This study reviews experiences in the management of three cases of lacerations of the vagina following coitus. A brief review of the recent literature is made. Although the extent of injuries can be very variable, the principles of management consist of prompt
resuscitation and arrest of haemorrhage, appropriate surgical repair under general anaesthesia, and systemic or local antibiotic therapy to combat infection. Avoidance of vigorous or abnormal coital practices, especially in single women, in the immediate postpartum period, and in postmenopausal women, can help to reduce the frequency and severity of such injuries.
Accidental organophosphate poisoning may occur in persons coming in close contact with animals being treated toitb organophosphate pesticides. The poisoning may manifest itself as a severe systemic disorder, but can be diagnosed by an alert physician and confirmed by specific tests of reduced cholinesterase activity in the blood, plasma and red blood cells. Treatment is with intravenous atropine. Supportive measures may be necessary.
Long-term ventilatory support of a child with bronchopulmonary dysplasia is described. Dedicated nursing care and emotional support of child and family were two important factors in the management of the child in intensive care, and in the weaning of the child from the ventilator.
From 1967-82, 9 children with testicular relapse (TR) of acute lymphoblastic leukaemia (ALL) were diagnosed out of 99 boys treated, an incidence of 9.1%. The median time from the onset of ALL until diagnosis was 28 months (range 3-41 months). All were asymptomatic; six were detected on routine examination while three were diagnosed only on biopsy. Routine biopsy prior to stopping chemotherapy is useful in detecting occult TR. Biopsies should be done on both the testes regardless of the clinical findings. The age, leucocyte count and hepatosplenomegaly at diagnosis of ALL were not found to be significant factors in influencing relapse. Eight children were in bone marrow remission at the time of TR, but three had preceding or concurrent meningeal leukaemia while in the other five the testis was the first and only site of relapse. Radiotherapy was effective in local disease control but failed to prevent bone marrow relapse in all except two patients despite continuation of chemotherapy. The median time from onset of TR until bone marrow relapse was 7 months (range 3-13 months) and the median time until death, was 11 months (range 6-18 months). The frequency of testicular relapse may be related to the intensity of either the initial induction therapy or the consolidation chemotherapy. Further studies are required to determine whether the incidence of testicular relapse will decline with more intensive early treatment.
Susceptibilities of two colonies of the taxon An. dirus (one from Perlis and from Thailand) and one colony of An. balabacensis from Sabah to DDT, dieldrin, malathion, fenitrothion and propoxur were determined. DDT and fenitrothion tolerance was found in An. dirus species B and An. balabacensis. No resistant strain was isolated as the two colonies were not either homozygous or nearly so for resistance. Field testing of the susceptibility of the adults of An. balabacensis to DDT was carried out between 1957 to 1976. The results indicated a progressive rise in the LC50 levels greater than 1% in almost all instance. The variation in the number of sprays applied in some districts have resulted in varying sensitivities. Association between the changes in levels of DDT susceptibility and exophilic habit of An. balabacensis has been observed but needs further confirmation. The significance of these findings and the difficulties in distinguishing tolerant from truly resistant individuals are discussed in relation to accurate species identification.
In 1982, Malaysia experienced the worst dengue/dengue haemorrhagic fever outbreak in its history. All states in Peninsular and East Malaysia were similarly affected. There was a total of 3,005 cases with 35 deaths, with the majority of cases occurring between the months of July to October. There was a total of 1,001 laboratory confirmed cases. Most of the cases were in patients over the age of 15 years. The Chinese population was mainly affected, although a much higher proportion of Malays was noted in comparison to previous years. The main serotypes involved were dengue-1 and dengue-3. No dengue-4 serotype were isolated.
Laboratory experiments were carried out to study the susceptibility of snail vectors to Oriental anthropophilic Schistosoma. Oncomelania hupensis hupensis was readily infected with the local strain of Schistosoma japonicum (Chinese strain), and also infected with S. japonicum (Philippines strain). O.h. quadrasi was only susceptible to its S. japonicum (Philippines strain). The Oncomelania races were refractory to S. mekongi, S. japonicum-like species (Malaysian strain). Tricula aperta (beta race) was readily infected with S. mekongi, S. sinensium and S. japonicum-like species from Malaysia, but not S. japonicum. T. bollingi was susceptible to S. sinensium and S. mekongi. Robertsiella kaporensis was only susceptible to the local strain, S. japonicum-like species from Malaysia. Geographical isolation may be the cause of these differences in compatibility between the snail vectors and the schistosome parasites.
