Despite time, mobility, knowledge and other constraints, it is still possible for General Practitioners to play an active role in Palliative Care. This article offers various roles where GP can play. Differences between hospice, palliative medicine, palliative care are discussed. Suggestions are made on where to seek formal or informal education on palliative care. Key Words: role, hospice, palliative medicine, palliative care, illness, sickness
MeSH terms: Malaysia; Palliative Care; Physicians; Physicians, Family; General Practitioners
Adolescent pregnancy is associated with long term medical and sociological problems. For intervention, it is important to have information on their profile and obstetric outcome. A study was conducted in 1999 on teenage mothers compared to mothers in the 20-34 year age group. Antenatal records of all these mothers registered in a Malaysian semi-rural Health Clinic in 1998 were reviewed and the relevant information was analysed using descriptive statistics and chi-square for comparison in SPSS 7.5. Only 402 (80.9%) of the 497 antenatal records could be included. There were 40 (9.95%) adolescent pregnancies and 362 (90.05%) pregnancies in mothers aged 20-34 years. Pregnant adolescents were more likely to be Malays (85% versus 66%), unmarried (65% versus 5.5%) and less educated (32.5% versus 12.1%). They have a significantly lower rate of contraceptive usage (2.5% versus 20.2%) and tend to come late for their first antenatal visit (55% versus 18.5%). Their pregnancy complications of anaemia and pregnancy induced hypertension were no worse. But they had a significantly higher preterm delivery rate (37.5% versus 21.8%) and their babies were more likely to have low birth weight (32.5% versus 9.9%). Based on this preliminary finding, further investigations should be carried out and polices should include programmes targeted for this group.
Asthma is a chronic reversible respiratory problem commonly seen by Family Physicians. Pregnancy can produce physiological and physical changes that can affect the severity of asthma and its management. Conversely poorly controlled asthmatic attacks can result in adverse obstetric outcome: prematurity, low birth weight babies, foetal hypoxia and increased maternal and foetal morbidity and mortality. It is important that Family Physicians should be able to manage competently and provide appropriate counseling for women with asthma in pregnancy, labour and lactation. Assessment of asthma control using a peak flow meter is recommended. The use of the usual inhaled and oral corticosteroids, beta 2 agonists, cromones and anticholinergics are generally safe in pregnancy, labour and lactation. But methylxanthines should be used with caution. Women should be advised that asthma medication would not adversely affect their unborn babies and the birth outcome of well-controlled asthmatic women approaches that of the normal population but uncontrolled asthma would be detrimental to the health of mother and child.
Epistaxis is a common clinical condition and perhaps the most common ENT cause for emergency hospital admission. Commonly epistaxis originates from the anterior septum and is easily controlled with caurterization and packing. Posterior epistaxis is less common, but more difficult to treat. It usually occurs in the elderly and is frequently associated with hypertension, artherosclerosis and conditions that decrease platelets and clotting function. In the elderly and hypertensive patient the source of bleeding is likely from the sphenopalatine area in lateral posterior nasal wall. Intractable posterior epistaxis that persists despite repeated use of nasal packing has been treated in many different ways. Conventional methods of arterial ligation in intractable epistaxis often involve surgical morbidity as well as failure due to arterial anastomosis. Embolization is most effective in hands of an experience radiologist, in patients with epistaxis refractory to arterial ligation, bleeding site difficult to reach surgically or epistaxis due to general bleeding disorder. Endoscopic ligation or clipping of sphenopalatine artery is a relatively simple and effective procedure for control of intractable posterior epistaxis.
