Medicinal herb preparations prescribed for specific treatment purposes were purchased from markets and were analyzed by instrumental neutron activation analysis with k0 standardization. Then, 500-700 mg of each sample was pelletized under a pressure of six tones and irradiated together with monitors for alpha and neutron flux ratio determinations for about 6 h in a thermal flux of 2.29 x 10(12) n/cm2/s. The accuracy of the method was established by analyzing standard reference materials. Twenty-nine elements, Ag, As, Au, Ba, Br, Ca, Ce, Co, Cr, Cs, Eu, Fe, Hf, K, La, Mn, Mo, Na, Rb, Sb, Sc, Se, Sm, Sr, Th, U, Yb, and Zn, were measured in all the samples, and Hg was detected in some samples, with good accuracy and reproducibility. The concentration of elements determined was found to vary depending on the composition of the herbs used. Although the trend linking the element of the medicinal plants to its curative abilities could not be clearly determined, this study showed that the toxic elements found in the samples were below the levels prescribed by health regulations. Nevertheless, such data are important to understand the pharmacological action and the exact mechanisms of action and formation of active constituents for each medicinal plant and to decide the dosage of the herbs used in the final formulation.
We report on the case of a 38-year-old Malay housewife diagnosed with conversion disorder. It was believed that 'evil spirits' caused her symptoms. The patient was eventually treated by the Main Puteri, a Malay shamanistic healing ceremony, after previous treatments failed. The patient improved on the third day of the performance, which was attributed to the departure of the spirits from her body. This case documents the potential benefits of indigenous psychotherapy.
Direct coronary angioplasty with stent implantation is an effective treatment for acute myocardial infarction. The use of adjunctive abciximab, a platelet glycoprotein IIb/IIIa receptor antagonist is expensive. We report on three cases of direct coronary angioplasty complicated by extensive thrombus formation that were successfully treated with attenuated dosing of abciximab via the intracoronary route. All patients presented with acute myocardial infarction complicated by cardiogenic shock or eminent cardiogenic shock. Abciximab was administered after balloon dilatation when extensive thrombus formation was noted and persisted despite repeated inflations. In all three patients a single 10 mg vial of intracoronary abciximab was administered, resulting in complete dissolution of thrombus, allowing successful deployment of stents. Thus, a single 10 mg intracoronary bolus dose of abciximab may be sufficient to achieve high local concentrations of antiplatelet activity. This facilitates thrombus dissolution and allows the safe deployment of a stent to normalise intracoronary rheology.
The increased development of hospital services in Hong Kong over the last decade has given rise in the demand for more recruits to join the nursing profession. Despite the advancement in education and the improvement in the working conditions, the problems of attracting sufficient new recruits remain critical. This study aimed to examine high school students' attitudes towards the nursing profession and to identify the contributing factors affecting shortage of nurses within the context of Hong Kong. A convenience sample of 375 high school students was recruited. A questionnaire was used to measure their knowledge, attitudes and intention to study nursing. Descriptive and inferential statistics were used to describe their career preferences and to compare knowledge, attitudes and intention scales between gender and nursing exposure groups. Results indicated that the students were generally knowledgeable about nursing but were reluctant to pursue nursing as a career. However, students who were socially acquainted with a nurse demonstrated a slightly more positive attitude towards nursing and slightly higher intention to pursue nursing as a career compared with those having no social acquaintance with a nurse. Implications for promotion of nursing profession and limitations of the study were discussed.
MeSH terms: Adolescent; Career Choice*; Female; Hong Kong; Humans; Health Knowledge, Attitudes, Practice; Male; Marketing of Health Services; Nursing/standards*; Surveys and Questionnaires; Social Perception*; Students/psychology*; Multivariate Analysis
A total of 1,157 sera from jaundiced patients with clinical and biochemical evidence of liver disease received from government hospital in Kelantan and Terengganu, during the period from 1994 to 1997, were investigated to determine the cause. Hepatitis A virus was found to be the main cause in 26.1% (24/92) of symptomatic clinical hepatitis cases in 1994, 47.8% (63/132) in 1995, 66.4% (613/923) in 1996 and 20% (2/10) in 1997. Sera received in 1996 were also tested for hepatitis B, hepatitis C, hepatitis D and hepatitis E. 1.4% (13/923) anti-bodies were found to be positive for HBc IgM indicating recent HBV infection, 5.4% (50/923) for total HCV Ab, 0.9% (8/923) for total HDV Ab and 0.4% (4/923) for anti-HEV IgM. This study shows that HAV is still a major problem in Kelantan and Terengganu, and there is a need to identify effective strategies for prevention and control in these two states.
