The Prevalence of Childhood Malnutrition : Its Measurement, what it Means and its Uses
Y H Chong, Division of Nutrition, Institute for Medical Research, Kuala Lumpur

Introduction
The prevalence of childhood malnutrition in a population or a community as with other diseases, is measured in terms of mortality and morbidity.

A Comparison of Morbidity Patterns in Peninsular Malaysia 1959 and 1974
John T Arokiasamy, MPH, Paul C Y Chen, MSc, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur

Introduction
With increasing expansion of medical and health systems in Malaysia in recent years, there has been a simultaneous increase in the demand for patient care services. Admissions in government hospitals and other governmental facilities increased from 40.1 per 1000 population in 1955 to 61.6 per 1000 population in 1975. In 1955, outpatient attendances in the same facilities were 730 per 1000 population while in 1975 this had increased to 1,164 per 1000 population. It is possible that accompanying this increase in utilisation of government facilities, changes in the patterns of disease seen at these facilities may have occurred.

Morbidity statistics on outpatients and inpatients though available are often too heterogenous to allow detailed analysis. Further a study on the patterns of diseases in governmental facilities may never give a true or complete picture of the disease problems that exist in the population. This becomes a greater limitation if one is to compare data at different time periods to look for changing disease patterns. Nevertheless, in the proper planning, implementation and evaluation of health services, it is important for health administrators to have an insight into the morbidity patterns existing as well as any changes that may have occurred over time.

Patient Health Education - An Experiment
Naranjan Singh, DPH, Deputy Director Medical & Health Services, Kelantan

Introduction
Patient Education Systems are being practised widely in the United States and other developed countries with varied experiences and sophistication. Patient Education in Malaysia is perhaps a new experiment.

Changes in lifestyle, stimulated through planned education intervention by the professionals in health care system, can be obtained, do have an impact, and are absolutely essential. This has of course resulted in the various Health Education Programmes of the Ministry of Health Malaysia. The burden of bringing about this change should not only be the responsibility of the general health workers but extended further to include hospital staff as well. In fact the hospital provides an excellent environment for health education of the patients, relatives and visitors. When an individual is ill he is impressed with effect of failure to take adequate precaution and the gravity of the situation strongly affects his friends and relatives. With this hope and from the experience gained in hospitals in Kelantan that a large percentage of our patients especially children enter hospitals for treatment of preventable diseases and are frequently readmitted for similar conditions or their sequele due to amongst other factors, the lack of knowledge and the improper personal health practises of the patient/parents (personal communication Dr S Bala Krishnan, former Paediatrician, General Hospital Kota Bahru) kindled the thought and concept of an activity in the field of patient health education as an integrated part of patient management in hospitals in Kelantan.

It was felt that if a positive start was made to provide useful pragmatic health information and practises demonstrated to patients, it would produce some beneficial effects not only in those sick and admitted, but perhaps also trickle into the community, through the patients - the new agent of change - return from hospital. These individuals who form the community which is in fact an aggregate of individuals between whom is an interdependent relationship that forms the basis of way of life would constitute another nucleus for changes in health behaviour in that community. This could be another additional channel to other efforts for implementation of preventive education in the community.

While it is true at present that patients acquire some knowledge of illness and its prevention during their stay in hospital, this is strictly limited in effect and extent especially from point of view of compliance as shown by several studies.

Keeping in mind these basic principles and problems, a pilot project to integrate health education activities or patient education was launched in October 1978 in the district hospitals of Kuala Krai and Machang, Kelantan after full concurrence and support of the State Director of Medical and Health Services, the Director of Dental Services and other senior staff concerned. This programme was designed to achieve the following objectives.

To impart knowledge, through providing information and demonstration on simple and basic health problems to the patients which when applied properly and regularly, would motivate to benefit the patients, family and the community as a whole in the maintenance and promotion of their basic needs of survival, safety and life enhancement.

It is also aimed to provide a better understanding of disease conditions and its preventive aspects which would give positive and long term beneficial effect to hospital treatment.