Blood samples were collected from 24 immature male, 55 immature female and 99 mature female water buffalo kept at an experimental farm in the Northern Territory. Haematological analysis was performed on blood collected in dipotassium--ethylene diamine tetra acetic acid while biochemical analysis was performed on serum and plasma (for glucose) samples. Haematological values of mature buffalo were similar to those recorded for swamp buffalo in Malaysia. Blood cell appearances were similar to those reported for adult Indian river buffalo though values recorded for red cell components were higher. Statistical analysis revealed no significant differences between immature male and female buffalo. Red cell components, eosinophils, total plasma and serum proteins, albumin, gamma globulins, inorganic phosphate and the enzyme gamma-glutamyl transferase were significantly higher for mature female buffalo when compared to immature females. Reasons for the differences were not fully determined but the effect of age and nutritional status in combination with a variable period of domestication were considered.
MeSH terms: Age Factors; Animals; Animals, Domestic/blood; Australia; Blood Cell Count/veterinary*; Blood Chemical Analysis/veterinary; Blood Proteins/analysis*; Buffaloes/blood*; Female; Hematologic Tests/veterinary; Male; Phosphates/blood; Reference Values; Sex Factors
One hundred and ten consecutive patients with falciparum malaria were treated with Fansidar and primaquine. Of the 61 patients who were followed up at one week, 4 (6.6%) failed to clear their parasitaemia (1 R III and 3 R II treatment failures). Of the subsequent 40 patients who were seen again at one month, another 3 (7.5%) had recrudesced (R I treatment failure). A total of 7 patients thus experienced some form of treatment failure in the cohort of 40 who completed the one month follow up. Only 1 of these 7 patients (with R III treatment failure) failed to respond to repeat Fansidar treatment, and may be the only one with true Fansidar resistance. The overall treatment failure rate of 17.5% (95% confidence interval: 6-29%) in the cohort who completed the study is consistent with the known clinical efficacy of Fansidar. These results suggest no significant Fansidar resistance in falciparum malaria found in Sabah.
A survey was conducted in six selected rural villages to obtain baseline data on socioeconomic status, nutrition, environmental sanitation and behavioural aspects in relation to diarrhoeal diseases, using a standard questionnaire. Subsequent to this, children 0-4 years of age were followed weekly for six months for diarrhoeal disease. Eleven variables representing socioeconomic status, nutritional status, housing condition, environmental sanitation, mother's knowledge and beliefs were investigated using stepwise logistic regression to determine significant predictors of diarrhoeal disease. Children who were below two years of age, living in conditions of poor sanitation and poor quality water supply, whose houses were prone to flooding and who had mothers whose sanitary habits were not influenced by their religious beliefs, were at significantly greater risk of diarrhoeal disease.
Perinatal mortality rates have been gradually declining in all countries. The initial decline mainly resulted from improvements in the late foetal mortality rates. Later with improvements in neonatal care, early neonatal mortality rates also improved. The developed countries have consistently shown better results than the developing countries, an indication of the higher standard of living, general health as well as the delivery of health care in these countries. In the Singapore situation, a rapid improvement in perinatal mortality was initially observed due to improvements in the late foetal mortality, followed later by reduction in the early neonatal mortality due to upgrading of neonatal intensive care. The perinatal mortality rate is lowest in the Chinese compared to the Indians and Malays, most likely due to the dietary practices of the three ethnic groups in Singapore; while the Chinese encourage extra nutrition in the pregnant female, the Malays and Indians tend to practise dietary restriction during this period. The improved nutrition of the pregnant mother is a factor in improving the perinatal mortality.
The definition of primary health care is basically the same, but the wide variety of concepts as to the form and type of worker required is largely due to variations in economic, demographic, socio-cultural and political factors. Whatever form it takes, in many parts of the developing world, it is increasingly clear that primary health care must be provided by non-physicians. The reasons for this trend are compelling, yet it is surprisingly opposed by the medical profession in many a developing country. Nonetheless, numerous field trials are being conducted in a variety of situations in several countries around the world. Non-physician primary health care workers vary from medical assistants and nurse practitioners to aide-level workers called village mobilizers, village volunteers, village aides and a variety of other names. The functions, limitations and training of such workers will need to be defined, so that an optimal combination of skills, knowledge and attitudes best suited to produce the desired effect on local health problems may be attained. The supervision of such workers by the physician and other health professionals will need to be developed in the spirit of the health team. An example of the use of non-physicians in providing primary health care in Sarawak is outlined.
