This retrospective study of radioactive needle implants at the Institute of Radiotherapy and Oncology, Kuala Lumpur Hospital serves as an audit of our practice as well as a demonstration of the usefulness of this technique of brachytherapy. A variety of tumour sites were implanted, of which over two-thirds involved the tongue and buccal mucosa. Although most of the implants were carried out with radical intent, one-tenth of these implants were performed for palliation. Radiotherapy techniques employed are described. The crude survival ranged from 1 month to 109 months while the disease free interval ranged from 0 months to 102 months.
Over a thousand subjects who visited a city private medical clinic for health screening and advice were examined for their lipid profile and other cardiovascular risk factors. The mean TC, TG, LDL-C and HDL-C were 5.43, 1.45, 3.61 and 1.15 mmol/l. Their derived ratios viz, TC:HDL-C and LDL:HDL-C were 5.11 and 3.43 respectively. The prevalence of hyperlipidaemia was moderately high. Of the subjects studied 58.5% had elevated serum cholesterol, 14.8% had raised triglycerides, 64.9% had raised LDL-C and 20.8% had low HDL-C. Male subjects generally showed higher mean values and abnormality frequency in TC, TG, LDL-C, TC:HDL-C and LDL:HDL-C as compared to female subjects. Although significant ethnic differences were not detected for certain lipid parameters (e.g. TC, TG and HDL-C), the Indians appeared to have higher mean lipid values (except HDL-C), and higher percentage abnormality for all the lipid parameters as compared to the Chinese and the Malays. In correlation studies, the following lipid parameters:- TC versus TG, LDL-C, TC:HDL-C; TG versus TC:HDL-C and LDL:HDL-C; LDL-C versus TC:HDL-C and LDL:HDL-C; were positively correlated. On the other hand, TC versus HDL-C, TG versus HDL-C, LDL-C and HDL-C, and HDL-C versus TC:HDL-C and LDL:HDL-C were negatively correlated. The coronary risk factors which generally showed positive correlations with lipid parameters were BMI and blood pressure. Positive correlations were also recorded between fasting blood glucose and TG; uric acid with TG, TC:HDL-C and LDL:HDL-C. In contrast, risk factors of negative correlations were observed between HDL-C and the coronary risk factors of BMI, diastolic blood pressure and uric acid. Smoking showed raised per cent lipid abnormality for TG, HDL-C, TC:HDL-C and LDL:HDL-C. Alcohol consumption also increased the mean level and abnormality frequency for TG. The implication of this investigation is discussed.
MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Child; Coronary Disease/etiology*; Female; Humans; Hyperlipidemias/complications; Life Style; Lipids/blood*; Male; Middle Aged; Risk Factors; Body Mass Index
The Well Man & Well Woman's Clinic in Ipoh Hospital provides screening for coronary risk factors and early detection of cancer. This retrospective review of 1095 patients screened between April and December 1995 showed 48% had one or more coronary risk factors--1 risk (29%), 2 risks (14%), 3 or more risks (5%). Modifiable risks included hypertension (10%), obesity (9%), diabetes mellitus (8%) and smoking (7%). Sixteen abnormal Papanicolaou smears and six cancers (three cervical, two breast and one ovarian) were detected. Public response was good. There is a need for clinics offering comprehensive screening in Malaysian primary health care.
