In vitro anticancer activity of fucoidan extracted from Sargassum cinereum against Caco-2 cells

Fucoidan is a marine sulfated polysaccharide, which is extracted from brown seaweed that has a wide range of bioactivities including anti-cancer properties. However, the underlying mechanism of fucoidan on its anti-cancer and apoptotic activity against colon cancer cell line Caco-2 remains to be elucidated. Hence, the present study evaluated the cytotoxicity, apoptotic and anti-cancer activity of fucoidan extracted from brown seaweed Sargassum cinereum against Caco-2 cell line. Cytotoxicity, morphological examination of nuclei, mitochondrial membrane potential, flow cytometry, reactive oxygen species (ROS) formation and detection of apoptotic efficacy of fucoidan were assessed by different assay protocols. Fucoidan inhibited growth of Caco-2 cells in a dose-dependent manner. IC50 concentration of fucoidan was found to be 250 μg/ml. AO/EB, Hoechst and Annexin V/PI staining confirmed the apoptosis induced by fucoidan in Caco-2 cells. Fucoidan was also found to increase ROS production and augment mitochondrial membrane permeability. The findings of the study suggest that fucoidan exerts potent anti-cancer and apoptotic effect on Caco-2 cells by enhancing ROS production. Thus, fucoidan may be used as a promising therapeutic regimen against various cancer cell types.

Bio-prospecting of coral (Porites lutea) mucus associated bacteria, Palk Bay reefs, Southeast coast of India

Coral mucus is one of the key localization in the coral holobiont, as this serves as an energy rich substrate for a wide range of abundant, diverse and multifunctional microbiota. However, very little is known about the functional role of bacterial communities in their associations with corals. In the present study, a total of 48 isolates were obtained from Porites lutea wherein the genus of Bacillus sp. and Vibrio sp. were predominant. Bio-prospecting the coral mucus revealed the existence of (10.42%) antagonistic bacteria against the tested bacterial pathogens. Molecular taxonomy (16S rRNA) proved the identity of these antagonistic bacteria belong to Enterobacter cloacae (CM1), Bacillus subtilis (CM2), Bacillus sp. (CM11) and Bacillus marisflavi (CM12). The secondary screening emphasized that the ethyl acetate extract of B. subtilis showed strong antagonistic effect, followed by the chloroform extract of E. cloacae and ethyl acetate extract of B. marisflavi. The antagonistic activity was statistically confirmed by Principal Component Analysis and Hierarchical Cluster Analysis. The privileged coral mucus associated bacterial (CMAB) solvent extracts inhibited the bacterial pathogens at 100 μg/ml (MIC) and ceased the growth at 200 μg/ml (MBC). The hemolytic and brine shrimp lethality assays disclosed the non-toxic nature of solvent extracts of CMAB. Altogether, the present investigation brought out the diversity of bacteria associated with the mucus of P. lutea. In addition, bio-prospecting corroborated the CMAB as the potential source of pharmacologically important bioactive compounds against a wide range of bacterial pathogens.

Differential response of coral communities to Caulerpa spp. bloom in the reefs of Indian Ocean

Coral reef ecosystems are disturbed in tandem by climatic and anthropogenic stressors. A number of factors act synergistically to reduce the live coral cover and threaten the existence of reefs. Continuous monitoring of the coral communities during 2012-2014 captured an unprecedented growth of macroalgae as a bloom at Gulf of Mannar (GoM) and Palk Bay (PB) which are protected and unprotected reefs, respectively. The two reefs varying in their protection level enabled to conduct an assessment on the response of coral communities and their recovery potential during and after the macroalgal bloom. Surveys in 2012 revealed a live coral cover of 36.8 and 14.6% in GoM and PB, respectively. Live coral cover was lost at an annual rate of 4% in PB due to the Caulerpa racemosa blooms that occurred in 2013 and 2014. In GoM, the loss of live coral cover was estimated to be 16.5% due to C. taxifolia bloom in 2013. Tissue regeneration by the foliose and branching coral morphotypes aided the recovery of live coral cover in GoM, whereas the chances for the recovery of live coral cover in PB reef were low, primarily due to frequent algal blooms, and the existing live coral cover was mainly due to the abundance of slow-growing massive corals. In combination, results of this study suggested that the recovery of a coral reef after a macroalgal bloom largely depends on coral species composition and the frequency of stress events. A further study linking macroalgal bloom to its specific cause is essential for the successful intervention and management.

