Malignant lymphoma constitutes the third most common childhood malignancy seen at the University Hospital, Kuala Lumpur and can be categorised into Hodgkin's disease and non-Hodgkin's lymphoma. Both diseases demonstrate a higher preference for Chinese males. The majority of patients presented with stage IV disease. High default rate and poor compliance to treatment were associated with poor overall cure rates but encouraging results have been obtained in those who adhered to therapy. There is an obvious need to educate the public on the improved outlook 'or childhood malignancies and 'or earlier referral to help reduce the higher mortality and morbidity associated with advanced disease.
Coronary artery surgery as we know it today, has undergone rapid evolution since its introduction in the late 1960's, resulting, not surprisingly, in much confusion. In an attempt to present the state of the art, a collective review of the literature, coupled with the experiences with 118 patients is presented and discussed. The modern surgical management of patients with obliterative coronary artery disease is designed to relieve symptoms, prolong life and identify patients at high risk of premature death or myocardial infarction if they were to continue with medical management. Though the most common indication for surgery is persistent limitation of life style by severe symptoms, management is influenced by the strong association between such symptoms and increased mortality. During the short history of coronary bypass surgery, other indications for operation have been influenced by a combination of lessons from the past and hopes for the future. In addition, advances in technology have produced an enormous impetus for improvements in patient evaluation, surgical technique and postoperative care. As these advances continue and as more and more late results of surgery become available, answers to questions about surgery may increasingly be deduced from lessons rather than from hopes. As a result of these changes, an aura of confusion has gradually crept into the scene. It is hoped that this collective review, together with experiences gained from a personal series of 118 patients over a 3 year period from 1984 to 1986, will put into proper perspective, the state of the art of surgical management of coronary artery disease today.
An 84 year old man who presented with Stokes Adams syncope with exertion was found to have complete heart block on walking with reversion to sinus rhythm on recovery. The resting ECG showed evidence of ischemic heart disease with old anteroseptal and old inferior infarction but there was no recent myocardial infarction as shown by normal cardiac enzymes levels. The probable explanation for the mechanism and causation of the transient A-V block is described.
Anopheles donaldi Reid, a member of the A. barbirostris species group, is a vector of human filariasis and probably malaria. The discovery of some old specimens of this species, collected in Kuala Lumpur town where it no longer occurs, together with evidence from the literature about past malaria in the town, suggest that donaldi may have played a part in transmitting that malaria.
The association of physical activity with dementia and its subtypes has remained controversial in the literature and has continued to be a subject of debate among researchers. A systematic review and meta-analysis of longitudinal studies on the relationship between physical activity and the risk of cognitive decline, all-cause dementia, Alzheimer's disease, and vascular dementia among nondemented subjects are considered. A comprehensive literature search in all available databases was conducted up until April 2016. Well-defined inclusion and exclusion criteria were developed with focus on prospective studies ≥ 12 months. The overall sample from all studies is 117410 with the highest follow-up of 28 years. The analyses are performed with both Bayesian parametric and nonparametric models. Our analysis reveals a protective effect for high physical activity on all-cause dementia, odds ratio of 0.79, 95% CI (0.69, 0.88), a higher and better protective effect for Alzheimer's disease, odds ratio of 0.62, 95% CI (0.49, 0.75), cognitive decline odds ratio of 0.67, 95% CI (0.55, 0.78), and a nonprotective effect for vascular dementia of 0.92, 95% CI (0.62, 1.30). Our findings suggest that physical activity is more protective against Alzheimer's disease than it is for all-cause dementia, vascular dementia, and cognitive decline.
Infective larvae of Brugia malayi subperiodic obtained by dissection of infected Aedes togoi were injected subcutaneously into the scrotal region of Mastomys natalensis. From altogether 58 infected male M. natalensis 81% showed consistently or intermittently detectable microfilaraemia, whereas in 19% of the animals no microfilaraemia could be detected at any stage. The mean prepatent period was 136 days; the microfilarial density varied from 1 to 535 per 20 c. mm blood. In those animlas with consistently detectable and in general higher microfilaraemia an average of 13.1 live adult worms were found, against an average of 6.4 adult worms in animals with intermittent detectable and in general lower microfilaraemia. An average of 1.5 worms was found in animals which at no stage showed detectable microfilaraemia. A correlation between worm burden and prepatent period could be observed in the individual groups. From the total of 520 live adult worms recovered at necropsy, 37% were found in the lungs, 29% in the parenchyma of the testes and 34% in the lymphatic system. 47% of live fertile female worms were found in the lymphatic system, whereas the majority, i.e; 52% of infertile female worms were detected in the lungs. In addition, 380 encapsulated dead worms were found, most of them (98%) in the lymphatic system. 61% of a total of 900 live and dead worms were found in the region of the lymphatic system.
Primary care practice with its defining features of continuity, comprehensiveness and coordination, is the cornerstone to provide high quality community-based chronic disease management. Poor chronic disease prevention and control at the primary care level will lead to the massive burden of treating complications at secondary care, burden to the patients and their families with regards to morbidity and premature death, and burden to the country with regards to the loss of human capital. Compelling evidence showed that there are innovative and cost-effective interventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into high quality population-wide chronic disease care. Primary health care systems around the world were developed in response to acute problems and have remained so despite the increasing prevalence of chronic conditions. An evolution of primary health care system beyond the acute care model to embrace the concept of caring for long term health problems is imperative in the wake of the rising epidemic of chronic diseases. This paper aims to review the evidence supporting high quality and innovative chronic disease management models in primary care and the applicability of this approach in low and middle income countries.