We reviewed all documented cases of septicaemia following caesarean deliveries in Kandang Kerbau Hospital between 1st January 1993 to 31st December 1995. There were 22 cases of septicaemia among 8201 caesarean births, and hence the incidence is 2.7:1000. There were 45,412 deliveries, and the overall caesarean section rate was 18.1%. Among the 22 documented cases of septicaemia which came under this study, the most common clinical conditions found were endomyometritis (7 cases), urinary tract infection (6 cases), and wound infection (3 cases). One of the three cases with wound infection also had pneumonia. There was one patient who had mild transient myocarditis. We could not determine with certainty any site of infection in five patients. The most common bloodstream bacterial isolates was Staphylococcus aureus (16), while the uncommon ones were Acinetobacter baumanii (2), Escherichia coli (1), Klebsiella sp. (1), Staphylococcus epidermidis (1), Streptococcus Group F (1), Peptostreptococcus species and Veillonella species (1). There was no mortality and prompt, vigorous treatment had led to uneventful recovery in all the cases.
The equilibrium sorption capacity of a macro-fungi, Pycnoporus sanguineus biomass was studied using a single-metal system comprising copper ions. The rate and extent for the removal of copper were subjected to environmental parameters such as pH, biomass loading, temperature, and contact time. Results showed that the uptake of copper increased as the pH increased. However, as the biomass loading increased, the amount of metal uptake decreased. Instead, temperature does not have a significant effect on the metal uptake, especially between 30 to 40 degrees C. A maximum adsorption of copper ions was also observed within 15 minutes of reaction time for the entire sample tested. Furthermore, pre-treatment with sodium bicarbonate and boiling water significantly improved the sorption capacity of copper by Pycnoporus sanguineus.
We conducted a retrospective study of 3 years duration beginning from the 1st January 1997 to the 31st December 1999 in order to identify the epidemiology of major limb amputations in Seremban Hospital. Two hundred and four patients were included in this study out of which 65.7% were male and 34.3% were female. The mean age of the amputees was 39.7 years old. Non traumatic amputations constitute 85.8% of the cases mainly due to diabetic ulcers or gangrene (91%) followed by peripheral vascular disease (7%) and malignancy (2%). Traumatic amputations represent 14.2% of the cases with road-traffic accident as the major cause (82.8%) followed by industrial accident (17.2%). Lower limb amputations were performed in 97.5% of the cases with below knee amputations as the commonest procedure (72%), followed by above knee amputations (27%) and Syme amputations (1%). Five patients had upper limb amputations done. Four of them were below elbow amputations while one had forequarter amputation done of the left shoulder. Of note, there were increasing number of amputations done over the last three years with alarming increasing trends of traumatic amputation. The three main risk factors for major limb amputations are diabetes mellitus, male gender and road traffic accident.
Ten years' hydrological investigations at Danum have provided strong evidence of the effects of extremes of drought, as in the April 1992 El Niño southern oscillation event, and flood, as in January 1996. The 1.5 km2 undisturbed forest control catchment experienced a complete drying out of the stream for the whole 1.5 km of defined channel above the gauging station in 1992, but concentrated surface flow along every declivity from within a few metres of the catchment divide after the exceptional rains of 19 January 1996. Under these natural conditions, erosion is episodic. Sediment is discharged in pulses caused by storm events, collapse of debris dams and occasional landslips. Disturbance by logging accentuates this irregular regime. In the first few months following disturbance, a wave of sediment is moved by each storm, but over subsequent years, rare events scour sediment from bare areas, gullies and channel deposits. The spatial distribution of sediment sources changes with time after logging, as bare areas on slopes are revegetated and small gullies are filled with debris. Extreme storm events, as in January 1996, cause logging roads to collapse, with landslides leading to surges of sediment into channels, reactivating the pulsed sediment delivery by every storm that happened immediately after logging. These effects are not dampened out with increasing catchment scale. Even the 721 km2 Sungai Segama has a sediment yield regime dominated by extreme events, the sediment yield in that single day on 19 January 1996 exceeding the annual sediment load in several previous years. In a large disturbed catchment, such road failures and logging-activity-induced mass movements increase the mud and silt in floodwaters affecting settlements downstream. Management systems require long-term sediment reduction strategies. This implies careful road design and good water movement regulation and erosion control throughout the logging process.
