduation. Further study is needed to confirm perceived strengths of the USM curriculum suggested by the study, which are skills in finding resources for further learning and skills in leadership. A task-analysis of the house-officership period is also needed.
For effective management of typhoid, diagnosis of the disease must be done with speed and accuracy. Development of such a test would require antigens that are specific for typhoid diagnosis. Attempts at finding the specific antigen have been carried out throughout the years. The finding of such an antigen can lead to carrier detection as well. Candidate antigens have been used in the development of antigen or antibody detection tests with variation in sensitivity and specificity. Further characterization and understanding of the candidate antigens combined with use of innovative technologies will allow for the ideal test for typhoid and typhoid carriers to be within reach.