One hundred four children with acute lymphoblastic leukaemia were diagnosed at the University Hospital, Kuala Lumpur, Malaysia, between 1976 and 1982; 87 were evaluable with respect to treatment. They were divided into good prognosis (GP) and bad prognosis (BP) groups based on their initial total white cell count, their treatment differing only during the maintenance phase. Remission was achieved in 82 patients (94%) of whom ten (12%) subsequently died in remission from infection. Twenty-eight (34%) relapsed while on treatment and three while off therapy. Eleven patients ceased treatment after 3 yr of continuous complete remission (CCR). Three of these later relapsed, two within the first year. Survival in CCR was significantly better in the GP group up to 30 months, after which the difference diminished. There was no difference in survival between boys and girls. The overall disease-free survival at 3 yr and 5 yr was 40% and 25%, respectively, with a median follow-up period of 20 months (range 4-69 months). The reasons for the relatively low survival rates as compared with those in developed countries are discussed.
Ameloblastomas formed 1.1 percent of all oral pathology cases reported. The race, sex and age group distribution of 133 cases are shown. The peak age incidence (70.6 percent) was between 11-40 years. The mandible was involved 9 times more commonly than the maxilla. The anatomical sites of distribution, clinical and radiological features, histological variants and their correlation are discussed. Twenty two patients (15 percent) had ameloblastomas associated with a dentigerous cyst and/or unerupted teeth. Ameloblastomas with the above clinical features represented a much less aggressive form of neoplasm. The authors could not correlate histological variants of ameloblastoma with recurrence rates. The various treatment methods and the respective recurrence rates are outlined. Radiotherapy and marsupialization as treatment of ameloblastoma are not recommended. The indications for enucleation curettage, resection en bloc, segmental resection and hemimandibulectomy
are emphasized. Ameloblastomas involving the maxilla should be treated by complete removal en bloc with a margin of normal tissue. Since ameloblastoma has the capacity to recur after several years of apparent cure patients who have been treated for ameloblastoma must be followed up periodically during their life time. So far no case of ameloblastoma in this study has shown evidence
ofmetastasis.
With 25% of its population living in over 148 squatter settlements, with a high incidence of communicable diseases, teenage pregnancies, and psychological and familial stress, the city of Kuala Lumpur has sought ways to improve conditions. This article describes one particularly promising approach: community-based centers integrating three socioeconomic components--preschool education, maternal and child health clinics, and income-generating activities.
PIP: The accomplishments of the Sang Kancil Intervention program, a project designed to improve the living conditions of squatter communities in Kuala Lumpur, Malaysia are described. 25% of Kuala Lumpur's population lives in 148 squatter settlements, where life is especially difficult for women and children. Hoping to improve the living conditions of the urban poor, Kuala Lumpur's City hall initiated the Sang Kancil Intervention program. This program contains 3 components: preschool education, maternal and child health, and income generation. The preschool component provides education, food supplements, and medical checkups and treatment to children in the squatter settlements. In order to foster community participation, the teachers of the preschool program are chosen from among the squatter community, and mothers are encouraged to become involved. Evaluations of the preschools reveal positive attitudes from mothers and teachers, high attendance rates, and higher IQ test scores among children attending the preschool than among children not in the program. Sang Kancil has also provided maternal and health services to the squatter communities. Once a week, nurse practitioners set up a clinic providing the following services: immunization, prenatal and postnatal care, health education, nutrition, family planning, and treatment of minor illnesses. Sang Kancil's income-generation program seeks to raise the living standards of poor families by creating employment opportunities for women. Sang Kancil has established companies staffed, owned, and managed entirely by women. Among other things, these companies manufacture toys, batik items, and ceramics. The success of the companies has pushed shareholders above the poverty line.
Indirect fluorescent antibody (IFA) tests and enzyme-linked immunosorbent assays (ELISA) were used to measure antibodies to Plasmodium falciparum in an indigenous population in an area of Malaysia with high malaria prevalence. The results of three surveys were analyzed to examine the relation of these serologic measures with age, parasite rate, and spleen size. For children 0-4 years old, increasing spleen size was associated with an increasing likelihood of malaria parasitemia, while for 5-9 year olds the two variables were unrelated. Parasite rate declined with age and ELISA titre increased with age in all surveys; IFA titre was consistently high and did not vary with age. Neither antibody measure was significantly correlated with either the presence or the actual density of parasitemia. These antibody measures are most useful as adjuncts to the more traditional techniques of malaria assessment.