Surveys were conducted of adult and immature mosquitoes in an area undergoing oil palm development in north Sarawak. Point prevalence data from 2 sites were collected annually, coinciding with annual phases of forest clearing, burning/cultivation, and maintenance. Major habitat perturbation during the forest/clearing transition shifted the major mosquito faunal equilibrium in terms of species composition, relative density and occurrence. Analyses of variance showed that the mean numbers of 4 species of Anopheles decreased significantly after forest clearing. Relative densities of immature stages decreased after forest clearing, but A. letifer and Culex tritaeniorhynchus remained relatively unchanged after the second year. Comparisons with the pre-development forest stage showed that the reductions in person-biting rates, adult survival and combined entomological inoculation rates (EIR) of A. donaldi and A. letifer decreased the risk of malaria transmission by 90% over the 4 years period. Concomitant reductions in EIR and annual malaria incidence were also correlated. This study highlighted the 'law of unintended consequences', since 2 contrasting effects were observed: reduction of malaria vectors but concomitant increase of dengue vectors.
The objectives of this study were to evaluate the time delays between the onset of symptoms and admission to hospital and provision of thrombolytic therapy in patients with suspected acute myocardial infarction; and to examine the accuracy of the clinical diagnosis and the therapeutic decision on thrombolysis in these patients. An observational study of 96 patients with suspected myocardial infarction was undertaken over a period of 15 months in the Coronary Care Unit of Hospital Kuala Terengganu. Seventy per cent of the patients arrived in the hospital within 6 hours of the onset of symptoms. After arrival in the emergency room, it took a median time of 85 minutes before the administration of thrombolytic therapy. Of the 67 patients who were given thrombolysis, 46 were treated within 6 hours of the onset of symptoms. About a quarter of patients said that they had delayed seeking treatment at the hospital. Treatment delays occurring in the hospital were mainly due to admission procedures as well as late diagnosis. Eighty-one patients had confirmed myocardial infarction of whom 59 received thrombolytic therapy. Eight patients receiving thrombolytic therapy had no confirmation of myocardial infarctions. Improvements in diagnostic accuracy and reduction of delays in the provision of thrombolytic therapy could be achieved by better training of health care staff as well as by further streamlining of admission procedures.
This retrospective study presents data from 26 women who underwent a reversal of female sterilization. The intrauterine pregnancy rate and ectopic pregnancy rate were 38.5% and 7.7% respectively. The most successful site of tubal anastomosis was isthmic-isthmic anastomosis. The importance of proper patient selection and factors that affect the success rate in attempted reversals are emphasised. The importance of microsurgical approach is highlighted.
In a coastal village in northwest Malaysia, 3231 fed Anopheles females of eight to 10 species were collected, marked with fluorescent dust, and released on three consecutive nights. In collections made on the 10 nights after the first release, 58 mosquitoes of three species, An. lesteri paraliae, An. subpictus and An. vagus, were recaptured; the recapture rates were 3.42%, 1.19% and 0.97%, respectively. The data for An. subpictus and An. vagus were insufficient for further analysis. Those for An. l. paraliae were plotted against time of recapture and, from the regression coefficient, an estimate of 0.68 was obtained for the daily survival rate. An independent estimate based on the parous rate during the previous year was 0.55. The temporal distribution of the recaptures strongly suggested a gonotrophic cycle and oviposition cycle of two days.
This study investigates the unusual relationship between breastfeeding and waiting time to conception in Malaysia as reported in Goldman et al. (1987). Using data from the Malaysian World Fertility Survey (MWFS), Goldman and her colleagues (1987) find that noncontracepting Malaysian women have an unusually long waiting time to conception, given their relatively short durations of breastfeeding. This study provides a similar analysis using data from the Malaysian Family Life Survey (MFLS) and finds a more typical relationship. I conclude that the distinction between full and partial breastfeeding made to respondents of the MFLS probably led to more reliable responses to questions about breastfeeding duration, especially for women who breastfeed for long durations.
The effect of temperature change on the working and setting time of a glass ionomer luting cement and a resin luting cement was measured using the oscillating rheometer. The time taken for each cement to set was calculated from the chart recordings. It was observed that as the temperature increased, the working and setting time of both materials decreased. However, the reduction was much more marked for the dual curing resin cement.