A cross-sectional survey of the nutritional status of children aged 1-10 years old from the Kuala Betis resettlement villages was carried out. A total of 620 children were examined, of which 329 were preschool children and 291 were schoolchildren. The age was determined and anthropometric measurements such as weight, height and MUAC were taken. The nutritional status was assessed by looking at the distributions of the z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) in relation to the growth charts of the National Center for Health Statistics reference population. It was found that the nutritional status of the Orang Asli children was poor, with a prevalence of 33.7-65.3% underweight, 55.3-74.4% stunting and 4.4-29.7% wasting based on the NCHS reference values. The prevalence of malnutrition among the Malay children was lower, underweight--7.3-34.1%, stunting--9.8-34.1% and wasting--1.7-17.1%. The nutritional status of the Orang Asli children were poorer compared to the Malay children. More preschool Orang Asli children were stunted compared to the Orang Asli schoolchildren. This may be due to the poor economic base of the Orang Asli community during the transformation period after resettlement. A comprehensive primary health care program is essential, especially targeting the preschool Orang Asli children in these resettlement villages.
To study the distribution of presenting features and their prognostic significance in neuroblastoma treated in a single institution in Malaysia. A retrospective study was made of 78 neuroblastoma cases diagnosed and treated in the University Hospital, Kuala Lumpur, Malaysia between June 1982 and February 1997. Diagnosis was established by standard histological criteria. The presenting features were evaluated for their distribution and prognostic influence. Disease-free survival from diagnosis was the outcome variable of interest. The ages ranged from 0.1 to 11 years old (median: 3 years old). The tumor originated from the adrenal glands in 83% and the majority of cases presented in advanced stage (stage III 22%, stage IV 66%). Bone marrow was the commonest site of distant metastasis occurring in 45% of patients. The main presenting signs and symptoms in decreasing order were pallor, fever, abdominal mass, weight loss, and bone/joint pain. Univariate analysis conferred age, initial stage and Hb level as significant prognostic factors. No influence in disease-free survival was found for sex, race, primary site, urinary vanillylmandelic acid level, white cell count and platelet count. Overall 2-year disease-free survival was achieved in 27 (39%) patients. Four patients underwent bone marrow transplant, three of whom achieved 2-year disease-free survival. The results suggest that age, initial stage and hemoglobin level are significant prognostic factors based on univariate analysis. In addition, more Malaysian children presented with adrenal primary site and advanced disease compared to previous reported studies.
Two formulations of lambda-cyhalothrin (EC-Emulsion concentrate and MC-Microencapsulated) were impregnated into bednets made of polyethylene and polyester. The nets were treated at a dosage of 15 mg/m2. For bioassay of insecticidal efficacy, female Anopheles maculatus and Aedes aegypti were exposed to the nets for two minutes and mortality was scored 24 hours later. The nets were also tested after repeated washings with water and with soap and water. Microencapsulated (2.5CS) formulation was more effective than emulsion concentrate (2.5EC) formulation on both net materials--polyethylene and polyester. Repeated washing with water and soap reduces the efficacy of all bednet treatment combinations. Microencapsulated formulation on polyethylene gave best results; it could sustain up to five washes with water and two with soap and water.
MeSH terms: Aedes; Animals; Anopheles; Bedding and Linens*; Biological Assay; Chemistry, Pharmaceutical; Drug Compounding; Emulsions; Female; Insecticides/chemistry*; Laundering; Microscopy, Electron, Scanning; Mosquito Control/instrumentation*; Nitriles; Polyesters; Pyrethrins/chemistry*; Time Factors; Polyethylene
To determine the knowledge, attitudes and practices of obstetricians with regards to HIV screening in pregnant women.
MeSH terms: Adult; Education, Medical, Continuing; Female; Hospitals, Public; Humans; Health Knowledge, Attitudes, Practice*; Malaysia; Male; Mass Screening*; Obstetrics/standards*; Pregnancy; Pregnancy Complications, Infectious/diagnosis*; Prenatal Care; Public Policy; AIDS Serodiagnosis*; HIV Infections/diagnosis*; Health Care Surveys
Undernutrition and the consumption of poor diets are prevalent among elderly people in developing countries. Recognising the importance of the early identification of individuals at high nutritional risk, this study aimed to develop a simple tool for screening. A cross-sectional study was conducted on 11 randomly selected villages among the 62 in Mersing District, Malaysia. Undernutrition was assessed using body mass index, plasma albumin and haemoglobin on 285 subjects. Dietary inadequacy (a count of nutrients falling below two-thirds of the Recommended Dietary Allowances) was examined for 337 subjects. Logistic regression analysis was performed to identify significant predictors of undernutrition and dietary inadequacy from social and health factors, and to derive appropriate indices based on these predictions. The multivariate predictors of undernutrition were 'no joint disease', 'smoker', 'no hypertension', 'depended on others for economic resource', 'respiratory disease', 'perceived weight loss' and 'chewing difficulty', with a joint sensitivity of 56% and specificity of 84%. The equivalent predictors of dietary inadequacy were 'unable to take public transport', 'loss of appetite', 'chewing difficulty', 'no regular fruit intake' and 'regularly taking less than three meals per day', with a joint sensitivity of 77% and specificity of 47%. These predictions, with minor modification to simplify operational use, led to the production of a simple screening tool. The tool can be used by public health professionals or community workers or leaders as a simple and rapid instrument to screen individual at high risk of undernutrition and/or dietary inadequacy.
