In this prospective study, we examined stool specimens from children with cancer receiving chemotherapy who were admitted for fever to the Universiti Sains Malaysia Hospital in Kota Baru, Kelantan. Stool specimens were examined for ova and cysts of parasites. Over a period of 15 months, there were 129 febrile episodes in 50 children with cancer and, in all, 237 stool specimens were examined. Sixty-six per cent of febrile episodes were associated with neutropenia and 9 per cent were associated with diarrhoea. Stool parasites were found in 42 per cent of children. The most common were helminths, followed by protozoa. Trichuris trichiura was the most common parasite (24 per cent), followed by Ascaris lumbricoides (22 per cent). Hookworm was found in 2 per cent. Giardia lamblia was found in 6 per cent of children, Blastocystis hominis in 4 per cent, and Cryptosporidium parvum in 2 per cent.
Iron deficiency is a major complication of regular blood donation as a result of regular iron loss from each donated blood unit. Ninety-two regular blood donors and 95 first time blood donors attending a hospital-based blood transfusion centre were assessed as to their haematological and iron status by blood counts and serum ferritin levels as an indicator of iron stores. All donors had passed the haemoglobin-screening test using a copper sulphate method prior to blood donation. Ferritin levels were found to be significantly lower among regular blood donors (47.8 mmol/L) as compared to first time blood donors (94.2 mmol/L). Iron deficiency as observed by low ferritin levels was seen in 7.4% of all first time donors as compared to 17.4% in regular donors. Male first time donors showed a low prevalence of iron deficiency but the prevalence significantly increased with regular blood donation. Female first time and regular blood donors however did not show any significant differences in prevalence of iron deficiency, with both groups exhibiting prevalence rates similar to male regular donors. The association between haemoglobin levels and iron deficiency was poor and the copper sulphate-screening test was found insensitive to anaemia with many donors passing the test and donating blood despite being anaemic. It is concluded that a high prevalence of iron deficiency is present among regular male blood donors and all female donors. Besides, the use of the copper sulphate screening test as a sole criterion for anaemia screening should be reviewed. Ferritin measurements should be included in the routine assessment of blood donors especially among regular blood donors.
A cross-sectional survey of 365 individuals, (51.9% males, 48.1% females; ages 5-85 years), from five remote interior communities in upper Rejang River basin Sarawak, Malaysia, found 24.4% were anemic. The range and mean of Hb concentration in male and female were: 7.2-17.0 mg/ml and 13.7 mg/ml and 7.9-15.7 mg/ml and 12.9 mg/ml respectively. Amongst the five tribes surveyed, the prevalence of anemia (range: 10.6-46.7%), was higher among the Penans (46.7%), Kenyahs (31.1%), Kajangs (27.8%) and Kayans (19.3%), than amongst the Ukits (10.6%). Anemia is more common among males >40 years and among adolescents and young reproductive females, as well as elderly females > 61 years old. Of the 83 anemic individuals, 6.0% and 3.6% had Trichuris trichiura or hookworm respectively; however there is no clear association with intestinal worm infection.
It is difficult to give a country report from Malaysia. A study done in 1999 reported the incidence of West Syndrome to be 3% among newly diagnosed cases of epilepsy. In this 3 year retrospective hospital-based study (1997-1999), the prevalence of early epileptic encephalopathy (EEE) and West Syndrome were 4.1 and 2.5% respectively. There is difficulty classifying EEE cases into distinct sub-groups of EIEE (early infantile epileptic encephalopathy), WS (West Syndrome) and SMEI (severe myoclonic epilepsy of infancy), using a combination of clinical features, EEG and CT/MRI findings.
Several risk factors for cardiovascular disease amongst a sample of urban Chinese women were investigated. These factors included body mass index (BMI), waist hip ratio, total blood cholesterol (TC), HDL-cholesterol and Lp(a) levels, blood pressure, cigarette smoking, family history of chronic disease, dietary habits and frequency of selected food intake. The subjects were found to have coronary risks with respect to BMI and TC level, both of which increased with age of the women. Hypertension, HDL-cholesterol and Lp(a) levels appeared not to pose as risk factors amongst these subjects. Dietary habits and intake showed significant correlations with subjects' BMI status. Health promotion is called for towards reducing the modifiable coronary risk factors.