MeSH terms: Allied Health Personnel/statistics & numerical data*; Community Health Workers/statistics & numerical data*; Cultural Characteristics; Demography; Developing Countries*; Humans; Malaysia; Patient Care Team; Politics; Rural Health
This study was conducted on 506 firemen in Singapore. Interviews, pulmonary function tests and audiometry were conducted. With regard to pulmonary function, the results showed that forced vital capacity (FVC) increased up to the age of 25-30 years for both Chinese and Malays. Both FVC and forced expiratory volume in one second (FEV1.0) increased with standing height over the whole age range studied. The mean values of FVC and FEV1.0 were higher in Chinese. It was also found that the FEV1 of the subjects in the study showed a greater decline in rate with age than other workers studied by the authors previously. The hearing threshold of 83 fire fighters showed a prominent upward shift of 6-8 KHz at ages 20-30. This upward shift was more pronounced in the right ear. The implications of the findings are discussed and a comparison with results of other similar studies in other countries is made.
This study is based on a survey conducted in Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore, Sri Lanka and Thailand on occupational injuries during the years 1975-1980. The number of work accidents have risen rapidly during this period in all of the 8 countries studied. In the case of Thailand, the total number of work injuries increased four fold from 1975-1978, whereas, in Singapore it has almost doubled in 6 years. The number of permanent disablement nearly trebled in Korea, and the Philippines for the year 1967-1980. The largest percentage of accidents are lost-time injuries in all of the 8 countries. Thailand had a three fold increase in lost-time injuries whilst in Hong Kong the figure doubled. Six out of the 8 countries indicated that the building construction industry had the largest number of fatal accidents, followed by the manufacturing industry.
MeSH terms: Accidents, Occupational*; Hong Kong; Humans; Indonesia; Korea; Malaysia; Philippines; Singapore; Sri Lanka; Thailand; Wounds and Injuries/epidemiology*
Mothers' recall data collected in Malaysia in 1976-1977 are analyzed to study correlates of mortality of 5471 infants. Respondent population is 1262 women living in 52 primary sampling units of Peninsular Malaysia. Lengths of unsupplemented and supplemented breastfeeding and presence of piped household water and toilet sanitation are related to infant mortality in regressions that also control other correlates. The analysis is disaggregated into three periods of infancy. Through six months of feeding, unsupplemented breastfeeding is more strongly associated with fewer infant deaths than is supplemented breastfeeding. Type of sanitation is generally more strongly associated with mortality than is type of water supply. The effects of breastfeeding and the environmental variables are shown to be strongly interactive and to change systematically during the course of infancy. Breastfeeding is more strongly associated with infant survival in homes without piped water or toilet sanitation. In homes with both modern facilities, supplemented breastfeeding has no significant effect, and unsupplemented breastfeeding is statistically significant only for mortality in days 8-28. Presence of modern water and sanitation systems appears unimportant for mortality of infants who are breastfed without supplementation for six months.
MeSH terms: Breast Feeding*; Epidemiologic Methods; Humans; Infant; Infant Food*; Infant Mortality*; Infant, Newborn; Malaysia; Surveys and Questionnaires; Sanitation*; Toilet Facilities; Water Supply*
Nine adult tree shrews, Tupaia glis, recently imported from West Malaysia were visually examined for ectoparasites while under general anesthesia. Three shrews were infested by the sucking louse, Sathrax durus , and six shrews had louse ova belonging to this species; two shrews had neither lice nor ova. A total of 20 adult female, 10 adult male, and three third instar nymphal lice was collected. Lice were located on the head, flanks, and dorsal body of shrews while ova were recorded mainly from the anterior flanks but also from some adjacent host sites. The tree shrews appeared to tolerate the lice well although louse vector capacity was not assessed. The last date that lice were recorded from shrews was 22 days after colony set-up, and the last date on which seemingly viable ova were recorded was 64 days after set-up showing that the infestations were ultimately lost.