Hospital records of children admitted to the department of Paediatrics, University Hospital, Kuala Lumpur, from January 1981 to December 1990, who were diagnosed to have acute rheumatic fever (ARF) were studied. 134 children satisfied the Jones' modified criteria, thus giving a hospital incidence of 21.2/100,000 paediatric admission per year, of which incidence of first attack was 15.8/100,000 per year and recurrent attack was 5.38/100,000 per year. The M:F ratio is 1.39:1. Majority of cases occur in the 6-11 years age group with 6 cases encountered below the age of 5. The Indians had a higher relative risk to develop both the first acute attack as well as recurrences with a relative risk of 2.4 and 4.10 respectively as compared to the Malays. Majority of the patients, irrespective of the ethnic group, came from families with low income.
A case of the Hutchinson-Gilford progeria syndrome (HGPS) in Malaysia is described. A brief discussion of this rare condition and its differential diagnosis follows.
19 cases of Kawasaki Syndrome were seen at the University Hospital, Kuala Lumpur between June 1979 and August 1984. The clinical features of the cases are reviewed in this paper. Kawasaki Syndrome is not an uncommon disease in Malaysia and clinicians should be aware of its presentation.
The halal logo(s) issued by JAKIM tend to confuse consumers as they greatly lacked information about the genuine halal logo. This was found by conducting open ended, but structured interviews from 20 Malays and showing them 10 halal logos (9 original and 1 fake) to see whether they could recognize the fake from the originals. This research found that while all the respondents had difficulty in differentiating the real halal logo from the fake, they all preferred a single, unified halal logo to end the confusion. This finding holds serious implications for JAKIM: it needs to extend efforts to educate people about the in-practice halal logo, without which many people would remain in the same confusion. This bears particular importance for the religious food requirements of Muslims as genuine halal logo determines the permissibility of food being taken.
In a cross-sectional study of 7 to 12-year-old primary school children in Kuala Lumpur, the prevalence of chronic cough and/or phlegm, persistent wheeze, and doctor-diagnosed asthma were 8.0%, 8.0% and 8.7%, respectively. The prevalence of asthma (defined as persistent wheeze and/or doctor-diagnosed asthma) was 13.8%. 4.3% experienced at least one episode of chest illness that resulted in inactivity for at least 3 days in the previous year. The mean age of commencement of symptoms in the doctor-diagnosed asthma group was 2.75 years. The prevalence of chronic cough and/or phlegm and persistent wheeze were highest among Indian children (p less than 0.05). More Malays had been diagnosed as having asthma than the other ethnic groups but the differences were not statistically significant. The patients' fathers' low levels of education were associated with chronic cough and/or phlegm (p less than 0.05) but not with other complaints. Asthma was significantly more common among boys than girls. No age differences were noted. Further analysis showed that persistent wheeze and doctor-diagnosed asthma were associated with increased likelihood of other respiratory illnesses or doctor-diagnosed allergy before the age of 2 years.
Twelve cases of purulent pericarditis seen over 6 years are described. Staphylococcus aureus was the most common causative organism (six patients), and a respiratory infection was the most common preceding illness. The chest radiograph and echocardiogram were useful pointers to the diagnosis, but the electrocardiogram was not reliable. Antibiotics, surgical drainage, and pericardiectomy were used in all 12 cases. There was one death (8.3%), which occurred in a patient who was seen late. A review of the literature dealing with the diagnosis and management of this condition is presented. The importance of early diagnosis before a significant degree of cardiac tamponade occurs is noted. Although there is general agreement that surgical drainage is mandatory, the approach, methods of drainage, and extent of pericardial resection have been the subject of some discussion, and at least seven techniques are available. We conclude that pericardiectomy has a definite place in the management of purulent pericarditis.
Six children who survived severe acute bronchiolitis in infancy and early childhood continued to have persistent symptoms of breathlessness, cough and wheeze resistant to bronchodilator therapy. Hyperinflation of the chest, widespread crepitations and rhonchi were persistent clinical features. Failure to thrive was a problem in most. At presentation clinical measles was diagnosed in one child and adenovirus titres were raised in another; the aetiological agents in the others were not known. Lung biopsy from the child with measles showed features of severe bronchiolitis. The clinical and radiological features and course of the illness were consistent with those of bronchiolitis obliterans. Although illness was prolonged the long term prognosis was satisfactory with the majority of children showing improved chest signs, growth and general health after four to eight years of follow up.
