A six-year-old boy, a known case of acute lymphoblastic leukaemia (ALL) on remission since 1991 presented with leukocoria and poor vision of the left eye for two days' duration. Examination revealed endophthalmitis in the left eye with raised intraocular pressure. Anterior chamber paracentesis with vitreous biopsy confirmed a diagnosis of ocular involvement. Further investigation revealed that he also had bone marrow and central nervous system relapse. Clinical manifestation and treatment modalities of ocular involvement in leukaemia are discussed.
We report two patients who had cerebral malaria, heavy parasitemia, hyperbilirubinemia, hypercatabolism with rapid rises of blood urea and serum creatinine and acute renal failure. There was no evidence of intravascular hemolysis. Renal biopsy was consistent with acute tubular necrosis. Both patients responded to treatment with intravenous quinine and dialysis.
A patient on oral contraceptives over several years developed unilateral proptosis, haemorrhagic retinopathy and increase in intraocular pressure. An orbital vein venogram confirmed the diagnosis of right superior ophthalmic vein thrombosis. There was complete resolution of thrombosis and eye signs and symptoms with discontinuation of the oral contraceptive.
A 16-year-old female from Rantau Panjang, Kelantan reported having diarrhoea for three months. During this period, she lost 15 lb in weight and was treated with antibiotics and anti-spasmodic tablets with no improvement. Stool examinations by private laboratories revealed "worm-like eggs". She was treated for worms with mebendazole which helped to reduce the symptoms but not completely. The patient continued passing out the abnormal "worm-like eggs" which were later identified as pollen grains.
Intensive chemotherapy has prolonged survival in cancer patients. Unfortunately it has also predisposed them to unusual infections because of their immunocompromised state. We report a case of fungal septicaemia caused by Geotrichum candidum, an imperfect yeast of low virulence in a young girl with acute lymphoblastic leukaemia. It was successfully treated with amphotericin B. The morphological characteristics of this fungus leading to its identification are described.
Excessive release of kinin (BK) in the synovial fluid can produce oedema, pain and loss of functions due to activation of B1 and B2 kinin receptors. Activation of the kinin forming system could be mediated via injury, trauma, coagulation pathways (Hageman factor and thrombin) and immune complexes. The activated B1 and B2 receptors might cause release of other powerful non-cytokine and cytokine mediators of inflammation, e.g., PGE2, PGI2, LTs, histamine, PAF, IL-1 and TNF, derived mainly from polymorphonuclear leukocytes, macrophages, endothelial cells and synovial tissue. These mediators are capable of inducing bone and cartilage damage, hypertrophic synovitis, vessel proliferation, inflammatory cell migration and, possibly, angiogenesis in pannus formation. These pathological changes, however, are not yet defined in the human model of chronic inflammation. The role of kinins and their interacting inflammatory mediators would soon start to clarify the detailed questions they revealed in clinical and experimental models of chronic inflammatory diseases. Several B1 and B2 receptor antagonists are being synthesized in an attempt to study the molecular functions of kinins in inflammatory processes, such as rheumatoid arthritis, periodontitis, inflammatory diseases of the gut and osteomyelitis. Future development of specific potent and stable B1 and B2 receptor antagonists or combined B1 and B2 antagonists with y-IFN might serve as a pharmacological basis for more effective treatment of joint inflammatory and related diseases.
Between 1978 and 1987, Kenyan authors contributed an average of 47% of papers published in the East African Medical Journal (EAMJ), in comparison to 24% originating from Nigeria and 29% from other countries, mainly those in the eastern and central African region. From January 1988 to December 1993, 44.1% of the papers published in EAMJ originated from Kenyan authors as compared to 26.7% from Nigerian authors and 29.2% from authors in other countries. During this six year period, there has been a steady increase in authorship from Saudi Arabia, Sudan, Zimbabwe, Ethiopia and Tanzania, whereas authorship from Uganda and Zambia has declined. Many authors from Saudi Arabia are individuals originally from Nigeria now working in Saudi Arabia. These data indicate that Kenyan authorship has dropped by 3% over the last six years compared to the 1978-1987 period, while that of Nigeria has increased by at least 3% over the same period. During the period under review, EAMJ has attracted papers from as far as China, Turkey, Malaysia, Canada, USA, France, Sweden and Hungary. Similarly, papers have been received from other African countries not previously contributing to the journal; these include: Gabon, Mozambique, RSA, Burkina Faso, Botswana, Burundi, Namibia, Liberia, Egypt, Somalia and Zaire. Possible factors influencing authorship in the EAMJ are discussed.
