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Malays with thalassaemia in West Malaysia.

Hereditary haemolytic anaemias have been found to be a significant cause of haemolytic disease in West Malaysia. This paper reports a micromapping study of 916 healthy Malay males from June to August 1983 to determine the distribution of the relevant thalassaemia genes in West Malaysia. Beta thalassaemia trait was found in 2.18%, HbE 3.49% and alpha thal2 (alpha+) trait in 26%. Of the sixteen transfusion dependant Malay thalassaemic patients at the Paediatric Unit, National University of Malaysia, eight patients had HbE beta thalassaemia and the rest are beta thalassaemia major; these patients who are transfusion dependant receive inadequate treatment. Prevention is the only resort.

Adolescent↗

A comparative study of road traffic accidents in West Malaysia.

The problem of road traffic accidents in developing countries is now becoming a cause for concern. This is more so as preventive measures have not kept pace with economic progress and development. This paper reviews the present situation in West Malaysia, one of the better developed countries of the East, during the period 1970 to 1975. A comparative study has been made between the United States and Malaysia. To enable the urgency of the problem in developing countries to be appreciated the increases in the country's population and in the number of vehicles in use and their relation to the lesser increase in road mileage over the period of study have been discussed. The study has considered every aspect of the causative factors leading to traffic accidents, such as the effects of weather, seasonal variation, and road and lighting conditions. The common human errors leading to accidents have been discussed. Other factors, such as the ethnic distribution in Malaysia, and their relation to road accidents have shown the effect of the social structure on the problems. The data evaluated in this study make it clear that preventive measures are very necessary in underdeveloped as well as in developed countries.

Accidents, Traffic↗

[Nematodes of the genus Spirura, parasites of Tupaia and Nycticebus in Malaysia (author's transl)].

Morphological study of two Spirura parasites of the oesophageal and the gastric wall of Tupaia and Nycticebus in Malaysia. -- Spirura malayensis n. sp. is found both in Tupaia in the District of Selangor (West Malaysia) and in Nycticebus coucang in Borneo. Its very primitive characteristics relate it to S. diplocyphos Chabaud, Brygoo and Petter, 1965, parasite of lemurs from Madagascar. Its larval development was obtained experimentally in Blatella germanica. -- Spirura aurangabadensis (Ali and Lovekar, 1966) described from a microchiroptera in India is found in west Malaysia in a Nycticebus coucang, and in a Tupaia glis. -- The distribution of the different species and the comparative study of the larval and adult cephalic structures show that the genus Spirura arose and became diversified in the old world in very primitive hosts according to two main evolutive lines.

Animals↗

The status of intermittent peritoneal dialysis in Hospital University Science Malaysia.

Acute (stab) peritoneal dialysis is commonly practised in Malaysia. This study is designed to improve the management of peritoneal dialysis (PD) in Hospital University Science Malaysia (HUSM). Consecutive peritoneal dialysis (PD) on adult inpatients from May 1992 to September 1992 were reviewed prospectively. There were 40 episodes of peritoneal dialysis on 27 patients during this period given at the rate of 2 PD per week. The mean age of patients were 53 +/- 15 years. Uraemia was the main indication for dialysis, while hyperkalaemia and pulmonary oedema were indications for urgent dialysis. Complications occurred in 14 episodes of dialysis (35%). The most common complication was bleeding in the peritoneal cavity while peritonitis was the second most common complication. Dialysis episodes complicated by peritonitis were done by less experienced performers compared to uncomplicated dialysis episodes. Overall mean time spent on each dialysis and time per cycle were longer than recommended (59 +/- 24 hours and 77 +/- 14 minutes). In conclusion, acute PD performed on patients admitted in Hospital University Malaysia was safe and had complication rates comparable to other established centres. However, improvements are possible through closer supervision of new doctors and tighter nursing precautions.

Adult↗

Recent urbanization trends in Peninsular Malaysia.

The pace of urbanization in Peninsular Malaysia was slower in the most recent intercensal interval, 1957 to 1970, than in the previous period, 1947 to 1957. Most of the small change in the rural-urban balance from 1957 to 1970 appears due to the growth of towns into the urban classification rather than to a redistribution of population into the previous urban settlements. A number of towns in Peninsular Malaysia do show exceptional growth from 1957 to 1970, but there seems to be no clear relationship between a city's size and its subsequent growth. The rural areas on the outskirts of the largest cities do show rapid growth, especially the periphery of the capital city. It appears that neither the classic model of urbanization based upon Western experience nor the over-urbanization thesis explain the urbanization process in Peninsular Malaysia.

Employment↗

Alcohol use patterns, problems and policies in Malaysia.

