MyMedR

Problems in diagnosis and classification of dengue virus infection

George R

Malays J Pathol, 1993 Jun;15(1):25-7.

Dengue haemorrhagic fever in Malaysia: a review

George R

Southeast Asian J Trop Med Public Health, 1987 Sep;18(3):278-83.

The historical background, epidemiology and changing pattern of clinical disease as seen in Malaysia is reviewed. The preliminary results of the longitudinal study of epidemiology of dengue in Malaysia is also presented. Studies led by Rudnick et al. over some 18 years have established that the disease is endemically transmitted by both Aedes aegypti and Aedes albopictus causing illnesses ranging from mild febrile episodes through classical dengue fever, dengue haemorrhagic fever and the dengue shock syndrome. The first epidemic occurred in 1962 in Penang, and the second major epidemic in 1974 in Selangor. From then on epidemics seem to occur every 4 years, i.e. 1978, and then in 1982. With increasing number of cases being seen from the end of 1985 and in 1986, and with the increasing numbers of positive virus isolates, another epidemic may occur this year. Though in the early years, mainly children were affected, recently more cases are being seen in 16-30 years age group. There is also a changing pattern in the clinical presentation of the cases. The clinician has to be aware of the various modes of presentation of this sinister disease. A high index of suspicion is needed for early diagnosis, as management is mainly symptomatic and there is no specific drug as yet to combat the shock and bleeding manifestations.

Bleeding manifestations of dengue haemorrhagic fever in Malaysia

George R, Duraisamy G

Acta Trop, 1981 Mar;38(1):71-8.

PMID: 6111919

Analysis of the bleeding manifestations of 130 cases of dengue haemorrhagic fever admitted into the Children's ward of the General Hospital, Kuala Lumpur from May 1973 to September 1978 has been done. Petechial skin rash, epistaxis and gum bleeding were seen most commonly in mild and moderately severe cases. However, blood stained gastric aspirates, and severe haematemesis were seen in severe or very severe cases. Though with better vector control and preventive measures, a marked reduction in the incidence of the cases has been noted, severe cases were seen with symptoms of shock and gastrointestinal bleeding. These symptoms carried a bad prognosis. Among 15 children that died 10 had gastrointestinal bleeding and 2 had a disseminated intravascular coagulation defect. Lymphocytosis with atypical lymphocytes, low platelet count, low reticulocyte count and raised packed cell volume were the main haematological features seen in all these cases. All these features reverted to normal within a week. Mild evidence of disseminated intravascular coagulation was seen in a number of cases, but severe features were seen only in four. Two cases improved as a result of heparin therapy.

Fulltext Resurrection of Bronchocela burmana Blanford, 1878 for the Green Crested Lizard (Squamata, Agamidae) of southern Myanmar

Zug GR, Mulcahy DG, Vindum JV

Zookeys, 2017.

PMID: 28331413 DOI: 10.3897/zookeys.657.11600

Recent fieldwork in southern Tanintharyi revealed the presence of a small Green Crested Lizard in the wet evergreen forest. We generated mtDNA sequence data (ND2) that demonstrates that this population's nearest relative is Bronchocela rayaensis Grismer et al., 2015 of Pulau Langkawi, northwestern Peninsular Malaysia and Phuket Island. Morphologically the Burmese Bronchocela shares many features with Bronchocela rayaensis, which potentially would make this recently described Thai-Malay species a synonym of Bronchocela burmana Blanford, 1878; however, we interpret the genetic and morphological differences to reflect evolutionary divergence and recommend the recognition of both species.

Dengue virus infection--the Malaysian experience

George R, Lam SK

Ann Acad Med Singap, 1997 Nov;26(6):815-9.

