One hundred consecutive patients attending the UKM (Universiti Kebangsaan Malaysia) Cardiology Clinic completed a questionnaire enquiring about their own assessment of their knowledge about their illness, their awareness of cardiac risk factors and their expectations in their management. Only 11% of our patients had graduated from tertiary education. 59% of our patients were being treated for ischaemic heart disease. Although only 28% of our patients considered having considerable knowledge of their illness, a majority of our patients were aware of cardiac risk factors. This was independent of the formal education achieved. However this awareness did not necessarily result in appropriate behaviour; 32% of patients admitted to smoking despite being aware of the harmful effects of smoking. 74% of our patients expected a cure from their doctors; only 37% of our patients thought they required medication indefinitely. Thus, patients could be made aware of their illness regardless of their formal educational status. However this may not necessarily result in appropriate behaviour. The high expectations which the patients have of their doctors is unrealistic and may be detrimental to appropriate long-term management of their chronic illness.
Study site: Cardiology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Three sisters with cassava poisoning are described. A review of the toxic properties of cassava is presented together with discussion on the methods of its preparation, its adverse effects on man, its detoxification in the body, and the treatment of its poisoning.
A case of intestinal obstruction due to ileal atresia where the diagnosis was made prenatally by ultrasound is presented. Close monitoring of the fetus was done ultrasonographically to look for any evidence of meconium peritonitis. The baby was delivered preterm but weighed 3.3 kg. Laparotomy and enterostomy was done and the baby is currently well.
A six year old Chinese boy with relapsed Acute Promyelocytic Leukaemia (APML) failed to respond to reinduction with Daunorubicin and Cytarabine infusion. He was successfully treated with all trans-Retinoic Acid (45 mg/m2/day) orally. After four weeks of treatment, he was in complete remission. The side effects of all trans-Retinoic Acid were negligible.
From 1988 to 1990, eighty operations on eighty knees of seventy-nine patients with a clinical diagnosis of meniscal tear was entered into a prospective study. The clinical diagnosis was correct in 76% of patients. Excellent or good results were achieved in 90% of knees which had only meniscal lesions but dropped to 70.5% when other intraarticular pathologies coexisted with the meniscal lesions. Excellent or good results were achieved in 71% of the knees in the presence of Anterior Cruciate Ligament (ACL) deficiency.
The results of sixty-four perforating eye injuries with intraocular foreign bodies (IOFB) treated at University Hospital over ten years were reported. Compared to an earlier report we found that the population at risk was the same and consisted of patients under 35 years (70%), males (95.3%) and work related (86%). The commonest causes of IOFB were hand hammer (64.1%) and grass cutting (20.3%). We also noted that while the incidence of cases had increased by 23%, the final visual outcome has improved significantly due to advances in preoperative diagnosis and surgical techniques. Preoperative factors found to have a statistically significant effect on the final visual outcome were the size of the IOFB, poor initial visual acuity, and the presence of the following complications: cataract, iris damage and vitreous haemorrhage. The outcome was also worse in posterior segment IOFBs but this was not statistically significant.
In a study of mild to significant malnutrition in an urban squatter settlement, the weights for age of 297 children between birth and ten years, and the heights for age and weights for height of 197 children between two to ten years were analysed. Using NCHS standards, the overall prevalence of underweight was found to be 18.9%, stunting 15.2%, and wasting 11.2%. Age and ethnicity were significantly associated with the prevalence of underweight and stunting. The growth achievement of children below the age of two years were significantly better off than the older children, and Chinese children significantly better off than Malay and Indian children.
A significant number of hand infections were found to occur in college students, a group not associated with manual labour. Diabetics did not have a significant delay in recognising the symptoms but have a significant longer period of hospitalisation. The right hand was predominantly involved especially the thumb, index finger and the thenar region. Staphylococcus aureus was the commonest infecting organism.
Public health administrations are responsible for monitoring the availability and use of foods. The information required can be obtained cheaply and easily by asking schoolchildren about the foods they have consumed. When the mean weights of adults is low and the number of kinds of food in use is small, nutritional problems probably exist and must be investigated. The same indicators may also be useful in the identification of families affected by poverty.