MeSH terms: Africa, Eastern; Authorship*; Periodicals as Topic/trends; Periodicals as Topic/statistics & numerical data*; Residence Characteristics/statistics & numerical data*
A study was conducted to compare the urinary iodine concentrations in populations from Pahang, Central Malaysia, with those in the capital city Kuala Lumpur, and to compare those of Malays from villages at Batu Talam, Batu Malim, FELDA Sungai Koyan and Hulu Sungai with neighboring aboriginal settlements at Lanai and Buntu. Two hundred and forty urine samples were collected randomly among the population (male 1 1 1 and female 129). The urinary iodine concentrations, measured by the ashing method, among Malays were as follows: Batu Talam 1.1-7.6 micrograms/dl, Batu Malim 1.4-6.6 micrograms/dl, FELDA Sungai Koyan 0.5-6.9 micrograms/dl and Hulu Sungai 0.6-9.9 micrograms/dl. Among aborigines, the urinary iodine levels were 0.1-2.9 micrograms/dl in Lanai and 1.7-6.5 micrograms/dl in Buntu. There was a significant difference in the levels of urinary iodine with regard to gender, but not regarding age. The aborigines had significantly lower iodine levels than Malays (P < 0.001). This difference was also significant with regard to location. The urinary iodine content in Kuala Lumpur was the highest and that in the aboriginal Lanai village was the lowest. Thus, the study showed that the levels of iodine in the urine were influenced by ethnicity and geographic location.
MeSH terms: Adolescent; Adult; Aged; Aging/urine; Female; Humans; Iodine/urine*; Malaysia; Male; Middle Aged; Rural Health*; Sex Factors; Urban Health*; Asian Continental Ancestry Group*; Oceanic Ancestry Group*; Continental Population Groups
DNA fingerprinting with the insertion sequence IS6110 (also known as IS986) has become established as a major tool for investigating the spread of tuberculosis. Most strains of Mycobacterium tuberculosis have multiple copies of IS6110, but a small minority carry a single copy only. We have examined selected strains from Malaysia, Tanzania and Oman, in comparison with M. bovis isolates and BCG strains carrying one or two copies of IS6110. The insertion sequence appears to be present in the same position in all these strains, which suggests that in these organisms the element is defective in transposition and that the loss of transposability may have occurred at an early stage in the evolution of the M. tuberculosis complex.
MeSH terms: Base Sequence; DNA Transposable Elements/genetics*; Molecular Sequence Data; Mycobacterium bovis/genetics; Mycobacterium tuberculosis/genetics*; Polymorphism, Restriction Fragment Length; Species Specificity; DNA Probes; Polymerase Chain Reaction; DNA Fingerprinting*; Sequence Analysis, DNA
The CD4+ T-lymphocyte absolute count (CD4ac), CD4+ T-lymphocyte percentage (CD4%) and total lymphocyte count (Løac) were assessed in HIV-seropositive intravenous drug users (IVDU) with reference to their correlation with the clinical categories A, B, and C as stipulated by the Centre of Disease Control and Prevention, USA (CDC) and with each other. It was found that while the CD4ac and Løac correlated with the clinical categories, CD4% did not. This may suggest that in our local setting, the CD4% may not necessarily be a suitable alternative marker to CD4ac as proposed by CDC. Furthermore, the CD4% of the normal subjects in this study was found to be relatively lower than the reported Caucasian levels. This may indicate that the use of the cut-off level of less than 14% as an AIDS-defining criteria may not be applicable for our HIV-seropositive IVDU. In addition, unlike the CD4ac which correlated directly with CD4% and Løac, the CD4% did not correlate with Løac. Therefore, due to the observed disparity with clinical status of patients and its possibly lower levels in our normal population, CD4% as a marker for staging HIV disease should be used with caution in our setting. Such findings may also have an impact on the use of established markers for the monitoring and classification of HIV-infected individuals in this region.
