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.
Comment in: Soh EB, Ng KB. A survey of hysterectomy patterns in Malaysia. Med J Malaysia. 1999 Mar;54(1):152-4; Teoh TG. Hysterectomies in Malaysia: why are we left behind? Med J Malaysia. 1999 Mar;54(1):151-2
Monoclonal immunoglobulin deposition disease (MIDD) is characterized by the deposition of amorphous non-congophilic materials predominantly in the kidneys leading to nephrotic syndrome or renal failure. As with light chain amyloidosis. MIDD is associated with a paraproteinemia. We report a patient suffering from multiple myeloma with IgG kappa paraproteinemia and immunoglobulin deposits predominantly in the bone marrow. The deposits are both as amorphous non-congophilic materials, and in the form of crystals, an observation not reported before.
In the field of human energy expenditure, the measurement of basal metabolic rate (BMR) is an essential element to derive energy requirement estimates for any given population. Besides basic anthropometrics data, this paper reports the generation of predictive equation for basal metabolic rates of healthy Malaysian adult from prospective measurements on 307 male and 349 females aged 18-60 years, using the Douglas bag technique. These new equations based on body-weight reveal that the current FAO/WHO/UNU (1985) predictive equations overestimate BMR of adult Malaysian by an average of 13% in males and 9% in female subjects while differences of between 4-5% were observed when compared to Henry & Rees (1991) equations for tropical people. There is a good reason to believe that the capacity to slow down metabolism amidst the hot and humid climate experience throughout the year as a genuine phenomenon for Malaysians. Similarly, these findings suggest that at equal energy intake recommendation for similar body weight, the lower energy needs of Malaysian could put them at greater risk for developing obesity. These observed deviations must be taken into account in formulating energy requirements of the population.
MeSH terms: Adult; Basal Metabolism; Body Weight; Energy Intake; Climate; Energy Metabolism; Female; Humans; Male; Nutritional Requirements; Obesity; Prospective Studies
The theoretical impact of the use of coconut cream (santan) powder and palm oil santan powder on the dietary levels of C12-16 saturated fatty acids (SFAs) and linoleic acid (18:2), and on serum total cholesterol (TC), was evaluated holding non-santan dietary variables constant. The prediction was based on a 2,300-kcal hypothetical diet, containing one santan-based dish or snack in each of the 5 daily meals with fat contributing 30% of total calories, while the santan contributed a total of 14% kcal (36g). Replacing coconut santan with palm oil santan reduced the overall dietary C12-16 SFAs from 10.8% kcal to 4.8% kcal (i.e. â€“6.0% kcal) and the virtual removal of lauric (12:0) + myristic (14:0) acids, while palmitic acid (16:0) rose by 3.3% kcal, and the polyunsaturated linoleic acid (18:2) increased by 1.13% kcal. Applying the Hegsted equation to these dietary fatty acid (FA) changes, predicted a serum TC reduction of 24 -31 mg/dL (0.62- 0.80 mM/L), with the hypocholesterolemic effect being influenced by the low-density lipoprotein receptor (LDLr) â€œset-pointâ€ of the individual(s) concerned. Thus, the prediction indicated that replacing coconut santan with palm oil santan in santan-based Malaysian dishes or snacks would have a significant beneficial impact on serum TC and hence, cardiovascular risk.
Accidental stab wounds caused by door handles are rare. A case is presented where a boy sustained a stab injury by a door handle with resultant impaction of the door handle into his forearm. The injury was possibly predisposed by the design of the door lock-and-handle complex and precipitated by his activity, both of which could have been avoided by a different design of the door lock and handle complex and perhaps closer supervision while at school.
Candidacidal assay was used to assess the phagocytic and killing activities of polymorphonuclear leukocytes from paediatric patients diagnosed to manifest with characteristics of atopic dermatitis. From this group of patients evaluated, all the 11 cases exhibited lower candidacidal activity in comparison to the normal children. However, there were no abnormalities observed in the engulfing abilities and myeloperoxidase activities of these leukocytes. The result indicated that lower killing capacity of polymorphonuclear leukocytes in these patients may contribute to the frequent bacterial infections in atopic dermatitis children.
