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Fulltext A community child and adolescent guidance clinic in Malaysia

Krahl W, Quek SL, Raman N

Med J Malaysia, 1981 Sep;36(3):171-3.
PMID: 7329374

Study site: Child and Adolescent Guidance Clinic, Hospital Bahagia, Perak, Malaysia

Matched MeSH terms: Adolescent
Fulltext Anaplastic squamous cell carcinoma of the mouth - a report on 100 consecutive cases

Ramanathan K, Ng KH, Ramanathan J, Chelvanayagam PI

Med J Malaysia, 1981 Sep;36(3):174-6.
PMID: 7329375

Squamous cell carcinoma is the commonest malignant tumour of the mouth (91 percent) in people living in Peninsular Malaysia. Since the histological grading of oral carcinoma ·is one of the several important factors to be considered in the long term survival of patients a more detailed study of anaplastic carcinoma of the mouth in 100 patients is made in this study. As reported in an earlier study the Chinese seem to be more prone to develop anaplastic carcinoma of the mouth. In contrast although oral carcinoma occurs most commonly in the Indians, the development of anaplastic carcinoma seems to be the least in them. The Indians seem to have a better host immune response to oral carcinoma than the Chinese and the Malays occupy an intermediary position. The peak age incidence was between 51-70 years (50 percent). In descending order of frequency anaplastic carcinoma involved the gingiva (29 percent), buccal mucosa (22 percent), palate (20 percent), and tongue (16 percent). Further studies may help to formulate a more effective tailor-made regime of treatment for each individual oral carcinoma patient.

Matched MeSH terms: Adolescent
Fulltext Incidence of urinary stones in the various states of mainland Malaysia

Sreenevasan G

Med J Malaysia, 1981 Sep;36(3):142-7.
PMID: 7329370

A study into the incidence of urinary calculi over a 15-year period from 1962-1976 in the states of mainland Malaysia is presented. Figures from the Ministry of Health Returns are the only source for such information. The incidence from the various states over each five year period from 1962-1972 is tabulated and its significance especially, the pattern of incidence, and its relation to industrialisation is discussed. Malaysia is beginning to show the same pattern of incidence in the upper and lower urinary tract as that of other industrialised countries. A plea is made for the establishment of a central register at the Institute of Urology and Nephrology to carry out a national survey of urinary calculi so that a study into the epidemiology, and if possible, preventive aspects of urolithiasis can be undertaken.

Matched MeSH terms: Adolescent
Fulltext The 1978 cholera outbreak in Krian district

Yadav H

Med J Malaysia, 1981 Sep;36(3):129-35.
PMID: 7329369

The findings of a cholera epidemic in Krian district is reported. There were 77 cases and 92 carriers in the epidemic. Although the three main ethnic groups of Malays, Chinese and Indians were involved in the epidemic, the Malays constituted majority of the cases and carriers. The overall infection rate and case attack rate was higher among the younger population. The case: carrier ratio was also higher among the younger population especially among Indians. Various reasons and probable causes of the epidemic have been described briefly.

Matched MeSH terms: Adolescent
Incomplete bladder emptying due to labial fusion in a pubertal girl: a delayed consequence of female circumcision

Awang NA, Viegas C, Viegas OAC

Aust N Z J Obstet Gynaecol, 2004 Aug;44(4):372-3.
PMID: 15282020 DOI: 10.1111/j.1479-828X.2004.00261.x
Matched MeSH terms: Adolescent
Fulltext The prevalence of musculoskeletal problems and risk factors among women assembly workers in the semiconductor industry

Chandrasakaran A, Chee HL, Rampal KG, Tan GLE

Med J Malaysia, 2003 Dec;58(5):657-66.
PMID: 15190650

A cross-sectional study to determine work-related musculoskeletal problems and ergonomic risk factors was conducted among 529 women semiconductor workers. Overall, 83.4% had musculoskeletal symptoms in the last one year. Pain in the back (57.8%), lower leg (48.4%) and shoulder (44.8%) were the three most common musculoskeletal problems. Significant associations were found between prolonged standing and upper and lower leg pain, between prolonged sitting and neck and shoulder pain and between prolonged bending and shoulder arm, back and upper leg pain. The study therefore showed a clear association between work-related musculoskeletal pain and prolonged hours spent in particular postures and movements.

Matched MeSH terms: Adolescent
Fulltext What are the clinical factors that affect quality of life in adult asthmatics?