MeSH terms: Adult; Female; Flow Cytometry; HIV Seropositivity/immunology; Humans; Malaysia; Male; Prognosis; CD4-Positive T-Lymphocytes/immunology*; HIV-1/immunology*; HIV Infections/classification; HIV Infections/immunology*; Substance Abuse, Intravenous/immunology*; CD4-CD8 Ratio; Lymphocyte Count; CD4 Lymphocyte Count
Ninety-six randomly selected farms, located throughout peninsular Malaysia, were surveyed for goat nematodes resistant to benzimidazoles (BZ). On 33 farms BZ resistance was demonstrated by means of an egg hatch assay. Haemonchus contortus was found to be the main species involved in anthelmintic resistance. There was a positive association between the frequency of anthelmintic treatments on a farm and the presence of benzimidazole resistance. To assess the value of the egg hatch assay, faecal egg count reduction (FECR) tests were also performed on 20 farms. On six farms the LD50 of thiabendazole (TBZ) was less than 0.10 micrograms ml-1 and the FECR higher than 95% and on ten farms with an LD50 TBZ of over 0.10 micrograms ml-1 a FECR of less than 95% was measured. On four farms the FECR was less than 95%, although the egg hatch assay showed LD50 TBZ values of less than 0.10 micrograms ml-1 and on two of these three farms a controlled efficacy test confirmed the presence of BZ resistant H. contortus. From these results it can be concluded that the egg hatch assay underestimated the true incidence of benzimidazole resistance. Levamisole resistance was detected with a FECR test on two of ten farms investigated.
Nine populations of three species of Nephotettix (Insecta: Hemiptera) from Peninsular Malaysia were analysed for nine enzymes comprising 11 loci. Nei's (Genetics 89, 583, 1978) genetic distance, D, between N. virescens and N. malayanus was 0.181, that between N. virescens and N. nigropictus was 0.283, and that between N. malayanus and N. nigropictus was 0.203. The genetic distance between N. nigropictus from rice plant and from the weed-grass L. hexandra at Universiti Pertanian Malaysia was 0.004 and their genetic identity was 0.996, thus indicating that this insect species fees on both host plants. The proportion of polymorphic loci and the observed heterozygosities were higher in N. nigropictus, with a wider range of host plants, than in N. virescens and N. malayanus, restricted to rice and L. hexandra, respectively.
A study was carried out to determine optimal assay conditions for an in-house hybridisation assay for detection of hepatitis B virus (HBV) genome in serum samples. Pre-treatment of samples, blot treatment and hybridisation conditions were found to affect assay performance. The indirect serum blot procedure was more robust and reliable than direct serum blotting. In the former, viral particles were isolated from the sample, lysed and then extracted. In comparison, no approaches to the direct serum spot method performed adequately. Sensitivity studies showed that labelling of the nucleic acid probe with dCTP was more efficient than with dATP. Using probes labelled to a specific activity of > 1 x 10(8) and an autoradiography period of about 48 h we could achieve a detection limit of < 1 pg. Specificity was achieved by use of a highly purified probe and moderately stringent hybridisation and wash conditions. Background binding was minimal and there was no non-specific binding of probe to negative control samples. Factors affecting speed of the assay were studied to identify steps that could be modified to shorten assay time without sacrificing performance. A shorter centrifugation step and the use of a high specific-activity probe permitted completion of an assay within four days.
