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Fulltext Renal tubular acidosis in Kelantan, Malaysia--a case review

Zainal D

Singapore Med J, 1994 Jun;35(3):303-5.
PMID: 7997910

Renal tubular acidosis (RTA) is a defect in urinary acidification in the absence of renal failure. All records of patients admitted to adult medical wards at the University Hospital USM (HUSM), Kelantan between 1986 to 1990 with the diagnosis of renal tubular acidosis were reviewed. Sixteen (16) patients were identified and fulfilled the diagnostic criteria. Their mean age at presentation was 28.9 +/- 0.74 years. The triad of muscle weakness, hypokalaemia and systemic metabolic acidosis were the characteristic features at presentation. Normal serum alkaline phosphatase and skeletal X-rays were noted. Their prognosis were generally good. Their mean serum bicarbonate and potassium on follow up were 17.84 +/- 0.35 and 3.82 +/- 0.05 mmol/L respectively. The importance of regular follow-up and long-term management is emphasised.
Fulltext The value of positive nitrites in screening asymptomatic bacteriuria amongst Malaysian school children

Zainal D, Baba A

Southeast Asian J. Trop. Med. Public Health, 1996 Mar;27(1):184-8.
PMID: 9031425

It is important to diagnose and treat urinary tract infection in children before renal damage has taken place. Hence a new screening procedure will be of interest. This study was conducted to evaluate the efficacy of urinary nitrite in screening for asymptomatic bacteriuria among school children compared to a more traditional method. Of the 44,816 school children investigated 240 (0.54%) students were judged to have bacteriuria ie 82 (0.19%) in boys and 158 (0.35%) in girls. Escherichia coli was the commonest organism isolated (28.75%). Urine dipstick testing for nitrite was found to have a low sensitivity and positive predictive value. While urinalysis for pyuria was noted to have a sensitivity of 77.9%, a specificity of 95.8% and a negative predictive value of 99.9%.
Fulltext Screening for bacteriuria in Malaysian school children

Zainal D, Baba A

Singapore Med J, 1994 Aug;35(4):374-5.
PMID: 7899895

Urinary tract infection is the most common of bacterial infections. Screening children for asymptomatic bacteriuria to prevent pyelonephritis and renal scarring is widely recommended. In Malaysia no such attempt has been made to establish the prevalence of asymptomatic bacteriuria. Bacteriuria was screened among 44,816 healthy school children from three different districts in Kelantan. There were 23,132 boys and 21,684 girls. The prevalence of bacteriuria was 0.12% after second screening. Higher prevalence was seen in other reports.
Fulltext Renal stones in Kelantan, Malaysia--has the pattern changed?

Nazmi N, Zainal D, Hashim M

Southeast Asian J. Trop. Med. Public Health, 1997 Sep;28(3):641-4.
PMID: 9561623

Records of 183 patients with renal stones managed at Hospital Universiti Sains Malaysia between 1985 and 1995 were retrospectively evaluated. The commonest symptom was lumbar pain which may be associated with either frequency, blood stained urine or dysuria. One hundred and sixty-one patients (88%) had upper tract stones while the remainder had lower tract stones. Positive urine cultures were seen in 33 patients. The commonest organism isolated was Escherichia coli followed by Klebsiella aeruginosa and Staphylococcus aureus. Almost all of our patients had renal impairment at presentation and 70% of them progressed to chronic renal failure. In contrast to previous findings, the pattern of renal stone in this region is similar to that described in Western society. Its effect on renal function is serious and hence warrant special attention.
The pattern of chronic renal failure in Kelantan, northeastern state of Malaysia

Zainal D, Monniaty M, Nazmi N

Southeast Asian J. Trop. Med. Public Health, 1995 Dec;26(4):781-4.
PMID: 9139394

The pattern and outcome of patients with chronic renal failure (CRF) in Kelantan, the northeastern state of Malaysia was determined. A total of 60 patients with CRF managed at the Hospital Universiti Sains Malaysia between January 1991 and June 1993 were reviewed retrospectively. The prevalence of CRF was 24.8 patients per year. The ratio of male to female patients was 1.5 : 1.0. Their mean age at presentation was 51.4 +/- 13.7 years. The cause of CRF in majority of our patients was unknown. Their mean blood urea and serum creatinine were 38.9 +/- 9.8 mmol/l and 1,154.9 +/- 458.7 mumol/l respectively. Sixty-five percent of our patients were already in end-stage renal failure (ESRF) at the time of presentation and only 53.8% of them could afford a definitive renal replacement therapy. Their mortality rate was 21.7% and majority of the death occurred in patients who were not receiving definitive renal replacement therapy. This debilitating course will continue unless the cost of renal replacement therapy is subsidised or a renal transplantation program is activated. Hence public education to encourage organ donation in this part of Malysia is necessary.
Fulltext Acute renal failure in a teaching hospital

