Quality programs are difficult to implement where social support for healthcare costs are inadequate and there is no institutional support for quality programs to guide and assist the doctor in pratice. ‘Quality’ is not the good intention to do better, but the process of measurement of behavioral change against set targets. For the majority of the doctors of this region who practice under great constraints, this article outlines some quality activities that are entirely within their personal initiative and responsibility, but should make a real difference to the quality of care provided.nd responsibility, but should make a real difference to the quality of care you provide.
Republished in: Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar. p75-84
MeSH terms: Family Practice; Quality Assurance, Health Care
Health is a fundamental right, not a commodity to be sold at a profit, argues Irene Fernandez in the second Jonathan Mann Memorial Lecture delivered on 8 July 2002 to the XIV International AIDS Conference in Barcelona. Ms Fernandez had to obtain a special permit from the Malaysian government to attend the Conference because she is on trial for having publicly released information about abuse, torture, illness, corruption, and death in Malaysian detention camps for migrants. This article, based on Ms Fernandez' presentation, describes how the policies of the rich world have failed the poor world. According to Ms Fernandez, the policies of globalization and privatization of health care have hindered the ability of developing countries to respond to the HIV/AIDS epidemic. The article decries the hypocrisy of the industrialized nations in increasing subsidies to farmers while demanding that the developing world open its doors to Western goods. It points out that the rich nations have failed to live up their foreign aid commitments. The article concludes that these commitments--and the other promises made in the last few years, such as those in the United Nations' Declaration of Commitment on HIV/AIDS--can only become a reality if they are translated into action.
MeSH terms: Ethics*; Health Services Accessibility/legislation & jurisprudence*; Humans; Human Rights*; Policy Making*; Spain; HIV Infections
This paper sheds light on infectious diseases and the status of malnutrition in Nepal, a Himalayan country located in South Asia. In spite of efforts by both Government and non-government sectors, infectious diseases are rampant in the countries constituting a major cause of morbidity and mortality, which in turn, impose a socio-economic and public health burden for the country. Intestinal parasitic infection has been implicated in the causation of malnutrition. Malnutrition associated with child mortality is more common among children aged less than five years. Nepalese women suffer from chronic malnutrition. People in rural areas are more affected by malnutrition than those in urban areas. This has been attributed to poverty, lack of education, and rampant infectious diseases.
Tocotrienols and tocopherols are isoforms of vitamin E. Vitamin E may exhibit antioxidant, prooxidant and non-antioxidant activities depending upon circumstances. In this study, the effect of tocotrienols and α-tocopherol on the activities of HMG CoA reductase and cholesterol 7 α-hydroxylase was investigated. Pure tocotrienols were isolated from palm fatty acid distillate and pure α-tocopherol was obtained commercially. Guinea pigs were treated with different dosages of tocotrienols and α-tocopherol. After the treatment period, animals were sacrificed and liver microsomes were prepared. HMG CoA reductase and cholesterol 7α-hydroxylase were assayed using tracer techniques. Our results showed that the effects of tocotrienols and α-tocopherol on the activities of both the enzymes were dose-dependent. At low dosages, both tocotrienols and α-tocopherol exhibited an inhibitory effect on both the enzymes. Moreover, tocotrienols were a much stronger inhibitors than α-tocopherol. At high dosages, on the other hand, tocotrienols and α-tocopherol showed opposite effects on the enzymes. While tocotrienols continued to exhibit an inhibitory effect, α-tocopherol actually exhibited a stimulatory effect on both the enzymes. A possible explanation for this observation is suggested.
