Browse publications by year: 1996

  1. Ahmad Z, Daw W, Isa A
    Malays J Nutr, 1996 Sep;2(2):148-54.
    PMID: 22692137 MyJurnal
    A survey of infant-feeding and weaning practices of 566 mothers, systematically sampled from 15 rural villages, randomly selected in the district of Tumpat, Kelantan was carried out. Almost all mothers (97.3%) breastfed their children, reinforcing the previously reported high incidence of breast-feeding among rural Malaysian mothers. One hundred and seventeen (21.3%) of the 551 children breastfed were also given mixed feeding with infant fomulae as well. Weaning started before 4 months of age in 28.3% of the children and after 6 months of age in 12.8% of the children. The 3 most common type of food used in weaning were Nestum (45.0%), rice porridge or paste (42.6%) and wheat porridge or cakes (11.5%). Forty eight children (12.1%) discontinued breastfeeding once weaning was initiated. The main reasons for initiating weaning was mothers' perception that there was insufficient milk and that the child was always hungry (55.7%). Most mothers were also given advice by the health clinic staff on weaning, including the timing and the suitable weaning foods to give. All of the mothers were able to name at least one commercial weaning food product available in their community.
    MeSH terms: Breast Feeding; Child; Female; Health Surveys; Humans; Infant; Infant Nutritional Physiological Phenomena; Malaysia; Milk; Mothers; Surveys and Questionnaires; Weaning
  2. Ismail MN, Isa M, Janudin A
    Malays J Nutr, 1996 Sep;2(2):168-74.
    PMID: 22692139 MyJurnal
    The energy intake and expenditure of 20 healthy soldiers (mean age, 25 years, weight 61 kg and height 1.67 m) was assessed. Trained personnel stayed in the camp throughout the 5 weeks study period. Each soldier was subjected to a 7-day comprehensive protocol involving anthropometric, food intake, activity pattern and energy expenditure measurements. The mean change in body weight and fat content was minimal, -0.2kg and -0.25%, respectively. Body fat and BMI ranges from 10.0-21.6% and 19.8-24.9, respectively. The mean energy intake of 2190 ± 197 kcal was well below (81%) the recommended allowance of 2700 kcal for the Malaysian Armed Forces. The ration scale analysed chemically provides 2900 kcal thus suggesting a 24% wastage of daily ration. Contribution of protein (15%), fat (25%) and carbohydrate (60%) to energy intake appears to be in line to healthy dietary guidelines. Energy cost of standardised activities were found to be lower in Malaysian soldiers as compared to British soldiers studied under similar environment in the tropics. The mean total daily energy expenditure (TDEE) for soldiers were 2886 ± 222 kcal with a negative energy balance of about 700 kcal. The results suggested that there is a need to review the current provision with regard to food supply and preparation in army camps, to ensure that the menu provided are appealing as well as nutritious for the soldiers.
  3. Hair-Bejo M, Alimon A, Maria J, Hass M, Moonafizad M
    Malays J Nutr, 1996 Sep;2(2):196-206.
    PMID: 22692141
    Thirty, 4 month-old male Maim x Polled Dorset crossbred sheep were allocated into 6 groups of 5 animals each. Four groups of animals were stall-fed with basal diet of 90% palm kernel cake (PKC) and 10% grass (G) for 16 weeks. One group of the animal was slaughtered at the end of the 16 weeks feeding trial (PKC group), whilst the other three groups were further fed with either the same diet (PKC+PKC group) or fed with a new diet consisting of 30% corn and 10% fish meals (CF) and grass (60%) either with (PKC+CF+Zn group) or without (PKC+CF group) zinc supplementation (500 mg/g Zn as zinc sulfate) for another 16 weeks and were slaughtered at the end of the feeding trial, The other two groups which act as controls were fed with corn (30%) and fish meals (10%) and grass (60%), and were slaughtered at weeks 16 (CF group) and 32 (CF+CF group) of the trial. The blood, right and left liver, renal cortex and medulla, pancreas, bile and urine of all animals were analysed for copper and zinc contents using an atomic absorption spectrophotometer. The liver and kidney were also fixed in 10% buffered formalin for histopathological examination. The study showed that neither clinical signs nor gross lesions of copper or zinc toxicity were observed throughout the trial. However, the copper concentration in both the right and left liver of PKC fed sheep at weeks 16 and 32 rose to about 3 times that of the controls and remained high in both the PKC+CF and PKC+CF+Zn groups. A similar pattern of copper concentration was observed in the blood. The copper and zinc contents in the renal cortex and medulla, pancreas, bile and urine remained low in all groups. The zinc content in the liver of PKC+CF+Zn group was significantly increased. Histologically, moderate hepatic lesions were observed in the PKC fed sheep at week 32. The lesions were milder in the other groups especially in the PKC+CF+Zn group. No significant renal lesions was recorded in all groups. It was concluded that the usage of dietary zinc supplementation (500 mg/g) in the treatment of PKC toxicity in sheep was unsatisfactory. The ability of Malin x Polled Dorset crossbred sheep to tolerate the high copper content in PKC at least during the first 16 weeks of the feeding trial may provide more avenue in the utilization of PKC as a major feed ingredient in sheep.