Lessons from the confidential enquiry into maternal deaths, Malaysia

Malaysia has successfully reduced maternal mortality through several efforts which, in the broad sense, include (i) the overall socio-economic development of the country; (ii) strengthened health services; and (iii) specific efforts and initiatives for the reduction of maternal mortality, one of which is the audit of maternal deaths by the confidential enquiry into maternal deaths.

Bacterial bioluminescence response to long-term exposure to reverse osmosis treated effluents from dye industries

The bacterial bioluminescence assay is one of the novel means for toxicity detection. The bioluminescence response of 2 marine bioluminescent bacteria was tested upon their long-term exposure to 9 different reverse osmosis (RO) rejects with varying chemical composition sampled from various dye industries. Bioluminescent bacteria were cultured in the RO reject samples, at different concentrations, and their growth rate and luminescence was measured for 24 h. The RO reject samples caused sublethal effects upon exposure and retarded the growth of bacteria, confirming their toxic nature. Further, continuation of the exposure showed that the initial luminescence, though reduced, recovered and increased beyond the control cultures irrespective of cell density, and finally decreased once again. The present study emphasizes the need of evolving a long-term exposure assay and shows that the method followed in this study is suitable to evaluate the toxicants that exert delayed toxicity, using lower concentrations of toxicants as well as coloured samples.

Community structure and coral status across reef fishing intensity gradients in Palk Bay reef, southeast coast of India

Coral reef fishes are exploited without the knowledge of their sustainability and their possible effect in altering the community structure of a coral reef ecosystem. Alteration of the community structure could cause a decline in the health of coral reefs and its services. We documented the coral community structure, status of live corals and reef fish assemblages in Palk Bay at the reef fishing hotspots and its nearby reef area with minimum fishing pressure and compared it with a control reef area where reef fishing was banned for more than two decades. The comparison was based on the percent cover of different forms of live corals, their diversity and the density and diversity of reef fishes. The reef fish stock in the reef fishing hotspots and its neighbouring reef was lower by 61 and 38%, respectively compared to the control reef. The herbivore fish Scarus ghobban and Siganus javus were exploited at a rate of 250 and 105 kg month(-1) fishermen(-1), respectively, relatively high comparing the small reef area. Live and dead corals colonized by turf algae were predominant in both the reef fishing hotspots and its nearby coral ecosystems. The percent cover of healthy live corals and live corals colonized by turf algae was <10 and >80%, respectively, in the intensively fished coral ecosystems. The corals were less diverse and the massive Porites and Favia colonies were abundant in the intensive reef fishing sites. Results of this study suggest that the impact of reef fish exploitation was not solely restricted to the intensively fished reefs, but also to the nearby reefs which play a critical role in the resilience of degraded reef ecosystems.

Fungi and their role in corals and coral reef ecosystems

Fungi in coral reefs exist as endoliths, endobionts, saprotrophs and as pathogens. Although algal and fungal endoliths in corals were described way back in 1973, their role in microboring, carbonate alteration, discoloration, density banding, symbiotic or parasitic association was postulated almost 25 years later. Fungi, as pathogens in corals, have become a much discussed topic in the last 10 years. It is either due to the availability of better tools for investigations or greater awareness among the research communities. Fungi which are exclusive as endoliths (endemic) in corals or ubiquitous forms seem to play a role in coral reef system. Fungi associated with sponges and their role in production or induction of secondary metabolites in their host is of primary interest to various pharmaceutical industries and funding agencies. Fungal enzymes in degradation of coral mucus, and plant detritus hold great promise in biotechnological applications. Unravelling fungal diversity in corals and associated reef organisms using culture and culture-independent approaches is a subject gaining attention from research community world over.

