Teleradiology is the most mature and rapidly evolving specialty in telemedicine. The use of teleradiology has grown tremendously during the past few years. This article describes the role of teleradiology in health care along with a brief history of its development in tandem with advances in telecommunications and computer technologies. Teleradiology standards, image acquisition, data compression, transmission and image interpretation are summarised. The impact of teleradiology in the practice of radiology, traces the evolution of the modality especially in the Malaysian perspective and its current and future role are discussed.
X-ray based radiological procedure statistics and trend in Malaysia for 1990-1994 is reported; this information allows comparisons to be made with the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Report. Additionally it is essential information for health care planners and providers. Malaysia is categorised as a health care level II country based on the UNSCEAR definition. In 1994, the number of physicians, radiologists, x-ray units and x-ray examinations per 1000 population was 0.45, 0.005, 0.065 and 183 respectively. 3.6 million x-ray examinations were performed in 1994, with chest radiography being the commonest study (63%). Information on x-ray examinations, number of hospitals and x-ray units is reported for the Ministry of Health, private practice and teaching hospitals. Examination frequency increased in computed tomography (161%), cardiac procedures (190%), and mammography (240%); while a decrease in barium studies (-23%), cholecystography (-36%), and intravenous urography (-51%) was noted. There is a potential and need to expand and upgrade radiological services.
This study aims to evaluate the bone mineral densities and hip axis lengths of women in the local population. 227 normal Singapore women of ages 20 to 70 years had evaluation of their bone mineral densities (BMDs) by means of dual X-ray absorptiometry (DXA). The trend of BMDs at the left femoral neck and the lumbar spine remains fairly constant with increasing age until the 45-49 years age-band, beyond which there is a consistent decline. The mean hip axis length is 10.3 cm with a standard deviation of 0.6 cm. In general, the bone mineral densities in the femoral neck and lumbar spine as measured by DXA and the hip axis length of the local population is lower than corresponding figures reported in the Western population.
We describe a case of adult chickenpox which was complicated by severe varicella pneumonia, mild hepatitis and thrombocytopenia. The hepatitis and the thrombocytopenia were asymptomatic clinically and were diagnosed on biochemistry and blood count results. These eventually improved without specific interventions. The pneumonia, however, deteriorated rapidly despite the early commencement of oxygen supplementation, acyclovir and antibiotic. Subsequently, systemic corticosteroid therapy was initiated and the patient was ventilated in the intensive care unit. The patient eventually recovered.
A 17 year old Malay student who is a known case of synovial sarcoma of left elbow (treated with an above elbow amputation) presented with duodenal obstruction. We report an unusual case of gastrointestinal tract metastases from synovial sarcoma. To our knowledge, there is no previous such report in the literature. The computed tomography (CT) and magnetic resonance imaging (MRI) features are described.
We analyzed the characteristics of patients presenting with acute pancreatitis to our unit. A total of 71 patients were admitted to the Surgical Department at University Kebangsaan Malaysia (UKM) over a period of seven years, between January 1990 to December 1996 with acute pancreatitis. There was a fourfold increase in incidence of acute pancreatitis in our hospital from January 1990 to December 1996. The commonest identifiable aetiology was gallstones followed by alcohol. There were two deaths. We conclude that acute pancreatitis is increasingly being diagnosed in our local population. This may be due to either greater awareness or changes in lifestyle of the population.
Most patients presenting with acute right sided peritonitic pain are diagnosed and managed as acute appendicitis. In a series of 336 patients, eight were found to have caecal diverticulitis. The occurrence of such diverticula appears to be more frequent in Asian populations. The diagnosis can be established at operation on the basis of surgical findings. The aim of this retrospective review is to discuss the management of such patients when acute diverticulitis is found at the time of appendicectomy. It is advocated that management be conservative where possible, with appendicectomy and antibiotics. Where the possibility of a carcinoma remains, investigation after surgery by colonoscopy may be undertaken.
A study was conducted in the Dermatology cum Genitourinary Clinic, Hospital Sultanah Aminah Johor Bahru to determine a local population's knowledge of HIV and their sexual behaviour in relation to it. A total of 231 men and 217 women were interviewed. The sexual culture seen is one of relatively late age of first sexual intercourse, low level of partner change and low level of condom use. Men reported a higher involvement in risk behaviour. Nearly all the respondents (95.8%) have heard of HIV/AIDS but had incorrect perceptions of its mode of transmission and its associations with risk groups. This study enable us to gain background information about our patients sexual behaviour and HIV knowledge. There is a need to continue HIV education to improve our public's HIV knowledge and the results of this study provides a baseline against which future educational interventions can be gauged.