Preventive fogging is defined as space spraying of insecticide against mosquitoes in order to prevent outbreak of mosquito borne infection. Despite provision of various preventive andcontrol activities against dengue and chikungunya infection by Ministry of Health Guideline, the detail on preventive fogging has not yet specified. However, this has been adopted by certain institutions as part of the routine strategies against dengue outbreak. A study on preventive fogging was conducted in one of the hostels in Universiti Putra Malaysia. The research was done for 16 weeks in which one routine fogging activity was done at the mid period of study. The main objectives of this study were to determine the effectiveness of preventive fogging activities against Aedes mosquitoes and to identify the distribution and abundance of Aedes mosquitoes in the area. Method: The fogging activity was carried out by the management staff as part of their preventive measures in the student hostels. Ovitrap was used as an indicator to monitor the impact of fogging activity and its continuous surveillance was monitored weekly. The ovitraps were placed indoors and outdoors. Species identification was carried out in the laboratory. The SPSS program was used to analyse the statistical data on the effectiveness of fogging activity. Larval count (indoors and outdoors) and ovitrap index (OI) readings were identified as ovitrap surveillance data for statistical analysis. Results: The results showed that Aedes albopictus was the only species of the genus Aedes found in this hostel. The area had been highly infested by Ae. Albopictus as indicated by high Ovitrap Index ranging between 48.33% to 90.00%. The mean (SD) of Ovitrap Index was reduced from 71.67% (12.73%) (before the preventive fogging), to 69.42% (14.40%) (after the fogging). Overall reduction in mosquito and larval density was also observed between pre and post fogging activity in this study. Conclusion: The implementation of preventive fogging has favourably reduced the dengue vector population up to 5 weeks after the introduction of preventive fogging. However, sole dependency on preventive fogging may lead to insecticide resistance. Revisiting the policy on preventive fogging; and identifying it as an additional tool for preventing dengue infection in higher learning institutions are recommended.
Malaria in Yemen is mainly caused by Plasmodium falciparum and 25% of the population is at high risk. Sulfadoxine-pyrimethamine (SP) had been used as monotherapy against P. falciparum. Emergence of chloroquine resistance led to the shift in anti-malarial treatment policy in Yemen to artemisinin-based combination therapy, that is artesunate (AS) plus SP as first-line therapy for uncomplicated malaria and artemether-lumefantrine as second-line treatment. This study aimed to screen mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) genes associated with SP resistance among P. falciparum population in Hadhramout governorate, Yemen.
Yemen is a Mediterranean country where 65% of its population is at risk of malaria, with 43% at high risk. Yemen is still in the control phase without sustainable reduction in the proportion of malaria cases. A cross-sectional household survey was carried out in different districts in the southeast of the country to determine malaria prevalence and identify factors that impede progress of the elimination phase.
Biological kinetic (bio-kinetic) study of the anaerobic stabilization pond treatment of palm oil mill effluent (POME) was carried out in a laboratory anaerobic bench scale reactor (ABSR). The reactor was operated at different feed flow-rates of 0.63, 0.76, 0.95, 1.27, 1.9 and 3.8l of raw POME for a day. Chemical oxygen demand (COD) as influent substrates was selected for bio-kinetic study. The investigation showed that the growth yield (Y(G)), specific biomass decay (b), maximum specific biomass growth rate (mu(max)), saturation constant (K(s)) and critical retention time (Theta(c)) were in the range of 0.990 g VSS/g COD(removed) day, 0.024 day(-1), 0.524 day(-1), 203.433 g COD l(-1) and 1.908 day, respectively.