Hepatocellular carcinoma (HCC) is one of the commonest cancers in Asian males. In Malaysia, it is one of the ten most common cancers amongst the male population. Most of our patients with HCC present to us rather late and almost all die within 4 months of diagnosis. HCC occurs more commonly in patients with cirrhosis associated with hepatitis B and C infections. Screening for HCC can lead to early detection of small tumours (< 5 cm) that are more amenable to surgical resection, resulting in improved survival rates. The average 5-year survival rate for those who have undergone surgical resection is 68% (range, 22-73%). Better results are obtained with the smaller tumours (< 2 cm in diameter). Patients with chronic hepatitis B and C infection especially those who are > 45 years of age, who have concomitant cirrhosis or have a family history of HCC should be examined every 3-6 months with periodic serum alpha-fetoprotein (AFP) measurements and abdominal ultrasound examinations. Abdominal ultrasound is useful in the detection of small tumours. While mass screening for HCC is not cost-effective in countries of low incidence of HCC, screening of high risk groups may be justified in countries with a high endemicity of HBV infection. Screening for HCC in Japan, Taiwan and China appears to yield better results than those in the West. Nonetheless, primary prevention with mass hepatitis B vaccination and blood donor screening for anti-HCV is expected to make a much greater impact in the control of HCC in the years to come.
A cross-sectional study was carried out to determine the prevalence of hypertension in the Chinese elderly and to examine its relationship with various behavioural and nutritional risk factors. This study involved 243 Chinese aged 55 years and older in 2 randomly selected Chinese Villages in Seberang Prai Tengah, Penang. The study included an interview, anthropometric assessment and blood pressure measurement. The prevalence of hypertension was 48.1% and out of this, 65 (55.6%) were on anti-hypertensive treatment. There was a significant rise in the prevalence with age. Hypertension was found to be inversely related to per capita income and physical activity (p < 0.05). Hypertension was significantly more common in smokers than non-smokers. Alcohol intake in the elderly was low and not related to hypertension. Obesity was significantly associated with hypertension only among the elderly aged 55-64 years. The dietary intake of sodium, potassium and calcium did not differ significantly between the hypertensive and normotensive elderly.
Twenty-seven out of five hundred and fifty three patients hospitalized for visceral leishmaniasis (Kala-azar) died during treatment with sodium antimony gluconate. Data from these patients were evaluated to find out the cause of death. Eight patients had associated diseases such as pulmonary tuberculosis (3), severe malnutrition (1), acute gastroenteritis (1), spleenic infarction (1), acute renal failure (1) and atrial septal defect (1) which could be attributed to death. Twelve patients developed spontaneous haemorrhages from nose, gums and gastrointestinal tract and died, despite of adequate supportive measures. Seven other patients who were improving slowly with antimony therapy died unexpectedly. Though, cause of death could be explained in some patients with associated disease conditions, it could not be explained in others as significant clinical manifestations, haematological, biochemical and electrocardiographic alterations were not evident prior to death. Our impression is that mortality in Kala-azar patients during standard antimonial therapy is more related to the drug rather than the disease process.
Sixty three and fifty nine non-insulin dependent diabetes mellitus (NIDDM) patients in rural (land resettlement scheme) and urban areas respectively were studied to determine factors associated with diabetic control. The anthropometric and metabolic data (HbA1 and fructosamine levels) were analysed. After adjusting for gender, age, body mass index (BMI) and food intake, the fructosamine level which correlates with short term diabetic control, was significantly lower among patients in urban areas compared to patients in rural areas (p < 0.05). However, for longer term diabetic control (HbA1 level) the difference was not statistically significant (p > 0.05). The socio-economic status, level of education, BMI and types of food did not correlate with diabetic control in either group of patients. More diabetes education is needed together with socio-economic development and changes in lifestyles to enhance compliance towards health and dietary regimens and to achieve better metabolic control.
