Quality of life of community-based chronic schizophrenia patients in Penang, Malaysia

OBJECTIVE: This is a study of the quality of life (QOL) of 174 community-based chronic schizophrenia patients in Penang, Malaysia. METHOD: The study samples were selected from the Out Patient Department, Department of Psychiatry, Penang General Hospital, Malaysia. The data was collected through personal interviews with the respondents. A questionnaire prepared by the research team was used to collect data on background characteristics. Lehman's (1988) Quality of Life Interview was used to collect data on patients' QOL. RESULT: Equal number of males and females participated in the study. The interviews on QOL indicated problems in the areas of life in general, place of living, daily activities, social relations, finance, work and general health. The results also revealed that community-based schizophrenia patients had acute poverty and experienced social isolation, discrimination and exploitation in the workplace. CONCLUSION: Implications of these results on the implementation process of National Mental Health Policy in Malaysia are discussed. The research paper also discusses the negative impacts of limited rehabilitation facilities available in the community and its implications on the QOL of severely mentally ill patients. The need for immediate research attention on QOL of such patients in the South-east Asian region has been highlighted.     

Serum Ornithine Carbamoyl Transferase as a Surrogate Marker in Malaria

Ornithine carbamoyl transferase (OCT) activity and other liver function tests were studied in a total of 50 patients of clinical malaria and 15 controls. They were grouped as group I (positive for malarial parasite on peripheral blood smear, n=18), group II (negative for malarial parasite on peripheral blood smear (PBS) but responded to antimalarials, n=17) and group III (peripheral blood smear negative and did not respond to antimalarial therapy, n=15). The mean OCT levels were significantly raised in group I (6.79 ± 1.84 IU/L, p value = 0.006) and group II (5.0 ± 1.15 IU/L, p value = 0.014) as compared to controls (2.5 ± 1.13 IU/L) and returned to normal after treatment In contrast, group III had normal levels except in a case of kala azar and septicemia where OCT levels were high and increased further on treatment. Taking PBS positivity as a gold standard of diagnostic criteria, OCT had a sensitivity of 83% and specificity of 86% with a high positive predictive value of 88% as compared to ALT which had a lower sensitivity of 55% and specificity of 80%. The clinical response rate in PBS negative cases of fever having high OCT level was 83% as compared to 35% in cases with normal OCT level, making OCT a good surrogate marker of malaria. OCT levels could also be of prognostic significance as 2 cases of cerebral malaria had high OCT levels of 11.1 UAL and 10.7 IU/L, respectively.Key Words: Malaria, Ornithine carbamoyl transferase     

Surgical experiences with two-muscle surgery for the treatment of intermittent exotropia.

BACKGROUND: The surgical management of intermittent exotropia, or X(T), remains a challenge. Not only are some quoted success rates relatively low (40-83%), but the outcome is notoriously unpredictable with a tendency to exotropic drift over time. METHODS: In this retrospective study, 118 patients who underwent either bilateral lateral rectus muscle recession (BLR) or unilateral medial rectus muscle resection and lateral rectus muscle recession (R&R) surgery during a 4-year period were reviewed. Surgical outcome between the 2 groups in addition to factors that influence outcome within groups were analyzed. Success was defined as an X(T) < or = 10PD. RESULTS: Sixty-four subjects underwent BLR, and 54 subjects underwent R&R surgery. Mean preoperative distant X(T) size was 38.7 +/- 6.7 PD. Subjects who underwent R&R did significantly better at 1-year follow-up (success 74.2% vs. 42.2%) but showed significantly more exotropic drift over time (P = 0.01). Within both BLR and R&R groups, subjects with basic-type X(T) did worse than those with divergence-excess X(T) at 1-year follow-up. Consecutive esotropias, however, were more likely with R&R surgery and in those with divergence excess X(T). Preoperative strabismus control, distant X(T) size, and patient age at surgery did not significantly influence outcome. CONCLUSION: In many cases, selection of surgery type continues to depend on the surgeon's preference, which is in turn influenced by his/her past experiences. The debate about which surgical type is best for different X(T) types continues.     

Prognostic significance of retinopathy at presentation in adult acute leukemia

 Retinal changes are common in adult acute leukemia patients at presentation, but their prognostic significance is controversial. A 5-year study has been carried out with newly diagnosed acute leukemia patients aged 12–77 years. Seventy-seven cases (49 AML, 28 ALL) were studied prospectively for the presence of intraretinal hemorrhages (IRH), white-centered hemorrhages, cotton-wool spots, and macular hemorrhages. They were treated according to standard chemotherapy protocols, and then achievement of complete remission (CR) and the duration of overall survival (OS) were compared between the groups with and without these different retinal features. No association was found between the presence of any retinal abnormality and CR induction rate, although there was a trend to a lower CR rate among patients with IRH. The median OS of those with IRH was 72 days, compared with 345 days among those without IRH (p=0.002). A WBC at presentation greater than 50×l0⁹/l and age greater than 40 years were also associated with shorter OS (p<0.0001 and p=0.0045, respectively). However, after regression analysis, IRH remained statistically significant as a poor prognostic indicator (p=0.01).) We conclude that the presence of IRH is an indicator of poor prognosis in acute leukemia. Received: 16 August 1997 / Accepted: 10 November 1997     

