288 notifications of syphilis in military personnel for 1974 to 1978 are analysed. 56 cases are primary and 232 are latent syphilis in service personnel and 13 in women and children. Antenatal screening detected 56 cases (0.9%) of syphilis. Only 24 cases among soldiers had confirmatory tests done. Treatment varied and some were inadequately treated, others overtreated and many with incorrect schedules. Intramuscular penicillin was the treatment of choice in 85% of cases. Follow-up of cases was inadequate. In all, it indicated a poor control programme for STD. A good programme is possible within the armed forces set-up and a number of measures are suggested.
Following the opening of the University Hospital of the University of Malaya in 1967, over 126,000 patients (excluding obstetric patients) have been admitted. A retrospective review, run concurrently with a prospective study, of over 200 patients thought to have suffered from systemic lupus erythematosus (SLE) revealed that, up until the 31st December 1975, 175 patients fulfilled the criteria for the diagnosis of SLE. There was a highly significant increase in the diagnosis of SLE over this period among Chinese patients compared to all other races, and no significant differencein the diagnosis of SLE among Indian and Malay patients. A review of the literature revealed that SLE appears to be a worldwide disease, reported frequently from Chinese communities but infrequently from tropical Africa. It is concluded that SLE is more common in the Chinese from Peninsular Malaysia than the other races, and that a careful study of geographical and racial factors in SLE may contribute to further understanding of its pathogenesis.
Food expenses accounted for 66% 54% of the total income in the two plantations. The nutritional value of foods purchased and consumed and the adequacy of nutrient intakes in two plantations was studied. The diets were found to be inadequate in calories, protein, calcium, iron and riboflavin. Carbohydrates provided the bulk of the calories. The significance of the findings are discussed.
A forty-four year old wife of an alcoholic husband with irregular employment sought repeated medical care for her headache, bodyache, chest pain and alleged falls at home. The family backgrounds of the battered wife and the violent husband, his alcoholism and their financial problems all contributed to the violence in marriage. Their six children had lived in fear and two of them had behaviour problems. Awareness of the multiple problems associated with a battered wife should prompt cooperation between medical, social and other workers involved in the management.
Study site: medical outpatients clinic of
T.H. Woon
M.B., B.S., M.D., M.R.A.N.Z.C.P.
Associate Professor and Head
Department of Psychological Medicine
Faculty of Medicine
University of Malaya
Kuala Lumpur, 22-11
and
Shirley George
M.B., B.S., M.P.M.
Psychiatrist
Psychiatric Unit
General Hospital, Seremban.
Running Title:
Battered wife - psychodynamics and social background of a
Malaysian family - alcoholic husband - medical symptoms -
multidisciplinary management.
University Hospital to the psychiatric Walk- inClinic
A postal questionnaire survey was carried out among military doctors during June to August 1979 on habits and attitudes to smoking. An 87% response rate was obtained. Smoking prevalence was found to be 50%. 45% of medical officers are heavy smokers. Age at starting influence the amount smoked. Service life had no influence on smoking habits. Attitudes to smoking vary between the different categories of doctors. The habits and attitudes indicate a mental revolution on the part of doctors is required prior to any anti-smoking programme as they have to be sufficiently motivated to lead the fight.
In the University Hospital, Kuala Lumpur, from 1984 to 1990, 184 patients with acute conjunctivitis were examined for chlamydial infection by direct immunofluorescence. Overall, 52 (28.3%) were found to be positive for chlamydial antigen. There was no significant difference in the detection rate between men and women and among the 3 major ethnic groups. The detection rate was highest among sexually active adults. Epidemiological and clinical features suggest that most of the chlamydial ocular infections seen were inclusion conjunctivitis and not classical trachoma.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
A case-control study was carried out to determine the child-minding practices and their relationships with nutritional status of children between 6 and 12 months old. Sixty-five percent of the mothers go to the farm and 25 percent of, them bring their children with them. Only 42.8 percent of the children were looked after by their mothers. The odds of being malnourished were greater among children who were not looked after by their mothers. It is suggested that nutrition education be given in the village so that the other child-minders can benefit from it.
A total of 38 cases of fireworks related injuries from Hospital USM over a 5-year period from 1986 to 1990 during Hari Raya festival were analysed. The majority (68.5%) of the patients were teenagers, between 10 to 19 years of age. All the cases were Malays and most of the accidents occurred before the Hari Raya Idilfitri festive seasons. Fourteen cases were caused by self-made fireworks and another 16 cases were due to modified fire-works. Twenty-four cases suffered permanent disabilities mostly finger amputations. Such injuries could be prevented by law enforcement coupled with public health education to modify social behaviour especially when the ban against the use of fireworks is lifted on religious grounds.
One hundred patients with carcinoma of the cervix stages 1B to 4A were treated with intracavitary high dose rate radiation using a linear cobalt source. All cases have received external beam pelvic irradiation to 4500cGy mid plane in twenty fractions over four weeks. The results in terms of patient compliance and convenience were good while acute and late morbidities were comparable to standard Manchester technique of low dose rate intracavitary therapy as practised in the Institute of Radiotherapy and Oncology General Hospital Kuala Lumpur. The four year actuarial survival rate is 76% for stage II and 48% for stage III. All three stage IV patients died within 1 year. Four out of seven stage I patients are alive (minimum follow-up 18 months, longest 43 months). One died of systemic spread at 33 months while one is lost to follow up.
