PCR and restriction fragment length polymorphism (RFLP) typing of flagellin genes (fliC) from 57 clinical isolates of Burkholderia cepacia indicated that only type 11 flagellins were present. Twenty-two isolates previously identified as the epidemic UK cystic fibrosis strain were indistinguishable by this method, as were 11 isolates from a pseudo-outbreak in Senegal. Other clinical isolates, including 19 from disparate sources in Malaysia, were separated into nine fliC RFLP groups, exhibiting a large degree of divergence. When isolates were indistinguishable by fliC genotyping, their similarity was confirmed by whole genome macro-restriction analysis with pulsed-field gel electrophoresis following XbaI digestion. The variation in fliC sequences of B. cepacia was far greater than that with B. pseudomallei, supporting the view that 'B. cepacia', as currently defined, may comprise several different genomic species.
The First International Teleconference in Ophthalmology was held during March 1998 between five sites in the UK, USA, Greece and Malaysia. ISDN transmission at 128 kbit/s was used to reduce costs while maintaining the clarity of the presented material. Specialized lecture theatres were not available at all sites and conventional halls had to be adapted for videoconferencing. For this reason initial point-to-point testing was carried with Bristol to simplify problem solving. Thereafter, a multipoint bridge was used to connect all sites together. During the conference a number of individual presentations were given, all followed by extensive discussion periods. Special instructions were given beforehand on the production of slide material, with particular reference to font sizes and colour combinations. Full use was made of various presentation media, including slides, videos and live demonstrations. The conference was attended by over 500 delegates, all of whom were specialists in ophthalmology. The technology employed was ideal for teaching purposes. However, if used in a clinical field, it should be kept in mind that the choice of transmission rate makes certain features not easily apparent in images but they become clearer when pointed out by the presenter.
Diagnosis by histopathology remams as one of the most important investigative methods used to establish a definitive diagnosis of a lesion or disease state. The provision of oral tissue diagnostic services is therefore an essential function of an Oral Pathology unit. A review of the English language literature disclosed that much of the documented information on the patterns of oral diagnostic services were from the United States, Canada and the United Kingdom. This paper provides an overview of such surveys carried out in these countries.
This study was conducted to examine how subjects modulate their food intake and energy balance when they migrate from a low energy density food intake pattern to one of high energy density. It was hypothesised that an increase in the energy density of food consumed would result in increased body weight of the migrating subjects unless food intake and energy balance could be modulated. Food selection, food intake, basal metabolic rate (BMR) and anthropometric measurements were made on 53 female and 56 male newly arrived overseas students. All subjects were from Malaysia, but the data was collected at Oxford Brookes University where the subjects were studying. Food intake using 3-day food diaries and food frequency questionnaires (FFQs). BMR and anthropometric measurements including body weight were measured on arrival in the UK and after 3 and 6 months' stay. Student's t-tests and analysis of variance (ANOVA) were used to compare the data. A significant difference (P < 0.05) was found between the energy density of the foods consumed in Malaysia and after 3 and 6 months in the UK. There was also a significant decrease (P < 0.05) in protein consumed. However, there were no differences in total energy intake. From results of the FFQs, differences were found in food selection due mainly to the lack of availability of certain foods in UK supermarkets. No significant differences were found in the BMR and anthropometric measurements made at the start of the study and later assessments. It appears that Malaysian students are able to remain in energy balance and are weight stable at least during the first 6 months of residence in the UK, despite the wider choice of energy dense food available. This suggests that at least in the short term, subjects are able to modulate their food intake in response to changes in the energy densities and free choice of food.
Historical perspective of terminations of unwanted pregnancies in the UK. Moral and ethical considerations imposed by established church's teachings becoming increasingly in conflict with the wishes and expectations of a more secular society. Recognition that illegal abortion was, as a matter of fact available, at great risk to vulnerable girls and women. Eventually public demand and a radical and reforming government led to the current Statutory Framework. Statutory provisions: Offences against the Person Act 1861, Sections 58 and 59; Infant Life Preservation Act 1929 Section 1. Recognition of the limited flexibility allowed by the law in the original restrictive statutory framework. The direction to the jury in July 1938 by Macnaghten J in the case of R. v. Bourne [1939] 1 KB 687, where an eminent obstetrician was acquitted after carrying out an abortion on a young rape victim. Then the modern statutory provisions: Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990. The statutory framework provides for healthcare professionals not to have to take part in terminations if they have a conscientious objection to doing so. While there are still fierce challenges from moral pressure groups when any changes in the detail of the law are proposed--such as reducing the maximum gestation period for a lawful termination--as a whole society seems to have accepted the current law. Issues affecting doctors who consider and provide terminations; current medico-legal problems relating to wanted pregnancies that have been lost by reason of clinical negligence, and unwanted children that have been born by reason of clinical negligence.
