A case of intra-uterine normal pregnancy with an extra-uterine abdominal full term dead foetus (lithopaedion) is described. The impossibility of differentiation from twin uterine pregnancy until after birth of first baby is pointed out.
Asthma is a chronic reversible respiratory problem commonly seen by Family Physicians. Pregnancy can produce physiological and physical changes that can affect the severity of asthma and its management. Conversely poorly controlled asthmatic attacks can result in adverse obstetric outcome: prematurity, low birth weight babies, foetal hypoxia and increased maternal and foetal morbidity and mortality. It is important that Family Physicians should be able to manage competently and provide appropriate counseling for women with asthma in pregnancy, labour and lactation. Assessment of asthma control using a peak flow meter is recommended. The use of the usual inhaled and oral corticosteroids, beta 2 agonists, cromones and anticholinergics are generally safe in pregnancy, labour and lactation. But methylxanthines should be used with caution. Women should be advised that asthma medication would not adversely affect their unborn babies and the birth outcome of well-controlled asthmatic women approaches that of the normal population but uncontrolled asthma would be detrimental to the health of mother and child.
Multidrug-resistant organisms cause late-onset ventilator-associated pneumonia (VAP). In a pilot, randomized and controlled study, the efficacy and safety of cefepime, in late-onset VAP in infants, have now been evaluated in Malaysia. Thirty children aged <1 year with late-onset VAP (i.e. VAP occurring 5 or more days after intubation) were randomized to receive cefepime or, as a control, ceftazidime. The clinical responses and the microbiological clearance of tracheal aspirates were evaluated in each arm. Adverse events, if any, were monitored clinically and by blood tests. Ten of the 15 children given cefepime and five of the 15 given ceftazidime showed a satisfactory clinical response (P<0.1). Cefepime appeared significantly better at clearing polymicrobial infections from tracheal aspirates. There were no fatalities in the cefepime arm but three in ceftazidime (P<0.1). The mean (S.E.) durations of antibiotic use were 9.4 (1.5) days for cefepime and 7.6 (1.0) days for ceftazidime (P>0.05). No serious adverse effects were observed in either arm. In conclusion, in late-onset VAP in infants, cefepime monotherapy appears to be at least as effective and safe as ceftazidime monotherapy, with better microbiological clearance.
The aim of this study was to compare and validate two simple methods of detecting excessive alcohol drinkers in a Malaysian hospital population. All 621 patients in the Medical, Surgical and Orthopaedic units of the General Hospital Kuala Lumpur were screened with the "CAGE" Questionnaire (a four question screening test to discriminate excessive drinkers) and two questions on the frequency and quantity of drinking called the Consumption Index. All CAGE scores had poor agreement (K = 0.37 to K = 0.1) with a psychiatric diagnosis of alcohol abuse and dependence using DSM III diagnosis. Reasons why the Consumption Index is a better screening instrument than the CAGE are discussed.