It is hoped that in the long term these continuous trations under the microscope and by other means was encouraged. The project is still in its infancy needing much perseverance, frequent supervision, guidance, consultation and adjustments. Several problems have been elicited in the early phases of the implementation of this project.

A Case Report of Acupuncture Anaesthesia in Amputation of the Knee
P T L Wong, DAc, Member of British and International Acupuncture Associations, Medical Officer, Bintulu, Sarawak

Introduction
Acupuncture anaesthesia is a recent development even though acupuncture had been applied for the relief of pain and psychosomatic disorders for thousands of years. It has been reported that a total of over 2,000 operations had been successfully performed at the Xuan Wu Hospital, Beijing, China, since 1965.

In this article, a below-knee amputation which was performed under acupuncture "anaesthesia" at the Bintulu Hospital, in October 1979, is reported.

Malay Psychiatric Patients and Traditional Healers (Bomohs)
O H Yeoh, MRANZCP, General Hospital, Kota Bahru

Introduction
In Malaysia modern psychiatric concepts and practice coexist with indigenous systems of traditional medicine among the three ethnic groups of Malays, Chinese and Indians. The mentally ill as well as physically ill avail themselves of both these systems of care simultaneously or at different periods. The consultation of traditional healers is at times by necessity because of the unavailability of psychiatrists.

An understanding of the concept and practice of the indigenous systems of medicine as applied to mental illness provides an insight into the behaviour and attitudes of patients who also seek modern pyschiatric care. The concepts and causation of mental illness among the Malays have been well documented by Chen (1970) and Hartog and Resner (1972), and among the Chinese in Malaysia by Gwee (1971). This paper presents a profile of Malay psychiatric patients admitted to hospital and the practice of traditional medicine experienced by them and their attitude towards practice.

Tolerance of Daily Single Compared to Space Dose of Merital
Syer M Haq, FRCP, Neil Buhrich, MRCP, Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda, Kuala Lumpur

Introduction
Merital (Nomifensine) is a tetrahydroiso quinolene which is structurally unrelated to the tricyclics or to the monoamino-oxidase inhibiters. Merital has been reported to have antidepressant properties equivalent to amitryptyline and imiprimime in the treatment of patients with depressive symptoms. Bruckner and Jansen (1977) reported that in 105 depressed patients whose mean age was 74 years. Merital produced significantly better results than placebo. It has been suggested that its mechanism of action is due to potent inhibition of dopamine reuptake at the synaptic terminals.

Published reports consistently show side effects of Merital to be minimal compared to tricyclic antidepressants. Tests of motor activity and vigilance show that patients taking Merital compared to those taking placebo perform equally well. Burrows, Vohra, Dumovic, Scoggins and Davies, 1978 found that Merital in doses of up to 200 mgs daily had no significant effect on heart rate or blood pressure. Brogden, Heel, Speight and Avery (1979) have given a comprehensive review of the literature of the pharmacological and therapeutic properties of Merital.

The aim of this study was to assess whether a single daily dose of Merital was as well tolerated and as effective in its antidepressant action as an equivalent amount of Merital given in spaced doses.

Diagnosis and Management of Brain Death
Mohamed Namazie, FFARCS, Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur

Introduction
Death is a common human event that a layman knows what it involves. Death is a term so simple and basic that definition is considered unnecessary by many people. There would have been little disagreement till recently, if death was defined as complete cessation of vital functions of respiration and circulation. However, recently, diagnosis of death has been an issue of much debate and discussion in several countries. This can be attributed to the advancement of medical sciences especially in the field of resuscitation and intensive care. With the development of new techniques and forms of management in the intensive care units, it is now possible to have deeply comatose and unresponsive patients with severe brain damage maintained on artificial respiration by means of mechanical ventilators.