Dynamics and diversity of phosphate mineralizing bacteria in the coral reefs of Gulf of Mannar

Phosphatase Producing Bacteria (PPB) and Inorganic Phosphate Solubilizing Bacteria (IPSB) are important to reef nutrition. These microbes and phosphate concentration play a significant role in the productivity of coral reef ecosystems. A study was conducted in Gulf of Mannar coral reef ecosystem to understand the diversity of these groups of bacteria and their competence in mineralizing the phosphate. The PPB isolates were identified under six genera i.e. Bacillus, Pseudomonas, Micrococcus, Vibrio, Arthrobacter and Brevibacterium. Likewise, the IPSB isolates were also identified that belong to six genera i.e. Bacillus, Arthrobacter, Pseudomonas, Flavobacterium, Flavomonas and Micrococcus. Among the PPB and IPSB strains, Bacillus represented more number of species than others. PPB exhibited maximum activity between pH 8 and 9 and the lowest was at pH 6. Among the phosphatase producers Bacillus cereus (546) showed maximum activity (0.333 mmol/l P) at pH 8. In general, the phosphatase activity in most of the Bacillus species varied with reference to different pH. The species Bacillus megaterium (573) showed highest phosphate solubilizing activity (0.906 mmol/l P) by producing 2-ketogluconic acid. The production of organic acids and phosphatase enzymes by these bacterial groups are responsible for the conversion of insoluble inorganic and organic phosphates into soluble forms which are available for the reef organisms.

Studies on luminous, Vibrio harveyi associated with shrimp culture system rearing Penaeus monodon

Microbiological studies in a modified extensive shrimp culture system at Nambuthalai, southeast coast of India were carried out fora period of 120 days. Population dynamics and distribution profile of luminous bacteria and total heterotrophic bacteria in the water sediment and animal samples were monitored. Luminous bacteria associated with exoskeleton, gills and gut were isolated and quantified. The total heterotrophic bacterial counts ranged from 1.3 x 10(4) to 25.3 x 10(4) CFU ml(-1) in water and 1.5 x 10(6) to 26.2 x 10(6) CFU g(-1) in sediment. The V. harveyi population density varied between 0.6 x 10(4) and 8.8 x 10(4) LCFU ml(-1) in water and from 1.2 x 10(6) to 10.4 x 10(6) LCFU g(-1) sediment respectively. The gut of the animal was found to harbor high density of V. harveyi than gills and exoskeleton. The total heterotrophic bacteria and V. harveyi population density showed increasing trend during the culture period. The high V harveyi density observed in this study at the end of the culture period correlated with the outbreak of white spot disease.

Maternal mortality in Malaysia 1991–1992: The paradox of increased rates

"This paper aims to show that the establishment of a better data collection and reporting system in Malaysia since 1991 has led to an apparent increase in the maternal mortality ratio.... Because of improved surveillance, the maternal mortality ratio may continue to appear to rise for a few years but should decline after that reflecting the improvement in the health status and service delivery in Malaysia."

Rising caesarean section rates in public hospitals in Malaysia 2006

The caesarean section rate in Malaysian public hospitals has increased to 15.7% from 10.5% in the year 2000. There are inter-state variations in the rate ranging from a high of 25.4% in Melaka to 10.9% in Sabah. The West Coast states generally had a higher caesarean section rate than the East Coast states as well as East Malaysia. It would be prudent for Malaysia to implement stringent caesarean audits to ensure that rising caesarean section rates are kept in check.

Risk factors associated with low birth weight infants in the Malaysian population

This study aimed to identify the risk factors which were significantly associated with low birth weight (LBW, <2500 g) infants among the Malaysian population. This was a case-control study carried out at the Tuanku Jaafar Hospital, Seremban, Malaysia over a five-month period. Cases were all infants born with birth weight less than 2500 g. Control infant were selected with the help a random sampling table from among infants with birth weight of > or =2500 g born on the same day in the hospital. Of 3341 livebirths delivered in the hospital, 422 (12.6%) were LBW infants. Logistic regression analysis showed that, after controlling for various potential confounders, the only significant risk factors associated with infants of LBW were gestational age (adjusted odds ratio (OR)=0.6, 95% C.I.: 0.5, 0.6; < 0.0001), maternal pre-pregnancy weight (adjusted OR = 0.97, 95% C.I.: 0.95, 0.99; p < 0.0001), nulliparity (adjusted OR = 3.4, 95% C.I.: 2.2, 5.1; p < 0.0001), previous history of LBW infants (adjusted OR = 2.3, 95% C.I.: 1.4, 3.8; p=0.001) and PIH during current pregnancy (adjusted OR=3.3, 95% C.I.: 1.6, 6.6; p = 0.001). A number of potentially preventable or treatable risk factors were identified to be associated with LBW infants in Malaysia.

