A detailed account and definition is given of the previously inadequately described "giant reactions" to tuberculin occasionally seen in leprosy patients. The reaction is an accelerated and exaggerated response to species-specific antigens of Mycobacterium tuberculosis found in both PPD and New tuberculin. Our studies were performed in Malaysia, Uganda, Spain, and England. There was a significantly higher incidence of the phenomenon in Malaysia than in the other centers, but this may have been because there alone previously untreated lepromatous (LL and BL) patients were serially tested for up to three years after starting chemotherapy. Of the 28 patients exhibiting giant reactions, 27 occurred among lepromatous patients (24 LL and 3 BL), of which only 3 (1 LL and 2 BL) were untreated. One treated BL patient had developed, and one untreated BL patient was a family contact of, active tuberculosis. Giant reactions are uncommon in untreated and in very long-term treated LL patients, but may occur in up to a fifth of those receiving their first 1-3 years of chemotherapy. Although the mechanism is not yet understood, it appears to be a coincidence of delayed hypersensitivity of the tuberculin type and a less-delayed phenomenon of excessive local edema associated with local lymphadenopathy and short-lasting symptoms of malaise and pyrexia. It is suggested that the majority of giant reactions occur during a period of temporary lack of immune regulation associated with changing levels of antigenic load.
"This article describes characteristics of prospective migrants in the Malaysian Family Life Survey and investigates how planning to move affects hours of work. [The authors] use ideas about intertemporal substitution...to discuss the response to temporary and permanent wage expectations on the part of potential migrants. [An] econometric section presents reduced-form estimates for wage rates and planned migration equations and two-stage least squares estimates for hours of work. Men currently planning a move were found to work fewer hours. Those originally planning only a temporary stay at their current location work more hours."
Analysis of mothers' recall data collected in 1976-1977 by a probability survey in Peninsular Malaysia shows an association between breastfeeding up to six months of age and improved survival of infants throughout the first year of life. Inappropriate sample selection and inadequate control of confounding can introduce large biases in these analyses. The magnitude and direction of these biases are presented. Even when these biases are dealt with, unsupplemented breastfeeding appears more beneficial than supplemented breastfeeding. The younger the infant and the longer the breastfeeding, the greater the estimated benefits in terms of deaths averted. The use of powdered infant formula did not appear to offset the detrimental effects of early weaning and supplementation. The positive relationships found in these analyses between breastfeeding and survival are not due to death precluding or terminating breastfeeding. Nor are they likely to be due to a shift away from breastfeeding because of recent illness, which was also controlled in the analyses. Nor are they likely to be due to other factors that both increase mortality risk and shorten breastfeeding; when such factors are taken into account, the beneficial effects of breastfeeding become stronger and imply that, if there had been no breastfeeding in this sample, twice as many babies would have died after the first week of life.
Field observations were made on Coquillettidia crassipes during a study of Mansonia in a swamp forest ecotype in Tanjong Karang. There was an increase in abundance in July consistent with the increase in abundance of Mansonia and an increase in rainfall. The biting cycle showed a dramatic early peak during the period 1900-2000 hours. The probability of daily survival through one day for the first three gonotrophic cycles was 0.770, 0.722 and 0.759. Two of the 54 Cq. crassipes dissected were infective, with two and 25 L3 larvae of Brugia. Both subperiodic B. malayi and B. pahangi developed into L3 larvae in laboratory bred Cq. crassipes. The index of experimental infection was higher for B. pahangi. Mansonia bonneae and Ma. uniformis showed higher indices of experimental infection than Cq. crassipes for subperiodic B. malayi. It is concluded that in an endemic area with a high density of Cq. crassipes it could act as a secondary vector of Brugian filariasis.
A preliminary report on the short-term use of Tioconazole for vaginal candidiasis is presented. The cure rate was found to be approximately 90% in mild degrees of the disease, with good patient compliance and minimal side effects. However no conclusion can be drawn for moderate or severe cases of the condition.
Data from the Malaysian Family Life Survey show an increase in the percentage of infants breastfed, at least initially, from 75 per cent in 1970-74 to 79 per cent in 1975-77. Contrary to what would be expected if Malaysia were following the trends observed in the United States and Western Europe, the increase has occurred among poor and uneducated women as well as among the more fortunate. The increase was especially marked for infants born in hospitals and private clinics, which had very low rates of breastfeeding in the early 1970s. The change may be due partly to a shift in the practices and recommendations of health professionals. Trends in infant feeding practices in Malaysia during the whole period 1950-77 are reviewed. Reasons for thinking the increase in the mid-1970s an artifact of the survey are presented and provisionally rejected. The implications of these findings for child health policy in Malaysia and for theories of infant feeding trends in developing countries are discussed.
