With the increasing ease of travel and the passage of peoples between counkies there is a need to ensure that the recipient country is not burdened by the need for care of ilniiiigrant with health problems as well as the increased risk posed to the local population froni exposure to conun~unicabled isease. To assess the chest radiographs of a selected group of inun~igrantsto ascertain the presence of abnormalities especially the presence of tuberculosis. A total of 250 imniigrants were prospectively evaluated by a PA chest radiograph. The chest radiograph was evaluated by two radiologists for the presence of abnormalities of the heart, lungs, mediastinum and bony rib cage. There were 112 Indonesians, 133 Bangladeshis, one Myanmar, three Pakistanis and one others. Males made-up 222 while there were 28 females. The chest radiograph was diagnostic in all cases. There were 13 cases with enlarged hearts but with no evidence of heart failure. There was only a single inlmigrant who had evidence of active TB though there were 6 others who had evidence of old disease. There was evidence of other infections in five. With regard to the mediastinuni there was a single case with enlarged hila probably secondary to increased cardiac output. There were 21 patients with scoliosis of the spine and two with abnormaIities of the ribs. Even though there was a single case with evidence of TB from this pilot study, from unreported data from the UMMC, there were 15,16 and 23 immigrants treated for TB for 1994,1995 and 1996 respectively. This was mainly seen in the Indonesians followed by the Bangladeshis and Myanmar. We attribute this discrepancy to the biased salnpie in this study where probably only the healthy were seen while those who were not well did not want to participate in this study. In addition, this may also be due to the small sample used in this study. We feel that screening of the immigrants out in the field may be able to detect cases of active TB. As for the large hearts we feel that in the absence of any cardiac symptoms and other radiological changes these are probably due to the increased workload on the heart from physical activities. This is a recognised presentation. The changes in the mediastinum and bony rib cage are probably not very significant.
A pilot study on 250 foreign workers was undertaken during a 7-month period beginning December 1996. The sample of subjects mainly males (88.8%) was selected on a non-probability basis from two sources i.e. from University of Malaya (72.8%) and PEREMBA group (27.2%). The study was a clinic-based and a face-to-face interview was carried out to elicit information on social, demographic, environmental, medical and recent illness using a structured questionnaire. Physical examinations were also performed on the same day of the interview. Subjects were also required to give their stool, venous blood, and urine specimens for microbiological, parasitological and clinical laboratory investigations. Chest X-Rays was done on ail subjects. The other investigators had already reported findings on the various specific areas of the study. In this part of the report attempt was made to relate the infectious diseases to some of the socio-environtnental variables on the 112 Indonesian, 133 Bangladeshi workers. Some aspects of health seeking behaviour of these foreign workers were also presented. Most of the Indonesian workers (84%) were from Jawa Timua and Jambi, Sumatra, while majority of the Bangladeshis (67.7%) were from two neighboring administrative districts of Dhaka and Chittagong. Majorities of the Indonesians (50.0%) were working in service industry, while 53.5% Bangladeshis were in the manufacturing. One-fifth of the workers lived in squatter areas, and nearly half of them were working for the service industry. About 70% of the workers had at least one infection. The proportion was slightly higher among the Indonesians (72.3%) compared to the Bangladeshis (67.7%). It is of interest to point out that 40.0% had multiple infections. Thirteen had five or more infections (details for the two of the 13 cases are presented as case studies). However, the findings did not indicate any association between sanitation and infections. Risk for transmission was developed based on the number of infections in the person. The Indonesian workers carried a higher risk of transmitting the diseases (33.9%) compared to 19.5% among the Bangladeshi workers. Those working in the construction industry were at a higher risk of transmitting the diseases compared to other industries. Slightly more than half of the workers experienced some form of minor illness or injury during the two-week period preceding the interview. Majority sought private care (43.1%), while 42.3% either self-medicate or did nothing al all. Nearly two-thirds paid out of their own pocket. Among the employers, construction sector made negligible contribution (2.9%) to the payment. It is interesting to find that 41.0% of the workers took some form of health suppletnents, and majority (48.4%) got it from the phartnacy or traditional sources. Nearly all (88.5%) paid on their own for the health supplements. The findings from this pilot project need to be interpreted with solne caution. However, it appears that the foreign workers carry sizeable anlount of health problems. If these are not addressed quickly it may eudanger the health of a nation, while we readily acknowledge their contribution towards our national development.