The clinical and genetic associations of anti-cyclic citrullinated peptide antibodies in psoriatic arthritis

OBJECTIVES

Antibodies recognizing a cyclic citrullinated peptide (anti-CCP) are highly specific for rheumatoid arthritis (RA) but their role in psoriatic arthritis (PsA) remains unclear. The aim of this study was therefore to investigate the prevalence of anti-CCP antibodies in PsA and assess their clinical and genetic associations.

METHODS

One hundred and twenty-six patients with PsA, 40 patients with seropositive RA and 40 controls were tested for the presence of anti-CCP antibodies, rheumatoid factor (RF) and the HLA-DRB1 shared epitope. Clinical and radiological data were collected prospectively on all patients and compared between anti-CCP-positive and -negative patients.

RESULTS

Seven (5.6%) patients with PsA were positive for anti-CCP antibodies compared with 0% of controls and 97% of patients with seropositive RA. The presence of anti-CCP antibodies in PsA was significantly associated with the HLA-DRB1 shared epitope (P<0.005), erosive disease (P<0.05), number of swollen joints (P<0.02) and DMARD use (P<0.05).

CONCLUSIONS

Overall, the increased prevalence of anti-CCP antibodies in this PsA population failed to reach statistical significance. However, when present, they were a marker of disease severity and had RA-linked MHC class II associations. Further studies are needed in a larger population of patients with PsA and appropriate controls to confirm any true association that may be present.

Medicine and the law

When a doctor is required to go to court, he does so with some amount of trepidation. The degree of trepidation increases in direct proportion as to whether he is required to be a witness or a defendant. The practice of medicine on the other hand requires the patient to have full confidence and open out his secrets to the doctor. If you hold back vital information, the diagnosis may be entirely different to the disease that you have. Lawyers who enter hospitals may also do so with some trepidation, maybe even more so than doctors who enter courts, as their lives are at stake. There is a perception that medico-legal matters are on the rise. We may put forward a few reasons for this: 1. A better educated and increasingly assertive public with greater awareness of the medical and legal systems; 2. Rising expectations of medical results; 3. Commercialization of medical care with erosion of the doctor-patient trust relationship. This paper will discuss the reasons for and the ways to address medical errors as well as explore the reasons for defensive medicine. The argument is put forward that public education programs on the risks inherent in some of the new advances in treatment modalities and surgery and professional education programs on the need for obtaining the patient's informed consent to such treatment is needed. Public advocacy programs to demonstrate the problems in medicine and the delivery of health care resulting from strict cost containment limitations should be carried out. There is also the need to enhance the level and quality of medical education for all physicians, including improved clinical training experiences. Doctors' must manage their clinical affairs in a professional manner without being dictated to by the legal system. However, it would be wise to take note of the views expressed by learned counsel and judges in their courts. The middle road is always the best and we must never be extreme in our viewpoints. We must always remember the patient is why we are here and the patient must never suffer in the process while we formulate our responses to the medico-legal challenges that lie ahead.

Unwanted pregnancy--medical and ethical dimensions

Globally, abortion mortality accounts for approximately 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high maternal mortality and morbidity from abortion tend to occur together. Unplanned and unwanted pregnancies constitute a serious public health responsibility. While fertility has declined by half in developing countries, the motivation to control and space births has risen faster than the rate of contraceptive use. Preventing maternal mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. A range of positive steps has been taken to reduce deaths and morbidity from abortion in a growing number of countries over the past 15 years. Making abortion legal is an essential prerequisite in making it safe. In this respect, changing the law does matter and assertions to the contrary are ill conceived and unsupported in practice. Although, in many countries, trends towards safer abortion have often occurred prior to or in the absence of changes in the law, legal changes need to take place if safety is to be sustained for all women. Religious laws may also require attention when legal change is being contemplated. There are three main ways of approaching this problem: liberalizing the existing law within the penal or criminal code; partially or fully legalizing abortion through a positive law or a court ruling; and decriminalising abortion by taking it out of the law. Women's health groups and other advocates, parliamentarians and health professionals, can work together to support the right of women not to die from unsafe abortions and to ensure they receive treatment for complications. Committed doctors can make a difference by providing treatment for abortion complications, interpreting the law in a liberal way and providing safe services where these are legal as well as training providers in the safest techniques to reduce mortality and morbidity. Although law, policy and women's rights are central to this issue, making abortions safe is above all a public health responsibility of governments. Moreover, reducing maternal mortality by making abortions safe is also an important part of the international commitment made in Cairo in 1994 at the ICPD and reaffirmed at the Cairo meeting in 1999.

