Cough associated with angiotensin converting-enzyme (ACE) inhibitor therapy has been reported in Western communities, where its incidence is disputed. We, therefore, reviewed our patients who were treated with captopril primarily for congestive cardiac failure. 19 of 61 patients (31.1%) receiving an ACE inhibitor had volunteered cough as an important adverse effect, compared with only one of 59 patients who recieved other treatment. In 3 patients, the cough was intolerably severe to require discontinuation of treatment. Another 7 patients were withdrawn from ACE inhibitor treatment because of other adverse effects including deteriorating renal function, insomnia, dizzy spells, ageusia and proteinuria, and skin rash. We suggest that although ACE inhibitors are very beneficial in improving the clinical status of congestive heart failure, intolerable adverse effects are not uncommon and might mandate withdrawal in a sizeable minority (16.4%).
Haematologic abnormalities are found in patients who develop acute ischaemic syndromes including acute myocardial infarction (AMI). A coronary care unit population of 660 consecutive patients were studied for their haematologic parameters on admission. There were 263 patients who had AMI, 207 who had non-infarct acute ischaemic syndromes (CAD), and the other 190 non-coronary patients served as controls. Overall patients with AMI had signijicantly higher haemoglobin (145 ± 2.2 vs 12.9 ± 3.0 g/dl, p<0.0001), haematocrit (45.4 ± 5.8% vs 41.2 ± 8.8%. P < 0.001). red cell count (5.0 ± 0.7 vs 4.5 ± 10^12 p<0.001), but there were no significant differences in their leucocyte count, platelet count or mean corpuscular volume. Patients with CAD had higher haemoglobin and red cell counts (p<0.002, p<0.02 respectively). Although infarct women tended to have lower counts (p<0.001), they still had significantly higher haemoglobin (p<0.01), haematocrit (p<0.02) and red cell count(p<0.002) when compared with controls. Interestingly, there were no ethnic differences at all with regard to haematologic values for infarct patients; haemoglobin, haematocrit, and red count were each significantly higher than controls. Our results suggest that a relatively high baseline Hb, haematocrit or RBC count may be associated with increased likelihood of acute ischaemic syndromes including AMI among Malaysians. Increased viscosity and abnormal haemorheological characteristics may contribute to the development and subsequent outcome of unstable coronary syndromes. Keywords: acute myocardial infarction, coronary artery disease, haemoglobin, haematocrit, haemorheology.
86 patients suspected of primary lung cancer, referred to the National Tuberculosis Centre for fibreoptic bronchoscopy, were selected for this study to determine the relative value of the various types of respiratory cytology material in establishing a diagnosis and to identify the factors which influence the exfoliation of malignant cells. Prebronchoscopic sputa and bronchial bnishings were found to yield diagnostic cells most frequently. Hilar tumours arising from large bronchi, squamous and small cell anaplastic types were found to exfoliate cells most frequently. The study highlights the effectiveness of cytologic methods in the diagnosis of bronchogenic carcinoma. Cytologic evaluation may be the only method of confirming the diagnosis whcn biopsy is contraindicated. In the investigation of a patient thought to have lung carcinoma, good "deep cough-up" sputa shuld be first examined to prove a diagnosis before subjecting him or her to procedure like bronchoscopy.
118 cases of cervical dysplasia were followed up by cytological smears for over 9 years to determine their biologic outcome. All grades of dysplasia showed evidence of regression and progression to more severe lesions, including carcinoma. Severe dysplasia however did not regress to normalcy and had the maximum conversion rates to malignancy. The period taken for transition to malignancy was found to be shorter than that generally described. Since even mild dysplasia carries with it a malignant potential, all patients with cervical dysplasia, irrespective of the grade, have to be followed up by repeated clinical and cytological examinations.
A study was conducted in an urban slum area of Kuala Lumpur, the capital of Malaysia, to determine the health status of the children under 6 years old and the knowledge and practice associated with diarrhoeal diseases and use of oral rehydration salts (ORS) among mothers in the area. It was seen that the health status of the children was poor with one fifth of them born underweight, 33% experiencing more than 6 spells of illness per year and a high percentage of them suffering from diarrhoeal diseases (4.3%). Child care practice was associated with urban lifestyles with early weaning, short term breast-feeding and early introduction of solid and bottle feeding. Knowledge and practice of mothers concerning child care was inadequate to support healthy living. Knowledge of diarrhoeal diseases and the effectivenss of oral rehydration salts was poor. Only 47.7% of mothers knew about ORS and 27.8% ever used it when their chidlren suffered from diarrhoea. Health care system dependence was shown by the high percentage of mothers immediately bringing to a doctor's attention (75.6%).
Analysis of the nutritional status and its related factors of three different geographic areas was conducted. The areas were Kampong Sungai Gulang-Gulang, a traditional village in Kuala Selangor, vegetable farming area in Kuala Terla, Cameron Highland and housing flats in Kuala Lumpur. Assessment of nutritional status was done using anthropometric, clinical, biochemical, dietary and stool examination. The results show that 13% of the children in traditional village were stunted, 8% were wasted and 17% were underweight. In vegetable farming area the prevalence were 16.5%, 10.2% and 20.2% respectively. The prevalence of anaemia among toddler was 81.0% in traditional village, 77.2% in vegetable farming area and 55.3% in urban flats. Anaemia in the three areas was strongly associated with inadequate intake of iron.