  4. Low WY, Zulkifli SN, Yusof K, Batumalail S, Aye KW
    Drug Alcohol Depend, 1996 Oct;42(2):105-15.
    PMID: 8889409
    A survey was carried out to gather information on knowledge, attitudes and perception of parents and their children in relation to drug abuse matters. Significantly more teenagers knew more of the cause of drug addiction, as well as places for treatment and rehabilitation. Both teenagers and parents were also aware of reasons why drug addicts find it difficult to change their habits, mainly lacking motivation to stop taking drugs and that drug addicts do not have the power to control themselves. Teenagers were significantly more aware of effects of negative parental attitudes contributing to drug abuse, apart from school factors. Personal experiences before abusing drugs such as knowledge of pleasurable effects of drugs and where to obtain them has also a role to play in leading to drug abuse. There was also agreement that unfulfilled needs such as 'not being respected recognised for ones capabilities' and 'not being loved or treated fairly by parents', were causes of drug abuse. Significantly more teenagers knew of the ways of abusing drugs, mainly by injection, smoking and sniffing, and also sources of information via the mass media, social clubs, rehabilitation centres and schools. However, both the parents and teenagers were relatively ignorant of the long term effects of abusing drugs.
    MeSH terms: Adolescent; Adult; Child; Cross-Cultural Comparison*; Ethnic Groups/psychology*; Humans; Health Knowledge, Attitudes, Practice*; Malaysia/epidemiology; Middle Aged; Parent-Child Relations; Parents/psychology*; Peer Group; Sampling Studies; Social Control, Informal; Social Desirability; Substance-Related Disorders/epidemiology; Substance-Related Disorders/psychology*; Substance-Related Disorders/rehabilitation
  5. Wells JC, Strickland SS
    Eur J Clin Nutr, 1996 Oct;50(10):668-71.
    PMID: 8909933
    To evaluate the effect of different methods (plateau or back extrapolation) of calculating total body water (TBW) from deuterium dilution in an environment characterised by high water turnover. The back extrapolation model is assumed to be more accurate when water turnover is high.
    MeSH terms: Adult; Body Water/metabolism; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Nutritional Status*; Rural Population; Body Mass Index*
  6. Razali SM, Khan UA, Hasanah CI
    Acta Psychiatr Scand, 1996 Oct;94(4):229-33.
    PMID: 8911557
    The concept of aetiology of mental illness in 134 Malay patients was investigated by means of a 20-item checklist. About 53% of the patients attributed their illnesses to supernatural agents. Witchcraft and possession by evil spirits were regarded as common causes of illness. The number of patients who believed in supernatural causes of their mental illness was significantly higher among those who had consulted bomohs (Malay traditional healers) than among those who had not consulted them. The belief that mental illness is caused by supernatural agents is firmly held by bomohs, who reinforce this notion in those who seek their advice. Belief in supernatural causes of mental illness was not significantly associated with age, gender, level of education or occupation of the patients. Patients who believed in supernatural causes of mental illness were also found to show poor drug compliance, and the number of such patients at 6 months follow-up was significantly lower than the corresponding figure for those who did not believe in supernatural causes. The importance of understanding the patients' cultural background when treating psychiatric patients is highlighted.
    MeSH terms: Adolescent; Adult; Aged; Mental Disorders/psychology*; Mental Disorders/therapy; Ethnic Groups/psychology*; Female; Follow-Up Studies; Humans; Magic*; Malaysia; Male; Medicine, Traditional*; Mental Healing; Middle Aged; Patient Admission; Patient Compliance/psychology; Psychotic Disorders/psychology; Psychotic Disorders/therapy; Psychotropic Drugs/administration & dosage; Witchcraft*
  7. Choo KE, Davis TM, Mansur MA, Azman E, Achana S
    J Paediatr Child Health, 1996 Oct;32(5):428-32.
    PMID: 8933405
    OBJECTIVE: Preliminary epidemiological data suggest that dyslipidaemia contributes significantly to rising mortality due to atherosclerosis in Peninsular Malays. The aim of this study was to determine whether abnormal serum lipid profiles are present at birth in this population.