PMID: 9522985

Since dengue was first documented in Malaysia in 1902 and made notifiable in 1973, the disease pattern has changed from major outbreaks every four years to one of increasing trend yearly. The largest outbreak was seen in 1996 with 14,255 dengue cases reported and 32 deaths. The case fatality rate varied from a high of 10.43% in 1985 when dengue type 3 was the predominant type to a low of 1.29% when dengue type 1 predominated. Severe disease patterns have been observed with dengue 2 and 3 serotypes in the country. The clinical spectrum has also been changing and multisystem involvement with more severe manifestations are being seen. Liver involvement has been documented since 1987. Fulminant hepatitis with encephalopathy can resemble Reye's syndrome. Dengue type 3 has been isolated from liver biopsy specimens. Neurological manifestations can very from irritability, convulsions, coma to peripheral neuritis. The isolation of dengue viruses from cerebrospinal fluids recently strongly suggests that dengue viruses can be neurovirulent. Adult respiratory distress syndrome was seen in three children admitted with shock. Deaths were more frequent in children in the early period but since 1982, over 50% of deaths have occurred in patients over the age of 15 years.

Abnormal haemoglobins and hereditary ovalocytosis in the Ulu Jempul District of Kuala Pilah, West Malaysia

Ganesan J, George R, Lie-Injo LE

Southeast Asian J Trop Med Public Health, 1976 Sep;7(3):430-3.

PMID: 1025742

A survey of abnormal haemoglobins and hereditary ovalocytosis was carried out among 629 Malays of Minangkabau descent in the Ulu Jempul District of Kuala Pilah, in the state of Negri Sembilan in West Malaysia.. Several abnormal haemoglobins were found with the following frequencies: Hb E 5.25%, Hb CoSp 2.38%, Hb A2 indonesia 0.80%, a fast moving Hb with a Mobility between A and Bart's 0.64% and Hb Q 0.16%. Hereditary ovalocytosis was found in 13.2% of these people. None of the persons with hereditary ovalocytosis had any evidence of haemolysis.

Fulltext Hormonal changes in exfoliated normal buccal mucosal cells

Donald PM, George R, Sriram G, Kavitha B, Sivapathasundharam B

J Cytol, 2013 Oct;30(4):252-6.

PMID: 24648669 DOI: 10.4103/0970-9371.126655

The present study was undertaken as a baseline study to evaluate the nuclear diameter (ND), cell diameter (CD) and nuclear-cytoplasmic ratio (N:C) and their variation with age in normal buccal smears of female subjects.

Fulltext Common variable immunodeficiency (hypogammaglobulinemia) with an autosomal recessive pattern of inheritance

Lokman MN, George R, Sukumaran S, Nasuruddin BA

Med J Malaysia, 1988 Sep;43(3):237-42.

PMID: 3241582

Fulltext Hepatitis B infection in multitransfused thalassaemics

George E, Ilina I, Yasmin AM, George R, Duraisamy G

Med J Malaysia, 1988 Dec;43(4):284-7.

PMID: 3241594

A study on mental retardation in Malaysian children

George R, Hoi Sen Y, Lim G, Boo LJ

Med J Malaysia, 1975 Dec;30(2):83-7.

PMID: 1228386

Mosquito-borne haemorrhagic fever

George R, Kassim MS, Wah LT

Med J Malaysia, 1974 Sep;29(1):11-6.

PMID: 4282623

Fulltext Serum ferritin concentrations in transfusion dependent beta-thalassaemia

George E, Wong HB, George R, Ariffin WA

Singapore Med J, 1994 Feb;35(1):62-4.

PMID: 8009283

Patients on a moderate red cell transfusion programme have iron overload where the concentrations of the serum ferritin were inappropriate to increases in the transfusion load as a result of limitations of apoferritin synthesis and conversion of ferritin into haemosiderin. This study confirms the limitations for the use of estimations of the serum ferritin to evaluate the iron status in patients with expected high overload as would be seen in patients on many years of maintenance red cell transfusions in the absence of iron chelation therapy. Poor compliance, inadequate dosage of Desferal (deferoxamine), and the late initiation of iron chelation therapy were factors that were considered in the patients with failure of response to iron chelation.

Fulltext Fulminant hepatitis in dengue infection

Lum LC, Lam SK, George R, Devi S

Southeast Asian J Trop Med Public Health, 1993 Sep;24(3):467-71.

PMID: 8160054

Eight cases of liver failure and encephalopathy were observed among twenty cases of grade 3 and grade 4 dengue hemorrhagic fever/dengue shock syndrome admitted to the Department of Pediatrics, University Hospital, Kuala Lumpur from January 1990 to December 1991. All patients with deterioriation in mental status showed a marked increase in liver enzymes (aspartate and alanine aminotransaminases) and severe coagulopathy. Six patients needed cerebral protection, including ventilation, intravenous sedation and muscle relaxants. There was one death during the period of study and one case of residual hemiparesis in a boy who had, in addition, intracerebral hemorrhage. All other survivors had complete recovery of liver and neurological function.