This study was conducted to determine the effects of increased edible palm oil consumption on community health status in the aboriginal communities in Tual Post (treatment group) and Sinderut Post (control group), Kuala Lipis, Pahang. Nutritional status, blood pressure, lipid profiles, fasting blood glucose (FBG), vitamin E (alpha-tocopherol) levels and lipid peroxidation product (malonaldehyde) levels were taken as indicators of health status. This is a pre-and post-controlled community trial in which similar variables were measured in each group. Every family of 2–6 household members was given 2–5 kg cooking palm oil per month for a period of 18 months. All subjects were measured for height (cm), weight (kg) and waist-hip ratio (WHR). For calorie intake measurement, house-to-house interviews were conducted using 24-hour dietary recall method. Blood pressure, percent body fat, lipid profiles, namely total cholesterol, high density lipoprotein cholesterol, triglyceride and fasting blood glucose (FBG) were also measured. Vitamin E (alpha-tocopherol) levels and lipid peroxidation products (MDA) were also determined. There was a significant increase (p
MeSH terms: Adipose Tissue; Blood Glucose; Blood Pressure; Body Weight; Cooking; Diet; Fasting; Cholesterol, HDL; Malondialdehyde; Nutritional Status; Plant Oils; Triglycerides; Vitamin E; Lipid Peroxidation; alpha-Tocopherol; Control Groups; Waist-Hip Ratio
The effects of dietary fat during pregnancy and lactation on growth performance of pups, milk composition and very low density lipoprotein composition in rats were studied. A total of 33 dams were used in this study and each litter was adjusted to 8 pups per dam. The dams were fed on high fat (150 g fat/kg diet, HF), medium fat (75 g fat/kg of diet, MF) and low fat (2.5 g fat/kg diet, LF) diets. The body weights of dams increased during pregnancy and decreased after pregnancy. The HF pups had a higher body weight and higher weight gain than those of LF pups. The amount of feed intake of HF dams was significantly higher than LF and MF dams. The HF dams had significantly higher milk fat and water concentrations than LF dams. The milk protein was not significantly different among the treatment groups. All dams showed hypertriacylglycerolaemia in their very low density lipoprotein (VLDL) in late pregnancy. The VLDL-protein concentrations increased during the first week after parturition. The HF dams showed a greater response to the dietary fat than that of LF and MF dams. The findings suggest that addition of fat in the diet during pregnancy and lactation may improve the milk quality through modifying the composition of VLDL contents, leading to better growth of pups.
For many years counting cells and identifying them under the microscope has been the conventional method to determine the number of abnormal and normal cells in cancers. During the last decade, studies have shown that the detection and quantification of residual tumor cells is important in predicting the clinical outcome of several types of hematological malignancies. Detection of
minimal residual disease (MRD) is now becoming routinely implemented in treatment protocols and is increasingly used for guiding therapy and for evaluation of new treatment modalities (Raanani & Hashomer, 2004). A wide variety of techniques have been developed to detect residual malignant cells beyond the sensitivity of conventional approaches by cell morphology. One of these technology is by real time quantitative (RQ) polymerase chain reaction (PCR) using the Taqman and LightCycler systems.
Roselle (Hibiscus sabdariffa L.) from Malvaceae family is an annual crop with potential for use by many industries including food, animal feed, neutraceutical, cosmeticeutical and pharmaceutical industries. Its origin is not fully known but it is believed to be from West Africa, although the plant is found native from India to Southeast Asia. The calyxes, stems and leaves are acid in flavour. The juice is produced from the calyces, and it is claimed to be a prohealth drink due to its high contents of ascorbic acid, anthocyanins and other antioxidants.
In various biological studies, for example those in population genetics, conservation biology, forensic science, gene mapping, breed, strain and population characterization and identification, marker assisted selection and the identification of cryptic species complexes, codominant genetic markers play important roles. The information that can be gained from them are far superior than those from dominant markers like random amplified polymorphic DNA (RAPD), amplified fragment length polymorphisms (AFLP), direct amplification of length polymorphisms (DALP) and randomly amplified microsatellites (RAM) or inter simple sequence repeats (ISSR).
MeSH terms: Chromosome Mapping; DNA; Genetic Markers; Genetics, Population; Polymorphism, Genetic; Microsatellite Repeats; Random Amplified Polymorphic DNA Technique; Forensic Sciences; Amplified Fragment Length Polymorphism Analysis
Smaller family size and advancing parental age have increased the demand for prenatal diagnosis.
