A case of apical hypertrophic cardiomyopathy occurring in a 53 year·old Indian man is described. So far only 39 cases have been reported in the english literature to the best of our knowledge. This case is the first reported in a non·Japanese and outside of Japan, suggesting that this condition may be encountered in future in other parts of the world.
A 13 year review at the University Hospital, Kuala Lumpur reveals that chronic myeloid leukaemia (CML) constitutes 4.3% of all childhood leukaemia. Adult type of CML occurs in older children and is associated with marked splenomegaly, leukocytosis and thrombocytosis and the presence of Philadelphia chromosome. Although the initial response to busulphan was encouraging most of the patients succumbed; 2 patients underwent acute lymphoblastic transformation. Juvenile CML occurs in younger children and is associated with less marked splenomegaly, leukocytosis and thrombocytopenia and the presence of elevated fetal haemoglobin levels. The disease is characterised by an acute fulminating course. Despite improved survival in acute lymphoblastic leukaemia, the outlook for chronic myeloid leukaemia in childhood remains poor and treatment needs re-evaluation.
Three cases of multiple drug resistant falciparum malaria in the same family are described. It is interesting to note that faIciparum malaria resistant to Fansidar has not as yet been reported in adults from West Malaysia up to the present time, although resistance to the drug in children is being encountered not infrequently. This presents a serious paediatric problem because malaria causes the highest incidence of mortality and morbidity in this age group in a proportion of the rural population.
From a total of 163 renal biopsies there were 12 cases (9.1%) of IgA nephropathy. All of them presented with symptomatic or asymptomatic proteinuria and/or haematuria. The pattern of disease here generally conforms to reports elsewhere. However in contrast it appears to be common in both sexes and the clinical course tends to be more severe In males. The absence of IgG In the glomeruli on immunoffourescence was an unexpected finding. The presence of hypertension, renal insufficiency and glomerulo·interstitial scarring seem to indicate poorer prognosis. There is no known effective treatment.
The birth weight distribution, mean birth weight and incidence of LBW amongst the various ethnic groups in Malaysia is described briefly. The data collected and analysed is hospital data where all deliveries in 1980 were analysed. The mean birth weight showed that the Chinese had the highest Mean Birth Weight amongst the three ethnic groups and the Indians had the lowest mean birth weights. The overall incidence of LBW was 11.8% and the Malay and Indian babies constituted the high
incidence of LBW whereas the Chinese had a low incidence of LBW babies in the study. Amongst the various ethnic groups the Indians had a higher incidence of LBW compared to the Chinese and Malays.
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.
A study was carried out to determine ventilatory capacity (Forced Expiratory Volume or FEV1 and Forced Vital Capacity or FVC) in apparently normal Malay office workers in Malaysia. The subjects, 78 males and 113 females, were interviewed using a standardized questionnaire to exclude those with symptoms or past history of cardiopulmonary disease. Measurements of age, height, weight, FEV, and FVC were made on each subject; the FEV, and FVC were measured using Vitalograph spirometers. The mean FEV, and FVC for males were 3.35 litres and 3.76 Iitres, respectively. For females, the mean FEV, and FVC were 3.46 and 2.72 Iitres, respectively. Height was positively correlated with FEV, and FVC (p
Clinical synopsis and investigations on fourteen patients with blast injuries of the ear successfully treated at the ENT Unit of the University Hospital, Kuala Lumpur, revealed few interesting observations in addition to usual findings. The most outstanding one was the absence of sensorineural deafness, although it has been claimed as one of the most constant features. Conservative management alone was found to be of significant value.
The practice of continuing ventilation into the post·operatlve period in certain poor risk patients resulted in a reduction in morbidity and mortality. So much more surgery can be performed on many patients which otherwise would not be justified without this back·up services provided by the intensive therapy unit. From 1970 - 80, 763 patients were electively ventilated following surgery (both elective and emergency) of which 115 died, giving a mortality incidence of 15.01%
In this paper the incidence of inhaled foreign body in the tracheobronchial tree at the University Hospital Kuala Lumpur, West Malaysia, is reviewed. Children are the usual victims. Food·related substance (peanut) is the most common foreign body, Successful removal of foreign body by bronchoscopy is achieved in the great majority of cases (86%), Prevention can be achieved by educating the parents not to give nuts to children below the age of 3 years.
In February to March 1982 at the psychiatric emergency service of the University Hospital, Kuala Lumpur, some data on 491 patients (92% of 531 patients seen) were collected. Two-hundred and eighty-three patients had received psychiatric treatment and 65 had previously received medical treatment. Fifty-three per cent of the patients have schizophrenic disorders, 5.1% had situational reactions and 1.63% had chronic alcoholism. Of the 111 patients presented with either physical complaints or insomnia, eleven of them were admitted to the psychiatric wards. Three-hundred and eleven patients were followed-up in the psychiatric outpatient clinics. The availability of a psychiatric emergency service in a general hospital can contribute towards early psychiatric case findings and preventive Intervention. II provides an opportunity for liaison and consultation with other medical colleagues in the care of patients with physical complaints and attempted suicides.