This analysis has identified several factors contributing to the dramatic decline in infant mortality since World War II in Malaysia, as well as one factor that prevented the infant mortality rate from declining even more rapidly. Our main findings are the following: On average, mothers' education more than doubled over the study period, contributing to the decline in their infants' mortality. In addition, the beneficial effect of mothers' education on infant survival appears to have become stronger over the study period. Hence, further advances in education should lead to further improvements in infants' survival prospects. Another analysis of these data (Peterson et al. 1985) found that education is somewhat more influential in affecting child mortality in low-mortality, high-income areas than in the opposite type of areas. Therefore, socioeconomic development may have complemented, instead of substituted for, the the beneficial effect of mothers' education in promoting infant and child survival in Malaysia. Improvements in water and sanitation also contributed to the infant mortality decline, especially for babies who did not breastfeed. However, unlike education, these influences have become less important over time, especially for babies who are not breastfed. Hence, further improvements in water and sanitation, a goal of Malaysia's Rural Environmental Sanitation Programme, may have smaller relative effects on infant mortality than did previous improvements. Targeting such improvements on areas where women breastfeed little or not at all, however, will increase their effectiveness in promoting infant survival. The substantial reductions in breastfeeding that have taken place since World War II have kept the infant mortality rate in Malaysia from declining as rapidly as it would have otherwise. We estimate that, in our sample, the detrimental effects on infant survival of the decline in breastfeeding have more than offset the beneficial effects of improvements in water and sanitation. Unlike some other researchers (e.g., Palloni 1981), we find that changes in fertility levels and in the timing and spacing of births have had negligible effect in explaining the decline in infant mortality within the samples we have considered. We have excluded births to older women from our analysis, however; this exclusion may have led to an understatement of the influence of changes in the age pattern of childbearing.(ABSTRACT TRUNCATED AT 400 WORDS)
PIP: The initial results of a study conducted to develop guidelines for the clinical management of family planning acceptors with regard to return of fertility following contraceptive use, are presented. 193 parous women attending an urban family planning clinic were interviewed regarding their last pregnancy conceived after stopping a method of contraception. The average interval to pregnancy was 3.9, 2.8 and 1.8 months for ex-users of oral pills, intrauterine devices and conventional methods of contraception, respectively, with median delays to conception of 1.9, 1 and within the 1st month for the 3 categories. In comparison, 149 women who had not used any method at all took 7.3 months before becoming pregnant. Selected variables including age and parity, duration of use and problems encountered, and outcome of pregnancy are further analysed. Follow-up investigations and treatment are recommended 12 months after stopping oral pills and 6 months after removal of intrauterine device for those who have not yet conceived.
Our previous study showed vitamin E deficiency in newborns (69.7%) and mothers at term (85.9%) when the ratio between serum vitamin E in mg/dl and total lipids in g/dl was used as an indicator of vitamin E status. This study was conducted to determine the human milk content of vitamin E. During the first 12 days of lactation milk vitamin E levels remained almost constant (day 1, 0.68 mg/dl; day 12, 0.65 mg/dl), milk total lipid levels increased daily (day 1, 1.11 g/dl; day 12, 3.60 g/dl), and the ratio between milk vitamin E and total lipids dropped steadily (day 1, 1.3; day 12, 0.2). In spite of this drop in vitamin E status, it is unlikely that vitamin E availability will be affected in neonates, because normal neonates absorb milk fats well and this ability increases with age.
Demonstration of arrested intracerebral blood flow is the ultimate evidence of brain death. Computerized radionuclide cerebral flow study was done on 18 patients diagnosed clinically as brain dead. Correlation was made with clinical neurophysiological and EEG findings. The criteria for diagnosis of arrested intracerebral perfusion using radionuclide flow study were: non-visualization of blood flow activity in the intracranial arteries during the arterial phase, diffused cerebral activity during the capillary phase and non-filling of venous sinuses during the venous phase; visualization of typical 'hot nasal' activity; the time activity curve over the cerebral hemispheres lacks a bolus effect and instead shows a delayed gradual rise of activity. These features are pathognomonic of brain tamponade.
Arrested intracranial circulation was seen in 16 patients (ten had electrocerebral silence; one had extremely abnormal EEG with small voltage activity and five had no EEG done). In the remaining two patients, some cerebral blood flow was demonstrated (one had no definite cerebral activity and the other had diffused EEG activity).
