Thirty four patients with cryptococcal meningitis seen in the University of Malaya medical centre since 1980 were reviewed. Eleven patients had bilateral papilloedema and visual impairment but eventually survived. Seven patients had intensive aggressive measures, including shunting to reduce intracranial hypertension irrespective of ventricular size shown in CT scan, and showed substantial improvement in vision. It is concluded that papilloedema and visual failure in cryptococcal meningitis reflects raised intracranial pressure and that this should be treated vigorously.
Following revision of the curriculum the effectiveness of a traditional cookbook experiment, used in conjunction with an 'interpretation seminar', was evaluated. Curriculum revision had been predominantly concerned with an avoidance of overloading and provision of self-study periods. The preceding lectures were integrated with the experiment. The learning resulting from the practical experience was assessed using pre- and post-tests. The practical exercise was ineffective and did not facilitate conceptual understanding. Due to the central role of passive teaching methods the students adopted a surface approach to all learning, were teacher dependent and did not make effective use of their private study. Furthermore, owing to a broad-based entry into medical school many students lacked the basic skills essential to the achievement of meaningful learning. Clearly, for effective learning the curriculum and pedagogy must be geared to the background and educational needs of the students.
Thirty consecutive patients from peninsular Malaysia with clinically definite multiple sclerosis were studied; 80% were ethnic Chinese, with a female-male ratio of 5:1. The average age at onset was 29.7 years, with one relapse average every 1.9 years. Optic-spinal recurrence was the most common clinical pattern of the disease, accounting for 63.3% (19/30) of the cases. All the patients had spinal cord involvement sometime during the course of the illness. The mortality was high at 36.7% (11/30), with an average duration of symptoms of 7.6 years. There was characteristic severe residual visual and motor disability. At the time of the last examination, 12 patients had bilateral optic atrophy with blindness or severe visual acuity impairment. Sixteen patients were bedridden or confined to a wheelchair. The severe motor disability reflected the severe spinal cord involvement. It was the main factor that accounted for the high mortality. The cerebral, cerebellar, and brain-stem involvements were, however, generally transient. None of the patients' had a family history of similar illness despite the average sibling size of six. There was no example of Devic's disease. The clinical pattern was closest to those patients who presented from Taiwan.
The current issue of JUMMEC touches on many diverse topics and in many ways reflects the evolution of modern medicine from the practice of acupuncture to epidemics facilitated by modern travel to the subject of ethics including controversies surrounding financial incentives given in promoting organ donation.(Copied from article).
Introduction: In Klang, a district in the state of Selangor in Peninsular Malaysia, the effects of westernization and urbanization in recent years have had an impact on infant feeding. The objective of this study was to evaluate the practice, knowledge and attitude to breastfeeding and to assess factors associated with breastfeeding among women in Klang, Malaysia. Materials and Methods: A cross-sectional study was carried out between June and October 2006 involving 220 women with infants aged six months from two randomly selected health clinics were selected and interviewed. Data on socio-demographic, infant factors, infant feeding in the first six months of life, knowledge and attitude towards breastfeeding were collected. Results: Exclusive breastfeeding was reported by 32.8%, mixed feeding was reported by 14.5% and infant formula feeding was reported by 52.7% of the respondents. Chinese women were more likely not to practice exclusive breastfeeding compared to Malay women (odds ratio 18.27, 95% CI: 3.95, 84.54) while working women were more likely not to practice exclusive breastfeeding compared to non working women (odds ratio 3.75, 95% CI: 1.64 , 8.55). Positive association with not exclusive breastfeeding included women with high household income and women with male infants. Malaysian women had a positive attitude but work place and short maternity leave had a negative impact on breastfeeding. Conclusion: Women of Chinese ethnicity, working, from high family income and with male infants were less likely to exclusively breastfeed. Adopting facilitatory measures at hospitals and work place could increase the rate of exclusive breastfeeding.
Epidemiological studies of human leptospirosis have generally been limited to countries with specialized laboratories employing the microscopic-agglutination (MA) test. The sensitized-erythrocyte-lysis (SEL) test is much simpler for routine hospital laboratories to carry out and it has been found valuable in the diagnosis of human leptospirosis. This paper reports the results of studies of the SEL test as an epidemiological tool in serological surveys.The results showed that the significant SEL titre was 1:80 and that the sensitivity of the test depended possibly on the antigen preparation and the amount of complement used. Most of the SEL antibodies were found to persist at significant titres for about 1 year after active infection, but less than half persisted longer than that. The SEL test is therefore useful for detecting recent infections and for indicating that stability of leptospirosis in an area.The endemicity of leptospirosis in West Malaysia was confirmed by the SEL test, based on the employment of 1:80 as the significant titre.