Two thousand five hundred and eight subjects from the state of Kelantan in North-East Peninsular Malaysia were included in this study to determine the prevalence of diabetes mellitus and impaired glucose tolerance and their association with cardiovascular risk factors. The overall prevalence of diabetes mellitus was 10.5% and impaired glucose tolerance was 16.5%. There was no difference in the prevalence of diabetes mellitus between males and females but the prevalence of impaired glucose tolerance was higher in females (19.0%) than in males (11.5%). Subjects with diabetes mellitus were more obese (38.4%) than normal subjects (24.1%). They also had a higher prevalence of hypertension (12.9%) and hypercholesterolaemia (71.9%) than normal subjects. Subjects with impaired glucose tolerance also had a higher prevalence of obesity (35.5%), hypertension (9.0%) and hypercholesterolaemia (63.0%) than normal subjects. In conclusion, the prevalence of diabetes mellitus and impaired glucose tolerance was high and they were associated with a high prevalence of obesity, hypertension and hypercholesterolaemia.
Ninety-five specimens of 14 freshwater fish species from small streams in the Kuala Terengganu district and the Lake Kenyir Reservoir, Malaysia, were surveyed for coccidian infections. Six fish species proved to be infected with apicomplexans belonging to the genus Goussia. In all of these fishes Goussia species were found in unsporulated and semisporulated stages. Oöcysts of four species inhabiting the intestinal epithelium became sporulated in tap-water within 24 hours. In two fish species sporulation failed and only unsporulated oöcysts were recorded in the intestine. Three of the intestinal species finishing sporulation proved to be new to science and were described as Goussia malayensis n. sp., G. bettae n. sp. and G. pogonognathi n. sp. from Apocheilus panchax, Betta splendens and Hemirhamphodon pogonognatus, respectively. The fourth species, found in Trichogaster pectoralis, was identified as G. trichogasteri Székely & Molnár, 1992, a species known from aquarium-cultured T. trichopterus.
OBJECTIVES: To determine the prevalence of chronic prostatitis/chronic pelvic pain syndrome (National Institutes of Health Category III prostatitis) in Penang, Malaysia and estimate the proportion of cases ascertained by population survey that met consensus clinical criteria for "chronic prostatitis."
METHODS: One percent of 20 to 50-year-old men in Penang, Malaysia were surveyed using the National Institutes of Health Chronic Prostatitis Symptom Index. A clinical evaluation that included lower urinary tract localization studies was recommended for symptomatic subjects who met the survey definition to identify bacterial prostatitis and other diagnoses that would exclude them from the consensus clinical definition for chronic prostatitis (Category III).
RESULTS: Of 3147 subjects surveyed, 275 (8.7%) met the survey criteria for chronic prostatitis. The prevalence of chronic prostatitis was 8.0% among Malays, 8.9% among non-Malays, and 16% among noncitizens (P = 0.025). The prevalence increased with age: 6.3% in 20 to 30-year-old men, 8.9% in 31 to 40-year-old men, and 12.6% in 41 to 50-year-old men (P <0.001). Of 87 subjects evaluated clinically, 65 (75%) met the consensus clinical criteria for chronic prostatitis.
CONCLUSIONS: Chronic prostatitis represents an important, international healthcare problem. A thorough clinical evaluation is necessary to verify that chronic prostatitis is indeed responsible for a patient's pelvic pain and lower urinary tract symptoms.