Radionuclide cerebral flow study is a very sensitive, accurate, safe, simple, rapid and non-invasive modality in confirming brain death and is especially useful in patients on "brain-protection" regime, in hypothermia or in certain metabolic states where diagnosis based on clinical and EEG criteria is difficult. EEG need not be a required procedure once brain death is established by the demonstration of arrested intracranial circulation.
Some insecticides to control and prevent screw-worm fly strike by Chrysomya bezziana in calves and adult cattle were tested in field trials on cattle in Sabah, East Malaysia. Ivermectin injected subcutaneously in newborn calves at 200 mu/kg provided 10 days protection from screw-worm fly strike, which allowed navels to dry. Ivermectin, 1% dichlofenthion plus gentian violet and 3% lindane plus pine oil smear were all effective in preventing re-strike of treated wounds in adult cattle. A single subcutaneous injection of ivermectin at 200 mu/kg was effective, whereas it was necessary to re-apply the dichlofenthion and lindane smear preparations every 48h.
PIP: Morality in Peninsular Malaysia has reached a level that is quite similar to that prevailing in the low mortality countries. This article systematically documents changes in mortality levels and differentials in Malaysia over time and relates these to changes in development indicators and health-related policies. Remedial measures undertaken by the authorities including the expansion of hospital and health services into the estates, together with a comprehensive malaria-eradication program, improvements in sanitation laws, and increased provision of public utilities and education, resulted in beriberi being eliminated and the incidence of malaria, typhus, and smallpox being greatly reduced by the time of World War II. The gain in life expectancy over the period of 1957-1979 was greatest for the Malay, the most significant period being 1957-1967, which saw the introduction of rural health programs. The infant mortality rate and the neonatal and post-neonatal rates declined substantially for all ethnic groups in Peninsular Malaysia for the same time period. Although the lower infant mortality of the Chinese can be explained by their advantageous socioeconomic position the same reason cannot explain the lower decline in infant mortality levels of the Indians. Much still needs to be done to narrow, if not to eliminate, the existing mortality differentials of different groups in the country. Overall, the quality of life of the general population can be further enhanced by reducing the high mortality level of disadvantaged groups.
A patient with organophosphate poisoning who survived the acute phase and subsequently developed delayed neuropathy is presented. The features of this form of delayed neuropathy are described and the implications in our local context discussed.
Temporary cardiac pacing is an established therapeutic modality in the treatment of heart block and bradyarrythmias due to various causes like drugs and metabolic causes and prior to permanent pacing. Temporary pacing using fluoroscopy is best but the image intensifier is not available to all medical units. The method of temporary pacing at the bedside is described in detail.
A 50-year-old male had an acute jejunogastric intussusception complicating a Bilroth 11 gastrectomy done 20 years previously for peptic ulcer. Preoperatively, the diagnosis was suspected from the plain abdominal radiograph which was subsequently confirmed by barium meal. The patient had an uneventful recovery following resection of the intussuscepted segment and an end-to-end anastomosis. Although rare, the condition is serious and should be recognised promptly and treated surgically. The diagnosis should always be considered in a patient who has had a previous gastrojejunostomy presented with a sudden onset of epigastric pain, bloody vomitus and epigastric mass.
The effects of breast-feeding on infant health and mortality, particularly in the developing nations, are a matter of controversy and importance. The Malaysian Family Life Survey (MFLS) of over 1200 women has recently been the source of a great deal of valuable information on the influence of breast-feeding and interacting social variables on the incidence of infant mortality. Accuracy of reporting of breast-feeding duration is a key issue in the validity of studies of breast-feeding and infant mortality. This paper presents an illustrative analysis of the quality of breast-feeding data from the Malaysian Family Life Survey, using logit model schedules. Lesthaeghe and Page derived a logit model schedule of breast-feeding, summarizing empirical experience. This family of model breast-feeding duration curves is similar to the logit model life tables developed by Brass, and was intended for similar applications. To verify the MFLS retrospective breast-feeding reports, the observed median duration and variability were calculated for ethnic group/cohort subsets, and expected duration distribution curves were generated from the model using these observed parameter values. The expected curve generated from the model fit the observed curve of breast-feeding discontinuation extremely closely. Thus it is unlikely that any significant distortion of the pattern of discontinuation of breast-feeding occurred in data collection. Extensions of this method of data quality checking to other duration distributions are suggested.
A case of actinomycosis occurring four years after the surgical removal of an impacted lower third molar is presented. The need for careful wound debridement and the use of antibiotics as a prophylactic measure is emphasized.