MeSH terms: Aged; Aged, 80 and over; Cross-Sectional Studies; Diet; Female; Hemoglobins/analysis; Humans; Malaysia; Male; Mass Screening/methods*; Nutrition Disorders/blood; Nutrition Disorders/diagnosis*; Nutritional Status; Predictive Value of Tests; Risk Factors; Rural Population; Sensitivity and Specificity; Serum Albumin/analysis; Body Mass Index
The Malaysian Telemedicine initiative advocates a paradigm shift in healthcare delivery patterns by way of implementing a person-centred and wellness-focused healthcare system. This paper introduces the Malaysian Telemedicine vision, its functionality and associated operational conditions. In particular, we focus on the conceptualisation of one key Telemedicine component i.e. the Lifetime Health Plan (LHP) system--a distributed multimodule application for the periodic monitoring and generation of health-care advisories for all Malaysians. In line with the LHP project, we present an innovative healthcare delivery info-structure--LifePlan--that aims to provide life-long, pro-active, personalised, wellness-oriented healthcare services to assist individuals to manage and interpret their health needs. Functionally, LifePlan based healthcare services are delivered over the WWW, packaged as Personalised Lifetime Health Plans that allow individuals to both monitor their health status and to guide them in healthcare planning.
MeSH terms: Computer Communication Networks/trends; Forecasting; Health Promotion/trends*; Humans; Malaysia; National Health Programs/trends*; Patient Care Planning/trends*; Medical Records Systems, Computerized/trends*; Telemedicine/trends*; Multimedia/trends*; Needs Assessment/trends
Presently, there is a growing demand from the healthcare community to leverage upon and transform the vast quantities of healthcare data into value-added, 'decision-quality' knowledge, vis-à-vis, strategic knowledge services oriented towards healthcare management and planning. To meet this end, we present a Strategic Knowledge Services Info-structure that leverages on existing healthcare knowledge/data bases to derive decision-quality knowledge-knowledge that is extracted from healthcare data through services akin to knowledge discovery in databases and data mining.
MeSH terms: Artificial Intelligence*; Decision Support Techniques; Expert Systems*; Health Planning/statistics & numerical data; Humans; Malaysia; National Health Programs/statistics & numerical data*; Policy Making; Information Storage and Retrieval/statistics & numerical data*
In this paper, we present a Java-based framework for the processing, storage and delivery of Electronic Medical Records (EMR). The choice of Java as a developmental and operational environment ensures operability over a wide-range of client-side platforms, with our on-going work emphasising migration towards Extensible Markup Language (XML) capable Web browser clients. Telemedicine in support of womb-to-tomb healthcare as articulated by the Multimedia Supercorridor (MSC) Telemedicine initiative--which motivated this project--will require high-volume data exchange over an insecure public-access Wide Area Network (WAN), thereby requiring a hybrid cryptosystem with both symmetric and asymmetric components. Our prototype framework features a pre-transaction authentication and key negotiation sequence which can be readily modified for client-side environments ranging from Web browsers without local storage capability to workstations with serial connectivity to a tamper-proof device, and also for point-to-multipoint transaction processes.
MeSH terms: Computer Communication Networks*; Humans; Malaysia; Software*; Medical Records Systems, Computerized*; Computer Security*; Telemedicine
The 21st century promises to usher in an era of Internet based healthcare services--Tele-Healthcare. Such services augur well with the on-going paradigm shift in healthcare delivery patterns, i.e. patient centred services as opposed to provider centred services and wellness maintenance as opposed to illness management. This paper presents a Tele-Healthcare info-structure TIDE--an 'intelligent' wellness-oriented healthcare delivery environment. TIDE incorporates two WWW-based healthcare systems: (1) AIMS (Automated Health Monitoring System) for wellness maintenance and (2) IDEAS (Illness Diagnostic & Advisory System) for illness management. Our proposal comes from an attempt to rethink the sources of possible leverage in improving healthcare; vis-à-vis the provision of a continuum of personalised home-based healthcare services that emphasise the role of the individual in self health maintenance.