Hooi LN

Med J Malaysia, 2003 Oct;58(4):506-15.
PMID: 15190625

A study was conducted to determine the clinical factors that affect the quality of life in adult asthmatics. As part of their routine follow-up visit, 399 patients completed the SF-36 quality of life questionnaire, had peak expiratory flow rate readings (PEFR) taken and were interviewed to determine current symptom severity. The grade of severity of asthma was verified by the consultant physician in-charge. The mean age of the patients was 41.8 years and 31.8% of the patients were men. Most of the patients were Malay (64.7%), 89% had at least secondary level education and the mean duration of asthma was 17.6 years. The majority of patients had moderate or severe disease (43.6% and 55.9% respectively). For asthmatics with moderate or severe symptoms of chest tightness and/or shortness of breath, all domains of SF-36 scored significantly lower than those with mild symptoms, with the exception of the domain bodily pain. Patients with moderate/severe cough recorded significantly lower scores than those with mild cough for all domains except for bodily pain and social functioning. Only the physical functioning, role physical, general health and role emotional scores were significantly worse in those with a consultant grade of severe asthma compared to those with mild/moderate asthma. Patients with PEFR < 80% predicted had lower scores for the domains physical functioning, role physical and general health than those with PEFR > or = 80% predicted, but the scores for the other domains were similar in both groups. Quality of life is significantly impaired in adult asthmatics with current respiratory symptoms. However, consultant grade of severity of asthma and PEFR readings do not affect quality of life scores as much.
Study site: Asthma clinics, hospitals, Malaysia

Matched MeSH terms: Adolescent
Fulltext A study of admission criteria and early management of adult patients with acute asthma

Kanesalingam R, Lu YS, Ong JJ, Wong SS, Vijayasingham P, Thayaparan T, et al.

Med J Malaysia, 2003 Oct;58(4):587-93.
PMID: 15190635

We studied the admission criteria and first 24-hour management of 62 asthmatic patients admitted from Accident and Emergency (A&E) department of a state hospital. Data was collected prospectively over a 6-month period from the doctors' medical records with reference to recommendations of the Malaysian Thoracic Society (MTS) on management of acute asthma. Peak Expiratory Flow Rate (PEFR) records were present in only 14.5% of the A&E notes and 54.8% of the ward notes. Most of these readings were below 75% of predicted normal values. Over half of the patients had records on ability to speak full sentences, and respiratory and pulse rates. Based on other records on criteria for life-threatening features (including arterial blood gases), 42% of patients studied had life threatening asthma exacerbations. Most received appropriate treatment as recommended by the MTS. We conclude that while most patients were admitted and treated appropriately, medical documentation regarding acute asthma assessment were inadequate in some.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia

Matched MeSH terms: Adolescent
Fulltext Spectrum of malignant lymphoma in Queen Elizabeth Hospital, Sabah

Peh SC, Shaminie J, Jayasurya P, Hiew J

Med J Malaysia, 2003 Oct;58(4):546-55.
PMID: 15190631

Lymphomas, ranked twelve among all cancers world-wide in the 1990s, in which it is more prevalent in males compared to females. A previous study on lymphomas in East Malaysia for a period of 3 years from 1981-1983 showed that the pattern of lymphomas conformed to the general pattern observed in Asia. Current study reviews lymphoma cases from the Department of Pathology, Queen Elizabeth Hospital, Sabah between 1997 and 1999, with the aim of investigating if the spectrum and pattern in Sabah has since changed, a decade later. A total of 91 confirmed lymphoma cases were phenotyped with a panel of antibodies and classified using the new WHO proposed list of lymphoid neoplasms. The 1981-1983 series was reviewed and cases reclassified accordingly for comparison. There are 83 (91.2%) NHL and 8 (8.8%) HL cases in this series, a ratio of NHL to HL of 9:1. Of the 83 cases of NHL, 66 (79.5%) were confirmed B-cell type, 13 (15.7%) T-phenotype, 1(1.2%) null cell type and one case unclassified. Diffuse large B-cell lymphoma is the most prevalent, (65.1%), followed by Burkitt's lymphoma and follicular lymphoma, (10.6%) each. Lymphoma pattern concurs with the previous series from Sabah, with higher prevalence of diffuse large cell lymphoma and lower incidence of follicular lymphoma and HL, as seen elsewhere in Asia. There is an overall increase in the number of cases of NHL in the 1990s. However, the proportion of T-NHL is reduced when compared to the series in the 1980s.

Matched MeSH terms: Adolescent
Fulltext An audit of upper gastrointestinal bleeding at Seremban Hospital

Lim TM, Lu PY, Meheshinder S, Selvindoss P, Balasingh D, Ramesh J, et al.