Study site: The Well Man & Well Woman's Clinic in Ipoh Hospital
This was a descriptive study to assess parents' knowledge of epilepsy in their children at the Klinik Pakar Pediatrik in Universiti Kebangsaan Malaysia from 1.1.93-31.6.93. Factors that influence the level of knowledge were examined. Our hypothesis was that the level of knowledge was low and level of education and social factors were important. Fifty consecutive parents were interviewed during the clinic appointments. The questionnaire consisted of 25 questions which had been used in a survey on epilepsy in Australia. In order to cater for the local population the questions were modified by adding new questions pertaining to local situation. The results showed that 90% (45/50) of parents were unaware of the type of epilepsy their children were suffering from. 50% (25/50) of parents knew the underlying cause of epilepsy of which 32% (8/25) attributed it to brain disease, 8% (2/25) to birth defects and 10% (3/25) to fever. Factors such as duration of epilepsy, parental education and racial differences between Malay and other races (Chinese, Indians) did not reach any statistical significance (p > 0.05). 80% of patients (30/50) were on monotherapy. However, 90% (45/50) of parents were unaware of their children's medications. 82% of parents (31/50) knew that the anti-convulsants would only control their children's convulsions. Only 10% (8/50) of parents knew the acute management of seizures. Wrong practices such as inserting spoons (5/50) or massaging their limbs (17/50) during an acute attack were still common. 70% of parents (35/50) attended the follow-up clinics hoping that their children's epilepsy would be cured. Parents with low economic status and of children with duration of epilepsy of less than five years had been coming to the clinic regularly. (p = 0.01 and p = 0.02 respectively). In conclusion, the overall knowledge of these parents was poor. In order to improve the management of epilepsy, it is necessary to educate parents with reading materials and effective educational packages.
Study site: Paediatric clinic, Institut Pediatrik, Kuala Lumpur, Malaysia
Blood glucose concentration was measured in 100 children immediately before and during surgery. These children were randomly assigned to receive either lactated Ringer's (LR) solution or 5% dextrose in lactated Ringer's (5%D/LR) intraoperatively as maintenance and replacement fluids. Blood samples were taken immediately after induction of anaesthesia and at 1/2, 1, 1.5, 2 and subsequent hours. Blood glucose concentration was assayed by a reflectance meter. None of the patients was noted to be hypoglycaemic pre- and intraoperatively. Intraoperative blood glucose concentration increased significantly (p < 0.05) from preoperative levels for both groups of children but the increase in those that received 5%D/LR was significantly greater (p < 0.05) than those who received LR. The number of children who were hyperglycaemic during surgery was also greater in those who received 5% dextrose in lactated Ringer's as their intraoperative fluid. These data suggest that lactated Ringer's alone is a safe and appropriate fluid for intraoperative fluid therapy in children.
Oxygen consumption values calculated by Fick's principle (cVO2) were compared to simultaneously obtained values measured by indirect calorimetry (mVO2) in two groups of patients; post-coronary artery bypass graft (post-CABG) and septic shock. In both groups of patients, oxygen consumption values derived using indirect calorimetry were higher than that from Fick's principle. Whilst the bias obtained between the two methods of measurement were of acceptable amount clinically, the limits of agreement were wide: -57 to 51 ml.min-1.m-2 in the post-CABG group and -101 to 67 ml.min-1.m-2 in the group of septic patients; indicating that significant differences exist between paired individual values such that cVO2 and mVO2 were not interchangeable in this study.
A survey of career choices were conducted for three batches of final year medical students at Universiti Sains Malaysia. A total of 241 students responded, giving a response rate of 76%, with 107 males (44.4%) and 134 females (55.6%). Surgery ranked highest among the male students while obstetrics and gynaecology ranked highest among female students. Internal medicine was the second choice for both males and females. Among the other specialties, the male students shows preferred Hospital Administration and Radiology while female students preferred Community Medicine, Psychiatry and Pathology. Both male and female students chose to be a clinical consultant in a general hospital as the first choice. They prefer to work in or near their hometowns.
MeSH terms: Career Choice*; Female; Humans; Malaysia; Male; Sex Factors; Students, Medical*
We report a case of endotracheal tube fire occurring during CO2 laser surgery of the larynx. The ignition of an endotracheal tube was thought to be caused by laser penetration of an unprotected portion of the tube during resection of vocal cord tumour. Fire hazard is inevitable when a laser is used in the path of combustible gases and in the presence of flammable objects. We discuss the methods of prevention that were used.
A 24-year-old man who was initially thought to have nocardiosis of his mediastinal lymph node which progressed to involve his right lung, had to undergo a right pneumonectomy when he failed to respond to treatment with sulphadiazine. Histology of the right lung specimen and a subsequent axillary lymph node biopsy revealed that he actually had lymphocyte-depleted Hodgkin's disease.
