It is known that alpha1-antitrypsin deficiency is associated with emphysema in adults and liver cirrhosis in neonates. The phenotypes PiZZ and PiSZ are considered to be high risk groups. alpha1-antitrypsin deficiency is one of the most common lethal congenital disorders in Europe and the USA, occurring in approximately 1 in 2,000 caucasians of North European descent. Studies in Malaysia have found that the phenotypes PiZ and PiS are present in our population. Out of 950 samples analyzed, it was found that 10 samples were shown to be apparently Z homozygous phenotype. The phenotype is determined by high resolution isoelectrofocusing on an ultra-thin polyacrylamide gel embedded with narrow range Pi phamarlyte. The isoelectrofocused bands are confirmed by immunofixation and the plasma alpha1-antitrypsin levels determined by electroimmunoassay. The abnormal phenotypes are further confirmed by polymerase chain reaction using allele specific oligonucleotides.
The chromosome in situ suppression hybridization or chromosome painting technic was applied to confirm and eliminate the markers involving chromosome 21 segments using a chromosome 21 DNA library. The library ATCCLL21SNO2 was amplified, directly biotinylated using the polymerase chain reaction. The results demonstrated a translocation of chromosome 21 material on chromosome 2 and X and eliminate the origin of the marker. Thus, the technique provides an important tool to complement the conventional G-banding technic.
The lymphatic filarial parasites which affect about 90 million people worldwide have similar host-parasite relationships in man. They are all able to survive, reproduce and cause chronic infections if they can successfully evade the protective responses of the host. Studies to investigate the wide spectrum of clinical manifestations of the infection even among those living in similar endemic areas and with presumed equal exposure to infective larvae, have been hampered by the lack of animal models showing similar host-parasite responses. The recent use of the nude mouse infected with Brugia spp, and the leaf-monkey (Presbytis spp) infected with B. malayi or Wuchereria spp for the study of immune responses and the associated pathology of these infections, has elucidated some of the host protective immune responses as well as the associated immunopathological reactions. The successfully entrenched parasite elicits minimal reactions and pathology, but with the onset of effective host responses, whether assisted by chemotherapy, development of protective immunity or both, severe inflammatory responses may occur. The role of such immune mediated response in determining subsequent pathology will probably be dependent on the frequency and duration of these episodes, but these have yet to be defined. Prenatal and perinatal sensitization by filarial antigens are postulated to result in tolerance and/or modification of immune responses to subsequent infections. A role for genetic predisposition to certain clinical outcomes, for example, the development of elephantiasis, has been postulated but needs further study. Advances have also been achieved in defining those parasite antigens/products involved in eliciting or suppressing protective and other immune responses.(ABSTRACT TRUNCATED AT 250 WORDS)
Neonatal septic arthritis has always been considered as separate from its counterpart in older children. The condition is uncommon but serious. Affected neonates usually survive, but with permanent skeletal deformities. Ten cases of neonatal septic arthritis were diagnosed between January 1989 and December 1993 in the neonatal intensive care units of two referral hospitals in the state of Kelantan, Malaysia. All except one neonate was born prematurely. The mean age of presentation was 15.6 days. Joint swelling (10/10), increased warmth (7/10) and erythema of the overlying skin (7/10) were the common presenting signs. Vague constitutional symptoms preceded the definitive signs of septic arthritis in all cases. The total white cell counts were raised with shift to the left. The knee (60%) was not commonly affected, followed by the hip (13%) and ankle (13%). Three neonates had multiple joint involvement. Coexistence of arthritis with osteomyelitis was observed in seven neonates. The commonest organism isolated was methicillin resistant Staphylococcus aureus (9/10). Needle aspiration was performed in nine neonates and one had incision with drainage. Follow up data was available for five neonates and two of these had skeletal morbidity. Early diagnosis by frequent examination of the joints, prompt treatment and control of nosocomial infection are important for management.
