The electrically stimulated guinea-pig ileum and spontaneously contracting guinea-pig ileum preparations were employed in studies on the effects of an alcoholic extract and two flavonoid compounds, quercetin and quercetin-3-arabinoside, extracted from the leaves of Psidium guajava. The extract showed a morphine-like inhibition of acetylcholine release in the coaxially stimulated ileum, together with an initial increase in muscular tone, followed by a gradual decrease. The morphine-like inhibition was found to be due to quercetin, starting at concentrations of 1.6 micrograms/ml. The glycoside did not show any such action at concentrations of up to 1.28 mg/ml. The extract inhibited spontaneous contractions in the unstimulated ileum with a concentration-response relationship.
Eleven infants who were suspected clinically of having cows' milk protein sensitive enteropathy were fed with a protein hydrolysate formula for six to eight weeks, after which they had jejunal and rectal biopsies taken before and 24 hours after challenge with cows' milk protein. When challenged six infants (group 1) developed clinical symptoms and five did not (group 2). In group 1 the lesions developed in both the jejunal mucosa (four infants at 24 hours and one at three days), and the rectal mucosa, and the injury was associated with depletion of alkaline phosphatase activity. Infants in group 2 were normal. It seems that rectal injury that develops as a direct consequence of oral challenge with the protein in reactive infants may be used as one of the measurements to confirm the diagnosis of cows' milk protein sensitive enteropathy. Moreover, ingestion of such food proteins may injure the distal colonic mucosa without affecting the proximal small gut in some infants.
The prevalence of Enterotoxigenic Escherichia coli (ETEC) in 433 stool samples from diarrhoeal cases of all ages was studied using two commercially available test kits for the detection of heat labile toxin (LT) and the infant mouse assay for the heat stable toxin (ST). 16 samples (3.7%) were positive for ETEC, of which nine were producing ST alone, six LT alone and only one was producing both LT and ST. Although the percentage of isolation rate was low, its occurrence was almost as common as the Shigella spp and Salmonella spp in the same study. Of the two test kits examined, the Phadebact ETEC-LT Test 50 (Pharmacia Diagnostics, Uppsala, Sweden) was found to be more suitable for use in a routine diagnostic laboratory. Ten out of 12 (83%) of the strains tested were resistant to one or more antibiotics.
A community based study was conducted on the understanding and knowledge of childhood diarrhoea and use of oral rehydration therapy (ORT), in four selected villages in Tumpat District, Kelantan. The calculated annual incidence of diarrhoeal disease in children aged 0 to four years in all study villages was 1.38 episodes for each child. The main care-givers of children aged 0 to four years were interviewed and asked to demonstrate how to mix a standard ORS (oral rehydration solution) sachet if they had previously used ORT. Forty percent of care-givers had heard of the locally available ORT and 30% had actually used ORT. Of those who had heard of or used ORT, 10% had good knowledge of what it was and what it was used for, 51% had some knowledge and 39% had either no knowledge or inaccurate knowledge. Of care-givers who had previously used ORT only 20.5% demonstrated the correct volume of water to add to one sachet of ORT, but 82% would discard an unused solution within 24 hours. Significantly more literate women had used ORT than those not literate (p = 0.002). Mothers, particularly those literate, are the primary target group for ORT intervention strategies. Components of health education should include advice on what ORS is, what it is used for, and how to correctly mix a standard sachet.
Rotaviral infections in cynomolgus monkeys (Macaca fasicularis) were studied to ascertain its suitability as a model of infection and diarrhea caused by group A human rotaviruses. Formula-fed monkeys were used as they could be observed closely. Experimental rotaviral infection of cynomolgus monkeys was age-dependent; only young monkeys were readily infected. Formula-fed newborns were readily infected with cell-culture-adapted human (WA) and simian (SA11) viruses and with a rotavirus from a human fecal specimen. However, diarrhea was detected only in very young animals. A number of rotaviral shedding patterns as a function of time were observed. Although there was no typical viral shedding pattern which represented exclusive association of viral infection with diarrhea, the initial level of viral excretion and the maximum level of viral shedding attained were much higher in animals with diarrhea. Seroconversion occurred in less than half of the inoculated animals. The presence of maternal rotaviral antibodies did not prevent infection or diarrhea.