    METHODOLOGY: The patients were 487 non-diabetic Malay women who had an uncomplicated antenatal course and delivered healthy singleton babies at term. Cord blood and maternal post-partum venous blood samples were taken for assay of serum cholesterol and triglyceride concentrations using standard enzymatic methods.

    RESULTS: Maternal total serum cholesterol concentrations (mean +/- SD; 7.5 +/- 2.5 mmol/L) were higher than in other reported series (range of published means 5.2-6.5 mmol/L) with a correspondingly low high-density lipoprotein (HDL): total cholesterol ratio. The mean cord blood total serum cholesterol (1.7 +/- 1.0 mmol/L) was consistent with previously reported population means (1.5-1.9 mmol/L) but there was a relatively high low-density lipoprotein (LDL)-cholesterol and depressed HDL: cholesterol ratio. Significant correlations between maternal and neonatal serum total (P = 0.038) and especially HDL-cholesterol (P < 0.001) were observed. Maternal and cord blood serum triglyceride levels were comparable to those in other series.

    CONCLUSIONS: These cross-sectional data provide evidence that abnormal serum cholesterol profiles are found in pregnant Malay women and their neonates which may have implications for the prevalence of macrovascular disease in the Malay population.

    MeSH terms: Adult; Cholesterol/blood; Cross-Sectional Studies; Female; Fetal Blood/chemistry*; Humans; Hyperlipidemias/blood*; Hyperlipidemias/etiology; Hyperlipidemias/epidemiology; Infant, Newborn; Lipids/blood*; Malaysia/epidemiology; Male; Pregnancy; Triglycerides/blood
  8. Boo NY, Ong LC, Lye MS, Chandran V, Teoh SL, Zamratol S, et al.
    J Paediatr Child Health, 1996 Oct;32(5):439-44.
    PMID: 8933407
    OBJECTIVE: To compare the morbidities in the very low birthweight (VLBW; < 1500 g) and normal birthweight (NBW; > or = 2500 g) Malaysian infants during the first year of life.

    METHODOLOGY: Prospective observational cohort study of consecutive surviving VLBW infants and randomly sampled NBW infants born in the Kuala Lumpur Maternity Hospital between 1 December 1989 and 31 December 1992. Infants were followed up regularly during the first year of life, after correction for prematurity.