Non-haemoglobin liver iron was estimated in 275 presumably normal individuals from Kuala Lumpur and Singapore at necropsy. Liver Iron concentrations were highest during the first two years after birth but declined sharply during childhood. They then rose gradually and reached a value of 20 mg/100gm in adult males. Liver iron concentrations of childbearing women remained low and it was only after menopause that values in women rose to those of males. Liver iron stores increased with age to a plateau of about 300 mg in adults, suggesting that this value may represent the adult size for liver iron store. Among the three major ethnic groups in Malaysia and Singapore, Chinese, being in a better socio-eonomic class, had larger liver iron stores. The median liver iron concentrations of Malaysians and Singaporeans, on the whole, were lower than those reported from western populations and as many as 35 per cent of the women were in a subclinical state of iron deficiency.
Using ELISA and COPT diagnostic tests, serological evidence of Malaysian schistosomiasis was discovered among Orang Asli populations from three areas in Peninsular Malaysia. Serum samples collected in 1975 indicated an ELISA-positive prevalence of 25% and a COPT prevalence of 11% from Pos Iskandar, Pahang and an ELISA prevalence of 13% and a COPT of 4% from Bukit Lanjan, Selangor. Resurveys at these site in 1982-1984 showed a continued presence of serological positive individuals but prevalence rates were markedly lower: 7% and 1% for ELISA and 4% and 2% for COPT at Pos Iskandar and Bukit Lanjan respectively. Snail hosts were not found at either site. The source of infection for persons living in these lowland areas remains unknown. In a third area, Kuala Tahan, Pahang, located in the foothills of the central mountain range, foci of transmission have been found near to Orang Asli settlements. The serological prevalence rate among Negrito Orang Asli in that study area was 9% for ELISA and 4% for COPT. Thirty-three of 36 COPT-positive sera produced vacuolated bleb precipates and in 31 these were the only reactions seen. The high percentage of positives producing only these precipates suggests that among Orang Asli schistosomiasis patients such reactions are not an indication of recently acquired infection as has been reported for schistosomiasis patients in the Philippines.
The prevalence of human rotavirus enteritis in children admitted to the gastroenteritis ward of the Kuala Lumpur General Hospital was studied in 1982. Human rotavirus in the stool of the patients was detected by enzyme-linked immunosorbent assay. The survey showed that rotavirus enteritis in children were observed throughout the year, with two broad peaks of rotavirus infection occurring around March and September. The lowest incidence was recorded in July, however, no prolonged period of low prevalence of rotavirus enteritis was observed. The average prevalence for the whole of 1982 was 40% of the total diarrhoeal cases. No significant relationship was noted between the prevalence of the disease and rainfall.
A total of 736 sera collected from cord blood babies, children and adults of both sexes and of different age groups in Malaysia were tested using indirect fluorescent antibody technique for Toxoplasma antibodies. The RH strain of Toxoplasma gondii zoites were used as antigen. One hundred and twenty five sera which were reactive at 1:64 or high titres were tested with IgM specific conjugate. Results of the present studies showed that the prevalence of Toxoplasma antibody was highest among the Malays and lowest among children than among adults. The significance of Toxoplasma specific IgM was discussed.
Kuala Lumpur is the capital city of Malaysia with an estimated population of 1.55 million. Approximately 12% of the population live in squatter settlements occupying about 7% of the city total area. The squatter settlements generally are provided with basic amenities such as piped water, toilet facilities and electricity. Health indicators for the overall population of Kuala Lumpur are better off than for the rest of the country; however, intra-city differentials prevail along ethnic and socio-economic lines. Malays and Indians have higher rates for stillbirths, and neonatal, infant and toddler mortality than the Chinese. The wide disparity in the socio-economic status between the advantaged and the poor groups in the city is reflected in the dietary practices and nutritional status of young children from these communities. The percentage of preschool children from urban poor households with inadequate intakes of calories and nutrients is two to three times higher than those from the advantaged group. Compared to rural infants, a lower percentage of urban infants are breastfed. A lower percentage of Malays from the urban advantaged group breastfed, compared with the urban poor group. The reversed trend is found for the Chinese community. Growth attainment of young children from the urban poor is worse than the urban advantaged, though better than the rural poor. Health and nutritional practices implications related to both undernutrition and overnutrition are discussed, to illustrate the twin challenges of malnutrition in the city.