Dengue encephalitis: a true entity?

Lum LC, Lam SK, Choy YS, George R, Harun F

Am J Trop Med Hyg, 1996 Mar;54(3):256-9.

PMID: 8600761 DOI: 10.4269/ajtmh.1996.54.256

Involvement of the central nervous system in dengue fever and dengue hemorrhagic fever has always been thought to be secondary to vasculitis with resultant fluid extravasation, cerebral edema, hypoperfusion, hyponatremia, liver failure, and/or renal failure. Thus, the condition has been referred to as dengue encephalopathy. Encephalitis or direct involvement of the brain by the virus was thought to be unlikely. This paper reports on six children who were seen over a period of two years presenting on the second or third day of illness with dengue encephalitis. The diagnosis was based upon a clinical picture of encephalitis and confirmed by cerebrospinal fluid (CSF) microscopy and electroencephalography changes. All six cases were confirmed dengue infections. Dengue 3 virus was isolated from the CSF of four cases and in one case, dengue 2 was detected by the polymerase chain reaction in both the CSF and blood. In the sixth case, virologic evidence was negative but dengue immunoglobulin M was detected in the CSF and blood. Since the onset of encephalitis appears early in the course of illness coinciding with the viremic phase, we postulate that the virus crosses the blood-brain barrier and directly invades the brain causing encephalitis. This study provides strong evidence that dengue 2 and 3 viruses have neurovirulent properties and behave similarly to other members of the Flaviviridae.

Fulltext Spectrum of beta-thalassaemia mutations in transfusion dependent thalassaemia patients: practical implications in prenatal diagnosis

George E, George R, Ariffin WA, Mokhtar AB, Azman ZA, Sivagengei K

Med J Malaysia, 1993 Sep;48(3):325-9.

PMID: 8183146

The study concerned the identification of the beta-thalassaemia mutations that were present in 24 patients with beta-thalassaemia major who were transfusion dependent. The application of a modified polymerase chain reaction, the amplification refractory system (ARMS) was found to be an effective and rapid method for the identification of the beta-thalassaemia mutations. Six different mutations were detected. Seventy five percent of the patients were Chinese-Malaysians and showed the commonly occurring anomalies: 1. frameshift codon 41 and 42 (-TCTT); 2. the C to T substitution at position 654 of intron 2 (IVS-2); 3. the mutation at position -28(A to G); and the nonsense mutation A to T at codon 17. In the Malays, the common mutations seen were: 1. the G to C mutation at position 5 of IVS-1; 2. the G to T mutation at position 1 of intron 1 (IVS-1); and the A to T at codon 17. The delineation of the specific mutations present will enable effective prenatal diagnosis for beta-thalassaemia to be instituted.

Severe protein-energy malnutrition in Kuala Lumpur

George R, Foo LC, Chong YH, Abraham SC

J Trop Pediatr, 1981 10;27(5):259-62.

PMID: 6798223 DOI: 10.1093/tropej/27.5.259

Fulltext Group A streptococcal skin infection in childhood

Jamal F, Minhaj AA, Kasim MS, Zainal Z, George R

Family Practitioner, 1985;8(2):53-56.

Bacterial skin infection was studied in 239 children between the ages of 1 and 12 years in an urban squatter area in Kuala Lumpur over a period of three months (January - March 1983). 62 children presented with dermatological problems, 33 of which were clinically diagnosed as pyoderma. Microbiological examination of swabs from the lesions yielded mixed growth from 54.5% (18/33) specimens. Beta-haemolytic streptococci were isolated from 63.6% (21/33) and Staphylococcus aureus from 54.5% (18/33) specimens. All streptococcal isolates were grouped with a commercial kit, the Streptex (Wellcome). 81% (17/21) belonged to Lancefield's group A, 90% of which were not M or T typable by the standard international set of antisera. Urine analysis, pharyngeal swab culture and determination of anti-streptococcal antibody titre were also performed for children with positive skin cultures for group A streptococcus. 6% (2/33) of children with impetigo developed acute glomerulonephritis, requiring hospitalization.
Study site: Growth and nutrition clinic, squatter area, Kuala Lumpur, Malaysia

Interaction of haemoglobin E with alpha-thalassaemia and haemoglobin Constant Spring

Ganesan J, Lie-Injo LE, Ng TS, George R

Acta Haematol., 1977;57(2):109-15.