Sugarcane yellow leaf virus (SCYLV) was detected for the first time in 1996 in the Centre de Coopération Internationale en Recherche Agronomique pour le Développement (CIRAD) sugarcane quarantine at Montpellier by reverse transcription-polymerase chain reaction (RT-PCR) in varieties from Brazil, Florida, Mauritius, and Réunion. Between 1997 and 2000, the virus was found by RT-PCR and/or tissue-blot immunoassay (TBIA) in additional varieties from Barbados, Cuba, Guadeloupe, Indonesia, Malaysia, Philippines, Puerto Rico, and Taiwan, suggesting a worldwide distribution of the pathogen. An excellent correlation was observed between results obtained for the two diagnostic techniques. However, even though only a few false negative results were obtained by either technique, both are now used to detect SCYLV in CIRAD's sugarcane quarantine in Montpellier. The pathogen was detected by TBIA or RT-PCR in all leaves of sugarcane foliage, but the highest percentage of infected vascular bundles was found in the top leaves. The long hot water treatment (soaking of cuttings in water at 25°C for 2 days and then at 50°C for 3 h) was ineffective in eliminating SCYLV from infected plants. Sugarcane varieties from various origins were grown in vitro by apical bud culture and apical meristem culture, and the latter proved to be the most effective method for producing SCYLV-free plants.
Chater B, Couper I, McLeod J, Naidoo N, Rajakumar MK, Reid S, et al.
Citation: Chater B, Couper I, McLeod J, Naidoo N, Rajakumar MK, Reid S, Rosenblatt R, Rourke J, Strasser R, Wainer J. WONCA Policy on Rural Practice and Rural Health. Traralgon, Victoria, Australia: Monash University School of Rural Health; World Organisation of Family Doctors (WONCA), 2001
1. Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 113-119
2. An Uncommon Hero. p221-240
To assess the efficacy of the trans-septal approach to the mitral valve, 40 patients who underwent mitral valve surgery via this approach were compared to 37 patients who underwent surgery via the standard left atriotomy. Concomitant procedures included tricuspid annuloplasty, aortic valve replacement, closure of atrial septal defect, coronary artery bypass grafting and aortic valve repair. There was one (1.2%) operative mortality. No patients required pacemaker implantation. Follow-up of up to 18 months showed that all patients were in NYHA classes I and II. One third of the patients who had trans-septal approach to the mitral valve achieved conversion from atrial fibrillation to sinus rhythm while none of the patients who underwent conventional left atriotomy had conversion (p < 0.02). The trans-septal approach to the mitral valve is a useful approach in selective patients requiring mitral valve surgery.
Comment in: Lim KG. The trans-septal approach to the mitral valve. Med J Malaysia. 2001 Dec;56(4):513
Nocardia infection is rare in bone marrow transplant (BMT) recipients with less than 30 cases reported in the literature [1-4]. The majority of the cases occurred late in the post-transplant period. Common clinical presentations included formation of widespread and multiple abscesses. Bone marrow hypoplasia is an uncommon finding. We describe the first case of nocardiosis, diagnosed at day 100 after non-myeloablative allogeneic peripheral blood stem cell transplantation, presenting as pancytopenia and hypocellular marrow. Eradication of the infection with antibiotics resulted in complete hematological recovery.
Leukemic infiltration of the optic nerve is rare . [Camera, A., Piccirillo, G., Tranfa, F., Rosa, N., Frigeri, F., Martinelli, V., Rotoloi, B. (1993) "Optic nerve involvement in acute lymphoblastic leukemia", Leuk. Lymph. 11, 153-155]. Radiotherapy should be given urgently to all patients with optic nerve infiltrate to restore their vision . [Rosenthal, A. (1983) "Ocular manifestation of leukemia", Ophthalmology 90, 899-905]. We report a case of a unilateral optic nerve relapse 7 months after diagnosis of acute lymphoblastic leukemia (ALL) in a 17-year-old boy who had been off treatment for 6 weeks. The ocular symptoms was initially diagnosed as primary optic neuritis and treated with corticosteroids resulting in temporary clinical recovery. Radiation therapy for ocular leukemia that was commenced 2 months after the onset of symptoms failed to reverse the visual loss. The lack of a reliable and effective tool to diagnose ocular leukemia at an early stage has resulted in significant treatment delay and poor visual outcome.
A case of signet-ring cell lymphoma diagnosed initially by fine needle aspiration cytology is reported. This rare tumor is a variant of follicular lymphoma, which closely resembles metastatic adenocarcinoma and other tumors which exhibit signet-ring cell appearance. Correct diagnosis can be achieved by careful morphologic analysis together with positive reactivity with lymphoid markers. The cytohistologic, immunohistochemical and electron microscopic features are described, and the differ ential diagnostic considerations are discussed in the report.