The nutritional status of 641 children between the ages of 0 to 4 years old, from 835 households in 41 randomly selected rural villages with water supply in Sarawak were determined. Based on Waterlow's classification and the National Center for Health Statistics (NCHS) standards, 61% of the children were stunted and 44.1% were wasted. Based on Gomez's classification and the NCHS standards 81.9% of the children were malnourished. There was no sex difference in nutritional status. The percentage of malnourished children increased continuously with age while the percentage of children who were wasted increased from 6 to 36 months and then it leveled off. The percentage of stunted children also increased with age but the increase was sharpest in children who were 12 to 23 months old. It is noted that the Gomez classification overestimates the prevalence of undernutrition.
In 1982, Malaysia experienced the worst dengue/dengue haemorrhagic fever outbreak in its history. All states in Peninsular and East Malaysia were similarly affected. There was a total of 3,005 cases with 35 deaths, with the majority of cases occurring between the months of July to October. There was a total of 1,001 laboratory confirmed cases. Most of the cases were in patients over the age of 15 years. The Chinese population was mainly affected, although a much higher proportion of Malays was noted in comparison to previous years. The main serotypes involved were dengue-1 and dengue-3. No dengue-4 serotype were isolated.
Toxoplasmosis was found not to be an important cause of intrauterine infection in Malaysia as the rate of toxoplasma-specific IgM in 1,060 congenitally defective Malaysian children, 0 to 4 months old (0.4%) was lower than that in 405 normal children of the same age group (2.0%). A total of 8.2 intra-uterine toxoplasmic infections per 1,000 live births was detected of which one-third (2.7 per 1,000 live births) was overt, manifesting symptoms more of liver damage, than eye or brain damage. A comparison was made with the rates in U.S.A. and Europe. The role of toxoplasmosis in abortion needs to be studied.
The prevalence of antibody to human herpesvirus type 6 (HHV-6) and Epstein-Barr virus (EBV) viral capsid antigens (VCA) were analysed in sera from Kadazans of Sabah, North Borneo. At a serum dilution of 10, about 34% were positive for HHV-6 antibody but in contrast all 95 individuals studied were positive for EBV VCA antibody. The study shows that HHV-6 and EBV infection occur independently. The low frequency of seropositive individuals in this community suggests that other than socioeconomic factors are responsible for the spread of the virus.
In a study of infant feeding practices in 95 infants aged three months and six months in the rural, predominantly Malay district of Kubang Pasu, which is recently undergoing rapid economic development consequent on the introduction of improved agricultural techniques in rice farming, it was found that approximately 75% of infants in both age groups were wholly or partially breast fed, modified powered milk being the milk food of most of the others. Semisolids were introduced early in the form of commercial prepacked cereals. It is suggested that medical officers of health recognising local socioeconomic and cultural changes that might affect health behavior can initiate simple studies of this type to identify local needs in health education. In circumstances such as this where a still popular beneficial traditional practice like breast feeding might be at risk of losing popularity in the face of socioeconomic development in the community it is suggested that the most useful educational effort regarding infant nutrition would be to preserve breast feeding.
This study presents clinical observations in pregnancy made on aborigines of the deep jungle and "outside" populations. Migration out of the jungle results in lowered nutritional status as a result of low socio-economic status in the "outside" aborigine. This, together with food habits, increased family size and higher incidence of helminthic infestations, results in lower mean values of Hb, PVC and MCHC and a higher prevalence of anaemia in pregnancy in the migrant aborigine. A higher population density in the "outside" population resulting in frequent intermingling and increased chances of cross-contamination probably explains the increased vaginal bacterial growth in the "outside" Aborigine women. A higher prevalence of vaginal candidiasis in the "outside" aborigine woman is probably related to exposure to oral contraceptives and broad-spectrum antibiotics. On the other hand, better medical and obstetrical services become more readily available to the "outside" aborigine and this results in a favourable influence on perinatal health.