The diagnosis of pulmonary tuberculosis is often delayed due to atypical clinical features and difficulty in obtaining positive bacteriology. We reviewed 232 cases of pulmonary tuberculosis diagnosed in Kedah Medical Centre, Alor Setar from January 1998 to December 2002. All age groups were affected with a male predominance (Male:Female ratio = 60:40). Risk factors include underlying diabetes mellitus (17.7%), positive family history (16.8%) and previous tuberculosis (5.2%). Nearly half (45.3%) of patients had symptoms for more than one year. Only 22% of patients had typical symptoms of tuberculosis (prolonged recurrent fever, cough, anorexia and weight loss), whilst others presented with haemoptysis, chronic cough, COPD, bronchiectasis, general ill-health, pyrexia of unknown origin or pleural effusion without other systemic symptoms. Fifteen percent of the patients presented with extrapulmonary diagnosis. Ninety percent of the patients had previous medical consultations but 40% had no chest radiograph or sputum examination done. The chest radiographs showed 'typical' changes of tuberculosis in 62% while in the other 38% the radiological features were 'not typical'. Sputum direct smear was positive for acid-fast bacilli in only 22.8% of patients and 11.2% were diagnosed base on positive sputum culture. Sputum may be negative even in patients with typical clinical presentations and chest radiograph changes. Bronchial washing improved the diagnosis rate being positive in 49.1% of cases (24.1% by direct smear and the other 25.0% by culture). In 16.8% of cases, the diagnosis was based on a good response to empirical anti-tuberculosis therapy in patients with clinical and radiological features characteristic of tuberculosis. In conclusions, the clinical and radiological manifestations of pulmonary tuberculosis may be atypical. Sputum is often negative and bronchoscopy with washings for Mycobacterium culture gives a higher yield for diagnosis. In highly probable cases, empirical therapy with antituberculosis drugs should be considered because it is safe and beneficial.
We reviewed the 52 new cases of pulmonary tuberculosis diagnosed at Pusat Pakar Utara, Kedah in 1998. It was found that the majority of the patients had symptoms for many years. They had seen many doctors but were not diagnosed. In 40% of the patients, no investigations for tuberculosis were done and in the others tuberculosis was excluded because of negative sputum smear examination. Many had typical history and X-ray changes suggestive of tuberculosis but more sensitive investigations such as sputum culture for Mycobacterium or bronchoscopy were not performed. Cases are presented to illustrate the problems in the diagnosis.
To assess the prevalence of skin test sensitivity among asthmatic patients in Malaysia, skin prick tests for allergy in 134 adult asthmatic patients and 120 control subjects were done. 90% of asthmatic patients had positive skin test to at least one allergens as compared to 78% of the controls. House dust mite was the most frequent allergen to which the subjects had positive reactions. Sixty-four percent of the asthmatic patients had associated rhinitis. There was no significant difference in the skin test sensitivity between asthmatic patients with associated rhinitis and those without.
Respiratory function testing was done using a portable electronic spirometer in 223 normal Malay subjects between the ages of 15 to 75 years. Tests of FEV1, FVC, PEFR, and MMF were recorded using standard forced expiratory maneuvers. Malay adults have lower respiratory function values compared to Caucasians and other Asians.
We describe two patients with recurrent hemopneumothorax associated with pelvic endometriosis. The first patient a 37-year-old nulliparous lady with recurrent bilateral hemopneumothorax. She had a past history endometriosis years earlier. Laparoscopy and biopsy confirmed widespread endometriosis including in the omentum. Recurrence of the hemopneumothorax stopped after danazol therapy suggesting thoracic endometriosis as the cause of hemopneumothorax. The second lady is 47-years old with 2 children. She first presented with hemopneumothorax associated with menstrual period but ultrasound of pelvis did not reveal evidence of endometriosis. However, when she presented with a second episode of hemopneumothorax one year later, she was confirmed to have endometriosis and no further recurrence after treatment with Gonadotropin-releasing hormone analogue.
We present 11 cases to illustrate the protean presentations of gastrointestinal tuberculosis. The patients presented with perianal fistula, appendicitis, ascites, rectal, intestinal or gastric 'growth', "ulcerative colitis", or recurrent anemia. In some of these cases there was no conclusive proof of infection with Mycobacterium tuberculosis but they responded well to empirical treatment with anti-tuberculous therapy. These cases illustrate that because signs and symptoms of intestinal tuberculosis are non-specific and even histology can be misleading, the diagnosis of gastrointestinal tuberculosis requires a high index of suspicion. A therapeutic trial of antituberculous drugs should be considered for patients with a high clinical suspicion of tuberculosis.
