Myocardial Infarct in Young Malaysian Men Forty Years and Under : A Retrospective Analysis of Risk Factors
Francis G F Chin, Michael G G Chin, Consultant Physicians, Our Lady's Hospital, Ipoh, Malaysia

Summary
From this preliminary observation of a small series, there seems to be a pattern of risk factors in our young Malaysian males which fall similar to that of Caucasians. These factors in Caucasians have been proven to be of use for their predictive value in assessing risk for a coronary and would we feel hold true for young Malaysians as well.

However, certain risk factors are more important on the predictive scale namely the cardinal risk factors of smoking, hyperlipoproteinaemia and hypertension and would be serious if present singly or worse if in combination. These factors have been shown to play a major role in causation of a coronary and our Malaysian subjects share these features to a certain extent except for hypertension. Besides the cardinal factors, the secondary risk factors although not so important, are also present in our subjects in varying degrees. Together, the cardinal and secondary factors form a basis for total assessment of the coronary profile, both for young Caucasians as well as for Malaysian men. It thus seem that exposure to similar environmental risk factors would bring the same risk for a coronary to different racial and geographical groups.

Certain of these factors can be altered; primarily smoking, cholesterol tryglyceride, obesity, diet, physical inertia and to a certain extent stress can all be reduced. If the predictive values are reasonably accurate and can even be worked out as a mathematical calculation, then this will enable an energetic and effective prevention programme to be worked out. This will be especially more urgent in young men of developing countries in reducing the wastage of skilled men in morbidity and mortality.

A Comparative Study of the Prevalence of Adult Obesity in the Three Racial Groups in Kuala Lumpur
J J Jones, Professor of Biology, Faculty of Medicine, National University of Malaysia

Summary
With the striking exception of the Chinese men, obesity appears to be equally prevalent in all sections of the adult population in Kuala Lumpur. After the age of 30 years, it is equally common as in America (6), 21 to 40% of the population being 20% or more overweight. In America and Europe, this degree of obesity carries a three-fold increase in the risk of developing coronary heart disease.

Apart from small differences in sucrose and alcohol consumption, diet does not appear to explain the Chinese man's relative freedom from obesity, nor were racial differences in plasma biochemistry or blood pressure detected. It is therefore suggested that the lower body weight of the Chinese man is most probably associated with a greater degree of physical activity.

If obesity carries the same risk for diabetes and coronary heart disease in the Asian as has already been recognized for the European, the Chinese man would be expected to be relatively free from these disorders when compared with the Malay and the Indians. This possibility is now being investigated.

Cervicograms of Normal Labour in Malaysian Women
Dr Wong Wai Peng, Dr Lim Meng Aun, Prof T A Sinnathuray & Dr Wong Mei Lin, Department of O & G, Faculty of Medicine, University of Malaya, Kuala Lumpur

Summary

Pharyngeal Exudates : Mere Mantle or Menace?
Dr P S Nathan*, Dr M Jagathesan**, *Physician, Kuala Lumpur, Hon. Consultant Dermatologist, Assunta Hospital, **Malaysia Senior Bacteriologist, Institute for Medical Research, Kuala Lumpur

Summary
Fifty cases of acute untreated exudative Pharyngitis were studied in a general practice situation. Of these, 62% proved to be of undisputed pathogenic bacterial aetiology, with strept Haemolyticus contributing a menacing 58%. Yellow or Yellowish white exudates gave a much higher yield (66.7%) of Strept Haemolyticus than white exudates (48%). Antibiotic exposure would thus seem justified if only while awaiting culture and more extensive studies.

Changes in Body Fluid Distribution in Experimental Protein Malnutrition
N Chandrasekharan, C L Ho, Department of Biochemistry, Faculty of Medicine, University of Malaya, Kuala Lumpur

Summary
The severity of protein malnutrition as gauged by gross alterations in body weights are not paralleled by equally significant alterations in the volumes of the fluid compartments of the body during the early stages. The classical edema so often associated with protein malnutrition is not evident during the early stages in the development of protein deficiency.

Occupational Health in West Malaysia
Dr R Mahathevan, Assistant Director of Health Services (Occupational Health)

Summary
An important task of the occupational health service will be to improve and strengthen the training and teaching of medical graduates (undergraduates and postgraduates), health inspectors and nurses in the principles of occupational health practices.

i) Develop guidelines, standards and threshold limit values for the country, taking into consideration local and ethnic factors.

