Severe jaundice (serum bilirubin level > 340 gmol/L) occurred in 81 infants admitted to the Neonatal Intensive Care Unit (NICU) of the Maternity Hospital Kuala Lumpur (MHKL) in 1993. Of these 46 (56.8%) underwent 53 exchange transfusions. In-patient case notes were available for study on 41 of them. Two infants had no cause identified while 12 were associated with prematurity, 13 ABO incompatibility, 8 G6PD deficiency, 6 sepsis 2 Rh isoimmunisation and 6 miscellaneous causes. In 14 infants it was felt that exchange transfusions might have been avoided if they were detected earlier and phototherapy instituted promptly. Twenty six (26) infants were deemed to have been given phototherapy at the appropriate time but jaundice increased to exchange transfusion levels, threshold values depending on the unit in charge. Use of higher intensity phototherapy might have been more effective in some of the cases. Available data showed similar outcomes in both groups.
Matched MeSH terms: Blood Group Incompatibility; Exchange Transfusion, Whole Blood
Accepted 07 August 2011.
Introduction Chronic kidney disease (CKD) has emerged as a major medical illness that drew the attention of the community. This research focused on the prevalence of five contributing factors to the progression of CKD, namely blood pressure control, glycaemic control, lipid control, smoking and alcohol intake, and explored significant association between these variables. This was a crosssectional study that examined the progression of CKD based on the worsening of CKD stages.
Methods This study was conducted among CKD patients with type 2 diabetes mellitus who attended Nephorology Clinic, UKMMC from April to May 2011. The progression of CKD was observed for 3 consecutive visits with 3 months intervals between the visits. Information regarding demographic data and social history were obtained through face-to-face interview, followed by case note review of the blood results. Data collected was analysed using SPSS version 19.0.
Results A total of 201 respondents were investigated, which included 39.3% (n=79) female and 60.7% (n=122) male. The mean age for the respondents was 66.9 years old (±SD 9.00). Among the respondents, 71.5% had poor glycaemic control; 59.7% had poor blood pressure control; 65.2% had poor lipid control; 19.9% smoked and 3.5% consumed alcohol. There was poor correlation, there were statistically significant association between systolic blood pressure control with the glomerular filtration rate (GFR) (p=0.001; r=-0.229). From this research, high systolic blood pressure was associated with low GFR, which indicated poor kidney function and resulted in progression of CKD.
Conclusions This study has clearly demonstrated that the control of blood pressure was essential in delaying the progression of CKD.
This paper aims to determine acute responses of standardized resistance training load on cardio-respiratory variables in recreationally active participants. The methodology involved twelve recreationally active males with an age of 23.5 (± 4.07) years, a mass of 70.5 (± 7.84 kg), a height of 1.69 (± 0.06 m), and a body mass index of 24.8 (± 2.14) kg/m2). The participants performed an exercise protocol that comprises five exercises on a standardized load. Each exercise was performed in a duration of 60 seconds with uncontrolled lifting velocity. Cardio-respiratory responses were measured using a portable metabolic system analyzer during the exercises. A wrist digital blood pressure monitor was used to determine pre- and postprotocol blood pressure responses. Based on the results, pre- and postprotocol systolic (p=0.744) and diastolic (p=0.758) blood pressure indicated no significant responses. However, significant differences were observed in pre- and post-heart rate responses (p=0.000). Peak cardio-respiratory responses recorded during the protocol were 30.2 (± 4.02) ml/Kg/min for oxygen consumption, 138 (± 61.9) bpm for heart rate, and 633 (± 71.2) kcal for energy expenditure (estimated per hour). On average, the Metabolic Equivalent of Task (MET) was recorded at a value of 8.62 (± 1.19). For a short duration standardized load circuit training exercise protocol, cardio respiratory responses were similar to other protocols. The metabolic cost of the predefined exercises was nearly half of the recommended energy expenditure through exercise per week. The prescribed protocol was comparable with other exercise protocols for cardiorespiratory variables. The single set protocol used was efficient in terms of caloric expenditure, and was less strenuous over similar exercise duration. Furthermore, the prescribed protocol is applicable and beneficial for active and healthy individuals.
A cross-sectional comparative study was conducted to determine the nutritional status among physically active groups in Kota Bharu. The study population comprised 83 adult male athletes from 8 different types of sports (athlete group), 80 active men who exercised a minimum of 30 min per day for at least 3 times per week (exercise group), and 80 inactive men (sedentary group). All the respondents were aged between 18 to 44 years. Measurements taken from the respondents were anthropometric measurements, systolic (SBP) and diastolic (DBP) blood pressure, and serum total cholesterol (TC). The results showed that the combined prevalence of pre-obese (BMI 25.0-29.9) and obese (BMI ¡Ã30.0) was 21.7% in athletes, 29.9% in exercise group, and 47.5% in sedentary group. The mean (± SD) percentage of body fat in athletes was 15.7 ± 5.4%, which was lower compared to the exercise (18.9 ± 5.5%) and sedentary (20.6 ± 5.8%) groups. The incidence of waist-to-hip ratio above 0.9 in athlete, exercise and sedentary groups was 9.6%, 18.7% and 31.3%, respectively. The incidence of hypertension (SBP ¡Ã140 and/or DBP ¡Ã90 mmHg) was 13.2% in athletes, 17.5% in exercise group and 42.5% in the sedentary group. The TC values showed that the prevalence of “high risk†individuals (TC ¡Ã6.20 mmol/l) was also lower in athletes (20.5%), compared to the exercise (36.2%) and sedentary (47.5%) groups. The study revealed that individuals who are actively involved in physical activity, particularly in sport activities have better nutritional status compared to sedentary people. However, the nutritional status in the athlete and exercise groups was still unsatisfactory. The incidence of poor health status related to over nutrition in the active groups was rather high and needs attention from health professionals. Further studies are needed to determine nutritional practices among physically active groups.