Congenital Coagulation Disorders (CCD) are inherited and present from birth. Their diagnosis depends on clinical awareness and correct laboratory investigations. The central registry for CCD or Congenital Bleeding Disorders (CBD) is at the Blood Services Centre, Kuala Lumpur Hospital and was established in 1975. There are 871 CCD registered. The commonest CCD are 631 (72%) Haemophilia A, 102 (12%) Haemophilia B and 93 (10.7%) von Willebrand's Disease. The other deficiencies registered are rare, only 45 in total:— Factor 1 (4), FV (4), FVII (21), FX (4), FXII (6), and FXIII (6). Diagnosis is based on clinical suspicion, screening tests namely the Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) and confirmation of the diagnosis was by doing specific factor assays. Molecular studies were done on FVIII and FXIII. Treatment is by transfusing the deficient factor when there is bleeding and comprehensive care involving the specialities like the neurologist/ neurosurgeon /orthopaedic / physiotherapy/ dental besides the haematologist and paediatrician to manage the complicatioons seen. There are fewer problems now as patients are diagnosed earlier and managed better. There is now a good prognosis and a better quality of life.
Twenty three major government hospitals were involved in a study to detect cases of child abuse and neglect admitted to the hospitals in 1995. There were 680 cases admitted for the year consisting of 328 cases of physical and 263 sexual abuse and 89 cases of neglect or abandonment. In the majority of hospitals, there was a predominance of physical abuse cases being admitted whereas in a few hospitals there were more cases of sexual abuse. 48.2% of those physically abused were below 5 years of age and 21.7% were 10 years and above. However, amongst those sexually abused, 14.4% were below 5 years and 46.7% were 10 years old and above. Fourteen of the children died due to physical abuse. In 11 cases, the death was due to subdural haemorrhage.
MeSH terms: Physical Abuse; Child; Child Abuse; Government; Hematoma, Subdural; Humans; Sexual Behavior; Sex Offenses
To study the role of pulse oximetry in the assessment of acute asthma in children presenting to the A&E department, 360 children who presented themselves to the A&E department were enrolled into the study. Those admitted were found to have a lower mean Sa02 of 92% compared to those discharged with Sa02 of 94% (p < 0.001). After the initial treatment at the A&E, those admitted still have a lower mean Sa02 of 94% compared to those discharged with a mean Sa02 of 96% (p < 0.001). However taking Sa02 of 92% as a predictor of admission hada sensitivity of 39% and a specificity of 80% but it had a high negative predictive value of 92%. Hence pulse oximetry alone is not sensitive for predicting admission in acute asthma in children.
Severe jaundice (serum bilirubin level > 340 gmol/L) occurred in 81 infants admitted to the Neonatal Intensive Care Unit (NICU) of the Maternity Hospital Kuala Lumpur (MHKL) in 1993. Of these 46 (56.8%) underwent 53 exchange transfusions. In-patient case notes were available for study on 41 of them. Two infants had no cause identified while 12 were associated with prematurity, 13 ABO incompatibility, 8 G6PD deficiency, 6 sepsis 2 Rh isoimmunisation and 6 miscellaneous causes. In 14 infants it was felt that exchange transfusions might have been avoided if they were detected earlier and phototherapy instituted promptly. Twenty six (26) infants were deemed to have been given phototherapy at the appropriate time but jaundice increased to exchange transfusion levels, threshold values depending on the unit in charge. Use of higher intensity phototherapy might have been more effective in some of the cases. Available data showed similar outcomes in both groups.
From November 1996 to December 1997, 24 infants with neonatal cholestasis were referred to the Department of Paediatrics, University of Malaya Medical Center, Kuala Lumpur for further investigations. Nineteen had neonatal hepatitis. There was considerable delay in referral of infants with cholestasis; the mean age of referral was 63.7 days. None had a positive family history of neonatal hepatitis. All infant had hepatomegaly and ten had splenomegaly. The stools were slightly pale in thirteen, persistently acholic in three and normally pigmented in three infants. Liver synthetic functions were normal in most of the infants. Cytomegalovirus (CMV) IgM antibodies were positive in seven but none were positive for toxoplasma or rubella. al - antitrypsin deficiency, hypothyroidism, and galactosaemia were excluded in all infants. DISIDA scans were performed in seventeen infants, being non-excretory in eight. Liver biopsies were performed in fifteen infants, showing neonatal hepatitis in fourteen, while histological features of large duct obstruction was seen in one. In majority of infants (eight out of ten) the jaundice disappeared by six months. Two infants had progressive jaundice and liver function impairment.
This research describes a comparative study using convenience sampling on management of intravenous lines in Maternity Neonatal Intensive Care Unit (MNICU), HKL. Questionnaires were answered by nurses and the techniques of anchoring, splinting and maintaining of intravenous lines by nurses in MNICU were observed by the researchers. The study showed that nurses with less than two years experience working in MNICU had significantly less knowledge and skills in the management of intravenous lines and are likely to encounter more difficulties and complications, compared to nurses with more experience.