Currently, death is not considered as an event but as a process though instant death does occur occasionally. Death is a process leading to the failure of the various organs and systems supporting the continuation of life and eventually complete cessation. Death can occur in 2 ways : In majority of the cases, the organ failure occurs and eventually reaches a point when brain death occurs and this is the point of no return. In some cases, however, death does not occur as a result of the failure of other organs or systems but as a direct result of severe damage to the brain itself. In this situation the process of dying is reversed. Brain death normally results in the arrest of spontaneous respiration and this is normally followed within a few minutes by cardiac arrest due to hypoxia. If however, artificial respiration is instituted early, the cardiac arrest can be delayed for several days or weeks and haemo-perfusion of other organs like liver and kidneys can be maintained.

With the advent of transplant surgery it became essential to establish the exact criteria for diagnosis of death. Several countries have drawn up their own criteria and tests for confirming brain death. In 1969 Harvard criteria was the first to be devised to guide doctors in USA to diagnose brain death. The National Board of Health of Finland published their diagnostic criteria in 1971 and Finland was the first country to legally accept brain death. In 1976 the Conference of Medical Royal Colleges and Faculties in the UK issued a statement setting out the diagnostic criteria of brain death and these are stated in the article.

Case Observation on the Common Peroneal Nerve Injury
Kyaw Myint, MBBS, Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur

Introduction
Peculiar anatomical features render the common peroneal nerve and its nutrient vessels particularly susceptible to damage in injuries about the knee. Sunderland (1968) observed that, at the knee, this nerve is opposed to the neck of the fibula by the attachments of the deep fascia. In this way not only is the nerve securely fixed at this site, but it is also angulated where it turns abruptly laterally from the gastrocnemius to pass between the two heads of the peroneus longus. Here it is flattened and its constituent are exposed and left unprotected between them. Although Lyle (1925), Perrin and Labry (1926), Woltman (1930), Selig (1938), Lewin (1943), Weddell et al. (1943), Parkes (1960), Barrett and Cramer Fritz (1963), Marwah (1964), Burkhart and Daly (1966), Crothers and Johnson (1973), Gloobe and Chain (1973), Mangieri (1973) and Ogden (1974) have reported the various causes of injury to the common peroneal nerve, none of them have compared the incidence and the severity between the superficial and deep divisions of this nerve.

Psoriasis in Hospital Population
B A Adam, MRCP, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur

Introduction
Psoriasis has a worldwide prevalence and its incidence in the University Hospital is 4%. The pattern of psoriasis in this index population was studied and the findings, probably applicable to the rest of the Peninsular Malaysia, are described and compared with the published reports from other countries.

Pseudomyxoma Peritonei - A Case Report
C C Ho, MBBS, Department of Medicine, University Hospital, Kuala Lumpur

Introduction
Pseudomyxoma peritonei is a rare condition in which mucinous material is found free within the peritoneal cavity. This condition is associated with ovarian cysts, mucocele of appendix, urachal cysts and rarely mucous secreting carcinomas of the gastrointestinal tract. Werth was the first to describe the presence of gelatinous material in the peritoneal cavity in 1884. He ascribed his first case to a ruptured pseudomucinous cyst of an ovary. Fraenkel in 1901 reported this condition in a man which resulted from a ruptured appendicular mucocele. Weaver in 1937 reporting a series of 256 cases of mucoceles of the appendix, found peritoneal pseudomyxoma in only 0.11 per cent of these cases. This rare, interesting condition has yet to be reported in Malaysian literature though two cases of mucocele of appendix were reported by Hussein Salleh (1973).

Aberrancies of Human T - and B - Lympocyte Populations in Peripherial Blood
Gan Seng Chiew, Yeoh Chee Weng, Division of Serology & Immunology, Institute for Medical Research, Kuala Lumpur

Introduction
About 50% of all current immunological papers published in journals have some aspects of T and B cell function being studied. Warner and Szenberg (1961) were the first to define the two cell types : B stands for bursa of fabricius and T stands for the thymus. Since then there is this general concept that B-cells are responsible for antibody production and T-cells for graft versus host type of reaction. Claman et al. (166) first gave evidence for the need for cooperation between T and B cells, if antibody is to be produced normaly. It was in mid-1974 that the controversy on the nature of the immune receptors on T-cells arose that remains unresolved till today. Until we are able to recognize, prepare and manipulate monoclonal populations of T-cells, any suggested interpretations is wholly tentative. The enumeration of T and B lymphocytes were started in 1978 at the Institute for Medical Research, Kuala Lumpur, and some of the clinical cases reported. Pang et al. (1979) published some results on the T and B lymphocyte percentages of our local populations. In agreeing with him that there is no known values of our local populations prior to our independent studies, this paper intends to supplement the previous publication on the same.