    RESULTS: Compared with NBW infants (n = 106), VLBW infants (n = 127) had significantly higher risk of failure to thrive (odds ratio [OR] = 8.0, 95% confidence intervals [CI]: 1.1 to 354.3), wheezing (OR = 3.7, 95% CI: 1.6 to 9.3), rehospitalization (OR = 2.3, 95% CI: 1.1 to 5.0), cerebral palsy (OR = 8.6, 95% CI: 2.0 to 77.6), neurosensory hearing loss (OR = 12.0, 95% CI: 1.7 to 513.6) and visual loss (7.9 vs 0%, P = 0.002). The mean mental developmental index (MDI) and mean psychomotor developmental index (PDI) at 1 year of age were significantly lower among VLBW infants (MDI 99 [SD = 28], PDI 89 [SD = 25]) than NBW infants (MDI 106 [SD = 18], PDI 101 [SD = 18]) (95% CI for difference between means being MDI: -14.1 to -1.7; and PDI: -17.6 to -6.0). Logistic regression analysis showed that among VLBW infants: (i) male sex, Malay ethnicity and bronchopulmonary dysplasia were significant risk factors associated with wheezing; (ii) longer duration of oxygen therapy during the neonatal period, seizures after the post-neonatal period and wheezing were significant risk factors associated with rehospitalization; and (iii) longer duration of oxygen therapy during the neonatal period was a significant risk factor associated with adverse neurodevelopmental outcome during the first year of life.

    CONCLUSIONS: Compared with NBW infants, VLBW Malaysian infants had significantly higher risks of physical and neuro-developmental morbidities.