A cross-sectional study was carried out to determine the prevalence of diabetes mellitus and its relationship with age, physical activity, nutritional status and diet amongst rural Malays in Kuala Selangor. By simple random sampling 360 subjects were selected for the study. Besides guided questionnaires, subjects also underwent a 2 hours post prandial (2HPP) test to determine the diabetic status as recommended by WHO. The crude prevalence of diabetes mellitus was 14.6% which increases with age. The prevalence of diabetes adjusted for age was 12.2%. Physical activity status seemed to be a significant risk factor for diabetes. A greater proportion of diabetics was obese and their mean fat intake was higher than normal subjects (p < 0.05). The prevalence of diabetes mellitus in this study was significantly higher compared with data from 1984 (3.9%), representing a marked increment of 212.8 per cent over a 10-year period.
The aim of this study, is to determine whether the fine characteristics of the fetal heart sounds could be used to identify intrauterine growth retarded fetuses. A preliminary evaluation, was conducted to compare these characteristics between intrauterine growth retarded fetuses and normal fetuses in the antenatal period after 36 weeks of gestation. Altogether, 7 IUGR fetuses were compared with 12 normal fetuses. An instrument named the Fetal Frequency Phonocardiogram was designed for this purpose. When connected to a personal computer and with a software programme specially written, the fetal heart sound characteristics were analysed. After detailed analysis, there were 3 significant differences between IUGR and normal fetuses, all of which gave a p-value of < 0.01. The frequency of the first heart sound was significantly higher in the IUGR fetuses compared to normal fetuses. The ratio of the amplitude of the first heart sound over the second heart sound was higher in the IUGR group. Finally, the ratio of the time between the first and second heart sound over the cardiac cycle was shorter in the IUGR fetuses. Fetal heart sound analysis, may provide a simple non-invasive method of detecting and monitoring fetuses at risk in the antenatal period.
The anaesthetic hazards for the obstetric patient are well known. Based on results of the first two reports on the confidential enquiry into maternal deaths in Malaysia for 1991 and 1992, ten cases of anaesthetic related deaths were analysed. There were 3 in 1991 and 7 in 1992 accounting for 1.34% and 2.8% of maternal deaths respectively. It was estimated that the crude mortality rate for the obstetric patient was 11.4 per 100,000 operative deliveries or a four-fold risk compared to the general surgical patient. One case resulted from administration of intravenous sedation while the rest involved general anaesthesia, seven of which were done under emergency conditions. Inadequate airway management and ventilation in the perioperative period, including during interhospital transfer was the single most important factor causing the majority of these deaths. The use of regional anaesthesia for Caesarean sections is strongly advocated. Substandard care was also present in all cases. Other issues pertinent to improvement of obstetric anaesthetic services are also discussed which include the quality of anaesthetic manpower, upgrading of infrastructure, facilities and staffing of operating and recovery areas, the use of regional anaesthesia, expanding the role of the anaesthetist and the quality of the anaesthetic services in general.
Microbial diseases continue to occur in Malaysia despite the marked socio-economic development that has been taking place in the country along with improvements in the medical, health, and environmental sectors. This paper highlights the continuing presence of the numerous microbial diseases including the emergence of new problems such as AIDS. Local publications dealing with work on several microbial diseases is reviewed to show that this group of diseases will pose challenges for a long while. Undoubtedly several other diseases that were relatively unrecognised in the past are increasingly being identified owing to recent availability of diagnostic facilities and equipments. The need for continued vigilance is emphasised.
A patient with severe hyponatreamia secondary to chronic renal failure was treated with peritoneal dialysis (PD). On the third day of admission, she developed progressive obtundation. Neurological examination showed bilateral brisk reflexes with intact brain stem reflexes. Magnetic resonance imaging demonstrated patchy demyelination of the pontine area indicating central pontine myelinolysis (CPM). Despite supportive measures, the patient died on the fifteenth day of admission. The rate of correction of hyponatraemia with peritoneal dialysis can be rapid and detrimental to hyponatraemic chronic renal failure patients and careful monitoring of serum sodium level is advocated.
A 34-year-old laboratory worker developed murine typhus after an accidental splashing of Rickettsia typhi over her right eye and lips. Indirect immunoperoxidase test showed a four-fold increase in titre to Rickettsia typhi. She responded well to doxycycline.