Ultrasound - A New Imaging Technique
Ahmad Kamal Bin Md Alif, FRCR, Radiology Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur

Introduction
Ultrasound, or high frequency sound beyond that of human hearing range, has been used for obstetrics work for the past decade or so. Although 20 kilohertz and above is considered to be in the ultrasound range, medical ultrasound uses frequencies of 0.5 to 20 megahertz. For abdominal ultrasound, a frequency of 2.5 megahertz is generally used.

Ultrasound is produced by mechanical vibrations of a piezo-electric material. This is housed in a transducer probe and the same transducer acts as a receiver, since the property of a piezo-electric material is reversible i.e. when a voltage is applied on opposite surfaces, the material changes shape and when mechanical forces are applied a voltage is produced.

The ultrasound produced is made to pass through the body and at every boundary it encounters, it is made to reflect back into the transducer probe from where the current produced is amplified and fed into a computer which reconstructs images either in the form of amplitudes, bright spots or a tomographic image of the area scanned. These are respectively called the A, B and compound B scans or modes. Further analysis by the computer converts the compound B into various shades of grey and this is called the grey-scale image.

Modification of the A mode with a moving base-line gives the M-mode which is used to detect foetal heart movements and to differentiate between blood vessels from other tubular structures.

In using ultrasound for imaging, the pulse-echo technique is employed, where the transducer produces the ultrasound in pulses and in the latent period, acts as the receiver of returning echoes. This is opposed to the Doppler technique employed to measure blood flow which uses two probes, one continuously producing ultrasound and the other acting as the receiver. The construction of the ultrasound unit is such that an organ can be scanned in various planes. As such, almost any abdominal andn pelvic organ can be accessible.

Adrenoceptor Study of Guinea-Pig Superior Mesenteric - Portal Vein
Muir C K, PhD, Lim Y M, B Pharm, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang

Introduction
Vasoactive agents have been extensively studied in precapillary resistance vessels but little emphasis has been directed to their effect on the venous system even though veins are probably important in governing haemodynamics. Approximately half the blood volume lies within the venous system, therefore a doubling in venous tone could increase the circulating volume by 25% and conversely a reduction in tone could produce cardiovascular collapse. The aim of this study was to determine the types of adrenoceptor involved in the adrenergic responses of guinea-pig superior mesenteric - portal vein.

Comparison of Fazadinium and Suxamethonium for Endotracheal Intubation in Malaysian Patients
Mohamed Namazie, FFARCS, Sylvian Das, MBBS, Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur

Introduction
Prevention of regurgitation and active vomiting with the resulting aspiration of the gastric contents into the tracheobronchial tree is of cardinal importance at the time of induction of anaesthesia. Death during induction of anaesthesia is most often due to aspiration of vomitus or regurgitated material especially in an emergency situation. It is for this reason that crash induction and rapid intubation is practiced especially when a patient has a full stomach.

Rapid intubation is facilitated by the use of a depolarising muscle relaxant, the commonly used being suxamethonium. Suxamethonium is considered to be the drug of choice since it acts fast and provides excellent muscle relaxation for rapid intubation. Suxamethonium is a depolarising muscle relaxant of short onset and duration of action and rapidly hydrolysed by serum cholinesterase. However, its use is associated with post-anaesthetic muscle pains. This has been attributed to the muscle fasciculation caused by depolarisation which in addition elevates the plasma potassium level. This elevation may be harmful and cardiac arrest has been reported. The other disadvantages include dysrhythmias, brady-cardia, elevation of intraocular pressure , and elevation of intragastric pressure. Furthermore, suxamethonium is known to induce malignant hyperpyrexia. Prolonged apnoea may occur in the presence of atypical serum cholinesterase or when the level of serum cholinesterase is decreased.

