1. Thirty male rabbits of local strain (weighing 1.5-2 kg) were divided into five groups. Four groups were treated with an oral dose of paraquat, which was followed by either Fuller's Earth or activated charcoal 0.5 or 2.0 h later. The remaining group acted as the control group and was treated only with an oral dose of paraquat. The dose of paraquat was 20.0 mg/kg given in a concentration of 20.0 mg/mL. 2. Both adsorbents were administered in 15 mL normal saline as a 30% slurry. Blood was sampled from the ear vein 0.5, 1, 2, 4, 8 and 24h after the administration of paraquat. 3. Paraquat concentration was determined spectophotometrically at 600 nm by comparing against a standard curve of paraquat obtained by the addition of standard paraquat into normal rabbit serum and extracting interfering substances with ether. 4. The results of the present study show that either adsorbent can bring down the serum paraquat level. There was no significant difference found in the effectiveness of either adsorbent. 5. It is concluded that the administration of an adsorbent as early as possible will help in the reduction of paraquat absorption from the gastrointestinal tract. 6. Activated charcoal is still effective in lowering serum paraquat concentration when given more than 1 h after ingestion of paraquat.
In an attempt to reduce costs, the role of Bactec anaerobic blood culture in the detection of bacteraemia and fungaemia in children was evaluated. Results from 3167 sets of aerobic and anaerobic blood cultures from children admitted to the University Hospital, Kuala Lumpur during a one year period, were analysed. Four hundred and eight (12.9%) sets of blood cultures were positive, of which 348 sets (11.0%) from 201 patients were clinically significant. Of the 348 significant positive sets, organisms were isolated on 177 (50.9%) occasions from both aerobic and anaerobic bottles, on 136 (39.1%) occasions from the aerobic bottle only and 35 (10.0%) occasions from the anaerobic bottle only. No strict anaerobes were isolated, but clinically significant isolates recovered from the anaerobic bottle only included Klebsiella pneumoniae, Salmonella species, Enterobacter cloacae, Staphylococcus aureus, coagulase negative staphylococci, Streptococcus pneumoniae and Group B streptococcus. Patients with bacteraemia diagnosed solely by anaerobic culture were distributed evenly across the various paediatric subspecialities. When results from the anaerobic bottles were excluded, the overall isolation rate was reduced from 11% to 9.9%. Potential financial savings resulting from omission of anaerobic cultures must be balanced against the small number of bacteraemic episodes that could be missed. Undiagnosed bacteraemia may result in increased morbidity and mortality with its own attendant financial implications.
Spinal vascular malformation is an uncommon but potentially treatable cause of myelopathy. We describe two cases of angiographically proven spinal vascular malformation in Malaysia. The first case is a 47-year-old man who had a progressive myelopathy and the second a 60-year-old man with intermittent attacks of transient paraparesis leading to paraplegia. As the clinical presentation of spinal vascular malformation is variable, it should be considered as a cause of patients with myelopathy.
The use of maternal age alone to identify pregnant mothers at risk of a fetus with Down's syndrome has recently been supplemented by maternal serum screening using biochemical markers such as alpha-protein, human chorionic gonadotrophin and oestriol. These tests have been reported to increase the sensitivity of antenatal detection of such fetuses from 35% to 67% with a false positive rate of 5%. However, these maternal serum markers may be affected by maternal weight, the smoking history of mothers and diabetes mellitus. Furthermore, such sensitivities are achieved only when gestational age is assessed accurately by ultrasound. Many further studies need to be carried out before the introduction of maternal serum screening into routine obstetric practice in Singapore. These include studies on the incidence of Down's syndrome in the local population, studies on the distribution of these serum markers in the second trimester of pregnancy, sensitivities and positive predictive values of such a test in the local population as well as the socio-economic implications of implementing such a screening test in the local obstetric population.
In a double-blind crossover study, 17 normocholesterolemic male volunteers were fed carefully designed whole-food diets in which 5% of energy was exchanged between palmitic (16:0) and lauric + myristic acids (12:0 + 14:0) whereas all other fatty acids were held constant. Resident males received each diet during separate 4-wk periods. The test diets supplied approximately 30% of energy as fat and 200 mg cholesterol/d. Compared with the 12:0 + 14:0-rich diet, the 16:0-rich diet produced a 9% lower serum cholesterol concentration, reflected primarily by a lower (11%) low-density-lipoprotein-cholesterol concentration and, to a lesser extent, high-density-lipoprotein cholesterol. No diet-induced changes were noted in the cholesterol content of other lipoproteins, nor did exchange of saturated fatty acids affect the triglyceride concentration in serum or lipoprotein fractions. These data indicate that a dietary 12:0 + 14:0 combination produces a higher serum cholesterol concentration than does 16:0 in healthy normocholesterolemic young men fed a low-cholesterol diet.