Stool samples from 836 cases with diarrhea and acute gastroenteritis from the Pediatric ward, Penang General Hospital, were examined for Cryptosporidium oocysts. A dimethyl sulfoxide modified acid fast technique was used for the identification of the parasites. 36 samples or 4.3% were found to be positive for Cryptosporidium. The prevalence of infection was higher (2.39%) in children with diarrhea and vomiting than in children with acute gastroenteritis alone (0.8%). Stool examination and cultures from the Cryptosporidium positive samples revealed no other parasites, rotavirus or enteropathogenic bacteria. This suggests that Cryptosporidium may be an important agent in the causation of diarrhea in young children. A routine laboratory examination for the detection of Cryptosporidium in the search for causal agents of childhood diarrhea in our environment may, therefore, be significant.
Due to the increasingly documented prevalence of diarrhoeal diseases in Malaysia, a number of water-related programmes have been implemented in an attempt to improve health status through the reduction of incidence of waterborne communicable diseases associated with poor public water supplies. The implicit assumption underlying these projects is that the enhancement of the physical infrastructure, and subsequent improvements in the quality of the water supply, will substantially reduce water-related disease. The present study questions this hypothesis and uses a socio-ecological model as a framework to assess risk factors associated with the increased probability of waterborne disease. Research is centred on Port Dickson, a district which typifies existing water and sanitation conditions in much of semi-rural Malaysia. Health services utilization data and a 268-household diarrhoeal morbidity survey were used to measure the burden of illness of waterborne disease within the district and to identify predictors of morbidity. It was concluded that although treatment facilities will reduce the health burden in the region, a number of behavioural and sanitation factors may be more important and could act to minimize the potential impacts of improved water quality.
A study was conducted in an urban slum area of Kuala Lumpur, the capital of Malaysia, to determine the health status of the children under 6 years old and the knowledge and practice associated with diarrhoeal diseases and use of oral rehydration salts (ORS) among mothers in the area. It was seen that the health status of the children was poor with one fifth of them born underweight, 33% experiencing more than 6 spells of illness per year and a high percentage of them suffering from diarrhoeal diseases (4.3%). Child care practice was associated with urban lifestyles with early weaning, short term breast-feeding and early introduction of solid and bottle feeding. Knowledge and practice of mothers concerning child care was inadequate to support healthy living. Knowledge of diarrhoeal diseases and the effectivenss of oral rehydration salts was poor. Only 47.7% of mothers knew about ORS and 27.8% ever used it when their chidlren suffered from diarrhoea. Health care system dependence was shown by the high percentage of mothers immediately bringing to a doctor's attention (75.6%).
In response to a recorded increasing incidence of diarrhoea in Tumpat District, Malaysia, a case-control study was performed to identify modifiable risk factors for the transmission of diarrhoea, in children aged 4-59 months. Ninety-eight pairs of children, matched on age and sex, were recruited prospectively from health centres. Exposure status was determined during a home visit. Interviewers were 'blinded' as to the disease status of each child. Odds ratios were measured through matched pair analysis and conditional logistic regression. Risk factors for diarrhoea identified were: reported--drinking of unboiled water, storage of cooked food before consumption and bottle feeding; and observations--animals inside the house and absence of washing water in latrines. Water quality, source of drinking water, reported hand washing behaviour, indiscriminate defecation by children, cup use and the absence of a functional latrine were not associated with diarrhoea. Nonsignificant associations were found for: accessibility of washing water source, type of water storage container and use of fly covers for food.
Three sisters with cassava poisoning are described. A review of the toxic properties of cassava is presented together with discussion on the methods of its preparation, its adverse effects on man, its detoxification in the body, and the treatment of its poisoning.
A 12-month study was carried out on the molecular epidemiology of rotavirus in urban and suburban Malaysian children. Analysis of faecal samples from 973 hospitalized diarrhoeic children by polyacrylamide gel electrophoresis detected 268 rotaviruses (28%). All isolates were group A rotaviruses, which produced 22 electropherotypes: 16 (91.5%) with long RNA migration patterns and 6 (8.5%) with short patterns. One of the long-pattern electropherotypes was the predominant strain (71.1% of the total electropherotypes) isolated during this study. Although 3 other strains were detected sporadically over the study period, 16 others were present only during the first 7 months and 2 others were confined to the last 5 months. Long- and short-pattern electropherotypes were found to co-circulate extensively. There was a significant association of short-pattern electropherotypes with infection in older children. In addition, the prevalence of vomiting and mean duration of diarrhoea were significantly associated with different electropherotypes.
