Anti-smoking measures, adopted by local authorities before the guideline on the ban of cigarette advertisement and anti-smoking campaign launched by the Government, are limited in scope and area. The activity is limited mainly to a ban on cigarette advertisements in theatres. Legislative measures are instituted only in the City Council, Municipal Councils and 2 ofthe 20 district councils surveyed. There is an awareness among several local authorities on the need for an increase in anti-smoking activities but action. is lacking. A population of 7.4 million. people lioe in areas controlled by the local authorities. The local authorities are expected to play a more active role along with other Government departments following a directive in August 1982 from the Chief Secretary to the Government.
A study was carried out by the Factories and Machinery Department of Malaysia to assess the problem ofoccupational exposure to inorganic lead in Malaysian battery workers. The eight factories studied were divided into two categories: large, multinational subsidiaries with good industrial hygiene measures and small, locally-owned companies with poor hygiene features. A total of 251 workers (221 males and 30 females) were included in the study. Personal air sampling showed that 47% of the samples in the small factories had lead-in-air levels exceeding 150 ug/m3, compared unth. 29% in the larger establishments. The highest air lead levels were found in the cutting, pasting/mixing and battery assembly sections. 86.7% ofthe female workers and 62.2% of the male workers in the smaller factories had blood lead concentrations above the proposed limits of 70 ug/100 ml (males) and 40 ug/100 ml (females). In contrast, only 7.6% of the male workers in the larger factories had blood lead levels exceeding the proposed limits. Three workers also had positive signs or symptoms on clinical examination. Legislation of specific regulations to protect the health of lead-exposed workers in Malaysia is currently being drafted by the government.
MeSH terms: Environmental Exposure; Female; Humans; Lead Poisoning/etiology*; Lead Poisoning/epidemiology; Malaysia; Male; Maximum Allowable Concentration
2 cases of idiopathic paroxysmal choreoathetosis with late onset and non familial were described. Examinations and investigations were normal and both responded to phenobarbitone.
MeSH terms: Adult; Female; Humans; Phenobarbital/therapeutic use
Gall stone is responsible for about 1% of total small bowel obstruction, 1.2 and recurrent gall stone ileus is even more unusual. 3 Gall stone ileus is caused by the impaction of the stone in bowel lumen. It was first described in a patient examined at autopsy by Bartholin in 1654. This paper based on unusual recurrent intestinal obstructions by a gall stone. The patient presented with large bowel obstruction and it was due to a large gall stone impacted in the pelvic colon. Four months later the same patient presented with small bowel obstruction due to large gall stone impacted in the terminal part of the ileum at 61 cms from the ileo-caecal valve. Gall stone obstruction of the colon is one of the rare complications. This rare complication usually occurs in elderly females' in whom there is frequently an underlying pathological condition at the site of obstruction in the colon. The calculus usually migrates through a cholecysto-colonic fistula in case of large bowel obstruction. In case of a small bowel obstruction the calculus usually migrates through a cholecysto-duodenal fistula. Diagnosis can be established by plain X-rays of the abdomen where there is gas shadow in the biliary system, sometimes the gall stone can be seen if it is radio opague (10-16% gall stone is radio opaque) at the site of obstruction. Otherwise diagnosis is always
made at laparotomy.
Physical abuse of women has been documented since the dawn of history. However, it is not frequent that such patients come for help as such. Rather, they present as part ofrelated complicated problems such as marital discord, attempted suicide, depression and even psychotic illness. Women have been traditionally considered to be the inferior sex and as such, in many countries, social rehabilitation is difficult within the legal rights granted by the provisions of the appropriate laws. Two cases of physical abuse were admitted to the University Hospital in 1981-82 and their difficult rehabilitation is described to highlight the inadequacies of the existing laws under which protection and rehabilitation of the patients were sought. An account of what was and could be done for them is given.
13 patients with the amenorrhoea-galactorrhoea syndrome who conceived during treatment with bromocriptine were reported. Mean period of amenorrhoea was 3.0 years. In ten patients galactorrhoea was noted for a mean period of 4.2 years while in three it was discovered during examination. Seven patients presented with primary infertility. Menses returned in all cases after a mean duration of 2 months of treatment with bromocriptine at an average dose of 5. 86 mg daily. Mean serum prolactin was 4344 mUll (range 750 mU/l to 23,000 mU/l) before treatment and this declined to 186 mU/l with treatment. Seven patients became pregnant 5 to 25 months of treatment while six conceived after first menses. 21 pregnancies resulted from the thirteen patients. There was one spontaneous abortion and one premature delivery in which the baby died. Of the 16 live- births, there were twelve girls and four boys and their mean birth-weight was 2932 g. All were normal at birth and during subsequent developments except one with congenital dislocation of hip. It is concluded that bromocriptine is effective in restoring menstrual cycles and fertility by lowering serum prolactin in patients with the amenorrhoea-galactorrhoea syndrome. Bromocriptine may be safe for use during pregnancy, but it is suggested that the medication should be stopped immediately after conception unless tumour growth is apparent.