The adverse effects of suxamethonium may be attributed to the depolarisation which occurs before the paralysis of muscle fibres. Consequently, a search for a rapidly acting non-depolarising muscle relaxant began. Commonly used non-depolarising muscle relaxants are slower in onset of action compared to suxamethonium and, therefore, unsuitable for rapid intubation in patients with full stomach.

Fazadinium (AH 8165, Fazadon) is an azobisarylimidazo-pyridinium derivative which has competitive neuromuscular blocking activity. It was the most potent of nine related compounds tested by Bolger et al. (1972). Initial animal studies showed that fazadinium had rapid onset, short duration, and non-depolarising mode of action. Simpson et al. (1972) did studies on human volunteers using isolated limb techniques and followed it with clinical trials. They showed that although paralysis was produced rapidly the duration of action was much longer than in animals and was similar to that of pancuronium. Coleman et al. (1973) found that the speed and ease of endotracheal intubation following the injection of fazadinium was comparable in every respect to those following suxamethonium.

This study was undertaken to compare the ease of intubation following the administration of suxamethonium and fazadinium at predetermined times in Malaysian patients.

First Isolates of Chloramphenicol Resistant S. Typhi in Malaysia
M Jegathesan, MRCP, Khor S Y, BSc, Division of Bacteriology, Institute for Medical Research, Kuala Lumpur

Introduction
Interest in the antibiotic sensitivity of S. typhi was stimulated by the report of a massive outbreak of chloramphenicol resistant typhoid in Mexico in 1972. The strain implicated in this outbreak had two important features : it was highly resistant to chloramphenicol and this resistance resulted from the carriage of a transferable resistance factor (R factor) which coded resistance to streptomycin, sulphonamides, and tetracycline. Since then transferable chloramphenicol resistance has been reported in the typhoid bacillus in countries such as India, Vietnam, Thailand and Indonesia. The incidence of such strains seems to be on the increase and they already constitute a substantial proportion of culture isolated from typhoid patients in countries like Vietnam and Thailand.

The bacteriology division of the Institute for Medical Research in Kuala Lumpur has been watching out for the emergence of such strains in this country for some time but until late 1978 no such strains were encountered. Subsequently 4 strains have been isolated. This paper discusses the bacteriological features of these first isolates of chloramphenicol resistant S. typhi in Malaysia.

Anopheles Donaldi : Some Recollections and Speculations
J A Reid, DSc, 43 The Orchard, Dorking, Surrey, England

Introduction
In May 1941 there was a widespread strike of labour on the rubber plantations of Malaya. The strike posed a considerable threat to the war effort for which rubber was essential. The Government therefore acted quickly with various measures, one of which was to mobilise the F.M.S.V.F. (The Federated Malay States Volunteer Force) to patrol the estates. Most of the estate workers were Tamils and in the State of Selangor, where I was a humble private in the F.M.S.V.F., the affair was referred to jokingly as "The Tamil War".

We spent several rather uncomfortable and boring days in patrol and guard duties on estates around Kuala Lumpur before the strike ended. But during that time I was bitten at night by what, with high sight, was probably Anopheles donaldi Reid, an important member of the Anopheles (An.) barbirostris species and possible significance of this encounter with A. donaldi that are related here.

Acute Gastroenteritis in Malaysian Children : Aetiological and Therapeutic Considerations
N Iyngkanan, MRCP*, Zainal Abidin, MRCP*, S K Lam, PhD**, S D Puthucheary, MBBS**, *Department of Paediatrics, **Department of Medical Microbiology, University of Malaya, Kuala Lumpur

Introduction
In recent years there have been a number of advances facilitating our understanding of the pathogenesis of acute gastroenteritis (AGE) in infancy and childhood. The discovery by Bishop et al. (1973) of the aetiological significance of the rotavirus has been confirmed by a number of other workers and it is now clear that the rotavirus is worldwide in distribution. The concept of toxigenic E. coli has replaced the unsatisfactory classification of pathogenicity of E. coli on the basis of serological types. Hopefully it should not be long before such toxigenic strains can be identified in routine diagnostic laboratories. The importance of acquired carbohydrate intolerance, complicating AGE is now well recognized. The ability to remove lactose enzymatically from cows' milk will hopefully provide a low cost palatable lactose-free milk acceptable to children in developing countries. In any event, proper management of sugar intolerance has reduced hospital admissions and reduced hospital stay in infants requiring admission for ineffective enteritis.