Med J Malaysia, 2003 Oct;58(4):522-5.
PMID: 15190627

We retrospectively analyzed all patients presenting with upper gastrointestinal bleeding to Seremban Hospital over a one-year period. A quarter of the oesophagogastro-duodenoscopies (OGD) performed were performed as emergency for upper gastrointestinal tract bleeding. Gastric ulcers and duodenal ulcers were the two most common findings. Our results suggest that there is a male preponderance of 2:1, the Chinese were more likely to be affected and the elderly (> 60 years) were at highest risk.

Matched MeSH terms: Adolescent
Midstream urine culture and sensitivity test is a poor predictor of infected urine proximal to the obstructing ureteral stone or infected stones: a prospective clinical study

Mariappan P, Loong CW

J Urol, 2004 Jun;171(6 Pt 1):2142-5.
PMID: 15126773

PURPOSE: This prospective study was performed to determine if midstream urine (MSU) culture and sensitivity (C&S) alone could adequately predict infected urine proximal to the obstructing ureteral stone or the infected stones. Can pelvic urine C&S predict infected stones?
MATERIALS AND METHODS: A prospective clinical study was performed on all patients undergoing ureterorenoscopy and lithotripsy for ureteral stones with obstruction between December 1, 2000 and January 31, 2002. We obtained MSU, renal pelvic urine and fragmented stones for culture and sensitivity. An analysis of the data was performed to assess statistical association.
RESULTS: A total of 73 patients who fulfilled the criteria were recruited. Of these patients 25 (34.3%) had positive stone culture, 43 (58.9%) had positive pelvic urine and 21 (28.8%) patients had positive MSU C&S. Stone and pelvic C&S were positive simultaneously in 17 (23.3%) cases, MSU and stone C&S were positive in 8 (10.9%) cases, whereas pelvic and MSU C&S were positive in 13 (16.4%) cases (p = 0.03). MSU C&S had a sensitivity of 30.2% and specificity of 73% to detect pelvic urine C&S positivity. MSU C&S had a low positive predictive value and negative predictive value (NPV) in relation to infected pelvic urine (positive predictive value = 0.62, NPV = 0.42). Pelvic urine C&S had a NPV of 0.73 in detecting noninfected stones.
CONCLUSIONS: The results of this study suggest that in obstructive uropathy secondary to a stone MSU C&S is a poor predictor of infected urine proximal to the obstruction and infected stones.

Matched MeSH terms: Adolescent
Spectrum of dentofacial deformities: a retrospective survey

Ong MA

Ann Acad Med Singap, 2004 Mar;33(2):239-42.
PMID: 15098641

INTRODUCTION: This retrospective study investigates the spectrum of dentofacial deformities, demographic profile, management and surgical outcomes of orthognathic patients treated in the University Hospital in Malaysia.
MATERIALS AND METHODS: Over a period of 10 years (1989 to 1999), 34 patients with dentofacial deformities who had orthognathic surgery were reviewed; patients with cleft lip and palate or syndromes were excluded.
RESULTS: The mean age (range, 17 to 35 years) of the patients was 24.3 years and the ratio of female to male was 2.4:1. The predominant ethnic group was Chinese, with females (47.1%) forming the largest group. The main reason for seeking surgery was aesthetic improvement (41%). The majority of the patients had skeletal class III pattern (91%) and bilateral sagittal split osteotomy was the most common surgery done (82%). Postoperative complications were mainly paraesthesia/numbness (56%) and infection (15%). In long-term review, 2 (6%) patients had persistent numbness of the inferior alveolar nerve.
CONCLUSION: The findings suggest that the majority of the patients are young adult female students with skeletal class III pattern and treated for mandibular prognathism. The complication of persistent numbness and higher rate of postoperative infection indicate that longterm reviews and good antibiotic prophylaxis/therapy are necessary.

Matched MeSH terms: Adolescent
Clinical course and determination of brainstem death in a children's hospital