We conducted a study to measure the peak expiratory flow rate (PEFR), forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) in a group of normal Malay primary school children aged 7 to 12 years. PEFR was measured in 920 children (482 boys and 438 girls) while FVC and FEV1 were measured in 292 of them (168 boys and 124 girls). In agreement with previous studies, we found that PEFR was correlated with age and height of the subjects but FVC and FEV1 were correlated with height only. Prediction equations for all 3 lung function indices for Malay boys and girls were formulated. In comparison with the lung function values from Western and Chinese subjects, the lung function values in our subjects are lower.
Between January 1990 and December 1991, 100 cases of extrapulmonary tuberculosis were identified at the General Hospital Kota Bharu representing 11% of all the newly diagnosed tuberculosis. It was commonest in the third decade of life and the sites involved were the lymph nodes (34%), osteoarticular (14%), miliary (12%) and pleura (10%). Tuberculous lymphadenitis appears to be more common in females and younger patients. Fourteen patients had concurrent active pulmonary tuberculosis and in 36 others the chest X-rays showed satisfactory response to standard chemotherapy. Six patients died and six were lost to follow-up.
A survey of inhaler technique using a placebo metered dose inhaler was performed among 41 house and medical officers from the Medical and Outpatient departments, Hospital USM. The majority (76%) of them had been taught at one time or another regarding inhaler technique. However, only 18 of them (48.9%) used the metered dose inhaler correctly. Medical officers currently in the Medical Department had the highest percentage of correct technique (75%); followed by medical officers in the Outpatient Department (57.1%). Among house officers, 30.8% demonstrated correct technique. The most common error was failure to hold their breath after inhaling the aerosol (53.7%).
Study site: Medical and Outpatient departments, Hospital USM.
We reviewed 116 chest radiographs done in 70 adult asthmatic patients who were admitted to the Hospital Universiti Sains Malaysia from January to December 1989. The chest radiographs were abnormal in 23% of cases. Twelve percent showed hyperinflation and 7% had pneumonia. Eight patients diagnosed clinically to have pneumonia had normal chest radiographs. Seven patients had radiographic findings of conditions which were unsuspected clinically. These included two cases of pneumonia, one case each of fibrosing alveolitis, pneumothorax, pneumomediastinum, mitral stenosis with left ventricular failure and right pleural effusion. In conclusion, we found that significant chest radiograph abnormalities in adult patients admitted for asthma were uncommon although chest radiographs were helpful in detecting complications or coincidental conditions. Chest radiograph is therefore an important investigation in adult asthmatic patients who are admitted. However, considering the cost and the risk of radiation, it should be done only in selective cases rather than as a routine procedure.
Study site: Hospital Universiti Sains Malaysia, Kelantan, Malaysia
An analytical cross-sectional study was conducted in a public university in Kuala Lumpur among a random sample of 2665 undergraduates. The objective was to study the prevalence of breakfast skipping and its associated factors. Data collection was conducted via a self-administered pre-tested questionnaire. There were 43.5% male respondents, with Malays being the majority (58.3%). The prevalence of breakfast skipping was 29.2 (95% CI: 27.3 - 30.3)%. The factors significantly associated with breakfast skipping (p<0.05) were age, race, accommodation, faculty and skipping dinner. As the respondents' age increased, their risk of breakfast skipping was lower (OR: 0.95; 0.89 - 0.99). Malays (OR: 1.94; 1.48 - 2.54), Indians (OR: 1.70; 1.08 - 2.66), and students from the Sabah and Sarawak indigenous communities (OR: 2.13; 1.37 - 3.33) were more likely to skip breakfast compared to their Chinese counterparts. Respondents who stayed in their own houses were also less likely to skip breakfast compared to those staying in hostel with meals catered (OR: 2.32; 1.39 - 3.84), hostel with cafeteria (OR: 2.92; 1.74 - 4.91) or in rented houses (OR: 2.08; 1.25 - 3.46). Respondents majoring in Arts and Economics had 1.40 (1.07 - 1.82) times risk of breakfast skipping compared to those majoring in Life Sciences. Those who skipped dinner too had twice the odds (1.47 - 2.77) of breakfast skipping. In conclusion the prevalence of breakfast skipping among the undergraduates of this university was moderately high. Health awareness campaigns or introduction of healthy eating guidelines should be initiated for the undergraduates as well as food caterers in campus. The policy and pricing of catered food in campus should also be reviewed.