Once-yearly, mass deworming with broad spectrum anthelmintics over a period of five years among four types of communities in Malaysia resulted in an overall education in the prevalence of soil-transmitted helminthiases by one-third to two-thirds. The reduction in prevalence of infection was highest among inhabitants in semi-urban settlements (65.5%), followed by those in the rural estates (53.0%) and high-rise flats (43.9%). Soil-transmitted helminthiases were only reduced by 35.5% in the urban slums. Reduction in infection with Trichuris trichiura was better than that with Ascaris lumbricoides whereas hook-infection was completely eliminated in some of the communities surveyed. The reduction in prevalence ofsoil-transmitted helminthiases by long-term, once-yearly deworming alone, without other supplementary interventions, reinforces the potential and feasibility of regular mass-deworming as an immediate and effective measure for the control ofsoil-transmitted helminthiases. This is of great public health significance especially in highly endemic communities where some form of intervention is urgently needed and facilities for other control measures such as the improvement of environmental sanitation and nutritional status and health education are neither feasible nor possible nor immediately available.
The reasons why 860 patients visited the general medical clinic at the University Hospital, Kuala Lumpur were studied. 75.3% of the patients came for evaluation of symptoms; 12.4% sought checkups for chronic diseases; 4.9% requested diagnostic checkups and screening tests; 4.8% came to renew prescription. Few visits were made for evaluation of injuries, receiving test results or for administrative examination. This profile reflected the function of the clinic as an acute diagnostic centre. Other applications of the results are discussed.
Study site: General Medical Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
MeSH terms: Cross-Sectional Studies; Hospitals, University; Humans; Malaysia; Morbidity*; Outpatient Clinics, Hospital*; Patient Acceptance of Health Care*
We analysed clinical and histological diagnoses in patients admitted with liver-related illnesses in order to determine the spectrum ofliver disease in our community. In a total of 380 such patients, liver disease was sixfold more frequent in males than in females. Admissions for cirrhosis were more common amongst the Indian ethnic group. Indians constituted 39% of the admissions (expected 11. 7%), Chinese 37% (expected 51%) and Malays 21% (expected 36%) (~2 = 293, p = H 0.001). Liver histology from 179 of the patients was reviewed blind by one pathologist. Based on the histological findings, the pre-biopsy diagnosis was 'wrongin 75%of cases. The age standardized incidence rate of hepatocellular carcinoma was 22/100,000/year in males 225 and 5/100,000/year in females. However, the peak age of onset was in the seventh decade and the age specific incidence in males aged 60 years or older was 93/100,000/year. The ethnic group representation of patients with hepatocellular carcinoma did notshow a racial preponderance. This study highlights a public health problem related to acute viral hepatitis and alcohol abuse. It also confirms a high incidence of hepatocellular carcinoma
One hundred (100) consecutive patients who underwent spinal analgesia for surgical and orthopaedic operations were studied. Postural headache occurred in 9% of patients, the majority in those cases where large bore (l8G to 21G) needless were used. No other neurological complications were encountered. Conservative measures provided some relief of the headache. Epidural blood patch was found to be effective.
Review of the haemodialysis experience revealed patient survival between 1976 and 1982 to be 90%, 77% and 44% at one, three and six years respectively. This was similar to other published reports. Patients under the age of 50 years did better than those above 50 years, and diabetics did worst of all. There was a high rate of rehabilitation and return to employment or household responsibilities. Our policy of self-care dialysis allowed more patients to be treated without increasing the number of staff Dialysis encephalopathy and sudden deaths were important causes of death.
Eight longhouses were selected randomly for a goitre survey in the Entabai area of the Sixth Division, Sarawak. 645 subjects were examined and a goitre prevalence of 46.4% (15 years and above) was found. The females had a higher rate of 69.5% as compared with their male counterparts with 24.4%. Below the age of 15 years, prevalence was low and there was not much difference between the two sexes. After the age of 15 years, the prevalence among the females
increased from 40% to almost 80% by the age of 25 years. The males, on the other hand, showed a decrease in prevalence after the age of 15 years and levelled off at about 30%. The females also had much larger goitres than males. About 43% of the households surveyed consumed iodised salt but the rates tend to fluctuate according to supplies. There was however no direct correlation between goitre prevalence and consumption of iodised salt.
A total of 23 patients with psychoses associated with thyrotoxicosis were admitted to the psychiatric unit of a University Hospital over a 13-year period, of which 20 patients were included in this retrospective study. It was found that a parallel relationship between thyrotoxicosis and psychosis appears to exist in six patients, while in the remaining 14 patients, the course of the two disease processes were largely independent of each other. Paranoid delusions and auditory hallucinations were the most prominent psychiatric symptoms. Depression was commonly seen even in patients who were not having an affective illness. In four patients, a mixed schizo-affective psychosis was seen, suggesting that the diagnostic distinction between the affective and schizophrenic reactions are often blurred in psychosis associated with thyrotoxicosis.
A term, Malay male neonate, delivered by spontaneous vertex delivery, was found to have a huge carvenous hemangioma on the anterior chest wall. He developed respiratory failure on the second day of life. Having considered the various options possible, an emergency surgical excision was carried outat the age of 57 hours. The patient recovered after a stormy post-operative period.
A child with massive hepatosplenomegaly was diagnosed on bone marrow biopsy to have Gaucher's disease. The clinical progress in this form of Gaucher's disease is highlighted and the clinical diagnosis correlated with published criteria.