Despite these advances, there is still a group of infants with AGE who despite conventional treatment and exclusion of all carbohydrates from the diet continue to have diarrhoea. There is compelling evidence that a large proportion of these are the results of cows' milk protein sensitive enteropathy (CMPSE). This problem of course would be resolved with a lactose and cows' milk protein-free formula.

The present study of infantile diarrhoea was undertaken to determine prospectively the aetiological agents of infantile diarrhoea and their relationship to clinical presentation, course of the illness, response to treatment and outcome in Malaysian infants.

A Preliminary Survey of Aedes Aegypti in Selangor, Peninsular Malaysia
Y M Ho, DAP & E*, I Vythilingam, MSc**, *Epidemiology Unit, Ministry of Health, **Office of the Director of Medical and Health Services, Selangor

Introduction
The presence of Aedes argypti in Malaya has been noted very early by Leicester (1908) and Stanton (1914). One of the earliest survey carried out on the species was by Reid (1954). Macdonald (1965a) submitted a paper dealing extensively with the distribution and dispersal of the species in Malaya. At that time, the interest in Ae. aegypti centered on it being a potential vector of yellow fever in Malaya but presently, its importance is as a vector of Dengue Haemorrhagic Fever (DHF).

Ae. aegypti breeds in both artificial and natural water containers as reported by Macdonald (1956b) and Cheong (1966). In Malaysia, the Ae. aegypti density is presently monitored by house searches using the single larva per container method devised by Sheppard et al (1969).

The aims of the present survey are firstly to provide information on the distribution of the species as related to different housing types and secondly, to observe the preferred larval habitats. Finally, it is to determine the accuracy of the single larva method of survey.

An Outbreak of Rubella Among Malaysian Air Force Recruits, 1979
V Supramaniam*, Dora S K Tan**, *Ministry of Defence, Kuala Lumpur, **Institute for Medical Research, Kuala Lumpur

Introduction
Outbreaks of disease in military recruits is a common occurrence due to the accumulation and close community living in barracks of many susceptible recruits. In the Malaysian armed forces, outbreaks of measles, mumps, rubella, acute respiratory diseases, conjunctivities and typhoid have been documented. This paper describes an outbreak of rubella among Royal Malaysian Air Force (RMAF) recruits at the RMAF School and suggests recommendations for the protection of hospital staff and patients against the infection.

Subacute Sclerosing Panencephalitis - A Case Report
C T Tan, MRCP, W C Ting, FRACP, N C Gong, MRCP, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur

Introduction
Subacute sclerosing panencephalitis (SSPE) is a progressive fatal disease of the central nervous system. It is rare and commonly affects children and young adults. The disease has characteristic clinical, EEG, measles serology and brain histological features. It is now considered to be caused by measles virus. We report here two typical cases seen in the University Hospital, Kuala Lumpur, and also briefly discuss the disease.

Experiments with Banana Trunk Juice as a Neuromuscular Blocker
Lee Siew Kheong*, Ng Lik Lin**, Lee Siew Inn***, *Department of Anaesthesiology, Faculty of Medicine, **Department of Orthopaedic Surgery, ***Department of Pharmacology, University of Malaya, Kuala Lumpur

Introduction
The juice of the banana plant is used by some African tribes to poison their arrow tips. The wooden arrows are driven into the tree trunk for approximately 24 hours. Although Heymer did not name the species of banana used, it was decided to experiment with a local variety of Musa sapientum called pisang rajah.