Primary non-Hodgkin's lymphoma of the brain is rare. Majority of the lesions are intraaxial, multicentric and involve the leptomeninges. We report a case of malignant primary non-Hodgkin's lymphoma arising from the cranial vault. Computed tomography of the brain showed an extraaxial lesion in the right parietal region mimicking a meningioma.
A 3-month-old Malay male infant presented with multiple infections (candidiasis, Pseudomonas aeruginosa, Cytomegalovirus), persistent pneumonia, intractable diarrhoea and failure to thrive. There was lymphopaenia affecting both T and B subsets. He developed Graft versus Host disease weeks following transfusion with non irradiated blood. In spite of aggressive microbicidal and supportive therapy including regular immunoglobulin infusions, the child succumbed to infection before a bone marrow transplant could be instituted.
MeSH terms: Graft vs Host Disease/etiology; Humans; Infant; Male; Severe Combined Immunodeficiency/complications; Severe Combined Immunodeficiency/immunology*
A female patient presenting with post-prandial epigastric pain and weight loss was diagnosed to have oesophageal tuberculosis by endoscopic biopsy. She responded well to standard anti-tuberculosis treatment.
Recto-prostatic fistula is a rare complication of prostatic surgery, occurring usually because surgical planes are not appreciated. We describe a combined abdomino-perineal approach for the repair of a large recto-prostatic fistula with the interposition of omentum and gracilis without formally closing the fistula in layers.
A nutritional study was carried out on six (five rural and one urban) low income groups in Peninsular Malaysia from 1992-1995. In this paper, the socio-economic data for the five rural groups - padi farmers, rubber smallholders, coconut smallholders, estate workers, and fishermen - are presented. With the exception of the estate workers, the sample was predominantly Malay, with an overall mean household size of 5.30. Household incomes were generally low, and 47% of all households had incomes that were below the poverty line income (PLI) of RM405. Based on this PLI, the prevalence of poverty was above 50% among the padi, rubber, coconut, and fishing households. Nevertheless, the study population appeared to be better off in terms of the other indicators examined. Poultry rearing, for example, was widespread in the padi, rubber, and coconut villages; 65% of all households owned at least one motorised vehicle, 53% owned a refrigerator, and 83% owned a television set. Furthermore, over 80% of all households had access to piped water, 96% had electricity supply, and over 90% had a flush or pour-flush latrine. In comparison to the 1979-1983 poverty villages study (Chong et al., 1984), the households in the current study enjoyed better living conditions. Strict comparisons between the two studies, however, is difficult owing to the different criteria adopted in the selection of the study villages.
This paper presents the results of anthropometric assessment of 2,364 boys and 2,415 girls aged 18 years and below drawn from the estates and rural community groups engaged in padi farming, rubber planting, coconut cultivation and fishing. The children were mainly Malay, however in the estates, Indians predominated. The results showed that the percentage of boys who have normal weight-for-age, height-for-age and weight-for-height were respectively 69.4%, 68.3% and 88.8%. Among girls, the percentage with normal values for weight-for-age, height-for-age and weight-for-height were 73.8%, 72.6% and 89.5% respectively. This study also showed the persistence of underweight, stunting and wasting amongst children in the study communities. Overall, the prevalence of underweight among boys was 29.8% and for girls 25.5%. The prevalence of stunting was 31.3% for boys and 26.9% for girls, while wasting was found in 9.3% boys and 8.5% girls. By age groups, the prevalence of underweight was lowest among the infants (16.8% for boys and 13.3% for girls), and highest among children aged above 1 to 6 years old (32.6% and 35.9% for boys and girls respectively). Children from the fishing, rubber and padi villages showed a higher prevalence of acute and chronic undernutrition than those from the coconut and the estate communities. In contrast, the mean prevalence of overweight in the five community groups did not exceed 2%. When compared with another peninsula-wide nutritional assessment of poverty villages undertaken in 1979-1983, it is found, over the past decade, that the prevalence of underweight in rural communities appeared to have decreased somewhat while that of stunting showed a more substantial decline. The persistence of current undernutrition has led to the manifestation of children who were too thin for their "non-stunted" height, thus giving rise to an apparently higher prevalence of wasting as found in this study. The implications of these results are discussed.
