A survey was conducted on three different groups of population viz. inpatients in the medical wards of General Hospital, Kuala Lumpur, the people of Kampong Pandan and two rubber estates as to their analgesic consuming habits. It is found that 0.5 to 2.0% of the people surveyed had consumed more than 2 kg of analgesics and 4.6 to 9.6% of the people surveyed had consumed more than 250g of analgesics. The commonest analgesic consumed is paracetamol followed by Chap Kaki Tiga and Chap Harimau. The commonest reason for consuming analgesic is headache. The implications of the above findings are discussed.
A prospective study was performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur. Over a period of 14 months from 1 January 1982, 12 new cases of analgesic nephropathy (AN) were documented. Contrary to the experience in the West and in Australia, AN in Malaysia tends to have a male preponderance and occurs even in the younger age groups. The common analgesics abused are paracetamol, Chap Kaki Tiga and Chap Harimau. The main reasons for analgesic abuse are headache and arthritis. In addition to radiological features of renal papillary necrosis patients have the other manifestations of the disease such as peptic ulceration, anaemia, neuro-psychiatric disorders and ischaemic heart disease.
Buddleja species play a minor role in the ethnopharmacology of several areas of the world where they are indigenous. Phytochemical investigation of the genus has been somewhat neglected but a picture is emerging of the type of constituents which are present in reasonable quantities, namely iridoid and flavonoid glycosides. Many of the uses of Buddleja in folk medicine such as a topical antiseptic and a diuretic can be partially explained at least by the known biological activity of compounds identical or similar to those found in the genus. Other reputed uses are, as yet, without explantation due to the incomplete state of knowledge of the chemistry and, to an even greater extent, the pharmacology of Buddleja.
The relief of pain is of crucial importance in the management of patients undergoing a total three-stage oesophagectomy. Respiratory problems as a result of inadequate or overzealous analgesic regimes can ruin all pre-operative and per-operative efforts. 90 patients who underwent a total oesophagectomy over a 15-year period (1967-1982) at University Hospital Kuala Lumpur, were reviewed (36 for benign stricture and 54 for carcinoma of the oesophagus). Four post-operative analgesic regimes were used: immediate extubation and parenteral analgesics; 24-48 hour IPPV and timed dose/continuous infusion of parenteral narcotics; 24-48 hour IPPV plus extradural catheter analgesia; intra-operative direct intercostal nerve blocks, extubation and parenteral analgesics. Morbidities and mortalities are analysed.
594 intravenous urograms done at the General Hospital, Ipoh, from January 1981 to March 1985 were reviewed for renal papillary necrosis (RPN). 11 cases (1.8%) of RPN were detected. Of these three were due to diabetes mellitus;eight were due to analgesic nephropathy. There was an equal incidence
in males and females, contrary to the experience in the West and Australia. RPN was observed mainly in the older age groups. Five of the 11 cases of RPN presented as renal colic.
We questioned 180 patients with end-stage renal disease on maintenance haemodialysis, chronic ambulatory peritoneal dialysis and those who had undergone renal transplantation at the Department of Nephrology, General Hospital, Kuala Lumpur. Twelve patients (6.7%) had consumed excessive quantities ofanalgesics prior to the institution of long-term dialysis or transplantation. Primary renal disease was considered to be analgesic nephropathy in seven patients (3.9%); in five patients (2.8%), analgesic abuse could have been a contributory factor to end-stage renal failure. Analgesic nephropathy is hence an uncommon cause of end-stage renal disease in Malaysia. However, it is important to be aware of the problem and to institute preventive measures as the cost of treatment for end-stage renal disease is prohibitive.
In a prospective study performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur, over a period of 14 months from January 1982, we documented 12 new cases of analgesic nephropathy (AN). Since then up to July 1986, we have documented a further 16 cases of AN giving a total of 28 cases over a four-and-a-half-year period.
The pattern of analgesic use, abuse and incidence of analgesic-associated nephropathy in 79 patients with chronic headache was studied. Sixty-eight of these patients had migraine. Most patients had consumed a combination of analgesics (81%) while 19% had taken single analgesics for their headache. Nonsteroidal anti-inflammatory drugs were the most commonly used analgesics (96.2%) followed by paracetamol (70.9%) and aspirin, phenacetin and caffeine compounds (5.1%). Mefenamic acid was the commonest nonsteroidal anti-inflammatory drug consumed (97.4%). Analgesic abuse which was defined as a minimum total of 1 kg of analgesics such as paracetamol or aspirin, phenacetin and caffeine compounds or 400 capsules/tablets of nonsteroidal anti-inflammatory drugs was noted in 65 patients. Nonsteroidal anti-inflammatory drugs were the most commonly abused analgesics (89.2%) followed by paracetamol (38.5%). Forty-five of the 65 analgesic abusers had an intravenous urogram or ultrasound performed and renal papillary necrosis was documented in one patient. Three (4.6%) of the analgesic abusers had mildly raised serum creatinine levels. Mild proteinuria of less than 1 gm/litre was present in 27.7% of abusers. In conclusion, although analgesic use and abuse is common in patients with chronic headache, the short term incidence of analgesic-associated nephropathy (2.2%) and renal impairment (4.6%) was low. Prolonged observations will be necessary to ascertain the safety of these drugs for long term use.
One hundred and eighty-three patients undergoing surgery were interviewed twenty-four hours following surgery to assess the quality of pain relief they received in the immediate postoperative period. Interviews were conducted using a standard questionnaire for all patients. They were asked to (1) rate the quality of pain relief they obtained on a Visual Pain Analogue Scale (VPAS-0 being no pain and 10 being the worst imaginable pain); (2) state whether they were happy and satisfied with the pain relief they received; (3) if dissatisfied, they were asked to give their reasons. 37.7% (69 patients) had moderate to severe pain--pain score greater than 6 on the VPAS. Most of these patients had undergone abdominal or major orthopaedic surgery. 32.7% (60 patients) were unhappy with their postoperative pain control. The main reasons for complaint from the patients were that analgesic injections were either not given promptly or were not given at all. The survey also highlighted the inadequate under-administration of narcotic injections in the postoperative period despite orders being written up. It showed there is an urgent need for setting up an Acute Pain Service for better postoperative pain control. An anaesthesiology based Acute Pain Service was started in October 1992.
Computed tomography (CT) and ultrasonography (US) were performed in 40 patients who had consumed excessive quantities of analgesics (> 1 kg) to compare their value in the diagnosis of analgesic nephropathy (AN). The computed tomography and sonographic features were renal papillary calcifications. Renal papillary necrosis (RPN) was documented in 20 of 40 patients by US and in 14 of 40 patients by CT. In 11 patients, both US and CT were positive. In 9 patients, US was positive whilst CT was negative. In 3 patients, CT was positive whilst US was negative. Prevalence of RPN was 50% using US and 35% using CT. Using US as a gold standard, sensitivity of CT was 55%, specificity 85%, positive predictive value 78.6% and negative predictive value 34.6%. Percent agreement with CT and US was 70%. Cohen's kappa statistic adjusting for chance agreement was 40%. Based on these results, it is found that US yielded a higher percentage of positive cases of RPN.
A small survey in Peninsular Malaysia indicates a marked tendency among the general population to treat minor ailments by self-medication with over-the-counter drugs and/or traditional medicines. The use of over-the-counter drugs appears to be favoured for skin conditions, general health care, aches and pains, and problems affecting the eyes, ears, mouth, gastrointestinal tract and respiratory tract. A doctor is usually consulted if self-medication fails.