Historical perspective of terminations of unwanted pregnancies in the UK. Moral and ethical considerations imposed by established church's teachings becoming increasingly in conflict with the wishes and expectations of a more secular society. Recognition that illegal abortion was, as a matter of fact available, at great risk to vulnerable girls and women. Eventually public demand and a radical and reforming government led to the current Statutory Framework. Statutory provisions: Offences against the Person Act 1861, Sections 58 and 59; Infant Life Preservation Act 1929 Section 1. Recognition of the limited flexibility allowed by the law in the original restrictive statutory framework. The direction to the jury in July 1938 by Macnaghten J in the case of R. v. Bourne [1939] 1 KB 687, where an eminent obstetrician was acquitted after carrying out an abortion on a young rape victim. Then the modern statutory provisions: Abortion Act 1967, amended by the Human Fertilisation and Embryology Act 1990. The statutory framework provides for healthcare professionals not to have to take part in terminations if they have a conscientious objection to doing so. While there are still fierce challenges from moral pressure groups when any changes in the detail of the law are proposed--such as reducing the maximum gestation period for a lawful termination--as a whole society seems to have accepted the current law. Issues affecting doctors who consider and provide terminations; current medico-legal problems relating to wanted pregnancies that have been lost by reason of clinical negligence, and unwanted children that have been born by reason of clinical negligence.
A prospective randomised study was done to assess the effect of supplemental oestradiol in addition to progesterone on the luteal steroid profiles and pregnancy outcome in stimulated cycles with and without pituitary down regulation. Women undergoing stimulated cycle IVF with GnRH-a and FSH (Group A, n = 63) or stimulated intrauterine insemination using CC and FSH (Group B, n = 55) were studied. These subjects were randomly allocated to receive either 400 mg daily of vaginally administrated Cyclogest (progesterone) alone or in combination with 2 mg daily of oral Oestradiol Valerate (E2V) during the luteal phase. Significant lower concentrations of plasma progesterone were observed in those subjects supplemented with both E2V and progesterone compared to those in whom progesterone only was given during the luteal phase (P < 0.05). Exogenous E2V had a minimal impact on plasma oestradiol concentrations and did not disguise the characterised mid luteal decline in oestradiol secretion. The suppressive effect of E2V on plasma progesterone was lost if implantation occurred normally because any small change in steroid concentrations was reversed by the rapidly increasing concentrations of HCG. Similar pregnancy rates were observed among subjects supplemented with or without oestradiol. The addition of oestradiol to the luteal supplement suppresses endogenous corpus luteum progesterone secretion irrespective of the type of assisted conception cycle and that its use is unlikely to be beneficial to the process of implantation.
OBJECTIVE: This paper compares the clinical experience in acute conditions of the undergraduate students of a medical school from a developing country (Malaysia) with those from a developed country (UK).
METHODS: This study was conducted at the School of Medical Sciences, Universiti Sains Malaysia (USM). Through questionnaire survey enquiry was made about 27 acute medical conditions (i.e. conditions related to internal medicine, paediatrics, and psychiatry), 15 acute surgical conditions (i.e. conditions related to general surgery, orthopaedics, ophthalmology, otorhinolaryngology, gynaecology and obstetrics), 15 surgical operations and 26 practical procedures. The results obtained were compared with published data from the UK.
RESULTS: Acute medical conditions were seen by higher number of the USM students but with less frequency than the British students. The USM students saw practical procedures more frequently than the British students did, but almost an equal number performed these procedures independently. The British students attended surgical operations more frequently than the USM students did.
CONCLUSION: Given the limitations of comparison (epidemiological, cultural and geographical differences, conventional curriculum (in the British medical schools) vs. problem based learning curriculum (in the Malaysian medical school)) the overall clinical experience of the medical students in the USM and the UK was comparable. The USM students had more opportunities to observe cases and procedures but "hands on" experience was similar to that of the British students.
BACKGROUND: This prospective study was undertaken to investigate whether spectral sensitivity can be useful in determining the prognosis of fellow eyes of eyes with macular holes.
METHODS: Spectral sensitivity measurements using a one degree test spot presented at a rate of 1 Hz and 25 Hz on a bright (1000 td) white background were carried out on 10 patients aged between 67 and 74 years (mean age 70.3 +/- 2.6 years). Each patient had a full thickness macular hole in one eye and a normal contralateral fellow eye. The spectral sensitivity measurements were made with eccentric fixation in the eyes with macular holes and with central fixation in the normal fellow eye. A year later, the patient files were reviewed to look at the patient's ocular condition. Another 10 subjects between the ages of 50 and 80 years (mean age 69.5 +/- 4.2 years) were also seen. These control group subjects had visual acuities of 6/9 or better with minimal ocular media changes and no ocular or systemic pathology that could affect colour vision.
RESULTS: The 1 Hz and 25 Hz spectral sensitivities of all patients were reduced for both eyes. Despite the good eye without a macular hole having a VA of 6/6, the spectral sensitivity was similar to that of the eye with the macular hole and markedly reduced visual acuity.
CONCLUSION: The present investigation enabled us to examine the chromatic and achromatic mechanisms by testing spectral sensitivity at 1 Hz and 25 Hz, respectively. The data revealed that both chromatic and achromatic processing could be damaged in the eye with a macular hole. Surprisingly, the spectral sensitivities of both 1 Hz and 25 Hz are equally reduced in the good fellow eye with no macular hole. A one-year follow-up showed that two of the 10 patients (20 per cent) did eventually develop a macular hole in the normal fellow eye. This indicates that there is some subclinical foveal dysfunction in the normal fellow eye, the nature of which is unclear.