(ii) Conduct operational surveys throughout the country to identify the nature and magnitude of the incidence and prevalence of occupational diseases.

(iii) Present industrial hygiene activity in relation to monitoring and surveillance be intensified.

(iv) The list of occupational diseases in the second schedule of the Workman's Compensation Act and the fifth schedule of the Employee Social Security Act be reviewed and enlarged.

Brief Psychotherapy with Children
Dr Diana Loh Pui Ying, Child Guidance Clinic, Assunta Hospital, Petaling Jaya

Summary
Child Guidance is a new development in Malaysia. This paper records my experience of brief psychotherapy with a multiracial group of children. Though the numbers are small, results are encouraging. In Malaysia, with the acute shortage of personnel in this field, greater use of brief psychotherapy is advocated.

Screening for G.6-P.D. Deficiency
M J Robinson, K S Lau, H P Lin & G L Chan, Department of Paediatrics & Department of Pathology, University Hospital, Kuala Lumpur

Summary
This is a simple, cheap, reliable and rapid test for G.6-P.D. deficiency. We recommend it as a screening test, especially for newborns and is particularly suitable for us in remote rural areas in Malaysia.

Ovarian Tumours Complicating Pregnancy in a Malaysian Study
V Sivanesaratnam, L T Ang & Prof T A Sinnathuray, Department of O & G, University of Malaya, Kuala Lumpur

Summary
An analysis of 27 cases of ovarian tumours diagnosed in pregnancy and puerperium is presented. The incidence was 1:512. One-third of the tumours was diagnosed in the first trimester. Ninety-two per cent of the tumours were benign of which dermoid cysts were the commonest. In three of these patients, torsion of the ovarian pedicle occurred and in another three, pelvic impaction caused obstructed labour. Two patients (7.4%) presented with malignant ovarian tumours. The management of these tumours is discussed.

Micromethod for the Measurement of Renin Activity
E K Gan, Lecturer in Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Penang

Summary
A micro-method was developed for the measurement of renin concentration in the plasma and renal lymph of cat. The method involved the interaction of renin from plasma or from renal lymph with excess renin substrate in a controlled environment in the presence of neomycin sulphate and trasylol for a period of 12 hours. The angiotensin so formed was absorbed onto 1 ml of prepared Dowex 50W-X2 (NH4+), 100-200 mesh and elution of angiotensin was done by using 7 ml 0.1 N diethylamine followed by 7 ml 0.2 N ammonia in a Erlenmeyer flask and freeze dried. The freeze dried residue was dissolved in 0.1 ml 0.9% NaC1 and bioassayed against Val5-angiotensin 11-asp-β-amide on the mean systemic arterial blood pressure of ganglion-blocked rat. The optimum pH of incubation was found to be 7.0 and hence this pH was recommended for incubation purposes. Recovery studies by using synthetic angiotensin was found to be extremely good. This method is reproducible and sensitive enough to detect the renin concentration in 0.1 ml of cat plasma/lymph. The method can be easily adapted to measure the plasma renin concentration in man.

Lumbar Epidural Anaesthesia in a Solo
Ting Ing Kiet, Kuching

Summary
Lumbar epidural anaesthesia has been found to be effective and safe for a wide range of lower abdominal operations in a solo surgical practice. With careful attention to details regarding the selection of patients and the actual technique if needle puncture and injection, it is relatively free from serious side effects. Until specialist anaesthetic services become freely available in the whole of Malaysia, I would recommend that epidural anaesthetic techniques, both lumbar and caudal, be included in the postgraduate curriculum for all surgical aspirants.

Brufen in Conditions allied to, but including Rheumatoid Arthritis and Osteoarthritis - Open Study
Dr N Subramaniam, Lecturer, Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur

Summary
In conclusion, it is felt that, despite a plethora of anti-rheumatic drugs available, some of which are undoubtedly effective, Ibuprofen is a valuable, pain-relieving drug in moderately painful non-rheumatoid articular and periarticular conditions. The optimal dose appears to be 1,200 milligrams in four divided doses daily and satisfactory clinical response takes at least two weeks. The complete absence of side effects makes this the drug of choice in long-term therapy.