Objective: Immunisation is known to be an effective health intervention that protects children from infectious diseases. Of all children, infants are the most vulnerable if they experience a vaccine preventable disease. The aim of the study was to determine the immunisation status of hospitalised infants, to obtain the reasons of incomplete immunisation and to assess carers' knowledge on immunisation.
Methods: This was a cross-sectional study conducted in the Institute of Paediatrics at Hospital Kuala Lumpur over a 2-month period from June to August 2001. Data were collected through an interview using a structured questionnaire, with the carer of the infant. Questions pertaining to the immunisation status of the infant, reasons of incomplete immunisation and the carer's knowledge of immunisation were assessed.
Results: 115 infants were admitted during the study period; however, only 100 carers of the infants were available for an interview. The average age of the infants was 5.7 months. 22% of the infants had incomplete immunisation. 64% of them had missed more than one vaccine. The commonest missed vaccine was the 3'4 dose of diptheria-pertussistetanus (DP1) and polio vaccine. Reasons of incomplete immunisation include misconception on contraindication of immunisation perceived by both parents and health providers, missed appointment and communication breakdown with health facilities regarding appointment dates. The under-immunisation rate in the study population was 22%. The underimmunisation rate in the study population was 22%.
Conclusion: Health providers and the public need to be educated on the importance of immunisation and the associated valid contraindications.
Keywords: Infants, carer, under-immunisation, incomplete immunisation
Introduction: This research was conducted to investigate the effects of Catharanthus roseus (Kemunting Cina), Kalanchoe laciniata (Setawar Kampung) and Piper longum (Kadok Kampung) on the in vitro proliferation of hormone dependent breast cancer (MCF-7) and colon cancer (Caco2) cell lines. Methodology:The effects of Catharanthus roseus, Kalanchoe laciniata and Piper longum extracts (hexane, chloroform, ethyl acetate and methanol extracts) on the cytotoxicity of MCF-7 and Caco2 cell lines were measured using (3-4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazoliumbromide) (MTT) assay. Results: Kalanchoe laciniata hexane extract showed significant inhibitions on MCF-7 carcinoma cell lines proliferation with IC50 value of 75.7 µg/ml. Catharanthus roseus extracts (hexane, chloroform and ethyl acetate) inhibited MCF-7 cells proliferation at concentrations of 80, 70 and 90 mg/ml, respectively. Discussion: IC50 value of all extracts of Piper longum and Kalanchoe laciniata chloroform, ethyl acetate and methanol extracts on the proliferation of MCF-7 cancer cells could not be determined, as it did not demonstrate any appreciable inhibition on the cellular proliferation at the concentration tested. However, Piper longum chloroform and ethyl acetate extracts showed anti-tumourigenic effect against colon cancer (Caco2) with IC50 of 87 mg/ml and 20 mg/ml, respectively. Kalanchoe laciniata hexane extracts inhibited Caco2 cellular proliferation with IC50 value of 100 mg/ml. Catharanthus roseus chloroform and ethyl acetate extracts inhibited Caco2 proliferation at IC50 of 28.2 µg/ml and 74.1 mg/ml, respectively. Conclusion: From this study, it can be concluded that only hexane extract of Kalanchoe laciniata was effective against cellular proliferations of MCF-7 while Piper longum was more effective in inhibiting Caco2 proliferations. However, both the herbs were not so effective against MCF-7 and Caco2 cell lines compared with Catharanthus roseus. Keywords: Catharanthus roseus, Kalanchoe laciniata, Piper longum, cytotoxicity
Introduction: A study on biological monitoring of lead on children was conducted when unleaded gasoline was widely used in 1998. The objectives were to monitor lead exposure using blood lead, urine d-aminolevulinic acid (d-ALA) and urine lead concentrations as biological indicators and to determine the relationship between these variables.
Methodology: Two hundred and sixty-nine school children, 169 from an urban school of Kuala Lumpur and 100 from an industrial school in southern Malaysia were selected for the study. These were Malay children in the age range of 61/2 to 81/2 years old. Blood and urine lead concentrations were analyzed using the Graphite Furnace Atomic Absorption Spectrophotometer. Urine d-ALA was measured with Spectrophotometer UV/VIS.
Results: The mean blood lead concentrations of the urban children (3.56 mg/dl) and the industrial children (3.75 mg/dl) were not significantly different (p=0.451). The urine d-ALA (urban=9.606; industrial=6.965 mg/g creatinine) and urine lead (urban=2.625; industrial=4.548 mg/g creatinine) of the urban children were significantly higher than the industrial children (p=0.014: p 10 mg/dl. About 78% of the urban children and 76% of the industrial children have urine d-ALA in a normal range (<0.6 mg/100ml) while 22% of the urban children and 24% of the industrial children were in the acceptable range (0.6 - 2.0 mg/100ml). All the children had normal urine lead concentrations (<8 mg/100ml).
Conclusion: These children were not highly exposed to lead as indicated by their blood lead, urine d-ALA and urine lead concentrations which were below the allowable standard in both study areas . This may be due to the total ban on leaded gasoline in the country since 1998 and as a result, the environmental lead exposure in these areas was quite low.