Cholesterol reduction reduces ischaemic cardiovascular morbidity and mortality in the asymptomatic healthy population as well as in those with known coronary artery disease. Angiographic studies have also demonstrated regression of atherosclerotic plaques as well as retardation of new atheroma formation with such therapy. Yet, there is a consistent inability to reduce overall mortality in cholesterol-lowering drug trials. An excess of suicide, homicide and violence has been attributed to cholesterol reduction interfering with membrane lipids and receptors, leading to aggressive behaviour. The risk and benefits of cholesterol reduction must thus be weighed in the individual patient; it is more useful in those with known coronary artery disease who are at high risk of subsequent ischaemic cardiovascular events.
We report the first documented Malaysian case of aggressive angiomyxoma (AAM) of the vulva. A 56-yr-old woman of Indian ethnic origin presented with a vulval lesion which was clinically mistaken for a Bartholin's cyst. The lesion was surgically excised and a diagnosis of AAM was made histologically. Of particular interest was the finding of foamy and mononuclear inflammatory cells and fibrin in the walls of most of the lesional blood vessels. The patient recovered uneventfully and remains without tumor recurrence at the time of writing 37 mths after initial presentation.
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.
A prospective observational study was carried out over a seven month period in the neonatal intensive care unit (NICU) of a large Malaysian maternity hospital to determine the rate of blood transfusion and the incidence of transfusion reactions in newborn infants. During the study period, the rates of blood transfusion was 6.1% (n = 117) of NICU admission or 8.2 per 1,000 live births. The median birth weight of the infants who had received blood transfusion was 1,740 grams (range: 725-4,350), and their mean gestational age was 33.6 weeks (sd = 5.1, range = 24-41 weeks). The median age of infants when they first received blood transfusion was 4.0 days (range: 1-27 days). When compared with infants of birth weight between 3,000 and 3,499 grams, infants of birth weight less than 1,500 grams received significantly higher median number of transfusions per infant, (p < 0.001). The incidence of transfusion reaction was 2.7% (3/110) of all transfused infants or 1.3% (3/223) of all blood transfusions. Febrile nonhemolytic reaction was the only type of transfusion reaction detected during the study period. This study showed that transfusion reactions in newborn infants were not common.
BACKGROUND: Dengue has been recognized as a potential hazard to tourists. A prospective, controlled study in the outpatient clinic of a German infectious disease clinic was conducted to assess the prevalence of dengue virus infection among international travelers.
METHODS: Serum samples from 130 patients with signs or recent history clinically compatible with dengue (fever, headache, muscle and joint pain, or rash), 95 matched controls with diarrhea, and 26 patients who never visited a country endemic for dengue were investigated.
RESULTS: Nine (6.9%) of the 130 patients with compatible symptoms and 1 (1%) of the 95 controls with diarrhea developed rising antibody titers against dengue virus. Of these 10 patients with probable dengue infection, 6 had been to Thailand, 2 to Malaysia, and 1 each to Indonesia and Brazil.
CONCLUSIONS: Infection with dengue virus appears to be a realistic threat to travelers to Southeast Asia. Symptoms commonly associated with dengue, such as fever, myalgia, arthralgia, and vomiting, can be helpful for diagnosis when present, but the absence of typical symptoms does not exclude infection.
We recently adopted immobilized jacalin as an affinity adsorbent to purify human serum IgA for laboratory study. In the course of our investigation, we detected a serum protein that co-eluted with IgA from jacalin-agarose affinity column. It constituted in significant quantity (24.0 +/- 0.9%, n = 30) of total jacalin-bound protein (JBP) and the yield was equivalent to 0.4 +/- 0.1 mg per ml serum. The molecular mass of this protein was 55 kDa with electromobility in the alpha 2 region as demonstrated by SDS-PAGE and immunoelectrophoresis. N-terminal microsequencing of this 55 kDa protein revealed that it is human alpha 2-HS glycoprotein (alpha 2HSG). The molecular interaction of alpha 2HSG with jacalin was characterized by competitive ELISA: human serum IgA, human colostrum secretory IgA (sIgA), and monosaccharides including D-galactose and melibiose exhibited strong inhibitory effect on its binding to jacalin. Accordingly, we propose that human alpha 2HSG binds in a similar manner as that of the bovine fetuin to jacalin. In addition, alpha 2HSG displays similar binding property to jacalin from different geographic area (India and Malaysia) and from different laboratory preparations (Sigma, Pierce and 'homemade' jacalin).
