To describe an appliance used for equalisation of severe congenital lower limb length discrepancy for patients who refuse to undergo any operative correction but wish to walk and look better.
MeSH terms: Adolescent; Adult; Child; Female; Humans; Leg Length Inequality/congenital*; Leg Length Inequality/physiopathology; Leg Length Inequality/psychology; Leg Length Inequality/rehabilitation*; Male; Prosthesis Design; Range of Motion, Articular; Walking; Patient Satisfaction
Chylothorax is a rarely recognised post-operative complication following repair of congenital diaphragmatic hernia. We report here a newborn infant with this condition which resolved with percutaneous chest drainage, total parenteral nutrition and enteral feeding of a formula high in medium-chain triglycerides.
MeSH terms: Academies and Institutes/history*; Academies and Institutes/organization & administration; Malaysia; Research/history*; History, 20th Century
A prospective observational study examing the incidence, predisposing factors and microbiological aspects of peritonitis complicating acute intermittent peritoneal dialysis (IPD) was performed in Hospital Universiti Sains Malaysia, a referral hospital situated in Northeast Malaysia. Over a 7- month period, a total of 126 acute IPD treatments were included involving 69 patients. The majority of patients suffered from chronic or end stage renal failure (92.7%) and nearly half (47.8%) have underlying diabetes mellitus. Peritonitis occured in 25 treatment sessions giving a frequency of 19.8% of procedures performed. The mean interval between starting dialysis and the first sign of peritonitis was 3.5 days, with 12% of peritonitis occuring before day 3 of treatment. Frequent catheter manipulation and/or leakages were identified as significant predisposing factors for peritonitis and the risk of peritonitis was increased with longer duration of IPD. Gram-negative infections were seen twice more commonly than gram-positive infections. We recommend the use of cloxacillin in combination with either an aminoglycoside or a cephalosporin as empirical antibiotic coverage until culture reports are available.
A cross sectional study was carried out to evaluate the effect of rice husk dust in rice millers in Malaysia. Altogether 69 workers participated in this study. They were interviewed using standardized questionnaires and lung function tests were performed. Chest tightness was among the common symptoms (34.9%) complained by workers. Age, duration of employment and smoking status were among the factors associated with respiratory symptoms (p < 0.01). Lung function tests revealed some degree of impairment compared to the healthy population.
MeSH terms: Cross-Sectional Studies; Female; Humans; Interviews as Topic; Malaysia; Male; Surveys and Questionnaires; Respiratory Function Tests; Respiratory Tract Diseases/etiology*; Respiratory Tract Diseases/physiopathology; Oryza; Occupational Exposure*; Inhalation Exposure*; Food Industry*
With a five-year survival rate of 20% in 1970 and 40-45% in 1990, and highest incidence and mortality in early and middle adult years, nasopharyngeal carcinoma (NPC) may have a severe social impact on families and households. The aim of this study was to measure the social impact of NPC in the Chinese population of Selangor, Malaysia.
MeSH terms: Adolescent; Adult; Carcinoma/diagnosis; Carcinoma/epidemiology*; Child; Child, Preschool; Family Characteristics/ethnology*; Female; Humans; Malaysia/epidemiology; Male; Middle Aged; Nasopharyngeal Neoplasms/diagnosis; Nasopharyngeal Neoplasms/epidemiology*; Risk Factors; Sampling Studies; Socioeconomic Factors; Incidence; Survival Rate; Case-Control Studies; Age Distribution; Sex Distribution; Asian Continental Ancestry Group*
A 37-year-old Malay man presented initially with the clinical picture of essential thrombocythaemia (ET) without the extreme leukocytosis, marked splenomegaly and low neutrophil alkaline phosphatase characteristic of chronic myelogenous leukaemia (CML). Bone marrow examination showed massive megakaryocytic hyperplasia; cytogenetic studies showed the presence of Philadelphia chromosome. The patient was treated with hydroxyurea that resulted in reduction in the platelet count. Seventeen months later, he presented with fever associated with tender massive splenomegaly. Bone marrow finding was consistent with chronic phase CML. The presence of a rearrangement involving the major breakpoint cluster region (M-bcr) on chromosome 22 was confirmed by reverse transcriptase-polymerase chain reaction. The clinical importance of finding the Philadelphia chromosome in patients who seem to have ET is in assessing prognosis. ET generally follows a chronic, indolent course. However, this patient who had Philadelphia chromosome underwent clinical transition to chronic phase CML17 months and blast crisis 29 months after presentation.