Did we do it right?--an evaluation of the colour coding system for antenatal care in Malaysia

Identification of pregnancies that are at greater than average risk is a fundamental component of antenatal care. The objective of this study was to assess the level of appropriate management and outcomes among mothers with hypertensive disorders of pregnancy, postdates and anemia in pregnancy, and to determine whether the colour coding system had any effect on the maternal mortality ratios. A retrospective follow-through study confined to users of government health services in Peninsular Malaysia was carried out in 1997. The study areas were stratified according to their high or low maternal mortality ratios. The study randomly sampled 1112 mothers out of 8388 mothers with the three common obstetric problems in the selected study districts. The study showed that the prevalence of anemia, hypertensive disorders in pregnancy and postmaturity among mothers with these conditions were according to known international standards. There was no significant difference in the colour coding practices between the high and low maternal mortality areas. Inappropriate referrals were surprisingly lower in the areas with high maternal mortality. Inappropriate care by diagnosis and by assigned colour code were significantly higher in the areas with high maternal mortality. The assigned colour code was accurate in only 56.1% of cases in the low maternal mortality areas and in 55.8% of the cases in the high maternal mortality areas and these two areas did not differ significantly in their accurate assignment of the colour codes. The colour coding system, as it exists now should be reviewed. Instead, a substantially revised system that takes cognisance of evidence in the scientific literature should be used to devise a more effective system that can be used by health care personnel involved in antenatal care to ensure appropriate level of care and referrals.

Fungi in Porites lutea: association with healthy and diseased corals

Healthy and diseased scleractinian corals have been reported to harbour fungi. However, the species of fungi occurring in them and their prevalence in terms of biomass have not been determined and their role in coral diseases is not clear. We have found fungi to occur regularly in healthy, partially dead, bleached and pink-line syndrome (PLS)-affected scleractinian coral, Porites lutea, in the reefs of Lakshadweep Islands in the Arabian Sea. Mostly terrestrial species of fungi were isolated in culture from these corals. Hyaline and dark, non-sporulating fungi were the most dominant forms. Fungal hyphae extended up to 3 cm within the corals. Immunofluorescence detection using polyclonal immunological probes for a dark, initially non-sporulating isolate (isolate # 98-N28) and for a hyaline, non-sporulating fungus (isolate # 98-N18) revealed high frequencies of these in PLS-affected, dead and healthy colonies of P. lutea. Total fungal biomass accounted for 0.04 to 0.05% of the weight of corals in bleached corals and was higher than in PLS-affected and healthy colonies. Scanning electron microscopy revealed the presence of fungi within the carbonate skeleton and around polyps. Fungi appear to be a regular component of healthy, partially dead and diseased coral skeleton.

Visual field loss associated with vigabatrin: pathological correlations

Pathological changes are reported in the anterior visual pathways of a 41 year old man with complex partial seizures treated with vigabatrin who developed bilateral visual field constriction. There was peripheral retinal atrophy with loss of ganglion cells and loss of nerve fibres in the optic nerves, chiasm, and tracts. No evidence of intramyelinic oedema was seen. These findings suggest that the primary site of injury lies within the ganglion cells in the retina. The degree of atrophy seen would suggest that the visual field loss is irreversible.

Maternal deaths due to liver disease in Malaysia

Liver disease is an important and serious condition in pregnancy. The Confidential Enquiries Into Maternal Deaths in Malaysia showed that there were 23 maternal deaths attributed to liver disease between 1991-1994. Over the same period, there were 1066 reported maternal deaths with 929 of them being due to direct and indirect causes. Thus 2.15% of such deaths were due to liver disease in Malaysia. The three main causes of maternal deaths due to liver disease in pregnancy were hepatitis (6 cases), acute fatty liver in pregnancy (6 cases) and septicaemia (4 cases). Liver disease is common at a mean of thirty weeks of gestation with a preponderance to women of low parity. Only two patients in this series had no antenatal care. The majority of cases (45.8%) presented between 28-37 weeks of gestation. All cases delivered by spontaneous vaginal delivery. Remediable factors that were identified included failure to appreciate the severity of disease. Case summaries of all the cases of maternal deaths due to liver disease are discussed and a guideline to management of liver disease in pregnancy presented.

