Manifestations of vitamin deficiencies observed in 6,000 Tamil and 4,000 Malay children and young adults during a survey carried out by the Institute for Medical Research in the Federated Malay States included phrynoderma, Bitot spots
and angular stomatitis. They were more frequent in Tamils than in Malays. Phrynoderma and Bitot spots responded rapidly to administration of vitamin A or carotene, though in some patients with phrynoderma improvement was not attained unless also the protein intake was increased and vitamin B complex added. Angular stomatitis was benefited by administration of riboflavin or vitamin B complex. The clinical and histologie observations of phrynoderma in Tamils and Malays in Malaya were identical with those previously reported in Chinese, Ceylonese and southern Indians. A supplementary food ration, composed of soy beans, skim milk powder, dal and red palm oil, given to Tamil children on rubber estates not only increased the general state of health but led to a rapid regression of the manifestations of vitamin deficiencies.
(1) The use of the thiochrome method for the estimation of thiamine in human milk is discussed, with special reference to the possible production of an artefact, following the incubation of the milk with pepsin, in addition to the use of takadiastase (clarase). No evidence could be found to suggest that an artefact resembling thiamine was produced by the method of analysis described.
(2) The thiamine content of 91 samples of full lactation human milk from apparently "normal" Malay, Chinese and Indian women in Malaya is recorded. The mean milk thiamine level of 11.3 ug/100 ml. found is considerably lower than the levels recorded for milk samples from apparently "normal " women in the United Kingdom and the U.S.A.; and slightly lower than that recorded in Australia. The results suggest that the dietary
intake of thiamine in Malaya is inadequate to maintain optimum thiamine levels in the milk of lactating women.
(3) No significant difference was found in the mean thiamine content of milk from women of the three principal racial groups in Malaya ; nor was any significant difference found to be associated with the parity or age of the women or, in the case of full lactation milks, with the time after parturition at which the sample was collected. No significant difference was found in samples collected from the same woman at different times of the day or before and after a main meal.
(4) Marked differences were found in the thiamine content of samples of milk from individual women, and the possible reasons for this are discussed.
(5) The examfnation of 48 samples of milk collected during the first month after parturition confirmed previous recorded observations that the thiamine content of such milks, initially low, gradually increases to reach "normal" levels towards the end of the first month of lactation.
The ABO, MN and Rh blood types, and the Hp, Tf, and Gm [Gm (a), Gm (x), Gm(b), and Gm-like] factors were determined for 128 unrelated Indians (parents of families, 63 with two parents tested and two with one parent tested), and 90 unrelated Chinese (parents of 46 families, 44 with two parents tested and two with one parent tested), and for the offspring from these families. The frequencies of the several blood types are presented. They were done primarily to aid in paternity testing. They compare favorably with the findings of previous studies. The allele Hp1 is rare in the Indian population (.09) and relatively infrequent in the Chinese (.29). Unfortunately, the data shed no light on the problem of the inheritance of the phenotype Hp O. Only Tf C was found among the Indians. About four per cent of the Chinese were heterozygous for Tf CD,, all other were Tf CC. The Indians have a high frequency of Gm(a) and of Gm (x), and a low frequency of Gm (b). They appear to have alleles Gma, Gmax, and Gmb in the following frequencies: .535, .234(5), and .230(5), respectively. Three families appear to have a GMxb allele, providing the offspring are not extra-marital. The Chinese appear to have the alleles Gm^ab, Gm^a, and Gm^ax in the following frequencies: .741, .231, and .028, respectively.
300 patients (185 males, 115 females) were examined for intestinal parasites. About 40% of these patients was infected, 14% of which was heavily infected. The highest prevalence and intensity of infection with soil-transmitted helminths was found among Malays and Indians of different ages. Heavy infections with these helminths were also frequently encountered in young Chinese. Helminthic infections in patients over 60 years of age was significantly lower. There was no significant differences in the prevalence and degree of infection among males and females. The commonest helminth encountered was Trichuris trichiura, which usually occurred as trace single infections. Mixed infections with Ascaris and Trichuris, usually with the former as the predominating parasite, were also frequently observed.
Investigations in 30 healthy control subjects of Indian, Chinese and Malay ethnic origin, revealed that all the Chinese and about two thirds of the Indians and Malays had a normal capacity to absorb D—xylose, Vitamin A, Co58 labelled Vitamin B12 and dietary fat. About a third of the Indians and Malays were unable to absorb one or two of the four test substances used in the absorption studies. Jejunal biopsies did not differ in the 3 ethnic groups and were normal or mildly abnormal. 27 patients presenting with anorexia, a sore tongue and pallor were also investigated. Indians formed the majority of the patients. Diarrhoea occurred in only 51 % of the patients. All had a megaloblastic anaemia. Absorption studies revealed malabsorption of xylose, Vitamin A and Vitamin B12 in the majority but steatorrhoea occurred in only 26% of the patients. Jejunal biopsies were mildly abnormal in 8% and moderately or severely abnormal in 92 % of the patients. All responded to folic acid or Vitamin B12 therapy. 16 patients were restudied after 5 to 24 months therapy and the majority were found to have improved. Results of investigations and response to therapy indicate that these patients were suffering from tropical sprue. These studies indicate that tropical sprue in Singapore affects Indians mainly and can often present without diarrhoea and steatorrhoea.
A clinical study was undertaken of new diabetics seen at a general medical unit in Singapore. Over a period of 12 months, there were seventy-five cases of which 38 (50.7%) were Chinese, 15 (20%) Malays and 22 (29.3%) Indians. Male patients were twice as common as female patients. The majority of patients (61.3%) were in the 5th and 6th decade and only 23 (30.7%) were obese. Oral sulphonylurea and dieting provided effective control in 80.6% of the patients, and only 9% of patients required insulin. Ketosis was present in only 6 cases and was easily controlled with appropriate treatment. Other clinical features are presented and discussed.
In West Malaysia RA appears to be less common than in temperate climates, but more common than in tropical Africa; furthermore, the incidence of gout and SLE is comparable. The clinical manifestations of RA are milder than those seen in more temperate climates. Subcutaneous rheumatoid nodules have not been observed. Positive serological tests for RF are significantly higher than in the general Malaysian population, but still lower than those reported for patients with RA in temperate climates. Of the three main ethnic groups, the highest incidence of positive results is found in the Chinese.
Study site: Arthritis Clinic, University Hospital, Kuala Lumpur (University Malaya Medical Centre, UMMC, Kuala Lumpur, Malaysia)
Spirit possession in an Indian family is described. Its importance as a culture-bound phenomenon is stressed. Its nature as a hysteria, and as a culturally sanctioned and accepted means of expression of emotions and feelings, are discussed.
A "registry" of all known cases of nasopharyngeal carcinoma in Malaysia, 1968-72, was established. Attention was focused on the State of Selangor where conditions are best for case finding. Age-adjusted incidence rates among Chinese males and females were 17·3 and 7·3 per 100,000; among Malay males and females, the rates were 2·5 and 0·3 and among Indian males, 1·1. The detailed ethnicity of 192 cases in Selangor was established. Estimated incidence rates for the Chinese sub-groups agreed with the pattern observed elsewhere: highest among the Cantonese, lowest among the Hokkien/Teochiu, with the Khek in between. There was no correlation between histological type and sub-ethnic group among the Chinese cases.