A total of 819 Indian inhabitants (from 6 months to over 60 years of age) in an oil-palm plantation in West Malaysia was examined for soil-transmitted helminthiases using the brine flotation and Kato thick smear techniques. Half (51.0%) of the inhabitants were found to be infected (33.9% had Ascaris lumbricoides; 36.4% had Trichuris trichiura and 15.6% had Necator americanus). Soil-transmitted helminthiases (both single and mixed infections) were significantly more common among children and young adults from 6 months to 20 years of age where 67.1% (range: 64.7-70.3%) of this age group were infected. The infection rate declined to about 25% or less among elderly people over 50 years of age. Trichuris trichiura was the commonest helminth observed--both as single and mixed infections--and Trichuris mixed with Ascaris was the commonest type of double infection reported. However, there were no significant differences in the distribution of the types of single and double infections among inhabitants of different age groups, nor were there any significant differences in the distribution of soil-transmitted helminthiases among male and female inhabitants. The socioeconomic, environmental and cultural factors contributing to persistently high rates of infection with soil-transmitted helminths among plantation inhabitants are discussed.
An outbreak of food poisoning resulting in 13 deaths in children occurred in Malaysia during the Chinese Festival of the Nine-Emperor Gods in 1988. The offending food was a Chinese noodle called 'Loh See Fun' (LSF). The source was traced to a factory where a banned food preservative was added to make the LSF. The food poisoning was attributable to aflatoxins and boric acid. The clinical features included vomiting, pyrexia, diarrhoea, abdominal pain, anorexia, giddiness, seizures, and eventual coma. Initially, many presented with a Reye-like syndrome. Eleven post-mortem examinations were performed. The pathological findings included extensive coagulative necrosis of the liver with proliferative 'ductal/ductular metaplasia of the hepatocytes'. Giant cell formation, central vein sclerosis, bile stasis, and steatosis were also noted. There was presence of acute tubular necrosis, superficial upper gastrointestinal erosions, and ensuing encephalopathy. The eventual cause of death is acute hepatic and renal failure.
An unusual case of proximal migration of a Hakim's valve intracranially into a porencephalic cyst two years after insertion of the ventriculo-peritoneal shunt in a neonate is reported. The underlying cause is discussed. It is recommended that all shunt should be anchored with nonabsorbable suture material properly on to the pericranium.
In 1985, 140 (26.1 %) of 536 admissions to the intensive care unit (ICU) were general surgical cases. Retrospective review of 107 of these admissions revealed four factors to be significantly different between survivors and non-survivors, p < 0.01. They were duration of stay, organ system failure, sepsis and complications. The role of the surgeon in an ICU where management is interdisciplinary is emphasised.
Two children with Juvenile Rheumatoid Arthritis (JRA) and severe growth suppression from corticosteroid therapy are described. Prolonged 'tailing-off' of steroids occurred during outpatients follow-up and this may be related to the high turnover of doctors involved. Suggestions for improving such follow-ups and caution against the continuous use of steroids are made.
Study site: Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
A retrospective study of 300 tuberculosis patients on short course chemotherapy registered in 1985 at the Chest Clinic, General Hospital Alor Setar, Kedah was carried out with the purpose of identifying patient characteristics, determining incidence of side-effects and modifying treatment regimens in order to minimise these side-effects. One hundred and sixteen (38.7%) patients developed side effects. Twenty seven (9%) had side effects severe enough to warrant a change in treatment regimen. Treatment modifications and ways to minimise or control side effects are discussed.
Study site: Chest clinic, Hospital Alor Setar, Kedah, Malaysia
The Cardiothoracic Department, General Hospital, Kuala Lumpur which was set up in April 1982, deals with a wide range of cardiac disease, general thoracic and also vascular cases. A total of 2,450 operations were performed from April 1982 to February 1987, and 79.3% of these were for cardiac cases (open and closed heart). This paper reports a review of the 1,110 consecutive open heart operations performed by the Department during the stated period.