The safety and efficacy of oral dextrose for relieving pain following venepuncture in neonates

The objective of this study was to assess the efficacy and safety of oral 30% dextrose during venepuncture in neonates. Neonates admitted in the Special Care Nursery for jaundice from September 200 to January 2001 were recruited for this double-blind randomised controlled trial. The intervention consisted of administration of either 2 ml of oral 30% dextrose or 2 ml of sterile water 2 minutes before venepuncture. The primary outcome measure was the cumulative Neonatal Infant Pain Scale (NIPS) score at 3 minutes after venepuncture and the duration of cry assessed from a videotaped recording. Twenty-six neonates received 30% dextrose and 26 neonates received sterile water. The cumulative NIPS score at 3 minutes (median, IQR) after venepuncture for neonates given 30% dextrose (13, 6.8-21) was significantly (p = 0.03) lower than that for neonates given sterile water (21, 13.8-21). The duration of cry in neonates given 30% dextrose (median 45 sec IQR 1.5-180.8 sec) was significantly (p = 0.03) shorter than that in neonates given sterile water (median 191 sec IQR 52.3-250 sec). No neonates developed diarrhoea, fever or rash during the 24 hour observation period. Both the intra-rater (ICC 0.993 95% CI 0.988-0.996) and inter rater (ICC 0.988 95% CI 0.980-0.993) agreement on the 3-minute NIPS score were good. In conclusion oral 30% dextrose given 2 minutes before venepuncture was effective in reducing neonatal pain following venepuncture. It is a simple, safe and fast acting analgesic and should be considered for minor invasive procedure in term neonates.     

Leptin resistance and enhancement of feeding facilitation by melanin-concentrating hormone in mice lacking bombesin receptor subtype-3

Mice lacking either bombesin receptor subtype (BRS)-3 or gastrin-releasing peptide receptor (GRP-R) exhibit feeding abnormalities. However, it is unclear how these receptors are associated with feeding regulation. In BRS-3-deficient mice, we found hyperphagia, subsequent hyperleptinemia, and brain leptin resistance that occurred after the onset of obesity. To explore the cause of this phenomenon, we examined changes in feeding responses to appetite-related neuropeptides in BRS-3-deficient, GRP-R-deficient, and wild-type littermate mice. Among orexigenic neuropeptides, the hyperphagic response to melanin-concentrating hormone (MCH) was significantly enhanced in BRS-3-deficient mice but not in GRP-R-deficient mice. In addition, the levels of MCH-R and prepro-MCH mRNAs in the hypothalamus of BRS-3-deficient mice were significantly more elevated than those of wild-type littermates. There was no significant difference in feeding between BRS-3-deficient and wild-type littermate mice after treatment with bombesin (BN), although the hypophagic response to low-dose BN was significantly suppressed in the GRP-R-deficient mice. These results suggest that upregulation of MCH-R and MCH triggers hyperphagia in BRS-3-deficient mice. From these results, we assume that the BRS-3 gene deletion upsets the mechanism by which leptin decreases the expression of MCH-R and that this effect may be mediated through neural networks independent of BN-related peptides such as GRP-R.     

Thiopurine methyltransferase polymorphisms in a multiracial asian population and children with acute lymphoblastic leukemia

The purpose of this study was to determine the frequency of thiopurine methyltransferase (TPMT) polymorphisms in a multiracial Asian population and to assess its relevance in the management of childhood acute lymphoblastic leukemia (ALL). Six hundred unrelated cord blood samples from 200 Chinese, Malay, and Indian healthy newborns were collected at the National University Hospital, Singapore; an additional 100 children with ALL were analyzed for five of the commonly reported TPMT variant alleles using polymerase chain reaction/restriction fragment length polymorphism and allele-specific polymerase chain reaction-based assays. In the cord blood study, the TPMT*3C variant was detected in all three ethnic groups; Chinese, Malays, and Indians had allele frequencies of 3%, 2.3%, and 0.8%, respectively. The TPMT*3A variant was found only among the Indians at a low allele frequency of 0.5%. The TPMT*6 variant was found in one Malay sample. Among the children with ALL, two white and one Chinese were heterozygous for the TPMT*3A variant and showed intermediate sensitivity to 6-mercaptopurine during maintenance therapy. Three Chinese patients and one Malay patient were heterozygous for the TPMT*3C variant. Mercaptopurine sensitivity could be validated in only one out of four TPMT*3C heterozygous patients. The overall allele frequency of the TPMT variants in this multiracial population was 2.5%. The TPMT*3C was the most common variant allele; TPMT*3A and TPMT*6 were rare. These results support the feasibility of performing TPMT genotyping in all children diagnosed with acute leukemia to minimize toxicity from thiopurine chemotherapy.     

