Perforated appendicitis, with its increased complication rate, today still poses a formidable problem in the Kuala Lumpur General Hospital. Out of 1694 emergency operations performed by our unit in 1987, there were 927 appendicectomies. A retrospective study of these cases showed 126 cases of perforated appendicitis, which were then subjected to detailed analysis. We have a diagnostic accuracy of 81% and perforation rate of 18%. In addition, it is interesting to note the racial differences in the relationship of diagnostic accuracy to perforation rate. Perforation is associated with an increased wound infection rate. Transperitoneal drainage in perforated appendicitis did not lead to a lower incidence of wound infection or improve postoperative performance. Distinguishing between perforated and non-perforated appendicitis may be difficult. Perforation could occur while awaiting operation. We recommend the early administration of systemic antibiotics should appendicectomy be delayed and the cautious use of drains in cases of perforated appendicitis.
Talon cusps were observed in a 10-year-old boy and his 12-year-old sister. Although the sister's affected tooth was asymptomatic and free of any occlusal interference, the boy's tooth presented some problems. The affected tooth had displaced the occluding mandibular tooth lingually, and this had resulted in a mid-line shift. To overcome the problem, the talon cusp was ground off and a prophylactic odontotomy performed. Orthodontic treatment was later carried out.
MeSH terms: Child; Female; Genetics; Humans; Incisor/abnormalities*; Incisor/pathology; Male
Two cases of hypokalaemia with serum potassium levels of 1.4 mmol/L and 1.9 mmol/L causing severe periodic paralysis since childhood are presented. There were associated with muscular aches and markedly raised muscle enzymes suggesting massive rhabdomyolysis. These abnormalities were due to renal tubular acidosis with markedly acidic arterial pH. The hypokalaemia and rhabdomyolysis responded to potassium and bicarbonate replacement. We postulate these patients had sporadic distal type of renal tubular acidosis and that the hypokalaemia and acidosis had caused the rhabdomyolysis.
A 26-year old woman with congenital complete heart block and prolonged QT interval presented for the first time with syncopal attacks associated with torsade de pointes in adulthood. Cardioversion followed by overdrive pacing was needed to finally control the unstable rhythm. During episodes of non-capture, paraoxysms of torsade de pointes leading to ventricular flutter were recorded by a 24-hour ambulatory electrocardiographic monitoring. Beta-blockade and permanent ventricular pacing finally abolished both the syncopal attacks and the torsade phenomena. The prognosis of congenital complete heart block associated with QT prolongation resembles that of the Romano-Ward syndrome. Recognition of this variant would facilitate earlier treatment of this rare but potentially lethal disorder.
We present an unusual case, where the medial meniscus does not coincide with the embryological development of the formation of a discoid cartilage. A fairly, careful perusal of English literature since 1945 to date makes us feel that the following case merits recording. The meniscus had a normal anterior horn attached to the intercondylar area, in front of the anterior cruciate ligament. Medially, it was attached to the capsule and the condylar surface of the medial tibial plateau. The posterior horn was rounded, smooth, and floating free of any attachments. It was approximately 2 cms in length, semilunar in shape, and extended posteriorly up to the anterior margin of the medial collateral ligament. The rest of the medial tibial plateau had no other protective covering.
Three new variants of acidic proline-rich proteins (At, Au, Aw) were found in human parotid saliva by isoelectric focusing and basic gel electrophoresis. Electrophoretic comparison of the purified proteins and their tryptic peptides suggested minor charge and size differences from other acidic PRPs. Genetic and biochemical studies indicate that the At and Aw proteins are allelic products of the PRH1 locus. Gene frequencies of the At productive allele (PRH1(6)) in Japanese, Chinese, and Malays were 0.008, 0.012, and 0.004, respectively. The Au protein was also found in Japanese (2 in 746 samples), Chinese (1 in 215 samples), and Malays (1 in 220 samples), however, the Aw protein was found only in one Japanese (n = 746). These three proteins were not found in 106 Indian subjects.
"The links between Indonesia and Johor, Malaysia, across the narrow straits have been strong for centuries. Many Johoreans trace their origins to various islands in the Indonesian archipelago. In recent years the presence of large numbers of Indonesian migrant workers in Malaysia has become the focus of media and political debate; it is seen not only as undermining working conditions but as aggravating fragile ethnic relations within Malaysia. The aim of this article is to examine the presence and employment of Indonesians in the southern area of Johor, and the responses of government and the public to this phenomenon."