MeSH terms: Gaucher Disease*; Humans; Infant; Male
This is a case report of a patient with a stab injury into the heart. It highlights the successful management in view of the limited facilities and personnel in a district hospital. This may probably be the first operation of its kind in the country.
An anthropometric study and dietary investigations were conducted in an Iban community in the Sixth Division of Sarawak. 140 children aged 0 to 6 years, were assessed anthropometrically. Their mean weights and heights were much lower than those of their counterparts in Singapore. 7% of the children were nutritional dwarfs while about 68% were either wasted or wasted as well as stunted. Rice was the staple food in the community while other foods were considered unnecessary. Child feeding practices also reflected this dependancy on rice leading to a toddler diet which is mainly carbohydrate in nature. The dietary assessment showed a quantitative adequacy of energy as well as protein, a [inding whicn does not reflect the seasonal fluctuations with periods of hunger. The predominant contribution from rice resulted in protein intakes which were qualitatively deficient.
The different methods of prenatal diagnosis are discussed with special reference to ultrasound scan, amniocentesis for cell culture with processing for chromosome study, biochemical analysis and DNA recombination analysis. Chorionic villi aspiration and fetoscopy are new methods which will enhance considerably the methods for prenatal diagnosis. With regard to chromosome study of amniotic cells, experience with 623 cases is reviewed. 2.7% demonstrated chromosome anomalies and of these Downs anomaly was the commonest. A large proportion of cases requesting for amniocentesis are Caucasians who represent only 2% of the population in Singapore, but 25% of the 440 requests were from Caucasions. The various problems associated with the different methods for prenatal deafness are discussed.
170 clinical isolates of Pseudomonas aeruginosa were tested for in vitro susceptibility to gentamicin, amikacin, tobramycin, netilmicin, kanamycin, streptomycin, cefotaxime, ceftriaxone, cefoperazone, ceftazidime, moxalactam, azlocillin, piperacillin and ticarcillin. Against 93 gentamicin-sensitive strains, the most active antibiotics were in descending order, ceftazidime, tobramycin, gentamicin, amikacin, and the ureidopenicillins. Against 77 gentamicin-resistant strains, only ceftazidime, amikacin and moxalactam had mode minimum inhibitory concentrations within achievable peak serum levels after standard therapeutic dosage. There was no correlation between cephalosporin resistance and aminoglycoside resistance except for cefoperazone, which, together with the ureidopenicillins and ticarcillin, showed marked decrease in activity against gentamicin-resistant strains.
The estimation of fecundability from survey data is plagued by methodological problems such as misreporting of dates of birth and marriage and the occurrence of premarital exposure to the risk of conception. Nevertheless, estimates of fecundability from World Fertility Survey data for women married in recent years appear to be plausible for most of the surveys analyzed here and are quite consistent with estimates reported in earlier studies. The estimates presented in this article are all derived from the first interval, the interval between marriage or consensual union and the first live birth conception.
PIP: The estimation of fecundability from survey data is plagued by methodological problems such as misreporting of dates of birth and marriage and the occurrence of premarital exposure to the risk of conception. The availability of data collected with a standard interview schedule from over 40 countries in the World Fertility Survey (WFS) is an invaluable resource for assessing the potential utility of measures of fecundability derived from single-round surveys as well as for comparing estimates across countries and regions of the world. In this article, data are used from 5 WFSs in Latin America (Colombia, Costa Rica, Panama, Mexico and Paraguay) and 3 in Asia (Korea, Malaysia and Sri Lanka) to determine the general usefulness of single-round survey data for the estimation of fecundability from survey data, given the limited information on contraceptive use available from many surveys and the data quality problems associated with reports of dates of marriage and dates of birth. Explored in the process are several different procedures for estimation and variations in estimates of fecundability by country, time period, and women's age. For most of this analysis, the median waiting time to conception in the absence of contraception is used as a measure of fecundability. All of the estimates presented are derived from the 1st birth interval. The estimates are based on data collected in both the birth and the marriage histories in the WFS individual interviews. The 8 surveys chosen for this analysis are characterized by relatively complete reporting of dates of birth and marriage. The primary conclusion of this exercise is that reasonable estimates of fecundability can be derived from WFS data only if one is careful to avoid numerous methodological pitfalls. The most plausible estimates appear to be for women married in the period from about 2 to 10 years before the survey. The average waiting times to 1st conception range from about 4 to 7 months; the corresponding monthly probabilities of conception lie between 0.17 and 0.26. The effect of age at marriage on fecundability is most apparent for ages below 16; differences between women married at ages 16-17 and at ages 18 and above are more modest. Suggestions for improvement of the estimation of fecundability by including a number of questions in survey questionnaires are presented.
MeSH terms: Actuarial Analysis; Adolescent; Adult; Asia; Contraception Behavior; Cross-Cultural Comparison; Female; Fertility*; Humans; Latin America; Marriage; Population Surveillance*; Pregnancy; Sexual Behavior
MeSH terms: Age Factors; Asia; Asia, Southeastern; Contraception Behavior; Culture; Delivery of Health Care; Demography*; Developing Countries; Economics; Emigration and Immigration*; Ethnic Groups*; Fertility*; Geography*; Government Programs; Human Rights; Infant Mortality*; Life Expectancy; Longevity; Malaysia; Mortality*; Politics*; Population*; Population Characteristics; Population Control*; Population Density*; Population Dynamics*; Population Growth*; Public Policy*; Sexual Behavior; Social Change; Social Planning; Women's Rights; Family Planning Policy*