    MeSH terms: Central Nervous System Diseases/etiology; Child Development/physiology; Developing Countries; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Malaysia/epidemiology; Male; Patient Readmission/statistics & numerical data; Prospective Studies; Respiration Disorders/etiology; Risk Factors; Vaccination/statistics & numerical data; Confidence Intervals; Logistic Models; Odds Ratio; Case-Control Studies; Infant, Very Low Birth Weight/growth & development*
  9. Ahmad A
    J Soc Psychol, 1996 Oct;136(5):663-5.
    PMID: 8942323 DOI: 10.1080/00224545.1996.9714054
    MeSH terms: Conflict (Psychology)*; Family*; Female; Humans; Job Satisfaction; Malaysia; Mothers/psychology*; Personal Satisfaction; Surveys and Questionnaires; Regression Analysis; Women, Working/psychology*; Spouses/psychology*
  10. Indudharan R, Haq JA
    J Laryngol Otol, 1996 Oct;110(10):950-1.
    PMID: 8977860
    A simple, safe and effective procedure for improving the bacterial isolation in chronic suppurative otitis media (CSOM) is described. It is most useful for the isolation of aerobes as well as anaerobes from the middle ear.
    MeSH terms: Bacteria, Anaerobic/isolation & purification; Bacteriological Techniques*; Child; Humans; Otitis Media, Suppurative/microbiology*; Specimen Handling
  11. Quah BS, Menon BS
    Clin Genet, 1996 Oct;50(4):232-4.
    PMID: 9001806
    Down syndrome may be associated with many complications. Among the malignancies associated with Down syndrome, leukaemia is the most common. This is a case report of a patient with Down syndrome associated with both a retroperitoneal teratoma and a Morgagni hernia.
    MeSH terms: Down Syndrome/complications*; Hernia, Diaphragmatic/complications*; Humans; Infant; Male; Peritoneal Neoplasms/complications*; Teratoma/complications*
  12. Lim SK, Lim WL, Elegbe EO
    West Afr J Med, 1996 Oct-Dec;15(4):186-9.
    PMID: 9020593
    30 patients who received electroconvulsive therapy were anaesthetized with either Propofol or Methohexitone in a randomized cross-over study. Recovery times were shorter in those who received Propofol. The decrease in diastolic pressure after induction was greater with Propofol than with Methohexitone. There was a greater increase in the blood pressure after the electroconvulsive therapy in those who received Methohexitone. The duration of convulsion was similar for both agents.
    MeSH terms: Adolescent; Adult; Blood Pressure/drug effects; Electroconvulsive Therapy*; Female; Humans; Male; Methohexital/therapeutic use*; Middle Aged; Time Factors; Propofol/therapeutic use*; Cross-Over Studies; Anesthetics, Intravenous/therapeutic use*
  13. George E, Mokhtar AB, Azman ZA, Hasnida K, Saripah S, Hwang CM
    Singapore Med J, 1996 Oct;37(5):501-4.
    PMID: 9046203
    Haemoglobin Bart's hydrops fetalis is the result of complete absence of functional alpha-globin genes where the fetus is homozygous for the alpha 0-thal gene. Prenatal diagnosis can be made by analysis of fetal DNA from chorionic villus, amniotic cells and fetal blood. Earlier studies for analysing genomic DNA needed digestion with restriction enzymes and hybridisation to radiolabelled probes which took 2 weeks. We have used the polymerase chain reaction (PCR) and non-radioactive primers to identify specific target sequences with results available within 1-3 days for the diagnosis of haemoglobin Bart's syndrome. With fetal blood samples, complete absence of alpha-chain synthesis is confirmed by globin chain electrophoresis on cellulose acetate pH 6.0.
    MeSH terms: Base Sequence; Female; Humans; Malaysia; Molecular Sequence Data; Pregnancy; Prenatal Diagnosis/methods*; Sensitivity and Specificity; Hydrops Fetalis/diagnosis*; Hydrops Fetalis/immunology; Polymerase Chain Reaction; Ultrasonography, Prenatal; alpha-Thalassemia/diagnosis; alpha-Thalassemia/immunology
  14. Sivalingam N, Rajesvaran D
    Singapore Med J, 1996 Oct;37(5):547-8.
    PMID: 9046215
    Profuse bleeding after voluntary sexual intercourse is an uncommon reason for admission to the gynaecological wards. Out of 12 such patients admitted to the Ipoh Hospital over a three-year period, one patient had life-threatening upper vaginal injury after coitus. Blood replacement and conventional suturing failed to arrest the bleeding. Bilateral internal iliac artery ligation promptly arrested further haemorrhage. Vigorous intercourse increases intra-abdominal pressure in women causing tensing of the cul-de-sac, decreasing the elasticity of the posterior fornix, resulting in vaginal laceration. Bilateral internal iliac artery ligation produces a 'pelvic compartment hypotension' converting a high arterial flow system to that of a low one resembling venous flow. The useful role of this procedure to contain pelvic haemorrhage is discussed.
    MeSH terms: Adult; Coitus*; Female; Hemorrhage/etiology*; Hemorrhage/surgery; Humans; Iliac Artery/surgery*; Ligation; Vagina/injuries*; Vaginal Diseases/etiology*; Vaginal Diseases/surgery
  15. Indudharan R, Das PK, Thida T
    Singapore Med J, 1996 Oct;37(5):559-61.
    PMID: 9046219
    Verrucous carcinoma of the paranasal sinuses is a rare malignant tumour. It occurs most frequently in the oral cavity and larynx. We present a case of extensive verrucous carcinoma of the maxillary sinus. This paper discusses the clinical and histological features and modes of treatment. All previous reports of verrucous carcinoma cases of paranasal sinuses are reviewed.
    MeSH terms: Adult; Combined Modality Therapy; Facial Bones/pathology*; Humans; Male; Maxilla/pathology; Skull Neoplasms/diagnosis*; Skull Neoplasms/pathology; Skull Neoplasms/therapy; Carcinoma, Verrucous/diagnosis*; Carcinoma, Verrucous/pathology; Carcinoma, Verrucous/therapy; Disease-Free Survival
  16. Yadav M, Arivananthan M, Kumar S
    Clin Diagn Virol, 1996 Oct;7(1):23-33.
    PMID: 9077427
    BACKGROUND: Human herpesvirus type 6 (HHV-6), an ubiquitous virus, is the causative agent for exanthem subitum. The virus is frequently associated with lymphoproliferative disorders and other diseases. Recently, we have reported the frequent presence of HHV-6 in oral carcinoma and the present study extends the observation to cervical carcinoma.