Keywords: Children's lead exposure, blood lead, urine lead, urine d-ALA
MeSH terms: Child; Humans; Lead; Malaysia; Schools; Students
Despite increasing interest in in nutraceuticals and their potential health benefits, not much is known about bioavailability of most of these nutraceutical compounds. Although they are considered dietary supplements and are subjected to a limited form of regulation, there is, however, a need to improve the efficacy and safety of these nutraceuticals. Additional research which defines the pharmacology, stability and bioavailability of these products is expected to gain strength and may offer a better understanding of their applicability in the prevention of disease conditions. This article reviews some aspects of nutraceutical bioavailability with examples from our work on the absorption studies of minerals from spirulina (Arthrospira plantensis) and gamma-oryzanol from rice bran (Oryza sativa) extract which employed human colon carcinoma (Caco-2) cell line and in vivo bioassays using animal models. Bioavailability of iron from spirulina was compared with its common source FeS04. Using the in vitro digestion protocol in combination with Caco-2 cell culture system, spirulina showed a high iron bioavailability compared to FeS04. The presence of other dietary factors (calcium, ascorbic acid, zinc, tannin and caffeine) was found to be not as significant as ferrous sulphate in affecting the iron uptake from spirulina. In vivo study showed that the efficacy of iron repletion in anaemic rats was enhanced in groups fed either commercial or cultured spirulina with improved haematological parameters of iron status. Further work on the behaviour and distribution of radiolabelled iron from spirulina has shown that iron-59 retained in the GIT of mice was lower in spirulina group compared to FeS04. Bioavailability study of gamme oryzanol was similarly conducted using Caco-2 cell as in vitro system and rabbit as in vivo model with the application of different formulations of gamma oryzanol in comparison with the natural form. Both systems showed that gamma oryzanol in its natural oil was poorly absorbed. However, when converted to other formulations, gamma oryzanol bioavailability was greatly increased by as much as 200 and 33 times more from the emulsion and microspheres respectively. These findings suggest that the efficacy of nutraceuticals in particular plant derived products which contain many phytochemicals should be assessed in terms of not only their potential health benefits such as antioxidant action but also their bioavailability in order to provide a more wholesome picture of their potential.
Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects. Keywords: Hyperthyroidism, pregnancy
Introduction. The aim of this study is to determine pregnant women's knowledge regarding AIDS and to identify factors affecting their knowledge This information would provide some baseline data in designing health education measures for this target group.
Methods. A face-to-face interview was carried out on one-hundred pregnant women attending an urban antenatal clinic in Malaysia between October and November 1999.
Results. The mean age of the women was 27.8 years old (SD = 5.0, range 20 - 40 years). In general, these women had good knowledge of HIV and AIDS. More than 80% of them were aware of the main modes of HIV transmission. However, only half knew that HIV could be transmitted through breastfeeding. Sixty percent of women had the misconception that the virus could be acquired through blood donation. There was a lack of knowledge regarding the symptoms and the progression of AIDS. More than 90% of the women knew that AIDS is incurable. Three quarters of them were aware that early treatment can slow down the progression of the disease, but only 16% knew that maternal HIV transmission can be reduced by treatment. Good knowledge was positively correlated with higher level of education (p<0.05).
Discussion. Although health education programs in Malaysia have succeeded in educating pregnant women regarding AIDS in general, certain important information is still not being disseminated. Future health education should formulate targeted strategies to overcome this problem.
MeSH terms: Adult; Ambulatory Care Facilities; Breast Feeding; China/ethnology; Cross-Sectional Studies; Female; Humans; India/ethnology; Malaysia/ethnology; Maternal-Child Health Centers; Outpatients; Pregnancy; Prenatal Care; Primary Health Care; Women; HIV Infections; Knowledge
A study was conducted at the Outpatient Department (OPD) of Ipoh Hospital, an urban public primary healthcare facility, over a weekend, to determine the profile of patients attending the clinic, the reasons for encounter and the reasons for choosing after hours medical care. The data from this study would be useful in determining the need for and formulating a policy for after hours medical care at urban primary health care facilities in the country. The study showed there was a low proportion of acute illness in the weekend clinic. A total of 17% of the patients had an acute illness and a further 8% had aggravation of an existing illness. This group of patients requires access to weekend medical services. The main reason for choosing after hours care was social, that is the convenience of an off-day from work or school. Several options can be explored to provide after hours care, including volunteer government doctors or private general practitioners running the service. Another option is to direct public patients during the weekends to private general practitioners in their locality who will be subsidized. The cost of providing after hours care is expected to be higher. Misuse of services may have to be considered as the study showed 5 % of the patients were not ill during the encounter.
Study site: Outpatient Department (OPD) of Hospital Ipoh
MeSH terms: Ambulatory Care Facilities; Cross-Sectional Studies; Hospitals, General; Humans; Malaysia; Outpatient Clinics, Hospital; Outpatients; Primary Health Care
Significant changes have occurred in relation to how chronic asthma is being treated. Emphasis has now shifted from viewing asthma as a condition of smooth muscle dysfunction to one of chronic inflammation. As such, anti-inflammatory therapy forming the cornerstone of treatment represents the first important milestone in the evolution of asthma treatment. For this purpose, inhaled corticosteroid (ICS) is by far the most effective anti-inflammatory therapy. Another important milestone is the recognition of the superiority of adding long-acting beta2-agonist (LABA) to ICS over escalating ICS dose alone or other forms of add-on therapies in treating asthmatic patients not responding to regular ICS alone. The effectiveness of adding LABA to ICS in treating asthma logically led to combining the two drugs into one single inhaler (salmeterol/fluticasone and budesonide/formoterol) that has the attractiveness of being user-friendly and ensuring that ICS is not missed out. The unique property of formoterol that allows for repetitive flexible dosing paved way to the concept of using Symbicort for both regular maintenance dosing and as required rescue medication. This revolutionary approach has been recently shown to provide improved asthma outcome, achieved at an overall lower or at least comparable corticosteroid intake, and may represent another evolutionary step in the treatment strategy of chronic asthma. Keywords: Asthma treatment, airway inflammation, corticosteroid, long-acting beta2-agonist