A consecutive series of 2,277 patients presenting for upper gastrointestinal endoscopy was analysed. The following groups of patients were studied with reference to sex, race and dialect groups: those presenting with dyspepsia but no haemorrhage, those presenting with upper gastrointestinal haemorrhage, those with non-ulcer dyspepsia, gastric ulcer and duodenal ulcer. Males out-numbered females in all diagnostic groups. Male and female Malays were under-represented in all diagnostic groups when compared to the Singapore population. Amongst female Chinese, there was an excess of Cantonese patients and an under-representation of Teochew patients in most diagnostic groups. These dialect differences were not remarkable amongst male Chinese. The possible reasons for these differences and their significance are discussed.
The purpose of this paper is to compare two forms of treatment for heroin abusers in Malaysia--traditional medicine and institutional--and to evaluate which form of treatment the drug abusers consider more effective. The study involved interviewing 100 male drug abusers in Malaysia who had had treatment from an institution and from a traditional healer. The data revealed that traditional medicine was better for some abusers, but institutional treatment was better for others, depending upon an individual's own needs and personality. Advantages and disadvantages of both forms of treatment were given by those interviewed. The data can be used as guidelines for the development of a more flexible, individualized program within an institutional setting in Malaysia.
MeSH terms: Adolescent; Adult; Attitude to Health; Heroin Dependence/rehabilitation; Heroin Dependence/therapy*; Humans; Malaysia; Male; Medicine, Ayurvedic*; Medicine, East Asian Traditional*; Surveys and Questionnaires; Acupuncture Therapy/methods
Blood haemoglobin and serum ferritin levels were measured at the initial visit and 12 months following sterilization and IUD insertion. Ferritin levels were unaltered in Progestasert users after 12 months but haemoglobin values increased though not significantly. Ferritin levels fell in Multiload Cu 250 users and in sterilized women; haemoglobin levels were also observed to fall but significantly only in the latter group. Iron-deficiency anaemia was prevalent at initial contact and there appeared to be an increased risk subsequently in Multiload Cu 250 users and in those who were sterilized. Screening and monitoring for anaemia is indicated. From the viewpoint of iron status, the Progestasert is preferable to the Multiload Cu 250 but it suffers the major disadvantages of needing frequent replacement and of causing menstrual disturbances which might compromise its acceptability. Menstrual blood loss studies may help explain why anaemia develops after sterilization.
Basal and pentagastrin stimulated acid output was measured in 80 normal and 179 duodenal ulcer subjects of Chinese, Indian and Malay origin. Basal and maximally stimulated acid output was significantly higher in duodenal ulcer patients compared with normal subjects. There was however considerable overlap and less than one in four duodenal ulcer patients were hypersecretors. The acid output (and hence the parietal cell mass) was lower than in Caucasian subjects and this was possibly related to weight differences. The acid output did not differ significantly in the Chinese, Indian and Malay subjects, suggesting that parietal cell mass in the three racial groups is closely similar. The difference in frequency of duodenal ulcer disease in the three racial groups is thus not related to gastric secretory capacity.
MeSH terms: Adolescent; Adult; Age Factors; Aged; Body Weight; Child; Duodenal Ulcer/etiology; Duodenal Ulcer/genetics; Duodenal Ulcer/metabolism*; Duodenal Ulcer/pathology; Female; Gastric Acid/metabolism*; Gastric Acidity Determination; Humans; Malaysia; Male; Middle Aged; Parietal Cells, Gastric/pathology; Pentagastrin/pharmacology; Peptic Ulcer/etiology; Peptic Ulcer Perforation/metabolism; Sex Factors; Singapore; European Continental Ancestry Group*; Asian Continental Ancestry Group*
Congo-red screening demonstrated intratumor deposits of amyloid in 35 of 53 unselected cases of basal cell carcinoma. Male subjects had a higher amyloid positivity rate than female subjects. The amyloid deposits were permanganate-resistant and located in the stroma between clumps of tumor cells, as well as abutting the advancing front of the neoplasm. Solar elastosis was often observed in the overlying and adjacent subepidermis. The relationship between amyloid positivity and the different histological subtypes of basal cell carcinoma, tumor ulceration, and density of the lymphoplasmacytic stromal infiltrate were also studied. The possibility that amyloid originates from the tumor cells and is a result of tumor apoptosis (degeneration) is discussed.
MeSH terms: Amyloid/analysis*; Amyloidosis/pathology*; Carcinoma, Basal Cell/pathology*; Congo Red; Female; Humans; Malaysia; Male; Microscopy, Electron; Sex Factors; Skin Neoplasms/pathology*; Time Factors; Continental Population Groups
110 normal, healthy adults were tested for antibody to hepatitis A (anti-HA) type IgG and 86 (78.2%) were found to be positive. An age-specific prevalence wasfound to be lowest in the lower agegroup and highest in the higher age-group. Out of 24 IgG positive individuals, only one was found to have type IgM. No significant difference in the incidence ofanti-HA type IgG was found between 42 patients in the Urology Unit, General Hospital, Kuala Lumpur and normal individuals (P > 0.1). 15 patients diagnosed as viral hepatitis were investigated for HA V IgG and IgM antibodies. 13 (86.7%) were positive for type IgG. Of this, only five (33%) were positive for the type IgM, suggesting that HA V is the cause of acute viral hepatitis in 33% of cases admitted to hospital as viral hepatitis.