Loo CS, Zainal D

Singapore Med J, 1995 Jun;36(3):278-81.
PMID: 8553092

This was a retrospective study of the clinical course of 164 adult inpatients with acute renal failure (ARF) at the Hospital of the University of Science Malaysia admitted from June 1986 to May 1990. The mean age was 49.8 +/- 17.2 years. 33.5%, 54.9% and 11.6% were surgical, medical and obstetrical patients respectively. Obstructive uropathy, poor cardiac output or decrease in intravascular volume and infection accounted for more than 67% of the cases. Acute renal failure was present at admission in 113 (69%) patients. The majority of the patients (80%) had nonoliguric acute renal failure with daily output of urine of more than 400 ml. Compared with nonoliguric patients, oliguric patients had higher mortality (56.3% vs 18.9%, p < 0.01), and needed dialysis more frequently (43.8% vs 12.9%, p < 0.01). Early recognition of acute renal failure, improvement in early treatment of renal stones and discerning use of nephrotoxic drugs could result in decrease in incidence and severity of renal failure.
Fulltext The pattern of acute renal failure in Kelantan

Zainal D, Loo CS

Singapore Med J, 1996 Feb;37(1):44-7.
PMID: 8783912

Acute renal failure (ARF) has undergone many changes with advances both in diagnosis and therapy. A retrospective study covering three and a half years from June 1986 to December 1989 of adults admitted to Hospital of the University of Science Malaysia examined the various aspects of presentation of the syndrome, management and areas where improvement can be made. A total of 164 patients were included in the study. 61.6% were male and 38.4% were female. The mean age was 49.8 +/- 17.2 years with 70% of patients being more than 40 years old. The aetiologies of acute renal failure were analysed and discussed. The majority of the patients (80%) had non-oliguric acute renal failure. Oliguric acute renal failure patients have higher mortality and more frequently need dialysis. Early recognition of acute renal failure and discerning use of nephrotoxic drugs could result in decrease in incidence and severity of renal failure.
Fulltext The status of intermittent peritoneal dialysis in Hospital University Science Malaysia

Zainal D, Loo CS

Singapore Med J, 1995 Aug;36(4):379-82.
PMID: 8919150

Acute (stab) peritoneal dialysis is commonly practised in Malaysia. This study is designed to improve the management of peritoneal dialysis (PD) in Hospital University Science Malaysia (HUSM). Consecutive peritoneal dialysis (PD) on adult inpatients from May 1992 to September 1992 were reviewed prospectively. There were 40 episodes of peritoneal dialysis on 27 patients during this period given at the rate of 2 PD per week. The mean age of patients were 53 +/- 15 years. Uraemia was the main indication for dialysis, while hyperkalaemia and pulmonary oedema were indications for urgent dialysis. Complications occurred in 14 episodes of dialysis (35%). The most common complication was bleeding in the peritoneal cavity while peritonitis was the second most common complication. Dialysis episodes complicated by peritonitis were done by less experienced performers compared to uncomplicated dialysis episodes. Overall mean time spent on each dialysis and time per cycle were longer than recommended (59 +/- 24 hours and 77 +/- 14 minutes). In conclusion, acute PD performed on patients admitted in Hospital University Malaysia was safe and had complication rates comparable to other established centres. However, improvements are possible through closer supervision of new doctors and tighter nursing precautions.
Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in northeastern Malaysia

Kamaliah MD, Zainal D, Mokhtar N, Nazmi N

Int J Dermatol, 1998 Jul;37(7):520-3.
PMID: 9679693

BACKGROUND: Previous studies have reported that drugs and infections are common causes of erythema multiforme (EM) and Stevens-Johnson syndrome (SJS). Toxic epidermal necrolysis (TEN) is mainly related to drugs. No study has been conducted in Kelantan, the northeastern state of Malaysia, to assess these cutaneous reactions.
METHODS: A retrospective study of all hospitalized cases of EM, SJS, and TEN was conducted covering an 8-year period from 1987 to 1994.
RESULTS: There were four cases (13.8%) of EM, 22 cases (75.9%) of SJS, and three cases (10.3%) of TEN. Drugs as a definitive cause was observed in one case (25%) of EM, 12 cases (54.5%) of SJS, and two cases (66.7%) of TEN. Drugs as a probable cause was observed in seven cases (31.8%) of SJS and one case (33.3%) of TEN. The male to female ratio was equal in EM and SJS. Antiepileptics were the commonest culprits, followed by antibiotics. One patient died of SJS and one patient died of TEN, giving mortality rates of 4.5% and 33.5% respectively. Fever was noted in 18 patients (62.1%). Leukocytosis was noted in 10 patients (34.5%), and nine patients (31.0%) had elevated liver transaminase enzymes. No significant correlation was noted between these biochemical changes and cutaneous eruption. Secondary infections were observed in 11 patients (37.9%): Staphylococcus aureus was the commonest isolated organism.
CONCLUSIONS: This study shows that drugs remain the commonest culprit in SJS and TEN. Despite adequate treatment, the mortality rate remains high, especially in TEN. These findings are similar to those of other reported studies.
Screening proteinuria and hematuria in Malaysian children