Prenatal cytogenetic diagnoses currently used, such as amniocentesis and chorionic villus
sampling, are usually not preferred by the expectant couples due to the risk imposed on the mother and child. High false positive rates (5%) of current non-invasive screening methods, such as serum analysts or ultrasound, cause a large number of unnecessary invasive practices to be performed, which apart from the associated risk, place considerable psychological distress on the couples
involved (Wald et al., 1999). (Copied from article).
Myiasis occurs when living tissues of mammals are invaded by eggs or larvae of flies, mainly from the order of Diptera. Most of the previousty reported cases are in the tropics and they were usually associated with inadequate personal hygiene, sometimes with poor manual dexterity. This report describes two cases of oral myiasis in cerebral palsy patients in Seremban General Hospital, Malaysia. This article also discusses the therapeutic property of maggots and highlights the importance of oral health care in the special needs patients.
Cigarette smoke contains numerous oxygen free radicals that when inhaled, overwhelm antioxidant defenses and produce a condition of oxidative stress. This study investigated whether or not supplementation with vitamin E can affect the state of oxidative stress in healthy smokers. In this randomised double blind trial, 32 smokers received 200 mg of vitamin E or placebo daily for 8 weeks. All smokers in the vitamin E group completed the trial whilst only nine in the placebo group completed the trial. Plasma vitamin E concentrations increased significantly [P
The retinoblastoma gene was the first tumour suppressor gene identified that was altered not only in retinoblastomas but has been described in a wide variety of human neoplasms. The retinoblastoma gene encodes a nuclear phosphoprotein that in its hypophosphorylated state plays an important role in regulating the cell cycle, thus preventing from tumour formation. Expression of retinoblastoma gene protein product (pRB) was investigated in 118 formalin-fixed, paraffin-embedded cervical tissues by immunohistochemistry using commercially available antibody directed against RB protein. Ten normal ectocervical epithelium, 16 cervical intraepithelial neoplasia (CIN) I, 13 CIN II, 14 CIN III, 53 invasive squamous cell carcinoma, 11 adenocarcinoma and 1 small cell carcinoma were selected for this study. The proportions of pRB-positive cells as well as the extent of pRB expression in ectocervical squamous epithelium were assessed and compared among the lesions. The pRB expression was observed in 100% of normal ectocervical epithelium (n=10), 100% of CIN lesions (n=43) and 98.5% of invasive carcinoma of the uterine cervix (n=65) and were statistically significant when CIN or CIN/invasive were compared to normal cases (P < 0.01, P < 0.05 respectively). While in invasive squamous cell carcinoma (SCC), 81.8% (9/11) pRB-positive cells were found in much higher percentages in well differentiated SCC compared to 64.3% (18/28) of moderately differentiated cases and only 7.1% (1/14) of poorly differentiated SCC (P < 0.01, respectively). The results of this study suggest that loss of RB protein expression is rare in carcinoma of the uterine cervix and this protein may be important in the pathogenesis of cervical carcinoma.
Despite common occurrence, congenital talipes equinovarus (clubfoot) is still a subject of controversy. It poses a significant problem with its unpredictable outcome, especially when the presentation for treatment is late. The true etiology remains unknown although many theories have been put forward. A standard management scheme is difficult as there is no uniformity in the pathoanatomy, classification and radiographic evaluation. These differ according to the age of the child and the severity of the condition. The paper discusses these controversies with an emphasis on the proposed etiologies and types of treatment performed.