MeSH terms: Acculturation*; Asia; Asia, Southeastern; Culture; Demography; Developing Countries; Economics; Emigration and Immigration*; Employment*; Ethnic Groups*; Health Manpower; Indonesia; Malaysia; Population; Population Characteristics; Population Dynamics; Prejudice*; Social Change; Social Class; Social Problems; Socioeconomic Factors; Transients and Migrants*
The Australian, heat-resistant, a virulent V4 strain of Newcastle disease (ND) virus was selected for further heat resistance to give a variant designated V4-UPM. V4-UPM was sprayed on to food pellets which were fed to chickens in amounts calculated to give about 10(6) EID50 per chicken. Chickens vaccinated only once by feeding developed no haemagglutination-inhibition (HI) antibodies and were not protected against challenge with a viscerotropic velogenic strain of ND virus. Chickens given food pellet vaccine at 3 and 6 weeks of age developed HI antibodies and were substantially protected against parenteral and contact challenge with virulent ND virus. Similar protection was achieved when the V4-UPM vaccine was given intranasally on two occasions or when the vaccine virus was allowed to spread by contact from intranasally vaccinated chickens to nonvaccinated chickens. Heat resistant ND vaccine incorporated in food pellets may provide a method for protecting village chickens against ND in tropical countries.
There was high mortality in late larval instars of Aedes albopictus (Skuse) from laboratory and field populations in the 24 h after application of three Bactimos formulations of Bacillus thuringiensis H-14. Mortalities were higher and residual effects longer in field populations than in laboratory ones. Briquets were the most effective formulation (mortality 96-100% after five weeks; 76-92% after eight weeks). Culex quinquefasciatus Say larvae were tested only against the briquet formulation. In the laboratory, 100% mortality of late instars persisted for six weeks and dropped to 48-88% after eight weeks. In the field, late instars were reduced by 62-87% after 24 h and 69-72% after one week compared to increases in an untreated population of 160% and 176% respectively.
The leaf-monkeys, Presbytis cristata and Presbytis melalophos, experimentally infected with subperiodic Brugia malayi, have been used for studies on the pathoimmunology of the infection and the screening of potential filaricides during the last 6-8 years, and considerable information on the pattern of microfilaraemia and adult worm recoveries have been obtained. The prepatent periods in 97 P. cristata and 45 P. melalophos, each infected with about 200 infective larvae, were similar, these being approximately 70 and 68 days respectively. Although all infected animals became microfilaraemic, the peak geometric mean count was much higher in P. cristata than in P. melalophos, this being 182.0 and 65.8 per ml blood respectively. Mean adult worm recovery expressed as the percentage of the infective dose was 4.7% and 2.5%, respectively. Most worms were recovered from the sacral nodes/thoracic duct or inguinal lymph nodes in these animals. In view of the higher worm recovery and the higher peak microfilaraemia attained, it is concluded that P. cristata is a better model for the infection than P. melalophos.
Over a 15-month period, 399 patients with dyspepsia were investigated for the presence of Campylobacter pylori infection. Half of the patients (50.6%) had Campylobacter organisms in the antrum of the stomach. C. pylori was found in 96.1% of patients with histological changes of chronic active gastritis in the antrum. Of patients with duodenal and gastric ulcers, 87.8% and 87.5%, respectively, had Campylobacter organisms, as did 39.3% of patients with non-ulcer dyspepsia. C. pylori infection was most commonly found in Chinese and Indians. Although the prevalence of infection appeared to increase with age, there was an equal distribution amongst the sexes.
Blood samples from 1,600 persons who sought immunisation against hepatitis B in private clinics in Singapore in 1988-1989 were screened for two viral markers. Of that total, 4.81% were positive for HBsAg and 17.31% had anti-HBs levels greater than 10 mIU/ml, indicating that about 22.12% of the general population would not benefit from immunisation. Preimmunisation screening will identify persons not requiring the hepatitis B vaccine and thus, avoid wastage. When immunisation has already been performed without screening, recall for post-immunisation screening should be considered in order to detect the infectious hepatitis B carriers. Data in this study indicates that at this point in time, it is important to immunise adolescents and adults, in addition to neonates and children.
MeSH terms: Ambulatory Care Facilities; Carrier State; China/ethnology; Female; Hepatitis B/diagnosis*; Hepatitis B/ethnology; Hepatitis B/immunology; Hepatitis B/prevention & control; Hepatitis B Antibodies/analysis; Hepatitis B Surface Antigens/analysis; Humans; India/ethnology; Malaysia/ethnology; Male; Singapore; Vaccines, Synthetic; Viral Hepatitis Vaccines; Hepatitis B Vaccines
A single antigen indirect immunofluorescence test was used to screen for chlamydial antibody among Malaysian infants, children, sexually active adults and prostitutes. Of 794 serum samples tested, 361 (45.5%) were positive. Seropositivity increased with age and sexual activity and ranged from 10 to 16% among children under 10 years old to 94.4% among prostitutes. Pregnant women and female adolescents showed a higher antibody prevalence than nonpregnant and older women. Six (13%) infants under 6 months of age were positive for chlamydial IgM.