Goh AY, Mok Q

Acta Paediatr, 2004 Jan;93(1):47-52.
PMID: 14989439

AIM: To study the aetiology and clinical course of children with brainstem death in a paediatric intensive care unit (ICU) and to determine whether current the practices that are used to declare brainstem death conform to accepted criteria.
METHODS: A retrospective review chart of all patients with brainstem death (n = 31) admitted to the paediatric ICU between January 1995 and December 1998 was drawn up.
RESULTS: Mean age of the patients was 51.9 +/- 54.5 mo with the main diagnoses being head trauma in 11 children, anoxic encephalopathy in 7, brain tumour in 5, drowning in 4, CNS haemorrhage in 3 and CNS infection in 1 child; 32.3% of the children were given pre-ICU admission cardiopulmonary resuscitation. The average time from insult to suspected brainstem death was 27 h and suspected brainstem death to confirmation was 25 h, with an average of 1.6 examinations performed. EEG was done in 14 patients, with electrocerebral silence in 8 after the first examination and in a further 5 after repeat testing. Cerebral blood-flow scans were done in 3 children and evoked potentials in 1 child.
CONCLUSIONS: Trauma remains the most common primary diagnosis leading to brainstem death. Intensivists in this large hospital for children mainly conform to accepted guidelines for determination of brainstem death although there is a wider use of ancillary tests to aid diagnosis. The study also showed a low rate of < 10% of organ procurement for transplantation.

Study site: Paediatric ICU, Great Ormond Street Hospital, London, United Kingdom

Matched MeSH terms: Adolescent
Fulltext Prevalence of Staphylococcus aureus carriage by young Malaysian footballers during indoor training

William JL, Radu S, Aziz SA, Rahim RA, Cheah YK, Liwan A, et al.

Br J Sports Med, 2004 Feb;38(1):12-4.
PMID: 14751938

BACKGROUND: Research has shown that athletes are carriers of Staphylococcus aureus during physical activity.
OBJECTIVE: To estimate the mean total plate count of S aureus carried by footballers before and after training at an indoor venue.
METHODS: Forty Malay and 20 Indian students volunteered to participate. There was also a control group consisting of 40 Malay and 20 Indian students who were not active. The experimental group were active footballers who had played at school or club level. The subjects were healthy and free of skin infection. The experiment was divided into three sessions, with 20 subjects present at each. At each session, the subjects trained for one hour. Swabs were taken from the skin, nose, and ear before and after training. For the control group, swabs were taken only once from the skin, nose, and ear. The swabs were subjected to biochemical tests and then streaked and cultured aerobically in Baird Parker agar plates for 24 hours at 37 degrees C. Black colonies with a clear zone were presumed to be S aureus, and the mean total plate count of the colonies was estimated. Gram staining, catalase, coagulase slide, coagulase tube, acetoin production, o-nitrophenyl beta-D-galactopyranoside (ONPG), and mannitol fermentation tests were used to confirm the colonies as S aureus. A haemolysin test was conducted with human blood to confirm haemolytic activity.
RESULTS: All subjects in the experimental group were carrying S aureus both before and after training. The estimated mean total counts of colonies from the skin, ear, and nose for the Malays before training were 33, 71, and 312 respectively. Counts after training were 21, 44, and 452 respectively. The results for the Indians were 72, 80, and 309 respectively before training and 55, 200, and 466 respectively after training. The positive results for Gram staining, catalase, coagulase slide, coagulase tube, acetoin production, ONPG, and mannitol fermentation tests were 100%, 96%, 95%, 95%, 93%, 93%, and 90% respectively. All subjects in the control group were also carrying S aureus.
CONCLUSIONS: All of the players were carriers of S aureus during training. The decrease in total count from the skin for both races may be due to lysozyme activity lysing the bacterial cells. Contamination of the environment with these bacteria may have increased the estimated total plate count in the nose. The experimental group face a higher risk of infection because of lower immunity during training and higher rate of injuries compared with the control group.

Matched MeSH terms: Adolescent
Fulltext Morbidity and process of care in urban Malaysian general practice: the impact of payment system

Teng CL, Syed Aljunid SM, Cheah M, Leong KC, Kwa SK

Med J Malaysia, 2003 Aug;58(3):365-74.
PMID: 14750376

BACKGROUND: The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting.
OBJECTIVES: We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities.
METHODS: 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index.
RESULTS: During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections.
CONCLUSION: This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system results in important differences in patient mix and influences some types of practice activities.

Matched MeSH terms: Adolescent
Fulltext Perioperative death in Malaysia: the transition phase from a developing nation to a developed one

Kandasami P, Inbasegaran K, Lim WL

Med J Malaysia, 2003 Aug;58(3):413-9.
PMID: 14750382

This paper examines the surgical pathology associated with perioperative deaths in a country that is undergoing the transition from a developing to a developed nation status. The data from an ongoing nation-wide perioperative mortality study was prospectively collected for the period July 1996 to December 1997 and analyzed. The surgical pathology related to perioperative deaths in Malaysia is different from other developing and developed countries. While death from trauma and the late presentation of surgical conditions are similar to developing countries, infective gastrointestinal conditions were rarely encountered. Diseases associated with advanced age such as colorectal cancer, peptic ulcer, urological diseases and vascular conditions are beginning to emerge. As the country races towards a developed nation status, increasing life expectancy and changing life-styles are expected to influence the disease pattern. The planning of surgical facilities and manpower development must recognize the changes taking place.