Malaria is still a major public health problem in Yemen. More than 95% of the malaria cases are due to Plasmodium falciparum. Recently in Yemen, the antimalarial treatment policy was changed from chloroquine (CQ) to artemisinin combination therapy (ACTs). However, CQ is still available and prescribed in the Yemeni market. The persistence of CQ resistance will be prolonged if the shift to ACT and the simultaneous withdrawal of CQ are not rigorously implemented. The aim of the current survey is to detect chloroquine-resistant mutations in P. falciparum chloroquine-resistance transporter (pfcrt) and P. falciparum multi-drug resistance-1 (pfmdr1) genes. These data will be important for future monitoring and assessment of antimalarial drug policy in Yemen. Blood specimens were collected from 735 individuals from different districts of the Hadhramout province, Yemen by house-to-house visit. Mutation-specific nested polymerase chain reaction (PCR) and restriction fragment length polymorphism (PCR-RFLP) methods were used to investigate the mutations in the pfmdr1(codons 86 and 1246) and pfcrt (codons 76, 271, 326, 356 and 371) genes. The overall prevalence of pfcrt mutations at codons 76, 271, 326 and 371 were 50.4%, 58.7%, 54.3% and 44.9%, respectively. All isolates had wild-type pfcrt 356 allele. The majority of pfmdr1 86 alleles (83.3%) and all pfmdr1 1246 alleles were wild type. There was no association between pfcrt mutations and symptomatology, gender and age groups. In conclusion, point mutations in codons 76, 271, 326 and 371 of pfcrt of P. falciparum are high suggesting a sustained high CQ resistance even after 4 years of shifting to ACTs. These findings warrant complete withdrawal of CQ use from the Yemeni market for P. falciparum and careful usage of CQ for treating Plasmodium vivax.
We review 81 cases of acute haematogenous osteomyelitis from 1983 to 1990 to establish current pattern of clinical presentation, modes of treatment and success of therapy. Majority of the patient (70%) presented within a week of symptom and significant number of them came with fever and swelling of the affected limb. Sedimentation rate was found to be raised in all of them. Fifty-four (55%) of them were treated surgically. The average antibiotic time was one week by intravenous administration followed by additional oral therapy for period up to four weeks. Average follow-up was 9 months. Six of them (7.5%) end up with various complication which was believed to be due to delay in getting medical treatment.
Fifteen cases of unstable fracture-dislocation of the thoracolumbar spine have been treated by open reduction, short segment transpedicular fixation and fusion in Universiti Unit, Kuala Lumpur Hospital from January 1994 until December 1997. Twelve male and three female patients were injured; their age ranged from 18 to 45 years. Five fracture-dislocations occurred in the lower thoracic spine (T8 to T11), eight at the thoracolumbar junction (T12 to L2) and two in the lumbar spine (L3 to L5). All the patients had neurological deficit. Seven patients with incomplete or cauda equina lesions regained some neural function, while all eight with complete lesions remained unchanged. Ten of the fifteen cases were grossly unstable and translated beyond 50% of the width of the spinal column. At the time of follow up (more than one year in all patients), no loss of reduction or of fixation was noted in any patient. Solid fusion was achieved in all patients. The advantages of this method of treatment include stable fixation, with maintenance of sagittal and coronal spinal alignments, to allow early rehabilitation.
Analysis of the investigations of 14 cases of spinal injury are presented. The significance of the level of injury and the pattern of bladder function is alluded too. Some aspects of the management of neurogenic bladder are discussed.
Domestic animals have been modified by selecting individuals exhibiting desirable traits and culling the others. To investigate the alterations introduced by domestication and selective breeding in heat stress response, 2 experiments were conducted using Red Jungle Fowl (RJF), village fowl (VF), and commercial broilers (CB). In experiment 1, RJF, VF, and CB of a common chronological age (30 d old) were exposed to 36 ± 1°C for 3 h. In experiment 2, RJF, VF, and CB of common BW (930 ± 15 g) were subjected to similar procedures as in experiment 1. Heat treatment significantly increased body temperature, heterophil:lymphocyte ratio, and plasma corticosterone concentration in CB but not in VF and RJF. In both experiments and irrespective of stage of heat treatment, RJF showed lower heterophil:lymphocyte ratio, higher plasma corticosterone concentration, and higher heat shock protein 70 expression than VF and CB. It can be concluded that selective breeding for phenotypic traits in the domestication process has resulted in alterations in the physiology of CB and concomitantly the ability to withstand high ambient temperature compared with RJF and VF. In other words, domestication and selective breeding are leading to individuals that are more susceptible to stress rather than resistant. It is also apparent that genetic differences in body size and age per se may not determine breed or strain variations in response to heat stress.