A total of 245 foreign workers was screened for various microbial and parasitic infections, as part of the pilot study on the health problems of foreign workers. The sample comprising of Indonesian and Bangladeshi workers, was selected on a non-probability basis from two sources, i.e. University Hospital and a private sector. This investigation revealed substantive number of workers with positive cases to some of the microbial and parasitic infections. KEYWORDS: Pilot study, infective agents, foreign workers
In multiethnic countries such as Malaysia more than six different languages are spoken by patients in publicly-funded clinics. Sometimes doctors are unable to speak the patient's language and there are no professional interpreters. Research on doctor-patient communication has rarely included the language variable and its impact on information exchange and patient outcome in consultations where the doctor does not speak the patient's language. The few studies carried out in linguistically plural societies show that doctors and patients can face language barriers and trained interpreters are not always available. This paper illustrates some of the problems of using untrained interpreters in a primary care setting. Consultations were audiotaped and the transcripts were used to show how messages underwent distortion, condensation, and omission in interpreter-mediated consultations. Research needs to be carried out based on a model of doctor-patient communication which reflects the realities of the multilingual consultation.
MeSH terms: Ambulatory Care Facilities; Communication; Hospitals, University; Humans; Language; Malaysia; Outpatient Clinics, Hospital; Outpatients; Primary Health Care
Parasitic infections have been reported to be relatively common among the Southeast Asian labourers in Taiwan. This study, conducted in 1992-6, was designed to determine the temporal changes of the prevalence. Faecal specimens were examined by the formalin-ethyl acetate sedimentation technique and blood samples screened using the quantitative buffy coat technique and confirmed by Giemsa stained blood smear. The overall prevalence of intestinal parasitic infections was 10.3%. The annual prevalence decreased from 33.3% in 1992-3 to 4.6% in 1995-6. The Thai (12.0%) and Indonesian (11.1%) had a higher prevalence than the Malaysian (6.7%) and Filipinos (5.9%). Opisthorchis viverrini was the most important parasite in the Thai and Trichuris trichiura in the remaining groups. Moreover, no blood parasites were found in the labourers. The dramatic temporal decline in the intestinal parasitic infections suggests that limiting the entry of infected persons, periodic follow-ups, and immediate treatment of sporadic cases are necessary in preventing transmission of non-indigenous parasites through large population change.
MeSH terms: Adult; Feces/parasitology; Female; Follow-Up Studies; Humans; Intestinal Diseases, Parasitic/epidemiology*; Intestinal Diseases, Parasitic/parasitology; Male; Occupational Diseases/epidemiology*; Occupational Diseases/parasitology; Population Surveillance; Taiwan/epidemiology; Time Factors; Prevalence; Age Distribution; Sex Distribution
In September 1997, plants of Hibiscus manihot (locally called nambele) were observed on Vaitupu Island, Tuvalu, exhibiting an angular leaf mosaic and chlorosis that was not always clearly discernible. Electron microscopy of negatively stained sap from affected leaves revealed the presence of numerous isometric virus particles 28 nm in diameter. Poly-acrylamide gel electrophoresis of purified virus gave a single protein band of Mr 38,000 similar to that of the carmoviruses. Immunosorbent electron microscopy tests with antisera kindly provided by N. Spence showed the virus to be hibiscus chlorotic ringspot carmovirus (HCRSV) (1). This virus is also reported from El Salvador, the U.S., Australia, Thailand, Malaysia, Fiji, the Solomon Islands, and Vanuatu. It is not known how the virus reached Tuvalu but we suspect it was via infected cuttings, which were imported for the production of food supplements to combat acute deficiencies of vitamins A and C in the population. The virus is most likely to have been disseminated throughout the islands and atolls of Tuvalu through infected cuttings. Local spread within fields could occur through contaminated hands and cutting implements because of the ease with which the virus is mechanically transmitted. Reference: (1) H. E.Waterworth et al. Phytopathology 66:570, 1976.
Hevea brasiliensis anther calli were genetically transformed using Agrobacterium GV2260 (p35SGUSINT) that harboured the β-glucuronidase (gus) and neomycin phosphotransferase (nptII) genes. β-Glucuronidase protein (GUS) was expressed in the leaves of kanamycin-resistant plants that were regnerated, and the presence of the gene was confirmed by Southern analysis. GUS was also observed to be expressed in the latex and more importantly in the serum fraction. Transverse sections of the leaf petiole from a transformed plant revealed GUS expression to be especially enhanced in the phloem and laticifers. GUS expression was subsequently detected in every one of 194 plants representing three successive vegetative cycles propagated from the original transformant. Transgenic Hevea could thus facilitate the continual production of foreign proteins expressed in the latex.
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. –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) “set-point†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