Food-handling practices were studied in 119 and 158 households, respectively, in an urban and a rural community in Peninsular Malaysia. Hazard analyses, including microbiological analysis of foods, were carried out in two households in each community and in a house that prepared food for distribution in the urban area. Kitchen hygiene was generally acceptable, although rated "poor" in some instances in the rural area. Food prepared for lunch was usually sufficient for dinner also, the leftover items being stored at ambient temperature until required. In the house that prepared food for distribution, breakfast was prepared during the evening, stored at ambient temperature overnight, and reheated before sale the next morning. There was a local preference for cooking food at temperatures close to boiling point; this reduced the numbers of vegetative cells but not those of spores. In some stored foods the populations of Staphylococcus aureus, Bacillus cereus and mesophilic aerobic bacteria increased, the last-mentioned reaching spoilage levels. Reheating reduced the populations of proliferating bacteria in most foods to acceptable levels but would not have destroyed heat-resistant enterotoxins. Because of their importance in combating acute bacterial foodborne disease, the control of the temperature and time factors during the cooking and storage of food should receive special attention in education on health and food safety.
Collections of anopheline mosquitos were made twice monthly for 13 months from a cow-baited trap in two villages, Kampung Permatang Rawa and Sungai Udang Kecil, on mainland coastal Penang, Malaysia. Each collection period was six hours from sunset. Unquantified larval collections were made regularly in each area. Although the villages were only about 50km apart, and each had extensive, irrigated rice-fields in its vicinity, the species abundance and the seasonal fluctuations differed significantly. In Kampung Permatang Rawa Anopheles sinensis and An. peditaeniatus were dominant in prevalence, whereas in Sungai Udang Kecil An. indefinitus and An. lesteri paraliae were most common and An. peditaeniatus was relatively rare. The rice growing schedules in the two areas differed, but there was a moderate correlation between the abundance of several species and the rice-growing pattern. There was no correlation at either site with rainfall.
A 25 year old female presented with hypothyroidism which was followed by the development of hyperthyroidism about 1 1/2 years later. This uncommon phenomenon is postulated to result from changes in the relative amounts of stimulatory and inhibitory TSH receptor antibodies. This case illustrates the possible continuum between Graves' disease and Hashimoto's thyroiditis within the broad spectrum of autoimmune thyroid disease.
Study site: Primary care clinic. University Malaya Medical Cengtre (UMMC), Kuala Lumpur, Malaysia
A total of 38 cases of fireworks related injuries from Hospital USM over a 5-year period from 1986 to 1990 during Hari Raya festival were analysed. The majority (68.5%) of the patients were teenagers, between 10 to 19 years of age. All the cases were Malays and most of the accidents occurred before the Hari Raya Idilfitri festive seasons. Fourteen cases were caused by self-made fireworks and another 16 cases were due to modified fire-works. Twenty-four cases suffered permanent disabilities mostly finger amputations. Such injuries could be prevented by law enforcement coupled with public health education to modify social behaviour especially when the ban against the use of fireworks is lifted on religious grounds.
Gas-Liquid chromatography (GLC) was used to detect the presence of isocaproic acid produced by Clostridium difficile from 54 stool samples grown in cycloserine-cefoxitin broth. Isocaproic acid was detected in 12 samples of which 5 were confirmed to be Clostridium difficile by culture and biochemical tests. The detection of isocaproic acid by GLC together with the presence of presumptive colonies on primary selective culture media provides a more rapid laboratory diagnosis for Clostridium difficile.
Thirty-nine displaced fractures of the lateral humeral condyle in children were followed for an average of 5 (2-5) years. The results were evaluated from functional and cosmetic aspects. Patients treated within 2 weeks by open reduction and internal fixation did well. Those operated on after 6 weeks did not do better than nonoperated on cases. Complications included cubitus varus and valgus deformities, osteonecrosis, nonunion and malunion, and loss of motion. We recommend that patients presenting late be left alone and any sequelae evaluated at a late stage.
Morphological and neuroelectrical changes of the skeletal muscle fibres after various types of injury to the nerve was studied in monkey. The percentage of normal and atrophic muscle fibres after various types of injury to the nerve was compared with the proportion of innervated and denervated muscle as shown by the position of the bend (kink) on the I.D. at corresponding stages. It was found that the pattern and the position of the I.D. curve when considered together only gave an approximate estimation of the proportion of all innervated and denervated muscle fibres as well as the condition ofthe muscle after denervation.
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.
A 37 year old female who presented with a history of foreign body ingestion ten months previously was found on examination to have a retropharyngeal swelling. An initial differential of foreign body granuloma or retropharyngeal tuberculous abscess was considered. The usefulness of the lateral neck radiograph in demonstrating retropharyngeal pathology and the supplementary role of the computed tomography scan in confirming and elucidating the identity of the radio-opacity is highlighted. This presentation is a timely reminder of the need for a simple inexpensive lateral neck radiograph in situations of doubt as to persisting foreign body impaction.