Pharmacokinetics of propranolol (PRN) given orally were studied in twelve cirrhotic Malay patients [10 males, 2 females], aged 33-62 years [49.83+9.17], body weight 39-72 kg [58.0+8.46] and height 142-168 cm [158.8+7.89] following single 20 mg and steady-state 20 mg tds for 7 days dosing of PRN. Blood samples were withdrawn hourly up to 48 hours. PRN concentrations in the plasma were assayed by HPLC with oxprenolol as the internal standard. Pharmacokinetic parameters were analysed using a non-linear regression program MultiForte. Area under the curve (AUC) as performed using the linear trapezoidal rule. Studentâ€™s t-test was used to test for statistical significance and AUC in Malay cirrhotic patients was found to be much bigger than that observed in Caucasians. Steady-state AUC was significantly increased following multiple dosing (961.31+7.47 vs 2954.19+1153.34 ng.hr/ml), however, the volume of distribution (Vd) declined (543.89+292.91 vs 224.14+1003.12 L) significantly compared to that of a single dose. The apparent systemic clearance (CL) was significantly reduced at steady-state (436.04+209.4 vs 129.51+48.42 ml/min) in comparison to single dose therapy. The peak plasma concentration (Cpmax) was greatly increased at steady-state (54.32+22.37 vs 136.10+38.63 ng/ml). Based on the AUC, PRN bioavailability was greater in cirrhotic Malay patients compared to Caucasians who took only 20 mg instead of 80 mg doses. The decline in drug clearance following steady-state was due to saturation of the metabolizing capacity of hepatic enzymes and a decreased portal blood flow. Reduced Vd was believed to be caused by increased drug-receptor interactions and decreased tissue/protein binding of PRN in these patients.
MeSH terms: Biological Availability; Body Weight; Chromatography, High Pressure Liquid; Female; Humans; Liver Cirrhosis; Male; Metabolic Clearance Rate; Oxprenolol; Plasma; Propranolol; Protein Binding; Research; Linear Models; Area Under Curve
Sixty primary school children, were measured for for accommodation and, vergence facility, accommodation accuracy, relative accommodation, fusional vergence / reserve and heterophoria. Analysis of Variance revealed that no â€“ single factor was significant by involved among the six age groups for all the above (p>0.05). However, a significant age difference (p
Biliary cystadenoma is a rare neoplasm of the biliary ductal system. Surgical management yields an excellent result. We present a case of recurrent biliary cystadenoma in the left lobe of the liver. The cyst was successfully treated with hepatic segmentectomy. The lobulated smoothly marginated septated cystic lesion noted on computed tomography (CT) were highlighted and the other imaging studies, differential diagnosis and management were reviewed.
Objective: to asses if children with Downâ€™s Syndrome have a higher prevalence of otological abnormality compared to their normal counterparts in Malaysia.
Methodology: Thirty children with Downâ€™s Syndrome and normal children underwent otoscopic ear examination and Impedance test in the ENT outpatients clinic in University Hospital, Kuala Lumpur, Malaysia.
Results: The study showed that children with Downâ€™s Syndrome had higher otological disorders. Forty four percent had impacted wax compared to 14.4% in normal children. Twenty one percent of ears in the study group had retracted drums compared to 6.6% of control. Fifteen percent of ears in the study group had middle ear effusion compared to 3.4% in controls, 55% had a type B tympanogram compared to 8.3% in controls and 73.4% had auditory canal stenosis compared to 14.4% in controls.
Conclusion: Children with Downâ€™s Syndrome, thus have a higher incidence of otological disorders.
MeSH terms: Animals; Child; Constriction, Pathologic; Ear Diseases; Hearing Tests; Hospitals, University; Humans; Malaysia; Otitis Media with Effusion; Outpatients; Syndrome; Incidence; Prevalence; Electric Impedance; Equidae; Otoscopy
Postal surveys are becoming an increasingly popular method of conducting research in Malaysia. However, the response rates from these surveys have not been well studied. All postal survey published in the Medical Journal of Malaysia between 1991-2000 were therefore reviewed to provide an overview of the response rates that may be expected, and to assess if this is a valid method of conducting research here. The response rates of postal surveys ranged from 30 - 87.5%. Seven of 13 postal surveys (54%) had a response rate of less than 50% and only 2 of 13 (15.4%) had a response rate of more than 70%, raising doubts on the use of postal surveys as a research tool.
MeSH terms: Malaysia; Publications; Surveys and Questionnaires; Medical Writing