The roots of Malaysia's drinking patterns lie in the introduction of most forms of alcohol by Europeans. Although Malaysia today has relatively low per capita alcohol consumption, available studies and interviews with alcohol industry officials point to a small segment of the population that drinks heavily and causes and experiences substantial alcohol related-problems. Indians are over-represented in this sub-population, but studies also reveal substantial drinking problems among Chinese and Malays. Government officials categorize alcohol as an Indian problem. The government devotes little resources to monitoring drinking patterns, use or problems; or to preventing, treating or educating the public about alcohol-related problems. Alcohol-producing transnational corporations own shares of all of Malaysia's major alcohol producers. In the face of high alcohol taxes and a ban on broadcast advertising of alcoholic beverages, these companies market alcohol aggressively, making health claims, targeting heavy drinkers and encouraging heavy drinking, employing indirect advertising, and using women in seductive poses and occupations to attract the mostly male drinking population. Monitoring of the country's alcohol problems is greatly needed in order to establish alcohol consumption more clearly as a national health and safety issue, while stronger controls and greater corporate responsibility are required to control alcohol marketing.

Journal Article↗

Vertebrate safety of Clostridium bifermentans serovar malaysia, a new larvicidal agent for vector control.

The safety of bacterial cells of Clostridium bifermentans serovar malaysia, which is highly toxic to mosquito larvae, was tested on mice, guinea pigs, rabbits, and goldfish. Inoculations of at least 1 x 10(8) cells per animal by routes recommended by World Health Organization (subcutaneous, percutaneous, inhalation, force-feeding, intraperitoneal, intravenous) and tests of subacute toxicity, anaphylactic shock, persistence in heart blood, and virulence by successive passages, were performed on mice, guinea pigs, or both. Growth was monitored for 1 mo before necropsy. Ocular irritation and skin scarification were tested with rabbits. C. bifermentans serovar malaysia did not induce any mortality or abnormal reactions in mammals at a dose 1,000 times higher than the level established by W.H.O. for the demonstration of safety. Bacterial cells are not toxic to goldfish at a dose 1,000 times higher than the LD50 for the target-mosquito larvae. We conclude that C. bifermentans serovar malaysia bacterial cells are safe for laboratory mammals and goldfish.

Animals↗

Clostridium bifermentans serovar malaysia: characterization of putative mosquito larvicidal proteins.

The toxicity of Clostridium bifermentans serovar malaysia to mosquito larvae is due to protein toxins, belonging to a novel class of insecticidal toxins. Toxic extracts contains three major proteins of 66, 18 and 16 kDa. The 18-kDa and 16-kDa proteins are probably involved in toxicity. They are synthesised during sporulation, concomitant with activity. They are absent from non-toxic strains of C. bifermentans and are present at very low levels in non-toxic C. bifermentans serovar malaysia cultures produced at 42 degrees C. The 66-kDa protein is present throughout the growth phases of C. bifermentans serovar malaysia, and an immunologically related 66-kDa protein is present in non-toxic C. bifermentans strains.

Animals↗

An ecological study of Paragonimus in Malaysia.

An ecologic study on Paragonimus in Malaysia was attempted from May to September 1967. Seven streams located in various directions and distances from Kuala Lumpur were surveyed for the study of intermediate hosts, snail and crab. One Malayan village and one aborigine village where infected crabs were found, and two tuberculosis hospitals in K.L. were surveyed for the study of human population. Intradermal tests along with sputum or stool examination to detect human infection by Paragonimus were employed. Wild animals, only a few, were shot in the vicinity of the aborigine village and several domestic cats from the Malayan village were bought. These animals were autopsied and examined for adult Paragonimus. Among five species of crab collected from the study areas, only two species, Potamon jahorenes and Parathelphusa maculata were found to be infected with Paragonimus. P. maculata seemed to be better crab host for the Paragonimus because this species had higher infection rate and metacercarial density than the other in the very same area. Three out of seven streams had infected crabs and the infection rate as well as the infection intensity varied from one stream to another. Only avilable snail in the streams was identified as Brotia costula. The infection rate of the snail was very low, six snails out of 11,898, which is about the same rate reported from other countries. Infected snail, however, had thousands of rediae uncountable containing about twelve microcercocercariae in each redia, sufficient enough to maintain the life cycle of the parasite even with only a few infected snail, the amplifier. This is the first confirmed report on the snail host of Paragonimus from Malaysia where the existence of Paragonimus had been reported in 1923. The first trial to study human population by means of intradermal test, sputum and/or stool examinations in Malaysia showed no evidence of human infection of Paragonimus. The number of animals, wild and domestic, examined for natural infection was too small to draw any statement. These examined animals were all negative for adult Paragonimus. Even though more extensive studies on wild animals and human population may be necessary for the definite conclusion, the facts that infected crabs from jungle stream where human contacts are extreamely rare, and also highly infected crabs from the area where none of humans or domestic animals were infected, strongly suggest the life cycle of Paragonimus in this area may be maintained by wild animal hosts rather than by human host. The morphology of all stages of the parasite, the pattern of penetrating glands, flame cells and excretroy bladder of cercaria, lancet shaped single cuticular spines and 6 branched ovary of adult worm obtained from experimentally infected cat, and the shape of egg including all measurements agree well with the characteristics of Paragonimus westermani.

