Manifestations of vitamin deficiencies observed in 6,000 Tamil and 4,000 Malay children and young adults during a survey carried out by the Institute for Medical Research in the Federated Malay States included phrynoderma, Bitot spots
and angular stomatitis. They were more frequent in Tamils than in Malays. Phrynoderma and Bitot spots responded rapidly to administration of vitamin A or carotene, though in some patients with phrynoderma improvement was not attained unless also the protein intake was increased and vitamin B complex added. Angular stomatitis was benefited by administration of riboflavin or vitamin B complex. The clinical and histologie observations of phrynoderma in Tamils and Malays in Malaya were identical with those previously reported in Chinese, Ceylonese and southern Indians. A supplementary food ration, composed of soy beans, skim milk powder, dal and red palm oil, given to Tamil children on rubber estates not only increased the general state of health but led to a rapid regression of the manifestations of vitamin deficiencies.
(1) The use of the thiochrome method for the estimation of thiamine in human milk is discussed, with special reference to the possible production of an artefact, following the incubation of the milk with pepsin, in addition to the use of takadiastase (clarase). No evidence could be found to suggest that an artefact resembling thiamine was produced by the method of analysis described.
(2) The thiamine content of 91 samples of full lactation human milk from apparently "normal" Malay, Chinese and Indian women in Malaya is recorded. The mean milk thiamine level of 11.3 ug/100 ml. found is considerably lower than the levels recorded for milk samples from apparently "normal " women in the United Kingdom and the U.S.A.; and slightly lower than that recorded in Australia. The results suggest that the dietary
intake of thiamine in Malaya is inadequate to maintain optimum thiamine levels in the milk of lactating women.
(3) No significant difference was found in the mean thiamine content of milk from women of the three principal racial groups in Malaya ; nor was any significant difference found to be associated with the parity or age of the women or, in the case of full lactation milks, with the time after parturition at which the sample was collected. No significant difference was found in samples collected from the same woman at different times of the day or before and after a main meal.
(4) Marked differences were found in the thiamine content of samples of milk from individual women, and the possible reasons for this are discussed.
(5) The examfnation of 48 samples of milk collected during the first month after parturition confirmed previous recorded observations that the thiamine content of such milks, initially low, gradually increases to reach "normal" levels towards the end of the first month of lactation.
A total of 1008 healthy unrelated young adult male police and military recruits, 317 from Brunei, 398 from Sabah and 293 from Sarawak, were examined for G-6-PD deficiency. The frequency in the 317 Brunei recruits, who were all of Malay origin, was 6.3 %. In Sabah the frequencies for the four main ethnic groups were 12.1 % in 165 Kadazans, 4.1% in 73 Malays, 3.4 % in 68 Bajaus and 24.2 % in 33 Muruts. In Sarawak the frequency was 11.6 % in 95 recruits of Malay origin. Three among 56 Ibans and one among 80 Sea Dayaks were found to be enzyme-deficient, but the numbers examined of these groups were too small for estimation of the frequency. The overall frequency for the Malay group in Brunei, Sabah and Sarawak was 7.0% in 485 persons examined.
Kveim tests using a validated material have been undertaken in Malaysia on 39 patients (32 Chinese; 4 Malay and 3 Aboriginal) with lepromatous or tuberculoid leprosy. All the patients had been treated for leprosy, most for two or more years. The tests were read microscopically. Of the 21 lepromatous patients one gave a weak positive and two an equivocal Kveim test whereas four of the nine tuberculoid patients gave equivocal or weak Kveim positivity. Only the tuberculoid form elicits a higher proportion of granulomas than might be expected in a comparable normal population. Of nine patients (8 lepromatous; 1 tuberculoid ) who failed to sensitize well to tuberculin
following two BCG vaccinations, two gave equivocal Kveim tests similar in appearance to those in the other groups.
300 patients (185 males, 115 females) were examined for intestinal parasites. About 40% of these patients was infected, 14% of which was heavily infected. The highest prevalence and intensity of infection with soil-transmitted helminths was found among Malays and Indians of different ages. Heavy infections with these helminths were also frequently encountered in young Chinese. Helminthic infections in patients over 60 years of age was significantly lower. There was no significant differences in the prevalence and degree of infection among males and females. The commonest helminth encountered was Trichuris trichiura, which usually occurred as trace single infections. Mixed infections with Ascaris and Trichuris, usually with the former as the predominating parasite, were also frequently observed.