Matched MeSH terms: Adolescent
Fulltext Combined needlescopic cholecystectomy and laparoscopic splenectomy for the treatment of thalassaemic splenomegaly and cholelithiasis

Jasmi AY, Thambidorai CR, Khairussalleh J

Med J Malaysia, 2003 Aug;58(3):443-5.
PMID: 14750388

Gallstone disease is a common association in patients with haematological splenomegaly. When indicated, simultaneous splenectomy and cholecystectomy should be performed and traditionally this is accomplished by open surgery. We report a 17 year old thalassaemic girl with splenomegaly complicated by gallstone pancreatitis. We treated her with a combination of needlescopic cholecystectomy and laparoscopic splenectomy as well as delivering the huge spleen via a pfannenstiel incision to hide the scar. We believe this technique is an acceptable alternative mainly for rapid delivery of the spleen and to minimize visible scars hence improving cosmesis.

Matched MeSH terms: Adolescent
Fulltext Surgical intervention in traumatic facial nerve paralysis

Yeoh TL, Mahmud R, Saim L

Med J Malaysia, 2003 Aug;58(3):432-6.
PMID: 14750385

A four years review from June 1998 to June 2002 of traumatic facial nerve paralysis from temporal bone fractures that required surgical intervention is presented. The aim of this clinical presentation was to determine the current pattern of cases with traumatic facial paralysis which required surgical intervention at our center. There were six cases, of which four (66%) were longitudinal fractures, one each (17%) had transverse fracture and fracture over the lateral wall of mastoid. Hearing loss (83%) was the commonest associated clinical symptom. All cases underwent decompression via the transmastoid surgical approach. Intraoperative findings revealed oedema of facial nerve involving vertical segment and horizontal segment in three cases each respectively. Two cases had concomitant bony impingement. The facial nerve functions in four cases (66%) and one case recovered to House Brackmann grade 2 and 4, 12 months and 3 months respectively postsurgery. The case with transverse fracture remained as House Brackmann grade 5 after two years.

Matched MeSH terms: Adolescent
Fulltext Protean manifestations of gastrointestinal tuberculosis

Ismail Y, Muhamad A

Med J Malaysia, 2003 Aug;58(3):345-9.
PMID: 14750373

We present 11 cases to illustrate the protean presentations of gastrointestinal tuberculosis. The patients presented with perianal fistula, appendicitis, ascites, rectal, intestinal or gastric 'growth', "ulcerative colitis", or recurrent anemia. In some of these cases there was no conclusive proof of infection with Mycobacterium tuberculosis but they responded well to empirical treatment with anti-tuberculous therapy. These cases illustrate that because signs and symptoms of intestinal tuberculosis are non-specific and even histology can be misleading, the diagnosis of gastrointestinal tuberculosis requires a high index of suspicion. A therapeutic trial of antituberculous drugs should be considered for patients with a high clinical suspicion of tuberculosis.

Matched MeSH terms: Adolescent
Appropriateness of colonoscopy in a tertiary referral centre

Jabar MF, Halim ME, Gul YA

Asian J Surg, 2004 Jan;27(1):26-31.
PMID: 14719511

The aim of this study was to determine the appropriateness of colonoscopy in relation to its diagnostic yield, with reference to the guidelines set by the American Society of Gastrointestinal Endoscopy (ASGE). A prospective 90-day audit was performed at Hospital Kualal Lumpur, which is a tertiary referral centre in Malaysia, to examine the appropriateness of colonoscopy by indication. During that time, 257 colonoscopies were performed in 244 patients. The predominant indications for colonoscopy were altered bowl habit (37%) and rectal bleeding (18%). Of the 257 colonoscopies, 216 (84%) were judged to be appropriate by ASGE guidelines. Only 43% of all colonoscopies had positive findings. Positive findings were found in 93% of cases judged appropriate compared with only 7% found in cases deemed inappropriate. There were statistically significant relationships between appropriateness and overall positive yield and between appropriateness and neoplastic findings (p < 0.05). Colonoscopy performed for appropriate indications yield more significant findings, this, we advocate the use of accepted guidelines to maintain or improve the standard colonoscopy services.

Matched MeSH terms: Adolescent

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