Cervical pregnancy is an uncommon variety of ectopic gestation. The aetiology is obscure. Diagnosis can be missed unless early evaluation is done by experienced personnel utilising pelvic ultrasonography. Three cases of cervical pregnancy managed at this hospital are described illustrating difficulties in early diagnosis and possible association with previous uterine scar and prior curettage of the uterus for retained products of conception. Treatment options vary according to the clinical state of the patient at the time of diagnosis. Non-surgical methods including systemic methotrexate administration in one and surgical evacuation of products of conception with subsequent cervical cerclage in another are discussed. Surgical interventions like total abdominal hysterectomy with internal iliac artery ligation to arrest life-threatening pelvic haemorrhage is also described. Other treatment options include potassium chloride (KCl) alone or in combination with methotrexate.
The aim of the present study was to determine whether Porphyromonas gingivalis-lipopolysaccharide (Pg-LPS) may stimulate nitric oxide (NO) production by murine spleen cells. Spleen cells derived from Balb/c mice were cultured in the presence of Pg-LPS or LPS from Salmonella Typhosa. The cell were also cultured in the presence of Pg-LPS with or without L-arginine, L-arginine plus NG-monomethyl-L-arginine (NMMA), or IFN-gamma. Furthermore, the plastic non-adherent spleen cells were stimulated with Pg-LPS and L-arginine. The results showed that Pg-LPS failed to stimulate splenic NO production by themselves. Exogenous L-arginine or IFN-gamma up-regulated the NO production of Pg-LPS-stimulated spleen cells, but the stimulatory effects of L-arginine were completely blocked by NMMA. It was also demonstrated that in the presence of Pg-LPS and L-arginine, splenic macrophages were the cellular source of NO. These results suggest, therefore, that P. gingivalis-LPS may induce murine splenic macrophages to produce NO in a L-arginine and an IFN-gamma-dependent mechanism.
Red man syndrome (RMS) is the occurrence flushing, pruritus, chest pain, muscle spasm or hypotension during vancomycin infusion. It usually happens as a result of rapid infusion of the drug but may also occur after slow administration. The frequency and severity of this phenomenon diminish with repeated administration of vancomycin. A case is presented whereby RMS occurred while prophylactic antibiotic against infective endocarditis was administered.
A survey was conducted to assess student's sexual knowledge and attitudes using a questionnaire based on the Sex Knowledge and Attitude Test (SKAT-II) to compare medical and nursing students with students (non-medical/nursing) who registered for a sexual health course. 85 Sexual Health, 115 medical and 81 nursing students voluntarily participated in the survey. This study showed that all the student groups showed relatively low scores in knowledge. Furthermore, average knowledge scores differed significantly between the three student groups with medical students scoring highest and nursing students lowest. Besides student groups, several other factors were found to be significantly associated with Knowledge score namely, race, religion, age, perception of the importance of religion and the extent to which religious beliefs influence sexual attitudes. Furthermore, multivariate statistical analyses showed that among these factors, student group, race/religion and religious importance were significant predictors of sexual knowledge. Specifically, being a medical student was associated with higher scores relative to a non-medical student, being a Malay student was independently associated with a lower average score compared to other races, and perceiving religion as extremely important was associated with a lower score.
MeSH terms: Adolescent; Adult; Female; Humans; Health Knowledge, Attitudes, Practice*; Malaysia; Male; Sexual Behavior*; Sex Education*; Students/statistics & numerical data*; Students, Medical/statistics & numerical data; Students, Nursing/statistics & numerical data; Multivariate Analysis; Linear Models; Statistics, Nonparametric
There is no doubt that gender bias has been inherent in medical and public health education, research, and clinical practice. This paper discusses the central question for medical and public health educators viz. whether women's health concerns and needs could be best addressed by the conventional biomedical approach to medical and public health education, research, and practice. Gender inequalities in health and gender bias in medical and public health education are revealed. It is found that in most public health and prevention issues related to women's health, the core issue is male-female power relations, and not merely the lack of public health services, medical technology, or information. There is, thus, an urgent need to gender-sensitize public health and medical education. The paper proposes a gender analysis of health to distinguish between biological causes and social explanations for the health differentials between men and women. It also assessed some of the gender approaches to public health and medical education currently adopted in the Asia-Pacific region. It poses the pressing question of how medical and public health educators integrate the gender perspective into medical and public health education. The paper exhorts all medical and public health practitioners to explore new directions and identify innovative strategies to formulate a gender-sensitive curriculum towards the best practices in medicine and public health that will meet the health needs of women and men in the 21st century.