An interview administered food frequency questionnaire (FFQ) consisting of 75 food items was developed and calibrated against a four day weighed record (WR). The FFQ was also calibrated against a proxy for biomarker, the energy intake/basal metabolic rate ratio (EI/BMR). A total of 58 subjects (35 women, 23 men) aged between 19 and 76 years of Pakistani and Indian origin in Southampton, United Kingdom (UK) participated in this calibration study. The results for men and women combined together suggested reasonable agreement between FFQ and WR estimates of intake with Spearman rank correlation coefficient ranging between 0.26 and 0.38 (energy unadjusted). Gender specific agreement was however, poor. The percent mean difference between nutrient estimates by FFQ and WR was in general within 10% for energy, fat and protein in women while in the range of 11% to 25% in men. The percent mean difference for other nutrients such as sugar and dietary fibre ranged between 18% and 99% in men and women; while was 9% and 6% for starch in men and women respectively. The ranking of subjects into the thirds of distribution was poor with gross misclassification in the range of 5% to 14% in men and 15% to 29% in women. Comparison of both FFQ and WR with EI/BMR ratio showed that there were more underreporters of energy intake when reporting intake using WR than FFQ in both men and women. Based on these results, it was concluded that further development of the FFQ was needed before the FFQ could be used to evaluate the usual dietary intake in the South Asian population.
A study to predict energy requirements of national athletes, 84 males and 24 females in 9 and 4 different types of sports respectively, were conducted during centralised training. Parameters assessed were anthropometry, 3-day activity pattern and energy cost (kcal/min) of common activities to derive total daily energy expenditure (TDEE). Based on body mass index (BMI), 68 males or 81% and 19 females or 79% of the athletes were classified as normal. The mean body fat content for males and females were 13.8 ± 4.5% and 24.7 ± 5.3%, respectively. The mean daily activity pattern of males and females athletes were similar for light activities (16½ hr or 68% of day), for moderate activities (3½ hr or 15% of day in male, 4 hr or 17% in females) while moderate to heavy activities related to training were 4 hr (17%) and 3½ hr (15%) in males and females, respectively. Energy cost of some common activities ranges from 1.00-3.00 kcal/min in males and 0.84-2.04 kcal/min in females, while values for jogging were 6.60 kcal/min and 5.62 kcal/min in males and females, respectively. The mean TDEE in male ranges from 2938 kcal (12.3 MJ) in boxers (57 kg) to 4861 kcal (20.3 MJ) in weightlifters (110 kg) while the mean TDEE in female ranges from 2099 kcal (8.8 MJ) in athletics (51 kg) to 3098 kcal (13.0 MJ) in basketball (61.4 kg). The calculated physical activity level (PAL) values using measured BMR for males and females athletes ranges from 1.99-2.58 and 1.77-2.34, respectively. In conclusion, the estimated energy requirement for the various sports event studied ranges from 44-55 kcal/kg/day in males and 38-50 kcal/kg/day in female athletes.
A retrospective study of anaemia in pregnancy in rural Kelantan was conducted. The study sample consist of 9,860 mothers who had antenatal care at one of the 102 rural health clinics selected and had delivered a live baby. Anaemia in pregnancy was determined by reviewing the antenatal records for the haemoglobin level recorded at the first and last antenatal visit. Estimation of haemoglobin was done either by photocalorimetric methods or the Sahli's method in these rural clinics. At the time of booking, 47.5% of the mothers were anaemic by WHO criteria (Hb < 11.0 g/dl), with 1.9% having less than 9.0 g/dl. Age of mother, parity and late gestational age at the first antenatal visit were associated with anaemia during pregnancy at the time of booking. However, practise of contraception by the mother did not show any association with anaemia in pregnancy. There were 594 mothers (6.0%) who delivered a baby weighing less than 2.5 kg. There was no association between the low birth weight of the child and the status of anaemia in the mother at the last antenatal visit.
MeSH terms: Adult; Ambulatory Care Facilities; Anemia*; Cross-Sectional Studies; Female; Humans; Malaysia; Maternal-Child Health Centers; Pregnancy*; Rural Population