Journal Article↗

Medical education in Universiti Sains Malaysia.

Universiti Sains Malaysia established it's medical school in 1979, the third medical school in Malaysia after Universiti Malaya and Universiti Kebangsaan Malaysia. During the time of its establishment, the university was fortunate to witness a revolution in the world of medical education. PBL-based education was one of the most talked about approach in medical education. The University was fortunate to have experienced medical educators with sufficient foresight to start a medical school that has in its philosophy a community-based integrated curriculum utilizing problem-based learning, one of it's main modes of curricular implementation. Over the last 20 years, the medical curriculum has been revised and fine-tuned twice. The first major curriculum review was undertaken in 1995. One major outcome of this review was a firm commitment to continue with it's original philosophy in medical education at the same time introducing several key strategies to enhance the teaching of medical ethics, attitude formation and reaffirming the need for a lean, integrated curriculum which addresses core knowledge, attitude and skills. A more recent review in 2001 took several approaches including getting the input of students to enhance the original philosophy.

Education, Medical↗

A review of human leptospirosis in Malaysia.

This paper reviews the literature on human leptospirosis in Malaysia from its first description in 1925 until the present day. Fletcher diagnosed the first case of human leptospirosis in Malaysia in 1925. Following Fletcher, many investigations on human leptospirosis in Malaysia disclosed a high prevalence of infection. These investigations indicated that the disease was endemic in the country. Examination of 1993 suspected human cases of leptospirosis by Tan indicated 28 % of the cases were positive. In a recent survey, 2190 serum samples from patients with different clinical manifestations in the country disclosed 12.6% were positive for antibodies to leptospires. The risk to leptospiral infection with respect to occupation, location, sex, race and age groups was demonstrated. Both civilians and military personnel were affected. Thirty-seven serovars from thirteen serogroups have been identified in the country. Recent studies on animal leptospirosis showed that the disease was highly endemic in the animal population. It is considered that the majority of leptospirosis cases in humans were due to association of man with animals and disease-infected environment.

Journal Article↗

The role of cytomegalovirus (CMV) infection in congenital diseases in Malaysia.

A previous cross-sectional serological survey of various age groups (0-55 years) of the Malaysian normal population showed that cytomegalovirus (CMV) infection is highly endemic in Malaysia. A total of 1,688 infants (0-4 months) with congenital abnormalities were screened for evidence of congenital CMV infection and the rest of the TORCHES (TOxoplasmosis, Rubella, Cytomegalovirus, HErpes simplex, Syphilis) group of congenital infections. Congenital CMV infection was detected in 193 (11.4%) infants which is significantly higher than the prevalence of congenital syphilis (4%), congenital rubella infection (3.7%), congenital toxoplasma (1.0%) and congenital herpes simplex virus infection (0%). Of the 193 cases, 10.4 per cent had CNS defects. We concluded that 1) congenital CMV appears to be the most important cause of congenital infections among the TORCHES diseases in Malaysia; and 2) secondary rather than primary infections or reactivation is responsible for most of the intrauterine CMV infection in Malaysia, as primary infection is usually associated with neurological involvement.

Cytomegalovirus Infections↗

Metric analyses of an early holocene human skeleton from Gua Gunung Runtuh, Malaysia.

A nearly complete human skeleton dating to the Early Holocene (epi-Paleolithic culture) excavated from Gua Gunung Runtuh, Malaysia, is described. Cranial, dental, and limb bone measurements are recorded on the skeleton, and compared with early and modern skeletal samples from Southeast Asia and Australia. The comparisons demonstrate that the Gua Gunung specimen is most similar to Australian Aborigines in dental and limb measurements, while the cranial measurements indicate a close affinity to Mesolithic samples from Malaysia and Flores. These findings further suggest that the Gua Gunung skeleton, as well as other fossils from Tabon and Niah, are representative of an early group of people who occupied Sundaland during the late Pleistocene, and may be the ancestors of Australian Aborigines. Some of the dental and limb bone measurements exhibited by the ancestors persist in Southeast Asian populations until the early Holocene. Differences in cranial traits have, however, accumulated since the late Pleistocene in Australian Aborigines and early Southeast Asian peoples.

Bone and Bones↗

Resting metabolic rate in a sample of girls in Malaysia and England.