The distribution of serum alpha 1-protease inhibitor (PI) or alpha 1-antitrypsin (alpha 1AT) subtypes was determined by thin-layer isoelectric focusing in a group of 1233 individuals from six Mongoloid populations of East Asia and Dravidian Indians. The sample comprised 385 Chinese from Singapore and 151 Chinese from the Fujien province; 126 Malays; 243 Filipinos; 112 Thais; 56 Koreans and 160 Dravidian Indians. The frequency of PiM1 ranged from 0.65 in the Thais to 0.81 in the Fujien Chinese. The highest frequency of PiM2 was found in the Dravidian Indians (0.28) followed by the Thais (0.25). The frequency of PiM3 was found to vary from 0.03 to 0.07 in these populations. A low frequency of PiF (0.01 to 0.02) and PiS (0.01 to 0.04) was also observed in the Mongoloid populations but absent in the Indians. The PiZ allele was completely absent in all these populations. The phenotypic distribution of PI subtypes was at Hardy-Weinburg equilibrium in all the populations.
A cross-sectional national survey was conducted amongst a random sample of medical practitioners registered in 1988 with the Malaysian Medical Council with the purpose of determining their educational needs with regards to continuing medical education (CME). A 91.0% response rate was obtained. It was found that more than 70% wanted a programme that would provide them with new practical skills and new knowledge or advances in specific fields. About 2/3 also wanted their intellectual skills in problem-solving to be further developed. Reinforcement of communication skills appears to be of secondary importance. They would also like a programme of CME to help them monitor and improve their diagnostic accuracy, investigative habits, prescribing pattern, skills in interpreting diagnostic tests and management of common illnesses. As for content areas it was found that the problems they have least confidence in managing come mainly from the disciplines of psychiatry, obstetrics and gynaecology, and emergency and critical care. More than 90% preferred self-learning methods with some group-type activities. Based on these needs it was recommended that a programme of CME be developed with orientation towards a practice-based setting, self-directed learning, utilizing problem-solving approaches and focusing on the major content areas identified. In addition, activities such as small-group discussions, clinical rounds and journal clubs should be encouraged to develop into local network group activities to supplement the self-learning and present lectures and talks.
The emphasis on cow records in Malaysian dairy extension programmes reflects the importance of herd fertility in the economics of dairying. Manual record keeping has not been able to make an impact on management due to difficulties experienced in quality control of the data and in analysing the data to produce useful information for farm managers. Computerised recording systems have been in use in Malaysia since 1985, both on government farms and in the small-holder dairy sector. The aim of both systems is firstly to improve farm efficiency by the provision of information to managers and extension workers and secondly to provide information for departmental planning purposes. The systems used in Malaysia are outlined, and the results over the first three years of operation are summarised.
In an ongoing effort to identify point mutations causing beta-thalassaemia, we have found two previously unreported mutations which are located in the Poly A site of the beta-globin gene. The screening programme used amplified DNA and dot-blot hybridization with several 32P-labelled oligonucleotide probes. DNA samples which remained unidentified by this methodology were subjected to sequencing with 32P-labelled primers and modified T7 DNA polymerase. The newly discovered mutations were confirmed by the dot-blot hybridization technique. One type concerned an AATAAA----AATGAA mutation in the polyadenylation site and was found in one family from Yugoslavia (including one patient with the C----T mutation at codon 29 in trans), one from Bulgaria (the patient had the G----A mutation at IVS-I-110 in trans), and one from Greece (this patient had the C----G mutation at IVS-II-745 in trans). Haematological data for three simple heterozygotes suggested a rather mild beta(+)-thalassemia. The second type involved an AATAAA----AATAGA mutation and was found in one family from Malaysia. The propositus had the beta E mutation on the other chromosome, was originally diagnosed as mild Hb E-beta(+)-thalassaemia, and had Hb A and Hb E percentages which were nearly the same.
MeSH terms: Adult; Aged; Aged, 80 and over; Base Sequence; Child; Child, Preschool; DNA Mutational Analysis; Family; Female; Globins/genetics*; Humans; Male; Middle Aged; Molecular Sequence Data; Mutation*; Poly A/genetics*; Thalassemia/genetics*