PMID: 402765 DOI: 10.1159/000207867

The combination of Hb E,alpha-thalassaemia and Hb CoSp was found in a 20-year-old female Malay who presented with a moderately severe haemolytic anaemia. The findings in the patient and her family from which this diagnosis was arrived at are discussed. Although this is the first report of this condition in this country it is pointed out that one may see more such cases in the future if one is aware of this condition since Hb E, alpha-thalassaemia and Hb CoSp all occur at significant frequencies in this country.

Fulltext The effects of temperature on extracted teeth of different age groups: A pilot study

George R, Tan WJ, Shih Yi AL, Donald PM

J Forensic Dent Sci, 2018 4 17;9(3):165-174.

PMID: 29657495 DOI: 10.4103/jfo.jfds_25_16

Context: Type of dentition and age related changes may affect the behavior of dental hard tissues under thermal stress.

Aim: This study was conducted to analyze the effects of varying temperatures on extracted teeth of different age groups in a simulated laboratory set up.

Settings and Design: Experimental pilot study.

Methods and Material: Extracted teeth from three age groups (deciduous, young permanent and adult permanent) were collected and were exposed to three different temperatures (400°C, 700°C and 1000°C) in a laboratory set up. Post-test changes were analyzed visually and radiographically.

Results: (1) The colour changes of the teeth may serve as an indicator for the temperature to which they were exposed. (2) Deciduous teeth tolerated thermal stress with lesser morphological changes compared to young and adult permanent teeth. (3) Coronal dentin of elderly permanent teeth appeared to be more resistant to thermal stress compared to that of young permanent teeth. (4) The root portion of the teeth showed better tolerance to temperature while crown was fragmented easily under thermal stress.

Conclusion: The age factor and type of the dentition may influence the heat induced changes in teeth. These variables should be taken into consideration while applying comparative dental identification methods where dental hard tissues are exposed to extreme temperatures.

Antineoplastic agents. 522. Hernandia peltata (Malaysia) and Hernandia nymphaeifolia (Republic of Maldives)

Pettit GR, Meng Y, Gearing RP, Herald DL, Pettit RK, Doubek DL, et al.

J Nat Prod, 2004 Feb;67(2):214-20.

PMID: 14987061

Bioassay (P388 lymphocytic leukemia cell line and human tumor cell lines)-guided separation of the extracts prepared from the tropical and coastal trees Hernandia peltata (Malaysia) and Hernandianymphaeifolia (Republic of Maldives) led to the isolation of a new lignan designated as hernanol (1) and 12 previously known lignans: (-)-deoxypodophyllotoxin (2), deoxypicropodophyllin (3), (+)-epiaschantin (4), (+)-epieudesmin (5), praderin (6), 5'-methoxyyatein (7), podorhizol (8), deoxypodorhizone (9), bursehernin (10), kusunokinol (11), clusin (12), and (-)-maculatin (13). The oxidative cyclization (with VOF(3)) of lignans 8, 9, and 10 resulted in a new and unusual benzopyran (14), isostegane (15), and a new dibenzocyclooctadiene lactone (16), respectively. The structure and relative stereochemistry of hernanol (1) and lignans 3, 7, 8, 9, 10, 11, and 12 were determined by 1D and 2DNMR and HRMS analyses. The structures and absolute stereochemistry of structures 2, 4, 5, 6, 13, 14, 15, and 16 were unequivocally determined by single-crystal X-ray diffraction analyses. Evaluation against the murine P388 lymphocytic leukemia cell line and human tumor cell lines showed podophyllotoxin derivatives 2 and 3 to be strong cancer cell line growth inhibitors and substances 4, 5, 8, and 15 to have marginal cancer cell line inhibitory activities. Seven of the lignans and one of the synthetic modifications (14) inhibited growth of the pathogenic bacterium Neisseria gonorrhoeae.

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