Revisiting the obstetric flying squad

The obstetric flying squad has been used in obstetric practice since 1933 to manage obstetric emergencies occurring in domicilliary practice. It has often been criticised in such situations as only delaying effective treatment to the patient. We have introduced the obstetric flying squad in an urban setting to cater for obstetric emergencies occurring in private practice. This service has been used on ten occasions since its inception without any maternal deaths being recorded or any delay in the provision of emergency care. The flying squad has led to closer cooperation between the government and private sectors in providing obstetric care.

Reproductive problems of the work force

The number of women in the workforce in increasing. A substantial proportion are in the reproductive age which brings to attention the problem of work exposures that adversely affect reproductive outcome. These exposures include chemicals, radiation, strenuous physical activity and infections. They affect reproduction by effect on the germ cells, through hormonal distribution which in turn affects transport of germ cells or zygote, implantation and development. Some of these exposures are teratogenic. At present, some regulations and policies seem to be directed at women workers while there is evidence to show that women are not the only victims. Paternal exposures have also been reported to be associated with infertility, spontaneous abortions and other adverse outcomes. There is insufficient information about reproductive effects of work exposures and hence further research is required in this area.

Evidence for a new malaria vector species, species E, within the Anopheles culicifacies complex (Diptera: Culicidae)

Female Anopheles culicifacies Giles from Ramanathapuram district, Tamil Nadu state, India, were examined for oocysts and sporozoites and their larval progeny for mitotic karyotype. Collections were made from Mandapam and Uchipuli on the mainland, and Thangachimadam and Pamban on Rameshwaram Island. Of the 451 An. culicifacies females that were collected and dissected, 24 were found positive for Plasmodia (21 for sporozoites and 3 for oocysts). Both acrocentric and submetacentric Y-chromosome karyotypes were observed among the progeny of females from all villages. All 11 iso-female lines whose parental females were positive for sporozoites or oocysts had progeny with submetacentric Y-chromosomes. Total absence of sporozoite-positives among mothers of acrocentric males was evidence of assortative mating between these 2 sympatric populations (i.e., 2 species). We propose that the nonvector population with acrocentric Y-chromosome sons retain the original designation of species B and that the vector population with the submetacentric Y-chromosome sons be designated as species E, a new species.

Late lateralizing and localizing EEG features of scalp-recorded temporal lobe seizures

The authors studied the lateralizing value for temporal epileptogenesis of focal or hemispheric EEG ictal features that first appear > or = 5 seconds after hemispheric or diffuse EEG changes or after an artifact-obscured onset, by correlation with side of lobectomy abolishing or producing > or = 90% improvement of complex partial seizures (CPS). One hundred forty-eight seizures in 39 patients rendered seizure-free (SF) by lobectomy lacked early localizing features of which 91 (61%) seizures in 37 (95%) patients had late lateralizing or localizing phenomena. Eighty-seven (96%) of 91 late localizing or lateralizing seizures occurred ipsilateral to lobectomy, involving 35 (95%) of 37 patients. Late contralateral and shifting phenomena occurred in a total of 4 seizures of 2 patients. Among 17 non-SF but > or = 90% improved patients, 30 (48%) of 63 seizures lacking early localizing features showed late localizing or lateralizing phenomena. Of these, twenty (67%) involving 12 (71%) patients occurred ipsilateral to lobectomy. Among the remaining 5 (29%) patients, a total of 5 seizures (17%) were contralateral while 5 (17%) exhibited shifting laterality. These data indicate that seizures with late (> or = 5 seconds) localizing or lateralizing features cannot be discounted when assessing laterality of temporal epileptogenesis but cannot be used as the sole electrographic criterion.

A survey of hysterectomy patterns in Malaysia

A prospective cross-sectional study involving 14 government hospitals was undertaken for a period of 6 months in Malaysia to study the patterns of hysterectomy for gynaecological indications. A total of 707 patients were enrolled in the study consisting of 612 abdominal hysterectomies and 95 vaginal hysterectomies. Fibroids (47.6%) and uterovaginal prolapse (13.4%) formed the main indications for surgery. The initial preoperative diagnosis was accurate in 82.8% of cases. A different pathology from that initially suspected was noted in 118 cases. The overall complication rate was 7.9% but vaginal hysterectomies carried a statistically higher complication rate compared to abdominal hysterectomies. Urinary tract infection was significant in vaginal hysterectomies. Blood transfusion was required in 25.0% of abdominal and 6.3% of vaginal hysterectomies. There were no laparoscopic hysterectomies or mortality in this series.