Between 1987 to 1995, a total of 334 patients infected with HIV were treated at the Hospital Kuala Lumpur. There were 159 Malays, 108 Chinese, 64 Indians, and 3 from other ethnic groups. Three hundred and twenty-one (96.1%) of these individuals were males and 262 (65.9%) were between the ages of 26-45 years. Intravenous drug users made up 77% (256) of the attributable risk behaviour from the group although many of them also had added risk behaviours like heterosexual activity with multiple partners (50 patients), tattoos (7 patients), homosexual practice (4 patients) and previous transfusions (3 patients). The others acquired their infection through heterosexual promiscuity (59 patients), homo/bisexual activity (7 patients), previous transfusion (5 patients) and tattoos (1 patient). Sixty-six patients (all males) had since progressed to full blown AIDS and 10 have died. The two commonest AIDS-defining events were tuberculosis infection and Pneumocystic carinii pneumonia occurring in 37 (56%) and 15 (22.7%) of patients respectively. Forty-one patients with AIDS presented for the first time with their AIDS-defining infections. The mean CD4 count of the patients when they progressed to AIDS was 130/mm3. The mean time for progression from "known" seropositivity to AIDS was 2.42 years. These results suggest that Malaysians infected with HIV are not coming forward for treatment until they are in the advanced stage of the disease.
A cross sectional study was carried out in Negeri Sembilan to identify factors associated with job satisfaction of doctors serving in Ministry of Health and their intentions to resign. All Ministry of Health doctors currently working in Negeri Sembilan were included in the study and data collection was done via a self-administered postal questionnaire. The response rate was 69.4%. Out of those who responded, only 31.3% had global job satisfaction, with the majority dissatisfied. Intention to resign was high among 32.7% of the respondents. Factors found to be significantly associated with job satisfaction were age, job designation, income, duration of service and intention to resign. Intention to resign was found to be significantly associated with ethnicity and income. From logistic regression, predictors of job satisfaction identified were age, place of first graduation, and satisfaction with status and autonomy, satisfaction with career development, satisfaction with workload and satisfaction with transfers. Predictors of intention to resign were race, income and global job satisfaction.
A retrospective review of 246 patients with established acute renal failure (ARF) needing dialysis from 1990-1994 is reported from Hospital Sultanah Aminah, Johor Bahru. Peritoneal dialysis was more commonly used than haemodialysis or haemofiltration. Patients on mechanical ventilation in Intensive Care Unit (ICU) who were hypercatabolic and fluid overloaded were treated with haemofiltration. Males outnumbered females by a ratio of 1.5:1. The majority were Malays (61.4%). Most patients were from the district of Johor Bahru, but 41.5% were from other districts in the Johor state. The mean age was 47.1 years (SD 18.2). The ARF was caused by acute tubular necrosis in 55.3%, post-renal obstruction in 22.8%, nephrotoxins in 5.7% and other causes in 16.2%. The proportions of patients referred from the medical, surgical and obstetric and gynaecology units were 50.8%, 45.5% and 3.7% respectively. The mortality rate was 48%. Patients with established ARF should be dialysed early as they tolerate uraemia poorly. Prevention is by prompt treatment of patients with sepsis, avoidance of hypovolaemia and nephrotoxic drugs.
Post meningitic sensori-neural hearing loss was studied in forty new cases of bacterial meningitis and ten cases of viral meningitis treated at the Pediatric Institute, Kuala Lumpur Hospital from April 1991 to March 1992. Hearing assessment at 2 weeks, 3 months and 6 months following the diagnosis of meningitis using Brain Stem Evoked Response Audiometry showed that hearing loss was prevalent only in patients with bacterial meningitis. Hearing loss was detected in 32.5% of these patients during the acute phase of the disease, 22.8% after 3 months and 24.2% after 6 months. In 63.6% of the affected cases, hearing loss was bilateral. In 61.5% of the patients who had hearing loss during the acute phase of the disease, it was permanent, 16.7% had either partial or complete recovery and, 15.4% had deterioration in hearing level. In 2 cases the subsequent hearing level was unknown. The risk of developing sensori neural hearing loss was found to be significantly higher in patients who developed other neurological sequelae. The study highlights the importance of performing repeated hearing assessment in children with bacterial meningitis and the difficulty in appropriate selection of hearing aids in the early stages.
The present study aims to compare the family's social environment, social supports and mental health of Malay women from rural and urban areas. Equal number (n-184) of Malay women from similar socio-economic back grounds were chosen from the rural areas of Kedah and urban areas of Pulau Pinang using the stratified random sampling method. The results indicated significantly higher level of mental health problems among the rural respondents when compared with the urban subjects. Among the family related variables included in the present study, cohesiveness, moral religious emphasis and organization and intellectual and cultural orientation were found to be significantly associated with the mental health problems of rural respondents. Whereas, only one variable, namely, active recreational orientation was found to be having an impact on the mental health of urban respondents. Similarly, deficiencies in the social support perceived from family and other members of the community were found to be significantly associated with the mental health problems of rural samples when compared to the social support perceived from the others for the urban subjects. The implications of these observations are discussed.