This cross-sectional study of age matched (10-11 years), pre-menarcheal girls in England and Malaysia investigated the effect of ethnicity on resting metabolic rate (RMR). The children were recruited from schools in Oxford, England, and Kuala Lumpur, Malaysia, and all measurements were conducted in the schools. The Malaysian girls were shorter (143.7 +/- 6.5 cm and 140.1 +/- 5.3 cm (mean +/- SD) for the English and Malaysian girls respectively) and lighter (32.5 +/- 5.3 kg compared with 38.0 +/- 8.7 kg for the English girls) with a smaller fat mass and fat free mass (FFM) than the English girls. Energy expenditure was lower in the Malaysian girls (4555 +/- 531 kJ/day compared with 5178 +/- 688 kJ/day for the English girls). Although a difference in RMR was observed between the two groups, when corrected for body composition the difference was no longer significant. No effect of ethnicity on the relationship of FFM and RMR was shown when the data were analyzed using analysis of covariance.

Body Composition↗

Assessing progressivity of out-of-pocket payment: with illustration to Malaysia.

Throughout the world, policy makers are considering or implementing financing strategies that are likely to have a substantial impact on the equity of health financing. The assessment of the equity implication is clearly important, given the potential impact that alternative finance sources have on households. Households incur out-of-pocket payment directly from their budget, apart from their public or private insurance. Out-of-pocket payment is the primary concern, given their undesirable impact on households. Progressivity measures departures from proportionality in the relationship between out-of-pocket payment and ability to pay. It is the most frequently used yardstick to assess the equity of out-of-pocket payments in empirical studies. This paper provides an evaluation of such progressivity measures, undertaken using four approaches (proportion approach, tabulation approach, concentration curve and Kakwani's index), in order to reveal their usefulness and underlying notion. It is illustrated empirically with data on out-of-pocket payment for health care in Malaysia for 1998/ 1999, based on the nationally representative Household Expenditure Survey. Results indicate that out-of-pocket payments are mildly progressive, whilst the four approaches have their benefits and limitations in assessing equity implications. This analysis is of interest from a policy perspective, given Malaysia's heavy reliance on out-of-pocket payments to finance health care.

Cost Sharing↗

Identification of a human group C rotavirus in Malaysia.

Stool specimens from 334 infants and young children hospitalized with diarrhea in the General Hospital, Kuala Lumpur, Malaysia between August and November, 1987 were analyzed for the presence of rotavirus double-stranded (ds) RNA by polyacrylamide gel electrophoresis. Of the 334 specimens analyzed, 32 (9.6%) were positive for rotavirus RNA. One specimen (designated G147) exhibited a ds RNA electropherotype profile characteristic of Group C rotavirus and was selected for further characterization. In Northern blot hybridization studies, the gene 5 segment of strain G147 hybridized with a cDNA probe generated from the cloned gene 5 (which encodes the VP6 inner capsid protein that is group specific) of porcine Group C rotavirus strain Cowden, confirming the classification of strain G147 in Group C. The association of Group C rotavirus with diarrheal illness in Malaysia is consistent with earlier studies that suggest a global distribution of this virus and supports the need for additional epidemiologic studies.

Child, Preschool↗

Descriptive epidemiology of nasopharyngeal carcinoma in Peninsular Malaysia.

Nasopharyngeal carcinoma (NPC) is one of the most common cancers in Malaysia, a country in Southeast Asia with a multiracial population. While hospital-based data on NPC and data from a few states have been reported, a comprehensive study involving every known NPC patient in the whole of Peninsular Malaysia in one particular year had never been done. In the present study, the computed incidence rate was not only adjusted for age, sex, ethnicity, and place of residence, but also direct standardization methods of Rothman and Dever were used to reduce any distortion. The mean age of the 365 new cases of NPC registered in 1988 was 46.8 years (SD +/- 12.2 years). The ages of patients ranged from 10 to 80 years. The incidence in both sexes rose after the age of 20-29 years and reached a plateau between 40 and 49 years. No further rise was exhibited after age 60 years. The Chinese had the highest age-adjusted incidence rates, particularly for the age group 40-49 years, where the incidence rate was 40.1 per 100,000 for males and 14.9 for females. The average age-adjusted male/female ratio was 2.8:1. Age-adjusted incidence varied by place of residence. The pattern that emerged from the data indicated the possibility of interaction between genetic susceptibility and environmental cofactors in the etiology of NPC.

Adolescent↗

Pulmonary aspergilloma. Case reports from Malaysia.

Pulmonary aspergilloma is by no means uncommon in Malaysia. The lack of documentation of its occurrence in Malaysia, is mainly due to the lack of clinical awareness, and the absence of facilities for the proper diagnosis of the infection.

Adult↗