The human immunodeficiency virus (HIV) epidemic has had a profound influence on the epidemiology of tuberculosis (TB). The potential for HIV-associated TB cases to transmit M. tuberculosis and to produce a secondary increase in TB morbidity is unknown. A cross-sectional study was carried out to compare the prevalence of M. tuberculosis infection among the household contacts of HIV-positive and HIV-negative pulmonary tuberculosis (PTB) patients. Records of tuberculin (Mantoux) tests administered during routine contact investigations at the Chest Clinic, Hospital Kota Bharu, from 1999 to 2000 were reviewed. The HIV status of the patients was based on the results of ELISA tests while information on household contacts was gathered during visits to their houses. Ninety-four contacts of 39 HIV-negative patients and 44 contacts of 17 cases of HIV-positive patients were included in this preliminary study. 30% (12/40) of the contacts of HIV-positive PTB had a positive tuberculin compared with 52.8% (47/ 94) of the contacts of HIV-negative patients [OR = 0.41, 95% Confidence interval (CI) 0.17 - 0.97; p = 0.016]. The difference was still significant after performing multivariate logistic regression analysis to adjust for variables associated with infectiousness of TB (adjusted OR = 0.24, 95% CI 0.07 - 0.87; p = 0.03). This study has shown that HIV-infected PTB patients are less infectious to their contacts than HIV-negative patients. The presence of MV in the community may not necessitate a change of the current policy of the management of contacts.
Study site: Chest Clinic, Hospital Kota Bharu, Kelantan, Malaysia
A malaria survey was conducted to examine the presence of common clinical features of malaria in individuals living in an endemic area of malaria. The overall infection rate was 11.0% with 7.5% and 3.5% infected with Plasmodium vivax and Plasmodium falciparum respectively. The mean parasitaemia level of both species was 2905.9 parasites/microliter blood, with the mean parasitaemia level of P. vivax and P. falciparum at 682.7 parasites/microliter blood and 6981.7 parasites/microliter blood respectively. The infection rates were higher in the younger age group. Hepatomegaly, hepatosplenomegaly and clinical anaemia were significantly associated with malaria. None of the patients were febrile. In conclusion, in low endemic areas, the presence of clinical anaemia, hepatomegaly and hepatosplenomegaly in afebrile individuals could be considered as useful criteria for the presence of asymptomatic parasitaemia. It is important to carry out laboratory diagnostic investigations, to ensure all the asymptomatic parasitaemia which act as reservoirs are detected and treated.
BACKGROUND: The larva of Toxocara spp., a common animal roundworm, may infect non-compatible hosts, causing a profound immunological reaction with marked eosinophil and IgE responses, not unlike in atopy. In this study, we determined the seroprevalence of Toxocara exposure in 66 asthmatic and 58 non-asthmatic children.
METHODS: Exposure to Toxocara was determined by examining the serum samples of the children for specific IgG antibodies to L2 Toxocara larvae, using a commercially available diagnostic kit.
RESULTS: There was no significant difference in the mean age, sex, social class, residence type and presence of domestic pets at home between the two children groups. Children with bronchial asthma were observed to have higher Toxocara seropositivity than that of the non-asthmatic controls (21.2 vs 8.6%, P=0.047).
CONCLUSION: The observed relationship between exposure to Toxocara infection and bronchial asthma in Malaysian children warrants further evaluation. An understanding of any possible contribution to the pathogenesis of childhood asthma provides a potential avenue for prevention.
Study site: Paediatric Asthma clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Iodine deficiency is recognized as a public health problem. This paper assesses iodine status by socioeconomic factors in school children in Sarawak, East Malaysia. Kuching, Bau and Simunjan districts were chosen based on advice from the Sarawak's Medical and Health Authority. 803 school children, aged eight years, were selected from 19 schools via proportionate systematic sampling. About half the proportion of the school children were from Kuching, 24% from Simunjan and 22% from Bau. Almost all were equally distributed by sex. By mother's race, almost half were Malays, followed by Bidayuh, Iban, Chinese and other races. Mean urinary iodine concentration was 3.36 microg/ 100ml, mean creatinine level was 111.10 mg/100ml and mean creatinine/iodine ratio was 39.45 microg/ gram. Four female children (0.5%) were found to have enlarged thyroid. Urinary iodine levels were significantly different by district, mother's race and household income. It was highest in Kuching, among children with Malay mothers, and with household incomes more than RM500 per month. Conversely, it was lowest in Bau, among children of Iban/Dayak and Chinese mothers, and incomes of RM500 or less per month. Based on the WHO/UNICEF/ICCIDD classification, the Sarawak school children in the present study fall into the moderate IDD category. The low prevalence of goitre is a positive finding indicating that iodine deficiency is corrected over time.