    OBJECTIVE: To examine the presence of HHV-6 in cervical carcinoma.

    STUDY DESIGN: Formalin-fixed, paraffin-embedded cervical carcinoma tissues were examined for the presence of HHV-6 by immunohistochemistry using two monoclonal antibodies that react to HHV-6-encoded p41/38 and gp116/64/54. In situ hybridization with variant-specific probes were used to type the HHV-6 DNA sequences present.

    RESULTS: A total of 14/26 (53.9%) carcinoma tissue specimens and 5/8 (62.5%) normal tissue specimens were positive for viral antigens. In situ hybridization studies revealed the presence of HHV-6 DNA sequences in 10/26 (38.5%) carcinoma tissue specimens and 1/8 (12.5%) normal tissue specimens. In the normal tissue, the HHV-6 was present in the endocervical ciliated columnar-epithelial cells and some cells in the subepithelial mucosa but in the carcinoma, the transformed cells were positive for the virus.

    CONCLUSIONS: HHV-6 viral proteins and DNA were found in more than one third of the cervical tissue examined suggesting possible viral expression in these tumours. The significance of the distribution and role of the HHV-6 in cervical tissue remains unclear. Since HHV-6 has an oncogenic potential, the virus may cooperate with other transforming agents for the progression of the disease.

    MeSH terms: Antigens, Viral/analysis*; Carcinoma, Squamous Cell/virology*; Uterine Cervical Neoplasms/virology*; DNA, Viral/analysis*; Exanthema Subitum/pathology; Exanthema Subitum/virology*; Female; Humans; Herpesvirus 6, Human/genetics; Herpesvirus 6, Human/immunology; Herpesvirus 6, Human/isolation & purification*; In Situ Hybridization
  17. Shimbo S, Moon CS, Zhang ZW, Watanabe T, Ismail NH, Ali RM, et al.
    Tohoku J Exp Med, 1996 Oct;180(2):99-114.
    PMID: 9111760
    Nutrient intake was surveyed by the total food duplicate method in 49 adult ethnically Malay women (at the ages of 18 to 47 years and mostly at 30-39 years) working in Kuala Lumpur, Malaysia. Simultaneously, hematological examinations, serum biochemistry, anthropometry and clinical examination were conducted. Nutrient intakes were estimated in reference to the weight of each food item and the standard food composition tables. Lunch was the most substantial meal of the day with rice as a staple food. Compared with the Recommended Dietary Allowance (RDA) values, daily intakes of energy (1,917 kcal as an arithmetic mean), protein (62.2 g), vitamin B1 (0.83 mg) and vitamin B2 (1.18 mg) were sufficient, but intakes of minerals [i.e., calcium (347.8 mg) and iron (12.5 mg)] and some vitamins [i.e., vitamin A (equivalent to 627 micrograms retinol) and niacin (7.84 mg)] were less than RDA. When evaluated on an individual basis, the prevalence of those who took less than 80% RDA was highest for iron (92%), followed by niacin (80%), calcium (57%) and vitamin A (57%). The presence of 7 hypohemoglobinemia cases may be related to the insufficient iron intake. Overweight cases (14 women) were also detected, the prevalence of which increased at advanced ages. Lipid intake was rather high (28% of total food on energy basis), for which the major source was plants with limited contribution from fish/shellfish.
    MeSH terms: Adolescent; Adult; Anthropometry; Energy Intake; Diet*; Ethnic Groups; Female; Humans; Malaysia; Middle Aged; Nutritional Requirements; Nutritional Status*; Personnel, Hospital; Physical Examination; Women, Working*; Nutrition Assessment; Body Mass Index
  18. Nik-Hussein NN, Abdul Majid Z
    J Clin Pediatr Dent, 1996;21(1):15-9.
    PMID: 9161200