A retrospective study of the pathology seen in 1,000 consecutive appendicectomy specimens with a pre-operative diagnosis of acute appendicitis, was made in an attempt to find common factors which might throw light on the aetiology of the disease. Acute inflammation was seen in 775 cases. In 225 cases where no inflammation was seen, 168 appendices were associated with other pathology, i.e., lymphoid hyperplasia, fibrosis and tumour. In 57 cases the appendix was not inflamed. Acute inflammation was seen more in males and in patients aged below 30 years, while normal appendices were more commonly seen in females of reproductive age.
One hundred children with peritonitis resulting from a perforated appendix were treated with ceftazidime or netilmicin. Metronidazole was added to both groups to treat the anaerobic organisms commonly associated with the infecting aerobic organisms in peritonitis. Escherichia coli was the most common aerobe found in peritoneal pus. Wound infection occurred in nine patients of the netilmicin group and in none treated with ceftazidime (P less than 0.01). No bacterial resistance was evident in the ceftazidime group, but gram-positive streptococci found in eight patients were resistant to netilmicin. Thus it is recommended that an antibiotic of the penicillin group be added if netilmicin is used to treat peritonitis. The results indicate that ceftazidime was more effective than netilmicin in the treatment of children with peritonitis resulting from a perforated appendix.
Serological markers were used to determine the infective agents causing acute viral hepatitis in 246 patients. The frequencies of the five viral infections investigated were: non-A, non-B hepatitis - 99 patients (40.2%); hepatitis A - 98 patients (39.8%); hepatitis B - 43 patients (17.5%); cytomegalovirus - 4 patients (1.6%); and Epstein-Barr virus - 2 patients (0.8%). The log mean ages of presentation for the three predominant infections were: hepatitis A - 18 years; hepatitis B - 25 years; and non-A, non-B hepatitis - 30 years (F = 18.8, p =< 0.001). 52% of all cases were Malays (expected 32. 7%); 32% Chinese (expected 54.6%); and 16% Indians (expected 1l.5%) (X2 = 53, p = < 0.001). Hepatitis A virus infection was more common amongst Malays whilst non-A, non-B hepatitis was more frequent amongst Chinese and Indians. 28% of children <16 years) and 50% of adults had serological markers of previous hepatitis B infection. The variation in frequency for the different forms of hepatitis amongst the three main ethnic groups would suggest that socioeconomic and/or cultural factors are important in the propagation of acute viral hepatitis in Malaysia. HBsAg-negative chronic liver disease in our community may be a product of the high incidence of non-A, non-B hepatitis.
A pragmatic and rational approach to the management of five child psychiatric cases in Malaysia is briefly reviewed. The significance of sociocultural factors in treating these cases within the context of a rapidly developing plural society is emphasized. The implications of overemphasis on educational and material achievements are noted.
A study of race-related distribution of hepatitis B markers was conducted in 458 children admitted consecutively to Singapore General Hospital. The positive rates for hepatitis B surface antigen (HBsAg) in Chinese, Malays and Indians were 11.2, 8.0 and 12.2% respectively and the corresponding figures for anti-HBs were 30.2, 12.0 and 14.6%. In Chinese children HBsAg prevalence was shown to be sex-related, being higher in males than females. The percentages of Chinese children positive for anti-HBs and anti-HBc were also higher than those of the Indians. This study confirmed that Singapore children were exposed to hepatitis B infection from early life. All three races were equally susceptible to this infection.
Between 1st January 1999 and 31st December 2000, 452 foreign nationals were treated at the Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru. Eighty-five percent were male. The peak age range was from 21 to 30 years old. The patients were predominantly Indonesians (61%). A history of trauma was present in 63% of patients. Eight percent of eyes had severe visual impairment. Six patients (1.3%) were blind by WHO standards. Traumatic eye conditions, inflammatory/allergic eye conditions and degenerative eye conditions comprised 66%, 13% and 10% respectively of ocular pathology seen. The commonest ocular findings were corneal foreign body, corneal abrasion and subconjunctival haemorrhage.