Multiplex polymerase chain reaction (PCR) using multiple tandem forward primers and a common reverse primer (MPTP) was recently established as a comprehensive screening method for mutations in X-linked recessive diseases. In the work reported here, MPTP was used to scan for mutations of the glucose-6-phosphate dehydrogenase (G6PD) gene. Mutations in exons 3,4,5,6,7,9, 11, and 12 of the G6PD gene were screened by MPTP in 93 unrelated Malaysian patients with G6PD deficiency. Of the 93 patients, 80 (86%) had identified mutations. Although all of these were missense mutations, identified nucleotide changes were heterogeneous, with 9 mutations involving various parts of the exons. These 9 mutations were G-to-A nucleotide changes at nucleotide 871 of the G6PD gene (G871A), corresponding to G6PD Viangchan, G6PD Mediterranean (C563T), G6PD Vanua Lava (T383C), G6PD Coimbra (C592T), G6PD Kaiping (G1388A), G6PD Orissa (C131G), G6PD Mahidol (G487A), G6PD Canton (G1376T), and G6PD Chatham (G1003A). Our results document heterogeneous mutations of the G6PD gene in the Malaysian population.
A large literature argues for the Chinese--whether in mainland China or elsewhere--being highly likely to express depression somatically, leading to predictable detection and diagnostic difficulties. If true, detection might be assisted if a set of somatic proxies of depression were identified, and this was the principal initial objective in mounting this study.
Chlamydia trachomatis is recognized as the most prevalent sexually transmitted organism in many parts of the world. Most complications associated with chlamydial infection in women and their infants can be avoided by appropriate treatment. However, treatment is often not initiated because infections are frequently asymptomatic. The identification of at risk patients and treatment of these patients is a practical clinical approach in the reduction of transmission and prevention of complications. The prevalence of chlamydial infection among patients with pelvic inflammatory disease admitted to Seremban General Hospital was 22.7%. The difference in seropositivity between PID patients (20.5%) and antenatal controls (2.3%) was statistically significant. The corresponding cervical antigen detection rates were 6.8% and 2.3% respectively. Chlamydial infection should be screened for in gynaecological patients and antibiotic policies should take cognizance of the aetiological role played by this organism in pelvic inflammatory disease.
One of the major complications in patients with transfusion dependent thalassemia is growth impairment secondary to iron overload. We studied the growth status in 66 patients with beta-thalassemia major and HbE-beta thalassemia who were transfusion dependent, aged from 2 to 24 years, and 66 controls matched for sex and age. The prevalence of short stature in transfusion-dependent thalassemics was 54.5% compared to 4.5% in control group (p<0.001). Short stature was more prevalent in those above the age of 10 years in this study group (83.3% vs 16.7%). Transfusion dependent thalassemics with short stature were found to have significantly lower mean standing height standard deviation scores (SDS), sitting height SDS and subischial leg length SDS values (p<0.001). There was also a significant difference between the mean sitting height SDS and the mean subischial leg length SDS in our thalassemics with short stature, suggesting that the short stature was due to disproportionate truncal shortening. Serum ferritin levels were significantly higher in transfusion dependent thalassemics who were short compared to those who were of normal height (p = 0.002). However, the mean pre-transfusion hemoglobin levels did not differ significantly between patients with short stature and those with normal height (p = 0.216). The prevalence of short stature also did not differ significantly between those with beta-thalassemia major and those with HbE-beta thalassemia (p = 0.32). This study highlighted the importance of providing optimal treatment in these patients, including monitoring of growth parameters and optimizing iron chelation therapy.