Zainal D, Baba A, Mustaffa BE

Southeast Asian J. Trop. Med. Public Health, 1995 Dec;26(4):785-8.
PMID: 9139395

Screening for proteinuria and hematuria is important in the prevention of chronic renal disease. In Malaysia to date no such attempt has been made to establish the prevalence of proteinuria and hematuria. A total of 45,149 primary school children from three districts in Kelantan were screened for proteinuria and hematuria. They were 23,289 boys and 21,860 girls. The prevalence of abnormal urinary sediments after third screening was 0.17% ie 0.07% were in boys and 0.10% were in girls. The commonest abnormality was proteinuria (0.12%), followed by hematuria (0.03%) and combination of proteinuria and hematuria (0.02%). Hematuria was more commonly seen in girls compared to boys while proteinuria was seen in almost equal proportion in boys and girls. Despite screening large number of children the prevalence of asymptomatic proteinuria and hematuria was far lower than in an earlier reported study. Furthermore the majority had mild abnormalities.
Fulltext Glomerulonephritis in Kelantan, Malaysia: a review of the histological pattern

Zainal D, Riduan A, Ismail AM, Norhayati O

Southeast Asian J. Trop. Med. Public Health, 1995 Mar;26(1):149-53.
PMID: 8525403

Renal biopsy is essential in the management of renal parenchymal diseases. Thus far there is no publish report on the pattern of glomerulonephritis in Kelantan. We decided to establish the pattern of glomerulonephritis in Kelantan and use this information as our reference in future studies. Records of patients who had proven glomerulonephritis histologically were analysed. Their biological data, clinical presentation, etiology and clinicopathological pattern were studied. Where appropriate mean and standard deviation were calculated. A total of 74 biopsies were performed during the study period (between January 1991 and December 1993), out of which 72 biopsies (97.3%) were considered suitable for analysis. The male to female ratio was 1:1.1. Mean age at presentation was 27.6 +/- 12.2 years. Nephrotic syndrome was the commonest clinical presentation (65.3%). The main underlying cause was systemic lupus erythematosus (50%) followed by primary glomerulonephritis. Histologically, IgA nephropathy and minimal change disease were the main patterns among patients with primary glomerulonephritis while diffuse proliferative glomerulonephritis was the commonest pattern among patients with lupus nephritis. Hence the pattern of glomerulonephritis is similar to other reported series. The procedure is considered safe and has a high success rate.
Fulltext Prevalence and risk factors for menstrual disorders among systemic lupus erythematosus patients

Fatnoon NN, Azarisman SM, Zainal D

Singapore Med J, 2008 May;49(5):413-8.
PMID: 18465054

INTRODUCTION: This study aims to determine the prevalence and the types of menstrual disorders among patients with systemic lupus erythematosus (SLE) and to identify factors that influence their development.
METHODS: 61 patients with SLE were enrolled into a cross-sectional, observational study at the medical outpatient clinic, Hospital Universiti Sains Malaysia. A total of 120 healthy women were selected randomly to act as the control group. A questionnaire was administered, vital signs were recorded, and blood was evaluated for routine investigations. A review of past medical records was also undertaken.
RESULTS: The mean age and standard deviation for the study group was 33.23 +/- 10.96 years, the majority being ethnic Malays. 75 percent had a severe SLE disease activity index score on initial presentation, and 59 percent were on cyclophosphamide. 49 percent of the study population had menstrual irregularities, of which 60 percent had sustained amenorrhoea. Nine patients with sustained amenorrhoea had hormonal assays, which confirmed the diagnosis of premature menopause.
CONCLUSION: This study showed that SLE patients had a higher risk of developing menstrual irregularities compared to the normal/healthy population. The risk was higher in the older age group (greater than 30 years old) and those on cyclophosphamide therapy, especially those with a cumulative dose of more than 10 g. Sustained amenorrhoea was the commonest irregularity and a majority of them had confirmed premature menopause.
Study site: medical outpatient clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Fulltext Serological evidence of hantavirus infections in Malaysia

Lam SK, Chua KB, Myshrall T, Devi S, Zainal D, Afifi SA, et al.

Southeast Asian J. Trop. Med. Public Health, 2001 Dec;32(4):809-13.
PMID: 12041558

Hantaviruses are primarily rodent-borne and transmission is by inhalation of virus-contaminated aerosols of rodent excreta, especially urine and saliva. The genus Hantavirus, family Bunyaviridae, comprises at least 14 serotypes and the symptoms of clinical illness range from mild fever to severe hemorrhagic manifestations with renal complications. Many countries in Southeast Asia are unaware of the importance of hantavirus infections and give them low priority. Malaysia, like other countries in the region, has conducted very few studies on the epidemiology of hantaviruses - and even these were conducted in the 1980s. Using a more extensive range of hantavirus antigens, we conducted a seroprevalence study of rodents and humans and found further evidence of hantavirus infections. Moreover, the data from the antibody profiles strongly suggest the presence of different hantaviruses at the study sites.