A clinical study was undertaken of new diabetics seen at a general medical unit in Singapore. Over a period of 12 months, there were seventy-five cases of which 38 (50.7%) were Chinese, 15 (20%) Malays and 22 (29.3%) Indians. Male patients were twice as common as female patients. The majority of patients (61.3%) were in the 5th and 6th decade and only 23 (30.7%) were obese. Oral sulphonylurea and dieting provided effective control in 80.6% of the patients, and only 9% of patients required insulin. Ketosis was present in only 6 cases and was easily controlled with appropriate treatment. Other clinical features are presented and discussed.
Complicated migraine is not well known. It is associated with transient and protean sensory and motor
nenrological features although disturbance of mood, affect and psyche has also been described.
This paper is based on a study of ten patients suffering from complicated migraine and attempt is made
to describe various neurological symptoms and signs.
It becomes apparent from this study that there arc diverse manifestations of this interesting disorder.
Furthermore complicated migraine seems to affect a younger age group and there may not be any
family history of migraine. In most cases the nenrological symptoms precede the attacks of headaches.
The nenrological deficit may persist after longer periods. Initially, the attacks arc usnally followed by
complete recovery, with repeated attacks there may be residual neurological deficit. Though the exact
aetiology of the migraine remains unknown, it has been suggested that it is due to spasm or oedema of
cerebral vascular system. If the vessels involved are the carotid artery system, the symptoms and signs
obviously would be due to involvement of cerebral hemisphere, whereas affection of basilar artery
would produce signs and symptoms of cerebellar or brain stem deficiency.
At times it may be extremely difficult to differentiate between a typical attack of migraine and headache
due to an underlying pathology e.g. intracranial angioma or space occupying lesions, which may
require investigations such as angiography. The angiography may prove fruitless and cause deterioration
in neurological signs. A careful follow-up should be planned for cases with complicated migraine
to exclude any underlying pathology.
In West Malaysia RA appears to be less common than in temperate climates, but more common than in tropical Africa; furthermore, the incidence of gout and SLE is comparable. The clinical manifestations of RA are milder than those seen in more temperate climates. Subcutaneous rheumatoid nodules have not been observed. Positive serological tests for RF are significantly higher than in the general Malaysian population, but still lower than those reported for patients with RA in temperate climates. Of the three main ethnic groups, the highest incidence of positive results is found in the Chinese.
Study site: Arthritis Clinic, University Hospital, Kuala Lumpur (University Malaya Medical Centre, UMMC, Kuala Lumpur, Malaysia)
Samples from 378 Chinese and 259 Malay blood donors in Singapore have been studied for electrophoretic variants in 13 red cell enzyme systems and for abnormal haemoglobins. Variants were detected in 8 of the enzyme systems, and the frequencies were polymorphic for acid phosphatase, 6 phosphogluconate dehydrogenase phosphoglucomutase (locus 1) among both Chinese and Malays, and for adenylate kinase also among Malays. Rare variants were detected in the phosphohexose, NADH diaphorase and lactate dehydrogenase systems. A new GPGD phenotype and three new LDH phenotypes have been described. Electrophoretic variants of haemoglobin were more frequent among Malays than among Chinese.
Newborns were examined for the presence of slow-moving haemoglobin components, tentatively designated X components and previously found in a group of Hb H disease in which invariably one of the parents of each patient had the same slow-moving Hb X components also. Structural studies showed that the abnormal haemoglobin in Chinese was identical with Hb Constant Spring, an c-chain variant. Newborns with Hb Bart’s and slow-moving X components invariably had one parent with the X components also. When the child grew older Hb Bart’s disappeared while the Hb X components remained in the blood. The homozygous state for the X components was found in a Malay boy through his newborn brother who had the X components in addition to Hb Bart’s and had both parents with the X components. One other Malay baby had the X components and Hb A2 Indonesia inherited from the parents. The present study of newborns also showed that Hb Bart’s can accompany different abnormalities of haemoglobin production, involving alpha-chains, beta-chains as well as gamm-chains. Its presence in cord blood is, therefore, not specific for alpha-thalassaemia
Key Words: Haemoglobinopathies; Hb Bart’s; Slow-moving Hb X; Thalassaemia
The chance of excluding from paternity a falsely accused Chinese man and a falsely accused Malay man by using a number of blood genetic marker systems have been calculated using the ABO, Rhesus and MNSs systems, the combined chances are. 46.4% for a Chinese and 50.2% for a MaIay. When serum protein and red cell enzyme systems are included, the chances increase to approximately 76%. The chances may be increased by testing for haemoglobin variants, by red cell typing for the Diego (Di^a)
antigen, and by testing for phenotypes other than Gm(a) in the Gm system. The Kell system may in some circumstances provide evidence in favour of paternity.