MeSH terms: Child; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Nurses; Surveys and Questionnaires; Research; Research Personnel
Background - Cardiac mumurs are common in childhood and are often innocent in nature. With careful examination, most innocent murmurs can be reliably diagnosed by a paediatric cardiologist, thus obviating the need for further investigations.
Aim - To look at the prevalence of cardiac murmurs amongst standard one schoolchildren in an urban setting, and calculate the sensitivity, specificity, positive and negative predictive values of clinical diagnosis in differentiating innocent from pathological murmurs.
Methods - One thousand three hundred and fourteen students from 7 primary schools in the district of Gombak were examined during a routine school health examination. Those who were found to have murmurs were referred for echocardiography. A diagnosis was made at the time of clinical examination and following echocardiography. Children with median sternotomy, lateral or posterior thoracotomy scars or those with previously diagnosed cardiac lesions were excludedfrom the study.
Results - Thirty six children were referred for echocardiography out of which 2 were confirmed to have underlying cardiac disease on echocardiography. The prevalence of previously undiagnosed cardiac mumurs in this study was 3%. The sensitivity of clinical examination in diagnosing pathological murmurs was 100% while the specificity was 75%. Positive predictive value was 25% and negative predictive value was 100%. Forty three percent of the students who underwent echocardiography were found to have trivial pulmonary regurgitatibn on Doppler echocardiography.
Conclusion - The prevalence of previously undiagnosed cardiac murmurs is low in this study. This may be due to the fact that they are detected and treated at an earlier age. There is need to conduct a similar study in a rural setting to compare the results.
MeSH terms: Child; Cicatrix; Echocardiography; Heart; Heart Diseases; Heart Murmurs; Humans; School Health Services; Students; Thoracotomy; Echocardiography, Doppler; Prevalence; Sternotomy
The total and allergen-specific IgE response of patients with rhinitis, rhinoconjunctivities, rhinitis with asthma and rhinitis with dermatitis was analyzed to a panel of twelve high risk airborne and food allergens. It has been found that this panel will detect 96 percent of the allergen-causing diseases in children. It was found that 26 (76%) of the 34 young patients had a family history for atopy suggesting a high frequency of inheritance of allergic disorders. Elevated total IgE was found in most patients with allergic disease. Positive IgE antibody response to two species of Dermatophagoides mite-allergens was found in 7/12 (58%) patients with rhinitis, 11/11 (100%) patients with rhinoconjunctivitis, 7/9 (78%) cases ofrhinitis with asthma and 3/3 (100%) cases of rhinitis with dermatitis. Some of the patients also responded to food allergens. Food allergy was noted in 4/12 (33%) cases of rhinitis, 11/11 (100%) cases of rhinoconjunctivitis, 4/9 (44%) cases of rhinitis with asthma and 1/3 (33%) cases of rhinitis with dermatitis. Patients with rhinoconjunctivitis who tested positive at high titres for mites invariably had enhanced response for cockroaches, shrimps and crabs suggesting invertebrate antigen cross-reactivity. A few patients however, did not show this type of cross-reactivity although they had high titres of anti-mite IgE antibodies indicating that they responded to non cross-reacting allergen epitopes. Response to multiple allergens appears to be a common feature of most patients with respiratory or skin allergic diseases. The prevalence of multiple target-organ allergy to wide variety offood and environmental allergens complicates the long term management ofpatients with such allergic disorders.
Learning disability occurs in 10-15% of children. It is manifested by an imperfect ability to listen, think, speak, read, write, spell, calculate or interact. It may be specific as in dyslexia, dyscalculia, dysgraphia or nonspecific learning disability. In the latter group, there may be under-achievement despite average or above-average-intelligence, slow learners and mental retardation. Factors that may cause learning disability include genetic abnormalities, antenatal and perinatal insults, abnormal growth and malnutrition in early childhood, parental mode of upbringing, poor opportunity for learning, physical illness and emotional and social problems. Meticulous history taking and physical examination is important to arrive at a proper diagnosis so that the most appropriate management is given, often involving professionals working as a team.
The thalassaemias are the commonest single gene disorders amongst the inherited diseases. In Malaysia, there are an estimated 2200 transfusion dependent thalassaemia patients. With a carrier rate of 3-5%, 120-340 new cases of thalassaemia are expected to be born each year. The reference treatments for these patients are regular blood transfusions and iron chelation therapy. With optimal management, these patients are able to survive into the third or fourth decade of life and most importantly avoid the complications related to transfusions and iron overload. The use of desferal locally is still limited to only those who can afford i.e. about 30% of the cases. Treatment for some of the complications such as hepatitis C, diabetes mellitus, growth impairment and pubertal delay, are now available. Curative treatment approaches like bone marrow transplantation have now become standard treatment for eligible cases whilst cord blood transplantation may yet offer hope for those who are without compatible sibling donors. Research on globin gene therapy looks very promising but will probably take some time to deliver. Hb F switching is a very novel idea but so far the results are mainly anecdotal. Finally, the strive for optimal management of thalassaemia must come hand in hand with a prevention programme to achieve a reduction of new cases.