MeSH terms: Artificial Intelligence*; Delivery of Health Care; Diagnosis, Computer-Assisted*; Expert Systems*; Health Promotion; Home Care Services*; Humans; Malaysia; Software; Therapy, Computer-Assisted*; Integrated Advanced Information Management Systems; Remote Consultation*; Internet
In this paper we suggest that the healthcare enterprise needs to be more conscious of its vast knowledge resources vis-à-vis the exploitation of knowledge management techniques to efficiently manage its knowledge. The development of healthcare enterprise memory is suggested as a solution, together with a novel approach advocating the operationalisation of healthcare enterprise memories leading to the modelling of healthcare processes for strategic planning. As an example, we present a simulation of Service Delivery Time in a hospital's OPD.
MeSH terms: Artificial Intelligence*; Computer Simulation; Database Management Systems*; Decision Support Systems, Management; Delivery of Health Care*; Expert Systems*; Health Planning; Humans; Malaysia; Outpatient Clinics, Hospital
Five species of adult nematodes, unidentifiable nematode larvae, and three species of acanthocephalans, were found in freshwater ornamental fishes newly imported into Germany from Brazil, Colombia, Indonesia, Malaysia, Nigeria, Peru, Sri Lanka and Thailand. The following species were identified: Adult Nematoda: Pseudocapillaria tomentosa, Capillariidae gen. sp., Dichelyne hartwichi sp. n., Procamallanus (Spirocamallanus) pintoi and Spinitectus allaeri; Acanthocephala: Pseudogorgorhynchus arii gen. et sp. n., Neoechinorhynchus sp. and Pallisentis sp. The nematode Dichelyne hartwichi sp. n. (male only) from the intestine of Chelonodon fluviatilis (Hamilton) from Thailand is characterised mainly by the presence of minute cuticular spines on the tail tip, length of spicules (510 microns) and arrangement of caudal papillae. The acanthocephalan Pseudogorgorhynchus arii sp. n. from the intestine of Ariopsis seemanni (Günther) from Colombia represents a new genus Pseudogorgorhynchus gen. n., differing from other genera of the Rhadinorhynchidae mainly in possessing a small proboscis armed with markedly few (18) hooks arranged in six spiral rows. Spinitectus macheirus Boomker et Puylaert, 1994 and Spinitectus moraveci Boomker et Puylaert, 1994 are considered junior synonyms of Spinitectus allaeri Campana-Rouget, 1961.
Apolipoprotein E (APOE = gene, apoE = protein) plays a central role in plasma lipoprotein metabolism and in lipid transport within tissues. The APOE shows a genetic polymorphism determined by three common alleles, APOE*2, APOE*3, APOE*4 and the product of the three alleles differs in several functional properties. APOE is involved in the development of certain pathological conditions. In particular, the APOE*4 allele is a risk factor for susceptibility to coronary artery disease (CAD) and Alzheimer's Disease (AD). In the present study we analyzed the APOE allele distribution in the world. The APOE*3 is the most frequent in all the human groups, especially in populations with a long-established agricultural economy like those of the Mediterranean basin (0.849-0.898). The frequency of APOE*4, the ancestral allele, remains higher in populations like Pygmies (0.407) and Khoi San (0.370), aborigines of Malaysia (0.240) and Australia (0.260), Papuans (0.368), some Native Americans (0.280), and Lapps (0.310) where an economy of foraging still exists, or food supply is (or was until the recent past) scarce and sporadically available. The APOE*2 frequency fluctuates with no apparent trend (0.145-0.02) and is absent in Native Americans. We suggest that the APOE*4, based on some functional properties it has and on its distribution among human populations, could be identified as a 'thrifty' allele. The exposure of APOE*4 to the contemporary environmental conditions (Western diet, longer lifespans) could have rendered it a susceptibility allele for CAD and AD. The absence of the association of APOE*4 with CAD and AD in Sub-Saharan Africans, and its presence in African Americans, seems to confirm this hypothesis.
One of the problems faced by manufacturers is the difficulty in constructing a robust and reliable, angled applicator tip. This can be overcome by handmaking your own retrograde carrier. The applicator tip may be bent to about 50 degrees and, if a kink occurs while bending the tip, it can be replaced easily by a new modified needle. Because the wire used is flexible, it can adapt to the bend without a problem. Narrower carriers can also be made using a 20-G needle, perhaps more suitable for retrograde fillings of molar apices. Because the carrier is designed to be used once only, the problems of it being difficult to load and liable to blockages should not arise.