The prevalence of Chlamydia trachomatis in patients with pelvic inflammatory disease

Chlamydia trachomatis is recognized as the most prevalent sexually transmitted organism in many parts of the world. Most complications associated with chlamydial infection in women and their infants can be avoided by appropriate treatment. However, treatment is often not initiated because infections are frequently asymptomatic. The identification of at risk patients and treatment of these patients is a practical clinical approach in the reduction of transmission and prevention of complications. The prevalence of chlamydial infection among patients with pelvic inflammatory disease admitted to Seremban General Hospital was 22.7%. The difference in seropositivity between PID patients (20.5%) and antenatal controls (2.3%) was statistically significant. The corresponding cervical antigen detection rates were 6.8% and 2.3% respectively. Chlamydial infection should be screened for in gynaecological patients and antibiotic policies should take cognizance of the aetiological role played by this organism in pelvic inflammatory disease.

Practice patterns of some gynaecologists in Malaysia with regards to prophylactic oophorectomy and hormone replacement therapy

This study aimed to look at the prevailing practice patterns of gynaecologists with regards to prophylactic oophorectomy and usage of hormone replacement therapy. Questionnaires were sent to the first 200 gynaecologists listed in the membership list of the Obstetrical and Gynaecological Society of Malaysia. The response rate was 30%. The results showed that most gynaecologists would perform prophylactic oophorectomy after the age of 49 years. The result was equivocal for the ages between 45 to 49 years. Of those who retained the ovaries at the age of 45 to the menopause, 55% did so because the ovaries were still functional. Almost all gynaecologists would prescribe hormone replacement therapy (HRT) after oophorectomy and the most commonly prescribed form was the oral type. Thirty-five per cent of gynaecologists claimed that more than 80% of their patients were compliant to HRT. The reasons perceived for the poor compliance were mainly poor knowledge and misconception.

Massive ovarian cysts--successful management of two cases

Massive ovarian cysts are not commonly encountered. They frequently present a challenge to the gynaecologist who is faced with them. Two cases of successful removal of massive ovarian cysts are presented. Successful management would involve recognition of complications which occur at various steps in the treatment.

High extracellular GABA levels in hippocampus--as a mechanism of neuronal protection in cerebral ischemia in adrenalectomized gerbils

Adrenalectomy protects the brain from delayed neuronal damage that occurs following transient forebrain ischemia in gerbils. Gamma-amino butyric acid (GABA) and GABA-mimetic drugs also have a neuro-protective effect. In this study we estimated the extracellular glutamate and GABA levels in the hippocampus during transient forebrain ischemia in adrenelectomized gerbils (n = 8) compared to controls (n = 6). Duration of ischemia was 10 min, and glutamate and GABA levels were measured with in vivo microdialysis. Microdialysis was started 2 h after the placement of a probe (to stabilise baseline) and samples were collected at 10-min intervals. The pattern of glutamate release did not show any difference between adrenelectomized animals and controls. Adrenelectomized animals showed marked increase in GABA levels during ischemia and upto 30 min after ischemia (P = 0.0287, 2-way ANOVA for repeated measurements). The enhanced GABA release may be one of the possible mechanisms of neuronal protection against ischemia in adrenelectomized gerbils.

Decreased glutamate release during hypothyroidism may contribute to protection in cerebral ischemia

Hypothyroidism protects the brain from the effects of transient forebrain ischemia in gerbils. The mechanism for this protection is not fully understood. In this study we looked at the release of glutamate during ischemia in gerbils exposed to surgical hypothyroidism (n = 7), chemical hypothyroidism (n = 8), and surgical hypothyroidism thyroxine-treated (n = 3) and compared them to control euthyroid animals (n = 8). The duration of ischemia was 10 min. Glutamate release was measured with in vivo microdialysis. Microdialysis analysis began 2 h after the placement of the probes (to stabilize the baseline) and collections were obtained in 10-min samples. During ischemia, there was an increase in the release of glutamate that returned to the baseline within 20 min following the insult. In animals made hypothyroid surgically and chemically, the extent of glutamate release was significantly lower than that in the controls. The release of glutamate in the surgically hypothyroid thyroxine-treated animals was similar to that in controls. The attenuated glutamate release could be a mechanism of protection during ischemia in hypothyroid gerbils.