Malignant neoplasms diagnosed histologically in the state of Sabah during the period November 1983 to October 1988 were analysed to determine the distribution of malignant neoplasms according to site, age, sex and major ethnic groups. The five commonest malignant neoplasms in males were carcinomas of the nasopharynx, stomach, skin, lung and liver. In females the five commonest malignant neoplasms were carcinomas of the cervix uteri, breast, ovary, thyroid and skin. There was variation in these frequencies among the major ethnic groups. The most striking of these was the high frequency of nasopharyngeal carcinoma among Kadazan and Chinese males but not in males of the other indigenous groups. A significant number of patients with nasopharyngeal carcinoma was found in the younger age groups and most of the patients in the younger age groups were Kadazans. A relatively high frequency of carcinoma of the stomach, skin and liver was seen among Kadazans and other indigenous groups while carcinoma of the lung was seen relatively frequently among Chinese males. Among females carcinomas of the breast and cervix uteri were the most frequent malignant neoplasms in all the main ethnic groups. Possible reasons for these findings are discussed.
Two-hundred and sixty-five patients with asymptomatic proteinuria and/or haematuria were studied at the Department of Medicine, Universiti Kebangsaan Malaysia and Department of Nephrology, General Hospital Kuala Lumpur. They represented 25.4% of all the renal biopsies performed during the period 1980-88. All the three races were affected with 71.3% occurring between the ages of 20-39 years and 41.1% were detected during routine medical examination. Excluding those patients with lupus nephritis, IgA nephropathy was the commonest histological diagnosis (51.7%). The presence of severe and advanced histological changes in a significant number of biopsies emphasises the need for more effective screening and early referral of this group of patients.
Twelve cases of primary hyperparathyroidism operated by the Universiti Kebangsaan Malaysia Surgical Team from 1978 to 1989 were reviewed. There was a preponderance of Indian females in this series. The majority of the cases presented late and with complications. Renal calculi and bone disease were the commonest complications noted. Of the 12 patients, 9 had single parathyroid adenoma of which 4 were ectopically located, and 2 had hyperplasia of the parathyroids. These were all successfully operated. The remaining patient had 2 failed neck explorations. Failure at initial exploration was due to ectopic location of the glands. Meticulous surgical technique, knowledge of the anatomical variations of location of the parathyroid glands and availability of frozen section facility are essential for successful outcome.
Even though artificial heart valve implants have a history of some 30 years, there is to this day no ideal valve substitute. Each of the categories of substitutes used has its own advantages as well as problems. Since my last review on the subject, that appeared in this journal, was some 13 years ago (Lim, 1977), it is perhaps appropriate to provide an update on the status of cardiac valve replacement for the general local readership.
Retinoblastoma was clinically diagnosed in 38 patients in the University Hospital between 1968 to 1988. White pupil or cat's eye reflex, found in 25 patients, was the most common symptom. Four patients refused any form of treatment. Of the 27 histopathologically confirmed cases, 16 were males and 11 were females. There was no ethnic group predominance, although a male preponderance was observed among Malay patients (M:F 3:1, p less than 0.05). Treatment in cases with unilateral disease, without extra ocular extension consisted of enucleation of the involved eye, with close examination of the contralateral eye in follow-up. In cases presenting with bilateral tumour the worse eye was removed. Of 20 cases of histopathologically proven unilateral retinoblastoma treated surgically, 12 patients survived for a mean period of 4.5 years (Range: 1-19 years). The defaulter rate for this group of patients was 55%. None of the 7 cases of bilateral retinoblastoma survived beyond 5 years (Mean survival 2.5 years).
The value of tuberculin skin testing in the diagnosis of active tuberculosis remains uncertain. Interpretation of tuberculin tests would be easier if the tuberculin test profiles in different communities were accurately known. We reviewed 468 Mantoux test reactions in patients coming to Hospital Universiti Sains Malaysia with suspected tuberculosis. Eighty six percent of patients with active tuberculosis had a positive Mantoux test. Forty two percent of the cases of positive Mantoux test did not have evidence of active tuberculosis. Most of these cases had evidence of past infection with tuberculosis. We conclude that Mantoux test is a sensitive but a non-specific test in the diagnosis of active tuberculosis.
Study site: outpatients, inpatients; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
The prescriptions of all patients who attended an urban general practice from September 1987 to December 1987 were studied. Of the 111 patients (60 females and 51 males) who received a psychotropic prescription the commonest presenting complaint was insomnia (56 patients or 50.5%). This was followed by tension, headache and unexplained aches and pains (19 patients or 17.1%), and anxiety (nine patients or 8.1%). Consistent with these presentations a vast majority (92.8%) received a benzodiazepine. The commonest drugs prescribed were Lorazepam and Bromazepam whereas the longer acting benzodiazepines were rarely used. Polypharmacy was rare.
A seven-month-old female child presenting with a large abdominal mass was found on investigation to have a duplex right kidney with a non-functioning obstructed upper moiety and a right ureterocele. The grossly dilated and tortuous upper moiety ureter presented as a large cystic mass on ultrasound and computed tomographic scans.