An investigation was conducted on the usage of a single-step extraction procedure involving the retention of a phenylboronate-salbutamol complex on an end-capped C18 solid-phase sorbent to determine the level of salbutamol in human plasma samples. Propranolol, a beta-blocker, was chosen as the internal standard for this assay. In this solid-phase clean-up method, 50 mM sodium carbonate buffer, pH 9.60, was used for conditioning the column as well as washing the endogenous interference. Under the optimal conditions, the recovery of salbutamol from spiked plasma samples was found to be high and reproducible with mean recoveries (n = 3) of more than 90% after elution by using 50% 1 M trifluoroacetic acid in methanol. This sample clean-up step was effectively analyzed under reversed-phase high-performance liquid chromatography with fluorimetric detection. The method was successfully applied to the routine measurement of salbutamol in human plasma from the bioequivalence study on the different administration route of salbutamol. Quantification of salbutamol was convincingly reported with the correlation of coefficient of 0.9980 for the concentration range from 0 to 1000 ng ml(-1). An adequate precision was achieved with both between- and within-day precisions of less than 10% (n = 6) for 100 and 1000 ng ml(-1) and less than 15% (n = 6) for 10 ng ml(-1).
A simple high-performance liquid chromatographic method using ultraviolet detection was developed for the determination of metformin in human plasma. The method entailed direct injection of the plasma sample after deproteination using perchloric acid. The mobile phase comprised 0.01 M potassium dihydrogen orthophosphate (pH 3.5) and acetonitrile (60:40, v/v). Analyses were run at a flow-rate of 1.0 ml/min with the detector operating at a detection wavelength of 234 nm. The method is specific and sensitive, with a quantification limit of approximately 60 ng/ml and a detection limit of 15 ng/ml at a signal-to-noise ratio of 3:1. The mean absolute recovery value was about 97%, while the within-day and between-day coefficient of variation and percent error values of the assay method were all less than 8%. The calibration curve was linear over a concentration range of 62.5-4000 ng/ml.
A simple high-performance liquid chromatographic method using ultraviolet detection was developed for the determination of pentoxifylline in human plasma. Prior to analysis, pentoxifylline and the internal standard (chloramphenicol) were extracted from plasma sample using dichloromethane. The mobile phase comprised 0.02 M phosphoric acid adjusted to pH 4, methanol and tetrahydrofuran (55:45:1, v/v). Analysis was run at a flow-rate of 1.4 ml/min with the detector operated at a wavelength of 273 nm. The method was specific and sensitive with a detection limit of approximately 3.0 ng/ml at a signal to noise ratio of 3:1, while the limit of quantification was 12.5 ng/ml. Mean recovery value of the extraction procedure was about 99.9%, while the within-day and between-day coefficient of variation and percent error values of the assay method were all less than 10.0%. The calibration curve was linear over a concentration range of 12.5-400.0 ng/ml.
A simple high-performance liquid chromatographic method using fluorescence detection was developed for the determination of ketoconazole in human plasma. The method entailed direct injection of the plasma sample after deproteinization using acetonitrile. The mobile phase comprised 0.05 M disodium hydrogen orthophosphate and acetonitrile (50:50, v/v) adjusted to pH 6. Analysis was run at a flow-rate of 1.5 ml/min with the detector operating at an excitation wavelength of 260 nm and an emission wavelength of 375 nm. The method is specific and sensitive with a quantification limit of approximately 60 ng/ml and a detection limit of 40 ng/ml at a signal-to-noise ratio of 3:1. Mean absolute recovery value was about 105%, while the within-day and between-day coefficient of variation and percent error values of the assay method were all less than 14%. The calibration curve was linear over a concentration range of 62.5-8000 ng/ml.
A sensitive and selective high-performance liquid chromatographic method was developed for the determination of itraconazole and its active metabolite, hydroxyitraconazole, in human plasma. Prior to analysis, both compounds together with the internal standard were extracted from alkalinized plasma samples using a 3:2 (v/v) mixture of 2,2,4-trimethylpentane and dichloromethane. The mobile phase comprised 0.02 M potassium dihydrogen phosphate-acetonitrile (1:1, v/v) adjusted to pH 3.0. Analysis was run at flow-rate of 0.9 ml/min with excitation and emission wavelengths set at 260 and 365 nm, respectively. Itraconazole was found to adsorb on glass or plastic tubes, but could be circumvented by prior treating the tubes using 10% dichlorodimethylsilane in toluene. Moreover, rinsing the injector port with acetonitrile helped to overcome any carry-over effect. This problem was not encountered with hydroxyitraconazole. The method was sensitive with limit of quantification of 3 ng/ml for itraconazole and 6 ng/ml for hydroxyitraconazole. The calibration curve was linear over a concentration range of 2.8-720 ng/ml for itraconazole and 5.6-720 ng/ml for the hydroxy metabolite. Mean recovery value of the extraction procedure for both compounds was about 85%, while the within-day and between-day coefficient of variation and percent error values of the assay method were all less than 15%. Hence, the method is suitable for use in pharmacokinetic and bioavailability studies of itraconazole.