MeSH terms: Curriculum; Education, Medical/methods*; Female; Humans; Malaysia; Male; Prejudice*; Public Health/education*; Sex Factors; Women's Health*
Sexuality of persons with spinal cord injury has received increased attention especially in the Western countries. However, in the local context, studies pertaining to the sexuality of the disabled are almost nil. This paper utilized a qualitative approach in assessing sexual knowledge, attitudes and practices of persons with spinal cord injury. Eight focus group discussions consisting of 28 adult spinal cord injured persons were carried out. The results showed that the frequency of sexual activity decreased following injury. The disabled themselves have a negative self-concept and a low self-esteem and this affects their attitudes towards sexuality and their sexual behaviour. Health care professionals tend to neglect this issue perhaps due to their insensitivity to the sexual needs for the disabled or a lack of understanding and expertise in this area. A need for sexual information related to their disability is warranted in the areas of reproduction, contraception and their ability/disability in achieving an erection or ejaculation. This study indicated a need for more comprehensive research in this neglected area of sexual issues of persons with disabilities. Public health education and counseling is deemed necessary for the disabled themselves so as to accommodate their sexual lives to their physical capabilities and desires. Attitudes and misconceptions of the public need to be corrected. Above all, there is a need for education and training for health care professionals in the area of sexual rehabilitation, which is currently non-existent in the country. Perhaps, it is timely to incorporate sexual rehabilitation as part of a holistic medical rehabilitation of the disabled.
MeSH terms: Disabled Persons/rehabilitation*; Health Services Needs and Demand; Humans; Health Knowledge, Attitudes, Practice*; Malaysia; Patient Education as Topic*; Spinal Cord Injuries/rehabilitation*; Sexuality*
Most of the features of fetal alcohol syndrome (FAS) have been replicated in experimental models. They provide an insight into the effects of alcohol on the developing embryo, however, satisfactory explanations for these effects are still not available. Certain maternal characteristics of children with FAS have been identified. However, it is not absolute as at times the most unlikely women are susceptible to problems of maternal alcoholism. The levels of awareness of FAS among the general public and health workers are inadequate. Measures need to be taken to remedy this condition.
Generally there is a significant delay before optimized performance of mammography is fully realized in the developing countries. To evaluate the status of mammographic performance, a survey of mammographic image quality and exposure was performed in nine hospitals from four selected South East Asian countries. The entrance exposure on the surface of the American College of Radiology (ACR) mammographic phantom (ACR-RMI model 156) was made using both thermoluminescent dosimeters (TLDs) and an ionization chamber. The TLDs were mailed from the University of Wisconsin Radiation Calibration Laboratory (UWRCL) to the cooperating hospitals. The surveyed hospitals processed the images and returned them to the UWRCL for subsequent evaluation of the image quality of the mammographic phantom. Machine-specific data, technique factors and sensitometric data were also obtained. At 28 kVp, the mean entrance exposure is 0.91 R (0.46 to 2.6 R), mean glandular dose is 1.61 mGy (0.90 to 4.15 mGy), mean optical density is 1.37 (0.66 to 2.30), mean total phantom image score is 9.1(4-12). Only three of the nine hospitals tested achieved an acceptable score above the minimum 10. Results for 25 and 30 kVp showed similar trend. The variation between the ion chamber measurements and TLD measurements ranged from 4 to 24%. There is a wide variation in the image quality and entrance exposure among hospitals in South East Asia. There is a need for a quality assurance program. The factors that cause low score in the phantom images must be corrected. Calibration and the use of appropriate ionization chambers for mammography is important.