The effect of expressing anger on cardiovascular reactivity and facial blood flow in Chinese and Caucasians

Blood pressure, heart rate, and changes in facial and finger blood flow were monitored in 24 male Chinese and 24 male Caucasians while they described anger-provoking incidents and read out neutral material, either loudly and rapidly or softly and slowly. Describing the incidents loudly and rapidly heightened anger ratings and enhanced digital vasoconstriction but not blood pressure or heart rate; however, anger enhanced blood pressure during soft, slow speech. Facial blood flow increased during anger expression, irrespective of speech style, but decreased when neutral material was read out. The findings suggest that an increase in facial blood flow reduces peripheral vascular resistance during anger expression, and that baroreflexes attenuate increases in heart rate and blood pressure. Racial background did not influence subjective reports or physiological responses, possibly because the procedure did not draw strongly enough on cultural taboos.     

Cryptococcal Meningitis: A Clinicopathological Account of Seven Cases Encountered in a Military Setting

The clinicopathological profile of 7 cases of Cryptococcal meningitis encountered over one year period in a military hospital has been described. Severe persistent headache was the main form of presentation followed by features of progressive ill-health. Age range of cases was 34–55 years (mean 40.8 years). All were males and 6 were serving soldiers. Duration of symptoms ranged from 10 days to 6 weeks. Six patients were positive for HIV-1 antibodies. This was the initial presentation of AIDS in 6 patients accounting for 10.34% among all cases of HIV infection during that year. Both clinical and laboratory findings were subtle. Nuchal rigidity was rare, cerebro spinal fluid (CSF) cell count and protein level was normal in 3 out of 7 cases. Although culture for Cryptococcus was positive in all, it took 10 days to grow in 2 cases. India-ink stain showed scanty number of organisms in 3 cases. Low cell counts in CSF and presence of associated hyponatremia appear to be bad prognostic indicators in Cryptococcal infections of central nervous system. Latex agglutination test is a worthwhile screening test.Key Words: Cryptococcal meningitis, Cryptococcus neoformans, Opportunistic infection     

Insulin-like growth factor binding proteins (IGFBPs) and IGFBP-related protein 1-levels in cerebrospinal fluid of children with acute lymphoblastic leukemia

Abnormalities in insulin-like growth factor binding proteins (IGFBPs) have been reported in the cerebrospinal fluid (CSF) of children with acute leukemia. In the present study, we have further characterized the IGFBPs in whole CSF prospectively in 11 children with acute B-lineage lymphoblastic leukemia (ALL) undergoing chemotherapy. Western ligand blots Western immunoblots using a new anti-IGFBP-6 and a new IGFBP-rP1 (related protein-1 antibody and immunoassays (Diagnostic Systems Laboratories, Inc., Webster, TX) were used to characterize and measure IGFBP-6, IGFBP-2, IGFBP-3, and IGFBP-rP1 in children with ALL at diagnosis, and with treatment. Comparisons at baseline were made with 11 children with meningitis and 11 children with febrile convulsions (controls). The mean (+/- SE) CSF IGFBP-6 in ALL patients, 56 (+/- 7) ng/mL, was significantly lower than in meningitis, 97 (+/- 17) ng/mL; and in controls, 123 (+/- 24) ng/mL (P < 0.05, t test). In contrast, CSF IGFBP-3 was elevated in ALL patients, 29 (+/- 9) ng/mL; compared with meningitis, 11 (+/- 1) ng/mL; and controls, 10 (+/- 1) ng/mL (P < 0.05, t test); and IGFBP-2 did not differ among the three groups (47-59 ng/mL, P > 0.05). CSF IGFBP-6 remained very low in the patients with ALL, at 4 and 36 weeks of treatment; whereas IGFBP-3 decreased to control levels, and IGFBP-2 did not change significantly. At baseline, Western ligand blots and Western immunoblots identified a 25- to 28-kDa broad band as IGFBP-6 and a 30-kDa band as IGFBP-2 and showed that there was almost no intact IGFBP-3 in CSF. IGFBP-rP1 was also present in the CSF and was elevated in patients with ALL, compared with the 2 control groups. In conclusion, at diagnosis, IGFBP-rP1 and fragments of IGFBP-3 are elevated, and IGFBP-6 is significantly decreased, in the CSF of ALL children; and IGFBP-6 remained low, with treatment, up to 36 weeks. The role of the IGFBPs and IGFBP-rPs in central nervous system acute leukemia remain to be further elucidated.