This study examined the prevalence of hepatitis B and C markers in 55 paediatric oncology patients who had completed treatment at the Hospital Universiti Sains Malaysia in Kota Baru. All these children had received blood products and had been treated between 1985-1996. Forty seven per cent of patients were positive for hepatitis B or C. Twenty nine per cent were positive for hepatitis C and twenty two per cent were HBsAg positive. Two children were positive for both and none were HIV positive. Four children had an elevated ALT level and one child had jaundice and hepatomegaly. Some children were marker-positive despite immunization and screening of blood.
We reviewed all documented cases of septicaemia following caesarean deliveries in Kandang Kerbau Hospital between 1st January 1993 to 31st December 1995. There were 22 cases of septicaemia among 8201 caesarean births, and hence the incidence is 2.7:1000. There were 45,412 deliveries, and the overall caesarean section rate was 18.1%. Among the 22 documented cases of septicaemia which came under this study, the most common clinical conditions found were endomyometritis (7 cases), urinary tract infection (6 cases), and wound infection (3 cases). One of the three cases with wound infection also had pneumonia. There was one patient who had mild transient myocarditis. We could not determine with certainty any site of infection in five patients. The most common bloodstream bacterial isolates was Staphylococcus aureus (16), while the uncommon ones were Acinetobacter baumanii (2), Escherichia coli (1), Klebsiella sp. (1), Staphylococcus epidermidis (1), Streptococcus Group F (1), Peptostreptococcus species and Veillonella species (1). There was no mortality and prompt, vigorous treatment had led to uneventful recovery in all the cases.
Adequacy of active resuscitation in collapsed inpatients aged 12 and above (excluding those with terminal illness) were studied in 6 Malaysian district hospitals for 3 months starting 1/1/93. Results showed 59.5% (25 out of 42 inpatients) were inadequately resuscitated measured by: failure of nurses to initiate resuscitation (24%), duration of resuscitation less than 30 minutes (42%) and incompletely equipped emergency trolleys (44%). Questionnaires revealed lack of knowledge and training in cardiopulmonary resuscitation in medical staff. Regular cardiopulmonary resuscitation courses, regular spot checks on emergency trolleys and management protocols on active resuscitation are recommended. Each hospital should design its own criteria for adequacy.
A comparative study was carried out to assess Year I and Year III student nurses' attitudes and knowledge of the elderly. Significantly more Year I students disagreed that the elderly had a capacity to learn (chi 2 = 11.08, p = 0.0006). Year III students were significantly more likely to obtain information about the elderly from the mass media, agencies, and relatives but not from health personnel. Nearly all respondents (96.25%) in the study wanted to know more about the elderly. Only 3 of the 14 questions on ageing revealed significant differences in knowledge between the two groups. The basic course in gerontology should be expanded and revised to dispel erroneous attitudes, allow better understanding of the ageing process, and ensure entry-level competence in caring for older people.
Several countries of Asia, including Malaysia, have in recent years experienced spectacular economic growth and social change. This, together with declining fertility
rates and mortality rates, and accompanying increased
expectation of life at birth have resulted in rapid population ageing of these countries. However, relative
to the developed countries, where fertility and mortality declines, and improvements in social and economic conditions have evolved gradually over a period of a century, these phenomena in the developing countries of Southeast Asia are evolving in a much shorter time period aided by the availability of medical and technological advances and interventions that can prevent deaths and births and prolong the duration of disability free years of life. This poses a challenge to countries like Malaysia who have to cope with the ageing phenomenon with limited resources that are available. The elderly are a heterogeneous group who are affected by both health and non health factors. The latter are largely social factors related to health that contribute to social problems faced by the elderly. This paper addresses these before looking at the care of the elderly.
Cholestatic disorders of infancy (viz neonatal hepatitis and biliary atresia) have not been well studied in Malaysia. In a retrospective study in the Department of Paediatrics, University Hospital, Kuala Lumpur from January 1982 through December 1991, a total of ninety-three infants with such conditions were identified: 35 (38%) had biliary atresia, 58 (62%) neonatal hepatitis. There was a statistically significant male preponderance in the neonatal hepatitis group (P = 0.020). There was no significant difference in the racial distribution and in the proportions of low birthweight infants between the two groups of disorders. When the biliary atresia group was compared with the neonatal hepatitis group, significant differences were observed in the age of presentation (mean +/- SD) 9.8 +/- 6.8 VS 20 +/- 17.3 weeks (P < 0.001), proportion of infants with prolonged jaundice (> seven weeks) 28/35 (80%) VS 20/58 (34.5%) (P < 0.00001), occurrence of alcoholic stools 26/35 (74.3%) VS 27/58 (46.6%) (P = 0.020), liver size (mean +/- SD): 4.3 (1.6 cm VS 3.3 +/- 1.8 cm (P < 0.01) and splenic size: 2.5 (1.8 cm VS 1.4 (1.2 cm (P < 0.001). There was however considerable overlap between the two groups in these features at presentation, making clinical differentiation between the two conditions difficult. Infants with cholestasis tended to present late, compromising the chance of survival. In order to improve the medical care of these patients, these conditions must be emphasised during the training of medical practitioners, and efforts to increase public awareness of these conditions must be created.