Meningitis due to an invasive Haemophilus influenzae type b (Hib) infection, has been previously perceived to be relatively uncommon in Asia. However, the incidence of disease and its impact may have been underestimated. In addition to a lack of microbiological facilities in some hospitals, difficulties in culturing the organism and the widespread use of antibiotics may have hidden the true incidence of the disease in some countries. Furthermore, the reported disease burden probably underestimates the incidence of Hib pneumonia. The epidemiology of invasive Hib disease for various Asian nations is reviewed in this paper. Hospital-based studies show that Hib is a major cause of bacterial meningitis and/or pneumonia in the Philippines, India, Thailand, Malaysia, Indonesia and Vietnam. Singapore and Hong Kong have a low incidence of infection compared with Western and other Asian nations. This low incidence is not due to a higher level of natural protective antibodies, but may be related to an interaction between environmental and genetic factors. Therefore the widespread belief that Hib infection is unimportant in Asia does not refer to Asia as a whole and possibly to Chinese patients only, and failure to recognize this has serious implications. The inclusion of Hib vaccine in the routine infant immunization schedule in many industrialized nations has significantly reduced the incidence of invasive disease. Recent studies have shown Hib vaccination is also effective in preventing invasive disease in children in developing countries. While population-based data may be required to confirm the need for public-funded infant Hib immunization in Asia, its introduction in countries with a high incidence of Hib meningitis and/or pneumonia has the potential to significantly improve pediatric health and survival.
A total of 57 Vibrio vulnificus isolates from coastal water were characterized for their antimicrobial resistance, plasmid profiles and were typed by the PCR-based techniques: a random amplification of polymorphic DNA (RAPD) method and the enterobacterial repetitive intergenic consensus sequence (ERIC) method. All isolates were susceptible to chloramphenicol, nalidixic acid, tetracycline and trimethoprim-sulfamethoxazole. Fifty-one isolates were resistant to one or more of the other antibiotics tested. Plasmid analysis indicated that only 18 isolates carried small plasmids of 1.6 to 16 megadaltons. Analysis of the RAPD and ERIC DNA fingerprints of the V. vulnificus isolates with Gel Compare and cluster analysis software revealed significant genetic heterogeneity among these isolates. The combination of RAPD and ERIC analysis allowed us to distinguish all isolates. Thus, the combination of the two techniques is recommended for epidemiological investigation.
MeSH terms: Base Sequence; Drug Resistance, Microbial; Malaysia; Tetracycline/pharmacology; Vibrio/classification; Vibrio/drug effects; Vibrio/genetics; Vibrio/isolation & purification*; Water Microbiology*; Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology; Polymerase Chain Reaction; DNA Primers; Random Amplified Polymorphic DNA Technique
Central nervous system manifestations are probably the most frequent extrapulmonary complications of infections due to Mycoplasma pneumoniae, occur mostly in children. In this study, we attempted to isolate M. pneumoniae and to detect the organism by polymerase chain reaction (PCR) from cerebrospinal fluid samples (CSF) of pediatric patients. Of the 244 CSF samples, no M. pneumoniae was isolated. Six (2.5%) of the CSF samples were positive by PCR amplification. More effort are necessary to isolate the organism from CSF samples in order to ascertain the role of M. pneumoniae in causing neurological complications.
Isolation and polymerase chain reaction (PCR) were performed for detection of Mycoplasma pneumoniae from respiratory tract specimens obtained from 200 adult and 200 pediatric patients. M. pneumoniae was isolated from bronchoalveolar lavage fluid of 1(0.5%) adult patient and 4(2.0%) tracheal aspirates of pediatric patients. PCR was positive for only one (0.5%) broncoalveolar lavage fluid of an adult patient and fifteen (7.5%) tracheal aspirates of pediatric patients. This study suggested that M. pneumoniae was more frequently detected in pediatric patients and PCR appears to have advantages over isolation, in terms of rapidity and sensitivity.
A total of 52 clinical strains of Helicobacter pylori were characterized on the basis of preformed enzyme production with API ZYM kits. Using the biotyping schemes as defined by Reina and Alomar (1989), Kung et al (1989) and Matsumoto et al (1996), 15.3% (8/52), 13.5% (7/52) and 11.5% (6/52) of the isolates were not biotypable, respectively. Two enzymes, valine arylamidase and cystine arylamidase could be additionally used to differentiate between isolates. Our isolates were either negative or positive for both the enzymes or positive only for cystine arylamidase. We propose the incorporation of these two enzymes into the Matsumoto et al (1996) biotyping scheme to biotype strains into additional enzyme biotypes.