Study site: Manchester Royal Eye Hospital (MREH), United Kingdom
Current understanding of the use of exclusion diets in the management of asthma in children is limited and controversial. The aim of this study was to examine the effects of excluding eggs and milk on the occurrence of symptoms in children with asthma and involved 22 children aged between three and 14 years clinically diagnosed as having mild to moderate disease. The investigation was single blind and prospective, and parents were given the option of volunteering to join the 'experiment' group, avoiding eggs, milk and their products for eight weeks, or the 'control' group, who consumed their customary food. Thirteen children were recruited to the experimental group and nine to the control group. A trained paediatrician at the beginning and end of the study period assessed the children. A seven-day assessment of food intake was made before, during and immediately after the period of dietary intervention in both groups. A blood sample was taken from each child for determination of food specific antibodies and in those children who could do so, the peak expiratory flow rate (PEFR) was measured. Based on the recommended nutrient intake (RNI), the mean percentage energy intake of the children in the experimental group was significantly lower (p < 0.05) in the experimental group. After the eight-week study period and compared with baseline values, the mean serum anti-ovalbumin IgG and anti-beta lactoglobulin IgG concentrations were statistically significantly reduced (p < 0.05) for both in the experimental group. In contrast, the values for anti-ovalbumin IgG in the control group were significantly increased and those for anti-beta lactoglobulin IgG were practically unchanged. The total IgE values were unchanged in both groups. Over the study period, the PEFR in those children in the experimental group able to perform the test was significantly increased, but no such change was noted in the children in the control group who could do the test. These results suggest that even over the short time period of eight weeks, an egg- and milk-free diet can reduce atopic symptoms and improve lung function in asthmatic children.
Study site: Outpatient Department, Royal County Hospital and the Frimley Children’s Centre, United Kingdom
There are disturbing trends of emerging and re-emerging infectious diseases, globally and locally thus giving it a real cause of concern. These include diseases by agents hitherto unknown in human such as Severe Acute Respiratory Syndrome (SARS) and Ebola; those that were purely zoonoses but had now affected man such as bovine spongioform encephalitis (BSE) in United Kingdom and avian influenza in Vietnam and Thailand; those that were thought to be eliminated but reappeared such as plague in India and those that begun to show reverse trends such as tuberculosis (TB) and malaria. Malaysia is no exception. Viral fever EV71, Chinkugunya, Conjunctivitis C24 variant or Nipah encephalitis were local examples of unknown or exotic infectious diseases occurring in recent years. In this age of globalization with expanding air travel and industrial trade, Malaysia is vulnerable to a wide array of new and resurgent infectious diseases. Apart from the direct health consequences on morbidity, mortality and its staggering cost, these infections also have far reaching implications upon sustainable development, psychosocial, economic, political and global security.
OBJECTIVE: To study the etiology, outcome and prognostic indicators in children with fulminant hepatic failure in the United Kingdom.
DESIGN: Retrospective review of all patients <17 years with fulminant hepatic failure from 1991 to 2000. Fulminant hepatic failure was defined as presence of coagulopathy (prothrombin time >24 seconds or International Normalized Ratio >2.0) with or without hepatic encephalopathy within 8 weeks of the onset of symptoms.
SETTING: Liver Unit, Birmingham Children's Hospital, United Kingdom.
RESULTS: Ninety-seven children (48 male, 49 female; median age, 27 months; range, 1 day-192.0 months) were identified with fulminant hepatic failure. The etiologies were: 22 metabolic, 53 infectious, 19 drug-induced, and 3 autoimmune hepatitis. The overall survival rate was 61%. 33% (32/97) recovered spontaneously with supportive management. Fifty-five children were assessed for liver transplantation. Four were unstable and were not listed for liver transplantation; 11 died while awaiting liver transplantation. Liver transplantation was contraindicated in 10 children. Of the 40 children who underwent liver transplantation, 27 survived. Children with autoimmune hepatitis, paracetamol overdose or hepatitis A were more likely to survive without liver transplantation. Children who had a delay between the first symptom of liver disease and the onset of hepatic encephalopathy (median, 10.5 days versus 3.5 days), higher plasma bilirubin (299 micromol/L versus 80 micromol/L), higher prothrombin time (62 seconds versus 40 seconds) or lower alanine aminotransferase (1288 IU/L versus 2929 IU/L) levels on admission were more likely to die of fulminant hepatic failure or require liver transplantation (P < 0.05). On multivariate analysis, the significant independent predictors for the eventual failure of conservative therapy were time to onset of hepatic encephalopathy >7 days, prothrombin time >55 seconds and alanine aminotransferase =2384 IU/L on admission.
CONCLUSIONS: Children with fulminant hepatic failure with severe coagulopathy, lower alanine aminotransferase on admission and prolonged duration of illness before the onset of hepatic encephalopathy are more likely to require liver transplantation. Early referral to a specialized center for consideration of liver transplantation is vital.