Four hundred and forty three teachers from eight ran-domly selected primary schools were enrolled in this study which was aimed at determining the knowledge regarding child abuse and neglect among primary school teachers in Kuala Lumpur. The areas that were examined included characteristics of child abusers and abused children. The results showed that the marital status of the teachers did not influence their level of knowledge and there was no significant difference between novice and senior teachers. The most impor-tant finding here was that knowledge regarding sexual and physical abuse was lacking in the teachers surveyed.
A Malay baby boy with the femoral-facial syndrome is presented. The phenotype included bilateral femoral hypoplasia, short nose with a broad nasal tip, long philtrum with a thin upper lip, micrognathia, bilateral cryptorchidism and hypoplastic penis.
MeSH terms: Bone Diseases, Developmental; Cryptorchidism; Femur; Humans; Infant; Lip; Male; Micrognathism; Nose; Penis; Phenotype; Pierre Robin Syndrome; Lower Extremity Deformities, Congenital
Thyroxine has been shown to have a beneficial effect on renal function in cases of impending renal failure in ani-mal studies.'5 Studies of the use of thyroxine in humans in impending renal failure are scarce. The aim of this study was to assess the effect of oral thyroxine on the renal function of asphyxiated term neonates who often have renal impairment.
A randomised control trial was conducted, involving 30 term asphyxiated neonates. The study group (n=15) was given thyroxine (50 pg) orally on days 1, 2 and 3 of life and placebo was given to the control group (n=15). Renal function was studied on day 1 and day 4 of life. The two groups did not differ significantly as regards gestational age, birth weight, severity of asphyxia, preg-nancy or delivery complications, fluids administered and drugs used. There was no significant difference in urine output, creatinine clearance and fractional excretion of sodium on day 1 but there was a trend towards a worse renal function on day 1 in the treatment group. The creatinine clearance was significantly better in the treat-ment group on day 4 (p = 0.017). Urine output and fractional excretion of sodium on day 4 were better in the treatment group but the differences did not reach statistical significance (p = 0.14 and 0.057 respectively). Statistical analysis on the differences between day 4 and day 1 showed statistical significance only for creatinine clearance: creatinine clearance day 4 minus creatinine clearance day 1 was 52.6 (±32.4) for the thyroxine group and 7.3 (±7.8) for the controls (p= 0.006).
These data support the hypothesis that thyroxine may have a significant beneficial effect on the renal function in term neonates with perinatal asphyxia. Thyroxine may be proven useful in future for patients with impending renal failure.
The aim of this paper was to study hand washing practices in the Neonatal Intensive Care Unit (NICU), Hospital Universiti Sains Malaysia. All medical personnel handling babies in the NICU were observed without their knowledge for a total of three times before and after an educational intervention between November 1, 1993 and December 31, 1993. Hand washing techniques with both Hibisol Spray and Chlorhexidine were scored from 1-4. The results of the study are shown as follows: the number of personnel observed were: before educational intervention -paediatric doctors (PD) 14, non-paediatric doctors (ND) 13 and nurses (N) 48; after educational intervention - PD 10 , ND 12 and N 42. PD and N washed hands significantly more often than ND (p < 0.001), before and after intervention. PD but not ND or N improved their rate of hand washing after educational intervention PD (p= 0.02). The Hibisol handwashing technique was poor in all groups (77.1% of all observations). The Chlorhexidine hand washing technique was better than Hibisol (p<0.0001). However only 15% of observed washes with Chlorhexidine were well done and almost one third were done poorly. Both Hibisol and Chlorhexidine techniques did not improve after educational intervention. Hand washing was performed more often in the Level III than Level II nursery [85% of all observations in Level III and 73% of all observations in Level II, p=0.002]. In conclusion, the present educational program is not sufficient and more direct means should be taken to improve the frequency of hand washing among all medical personnel. All medical personnel in the NICU should be educated in the use of the Hibisol, otherwise Hibisol should be removed from the nursery.
Keywords: Handwashing, doctors, neonatal intensive care unit, nurses
Study site: Hospital Universiti Sains Malaysia, Kelantan, Malaysia
MeSH terms: Child; Chlorhexidine; Hand Disinfection; Hospitals; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Malaysia; Physicians; Knowledge