    The study consisted of analysis of all cases of anomalies in the primary dentition that were seen or treated by the authors in the Department of Children's Dentistry and Orthodontics. A total of 79 occurrences of anomalies was seen in 65 children. The anomalies detected were double teeth, hypodontia and supernumerary teeth. Radiographic examinations of the affected children showed that over 60% of the cases with anomalies in the primary dentition are associated with anomalies of the succadeneous permanent dentition. All subjects with hypodontia of the primary dentition presented with hypodontia of the permanent dentition. However, anomalies of the permanent dentition were seen in 59% of subjects with primary double tooth and 50% of subjects with primary supernumerary tooth.
    MeSH terms: Anodontia/epidemiology; Child; Cuspid/abnormalities; Female; Fused Teeth/epidemiology; Humans; Incisor/abnormalities; Malaysia/epidemiology; Male; Tooth, Supernumerary/epidemiology; Prevalence; Dentition, Permanent*
  19. Poh BL, Khairuddean M
    Talanta, 1996 Oct;43(10):1727-31.
    PMID: 18966659
    A non-cyclic tetrameric structure has been suggested for calcichrome (calcion). This structure is consistent with its mass spectrum, proton NMR spectrum, elemental composition and complexing ability with polyaromatic hydrocarbons in water. The stability constants of the 1:1 complexes formed between calcichrome and seven polyaromatic hydrocarbons in water at room temperature have been measured.
    MeSH terms: Hydrocarbons, Aromatic; Magnetic Resonance Imaging; Naphthalenesulfonates; Magnetic Resonance Spectroscopy; Protons; Temperature; Water
  20. Cassol S, Weniger BG, Babu PG, Salminen MO, Zheng X, Htoon MT, et al.
    AIDS Res Hum Retroviruses, 1996 Oct 10;12(15):1435-41.
    PMID: 8893051
    Global surveillance of HIV-1 subtypes for genetic characterization is hampered by the biohazard of processing and the difficulties of shipping whole blood or cells from many developing country regions. We developed a technique for the direct automated sequencing of viral DNA from dried blood spot (DBS) specimens collected on absorbent paper, which can be mailed unrefrigerated in sturdy paper envelopes with low biohazard risk. DBS were collected nonrandomly from HIV-1-infected, mostly asymptomatic, patients in five Asian countries in 1991, and shipped via airmail or hand carried without refrigeration to Bangkok, and then transshipped to North America for processing. After more than 2 years of storage, including 6 months at ambient temperatures, proviral DNA in the DBS was amplified by nested PCR, and a 389-nucleotide segment of the C2-V3 env gene region was sequenced, from which 287 base pairs were aligned and subtyped by phylogenetic analysis with neighbor-joining and other methods. From southern India, there were 25 infections with subtype C and 2 with subtype A. From Myanmar (Burma), we identified the first subtype E infection, as well as six subtype BB, a distinct cluster within subtype B that was first discovered in Thailand and that has now appeared in China, Malaysia, and Japan. From southwest China, one BB was identified, while a "classical" B typical of North American and European strains was found in Indonesia. From Thailand, five DBS of ambiguous serotype were identified as three B, one BB, and one E. A blinded control serotype E specimen was correctly identified, but a serotype BB control was not tested. Most HIV-1 in southern India appears to be env subtype C, with rare A, as others have reported in western and northern India. The subtypes BB and E in Myanmar, and the BB in China, suggest epidemiological linkage with these subtypes in neighboring Thailand. DBS are a practical, economical technique for conducting large-scale molecular epidemiological surveillance to track the global distribution and spread of HIV-1 variants.
    MeSH terms: Myanmar/epidemiology; China/epidemiology; Female; HIV Seropositivity/epidemiology*; Humans; India/epidemiology; Indonesia/epidemiology; Male; Molecular Sequence Data; Risk Factors; Sexual Behavior; Thailand/epidemiology; HIV-1/genetics*; Molecular Epidemiology/methods*
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