Study site: Universiti Malaya Medical Centre (UMMC)
The infectiousness with regard to HBV Infection of staff and patients in various units of the General Hospital, Kuala Lumpur
was assessed. It was found that all units, with the exception of the obstetric unit, were equally high risk areas. At least 50% of the patients in all these units had one or more of the markers. Among the medical staff, the anaesthetists had the highest
incidence of HBV markers (100%) while medical officers who had worked for three years or more were more likely to have to
have the HBV markers. The degree of infectiousness of the nurses In HDU and ICU/OT was found to be similar.
A clinical isolate of Proteus sp., resistant to ampicillin, carbenicillin, cephaloridine, chloramphenicol, cotrimoxazole, gentamicin,
kanamycin and tetracycline, was examined for the presence of conjugative R plasmids. Results from conjugation, agarose gel
electrophoresis and transformation experiments showed that it harboured a large self-transmissible R plasmid which coded for all
the resistance traits.
Dr Rajakumar delivered this lecture at the 14th SMA National Medical Convention on 16.4.1983
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 83-90
This study presents the demographical characteristics of 271 cases of parasuicide seen at the Psychiatric Clinic, General Hospital, Kuala Lumpur, during 1982. The majority of cases were women in the 20 - 30 year age group, from a lower economic class, with minimal education. About one-half were single and 61.5% were actively religious. The racial breakdown was Indians 55%, Chinese 32% and Malays 13%. Self-poisoning using easily available drugs was the most common method employed and more than one-half intended to die at the time of the suicidal act. Most attempts were impulsive, carried out while alone, inside the
house. The findings are discussed and compared with earlier studies of attempted suicides in Malaysia and Singapore.
Cultures of Staphylococcus aureus from eight food poisoning incidents in Malaysia were examined for their ability to produce enterotoxins. Five of the eight strains were found to be enterotoxigenic, the enterotoxins detected being A and E (three strains), A and C (one strain), and C (one strain). Penicillinase production was observed in four of the five enterotoxigenic strains; the penicillin·sensitive strain was also found to be coagulase-negative. The bacteriological and epidemiological investigations for confirming staphylococcal food poisoning are presented. The preventive measures to be taken in reducing such outbreaks are emphasized.
The results of 2449 investigations of the upper gastrointestinal tract were analysed to determine the incidence of disease. Abnormalities were detected in 53% of patients who had endoscopy, but were found in only 24% of patients who had barium studies (p <= 0.001). Altogether 916 patients had abnormal findings. Duodenal ulcer accounted for 42% of cases, gastric ulcer 16% and gastric cancer 9%. The prevalence of perforated ulcer was 13%. The annual incidence/1000 in males and females (>14 years) were respectively, for duodenal ulcer 1.66 and 0.42, for gastric ulcer 0.57 and 0.25, for perforated ulcer 0.36 and 0.05, and for gastric cancer 0.29 and 0.14. Most types of gastro-duodenal disease were less common in Malays than expected (p = <0.001). However oesophageal cancer and varices were more common in Indians compared to Malays and Chinese (p = <0.001). This study showed that the pallern of perforating ulcers was not the same as that of non-peforating ulcers, suggesting a differing pathogenesis. Identification of the factors causing a different prevalence of disease between the three ethnic groups would help in the understanding of the causes of upper gastrointestinal disease.
This study examines the primary reasons for attempting suicide as described by the 271 parasuicidal patients assessed at the Psychiatric Clinic, General Hospital, Kuala Lumpur during 1982. The reasons in order of frequency were: marital problems; family problems; boyfriend, girlfriend problems; a medical illness; a psychiatric illness; and others, The types of marriage, family, and love problems experienced by each of the three major Malaysian racial groups are discussed. Indians presented with family problems more frequently than the other racial groups and Indian females were more frequently battered before the suicidal attempt. Suggested treatment measures based on the findings include employing a crisis intervention model for suitable patients, interviewing the patients on the Medical Wards, and involving more Psychiatric Social Workers in their management.
We report a retrospective study of all cases of toxic epidermal necrolysis admitted to the adult medical wards of the University Hospital in Kuala Lumpur over a 16 year period from 1967 to 1983. Over this period of time only 7 cases were encountered, suggesting the condition is rare in adults in our country. All the cases were females and the age ranged from 21 to 41 years. Four cases were due to drugs, 2 were idiopathic and one was attributed to Staphylococcal infection. One patient died. The other patients recovered completely with no sequelae.