MeSH terms: DNA, Viral/blood*; Hepatitis B virus/isolation & purification*; Humans; Nucleic Acid Hybridization*; Sensitivity and Specificity; Virology/methods
Nonsedating selective peripheral H1 receptor antagonists are an important advance in antihistaminic therapy in allergic patients. This is a randomised, double-blind parallel group study comparing the use of two such agents viz loratadine 10mg daily and astemizole 10mg daily for two weeks in 39 Malaysian allergic rhinitis patients. At these dosages, both drugs were demonstrated to be efficacious (p < 0.05) for controlling nasal symptoms and safe in terms of short term biochemical and haematological changes and adverse effects noted. Evaluating efficacy criteria utilised in this study loratadine and astemizole were comparable but loratadine was significantly more effective in three areas viz: (i) in diminishing nasal symptoms after 2 weeks of treatment (p = 0.03); (ii) physician's efficacy evaluation after 2 weeks' treatment (p = 0.009); (iii) patient's efficacy evaluation after 2 weeks' treatment (p = 0.019).
Study site: Allergy clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
A descriptive study of 143 cases of clinically diagnosed measles in patients under the age of 12 years admitted to the Duchess of Kent Hospital, Sandakan, Sabah, during the year 1990 was carried out. The median age of the patients was one year and 13.3% of the cases were between the ages of 6 and 9 months. The male to female ratio was 1.3:1. The majority of the cases (85.3%) were not immunised against measles while 60.0% of the cases were malnourished. Most of the cases (86.0%) had at least one complication with 32.9% of the cases having more than one complications. The main complications were pneumonia (74.1%) and diarrhea (38.5%). Other complications were convulsions, otitis media and corneal ulceration/scarring. A case of pneumonia with mediastinal emphysema and subcutaneous emphysema was noted. The case fatality rate was 1.4% while blindness was the long term morbidity in 1.4% of the cases. Measles remains an important cause of morbidity in children in Sabah.
The outcome of 100 patients undergoing instrumental delivery with vacuum extractor is compared with that of 100 women delivered with the aid of obstetric forceps. Forceps deliveries were more commonly associated with maternal birth canal trauma (including episiotomy) whilst vacuum extractor carried higher odds of the neonate developing jaundice. Apart from these, there were no significant differences between these two groups in terms of maternal morbidity, neonatal trauma and morbidity and ultimate outcome (success with the type of instrument used). We conclude that with meticulous handling of the instrument and with an appropriate decision on the indication and the type of instrument used, the maternal and neonatal outcome could be equally good with the use of either instrument.
S. mansoni and S. japonicum complex schistosomes cause hepatosplenic and hepatointestinal schistosomiasis. The prevalence and incidence of this disease is increasing in all the endemic areas. Hepatosplenic schistosomiasis is seen in a small subset of clinically infected patients and represents a good model of intrahepatic portal hypertension characterised by a presinusoidal portal block and a well preserved liver parenchyma. Symmers' fibrosis is seen in a significant proportion of patients with high worm load. While the pathogenesis of Symmers' pipe stem fibrosis has not been well established, experimental and clinical data point to egg induced granulomata. The main consequences are presinusoidal portal hypertension, oesophageal varices and hepatosplenomegaly. The most striking symptoms are haematemesis or melena secondary to variceal and gastrointestinal bleeding. Cofactors associated with the pathogenesis include aflatoxins, malnutrition, alcoholism, hepatitis B and C virus. While stool examination is the best technique for diagnosis, a number of immunological tests though sensitive are not specific. Ultrasonography is sensitive for detection of Symmer's fibrosis. Praziquantel and oxaminiquine are drugs found to be effective in the treatment of hepatosplenic schistosomiasis. Recently beta-blockers have been found to be effective in the treatment of gastrointestinal rebleeding. Endoscopic sclerotherapy has been found to be effective for treatment of bleeding oesophageal varices. The treatment of choice for portal hypertension is oesophagogastric devascularization with splenectomy (EGDS).