The group A rotavirus staphylococcal co-agglutination test was evaluated and its sensitivity and specificity compared with an in-house enzyme-linked immunosorbent assay (ELISA) and a commercial latex agglutination test (Rotalex). In addition, the storage stability of the staphylococcal reagents was ascertained. Examination of 136 clarified suspensions of diarrhoeal faeces by the staphylococcal co-agglutination test revealed a high proportion of false positives (26%) and uninterpretable results (34%) due to non-specific agglutination. Non-specific agglutination could be removed effectively by prior absorption of the clarified faecal specimens with unsensitized staphylococci. The staphylococcal co-agglutination test was less sensitive and specific than the in-house enzyme-linked immunosorbent assay but was comparable to the Rotalex slide latex agglutination test. The staphylococcal reagents have a shelf life of at least 29 weeks.
A 1 year longitudinal study of 156 Malaysian children from urban and suburban areas in the Klang Valley revealed that the incidence rate of diarrhoea was 23.6 per 100 person-year with abnormal faeces reported on 0.26% of the total days of observation. Diarrhoea cases were detected in children from all socioeconomic classes. Rotavirus was isolated from 12% of the diarrheic children and asymptomatic rotavirus infection occurred in 3.2% of the children. All rotaviruses isolated were group A rotaviruses with long electrophoretypic pattern.
Intestinal protozoa are found in all communities in Malaysia and among all ethnic groups. Prevalence of intestinal protozoa is not affected by ethnicity but by living conditions. Communities with both basic amenities of safe water supply and proper toilets have lower prevalence than those with one or none of the amenity. Cryptosporidium is an important intestinal protozoon in Malaysia and should be included in future field and laboratory studies and also in laboratory diagnosis for pathogens. Much interest will be centered on Blastocystis hominis in future studies in view that it may be a cause of diarrhea.
Cryptosporidium is an intestinal protozoan parasite which causes diarrhoea in animals and has recently been reported to cause similar symptoms in man. Cryptosporidiosis is a zoonotic infection and the first human case was reported in 1976.2 Since then the number of cases has increased by the hundreds especially among patients with acquired immuno-deficiency syndrome (AIDS), as a result of the severe symptoms that they cause in the im-munosuppressed patients and also due to the better screening techniques which have been developed resulting in the detection of cases.3 To date 20 species of Cryptosporidium have been reported but these cannot be differentiated morphologically. The differences are based mainly on the host from which the parasites were recovered. The species responsible for causing infection in man is Cryptosporidium parvum.4 Of the 20 species reported several are invalid because the oocysts of some of them were found to be the same as the sporocyst of Sarcocystis. It is now concluded that there are only two species that infect mammals (C. Muris and C. parvum). (Copied from article).
A cross-sectional study was conducted in four Orang Asli settlements, in the district of Kuala Langat, to determine the knowledge and practice associated with diarrhoeal disease among the Orang asli children (0-5 years). It was seen that the social and environmental factors of the settlements were poor. Only 26% of the households had sanitary latrines and 36% had access to safer water supplies. Ninety-five percent of them had monthly income below the national poverty line. The diarrhoeal incidence was high, ie 240/1000 and the most affected were the older children in the age group of 49 - 60 months. Knowledge of diarrhoeal disease was poor. But the majority (84.2%) knew that breast feeding is the best milk for the child in order to avoid diarrhoeal disease.
A 68-year-old diabetic and hypertensive woman presented with chronic autonomic diarrhoea, syncope and palpitations which were associated with QT prolongation and recurrent episodes of torsade de pointes. She was on glibenclamide, indapamide and probucol (for type V hyperlipidaemia). Despite intravenous infusions of potassium, lignocaine and amiodarone, the unstable rhythm persisted. However, intravenous magnesium sulphate with small doses of intravenous propranolol terminated the torsade de pointes. She was stabilised but following discharge she relapsed, and upon re-admission, succumbed to intractable ventricular fibrillation. Early recognition and aggressive treatment of this condition is emphasised. Multiple aggravating factors ie autonomic diarrhoea resulting in severe potassium and magnesium depletion, kaliuretic effect of indapamide, probable QT prolongation associated with diabetic autonomic neuropathy and probucol; probable underlying coronary artery disease and heightened emotional and sympathetic discharge could have contributed to this very unstable ventricular arrhythmia and sudden death.
An AIDS patient with multiple opportunistic infections (Candida, Pneumocystis carinii and Isospora belli) was identified at the University Hospital, Kuala Lumpur. The patient presented with profuse diarrhoea associated with lethargy, anorexia and weight loss. Routine stool examination showed Isospora belli oocysts. The infection responded to treatment with trimethroprim-sulfamethoxazole but relapse occurred 8 weeks later. This represents the first documented case of isosporiasis to occur in an AIDS patient in Malaysia.