This study was conducted to determine the effects of increased edible palm oil consumption on community health status in the aboriginal communities in Tual Post (treatment group) and Sinderut Post (control group), Kuala Lipis, Pahang. Nutritional status, blood pressure, lipid profiles, fasting blood glucose (FBG), vitamin E (alpha-tocopherol) levels and lipid peroxidation product (malonaldehyde) levels were taken as indicators of health status. This is a pre-and post-controlled community trial in which similar variables were measured in each group. Every family of 2–6 household members was given 2–5 kg cooking palm oil per month for a period of 18 months. All subjects were measured for height (cm), weight (kg) and waist-hip ratio (WHR). For calorie intake measurement, house-to-house interviews were conducted using 24-hour dietary recall method. Blood pressure, percent body fat, lipid profiles, namely total cholesterol, high density lipoprotein cholesterol, triglyceride and fasting blood glucose (FBG) were also measured. Vitamin E (alpha-tocopherol) levels and lipid peroxidation products (MDA) were also determined. There was a significant increase (p
Hypertension is a prevalent chronic disease, which is strongly related to the development of cerebrovascular and cardiovascular diseases. The prevalence of hypertension in Malaysia in subjects aged 15 years and above was estimated to be 27.8%. Cost-effectiveness analysis (CEA) compares treatment options with different effectiveness and safety profiles. The utilisation of antihypertensive drugs has raised some concerns about the balance between its costs and benefits. This study was conducted to describe the healthcare costs for hypertensive subjects and to examine the cost-effectiveness of different classes of antihypertensive drugs used in Malaysia. Retrospective and prospective data analysis of a cohort of uncomplicated hypertensive patients was conducted to determine ambulatory health care costs among hypertensive patients groups. The total direct and
indirect costs of controlled and uncontrolled blood pressure (BP) were described. The health care
costs ($) / clinical outcome (AC/E ratio) was calculated. Mean total direct costs per patient per month was higher in uncontrolled blood pressure groups compared to the controlled blood pressure groups. The cost-effectiveness relationship was more favourable for diuretics (1.9), angiotensin converting enzyme inhibitors (ACEIs) (2.0), prazosin (2.4) and beta blockers (2.5), more than the diuretics and beta blockers combination theraphy (3.0), calcium channel blockers (CCBs) (3.4) and other combinations (6.1). Antihypertensive drugs used to treat hypertensive patients were different
in their cost-effectiveness ratios. Such results will allow health care professionals and/or decision
makers to make better decisions on how to select treatment options for hypertensive patients in
Malaysia and how to distribute and allocate scarce health care resources. Pharmacoeconomic
evaluations can help in making difficult choices rationally and allocate scarce resources efficiently.
Non-communicable diseases are raising much concern in Malaysia due to changing lifestyles which is parallel to the economic development. Intervention program like community health screening (CHS) allows early detection, prevention and reduction of chronic diseases and its risk factors. This study aimed to assess the obesity level, risk factors for chronic diseases and blood cholesterol level among the Malaysian public. A health screening program was conducted on April 2012 at Sungai Pinang township, in the state of Pulau Pinang, Malaysia. A convenient sample of the general public was recruited. Screening tests consisted of measurements of blood pressure, body mass index (BMI), body fat percentage, visceral fat accumulation (VFA) and blood cholesterol. Chi-square analysis was used to determine the difference between prevalence of obesity among subjects with different age groups and gender. Out of 76 recruited subjects, 23.7% had systolic blood pressure of 140 mmHg or greater and 7.9% had diastolic blood pressure of 90 mmHg or greater. Approximately 51% of the subjects were obese (BMI ≥ 27.5 kg/m2). Body fat percentage was high in 63.6% and 63.0% of male and female subjects, respectively. High VFA (≥15) was found in 19.8% of subjects. There were three newly discovered hypercholesterolemia cases (total cholesterol ≥ 5.2 mmol/L). Counselling was given during the health screening program to help the public to take necessary measures to reduce risk factors while preventing complication resulting from these chronic diseases. In conclusion, prevalence of obesity found to be high in the present screened population.
Background: Metabolic Syndrome is a major concern for the general population but more so for depressed patients. While it is well established that it is highly prevalent among patients who are depressed, none of the local studies identified the factors contributing to the syndrome.
Objective: This study aimed to determine the rate of metabolic syndrome and its associated factors (socio-demographic, clinical features and lifestyle risk factors) in depressed patients.
Methods: A cross sectional study was conducted on patients with major depressive disorders (MDD) attending psychiatric outpatient clinic in Universiti Kebangsaan Malaysia Medical Centre (UKMMC), a teaching hospital in Kuala Lumpur. A total of 72 outpatients who fulfilled the selection criteria were informed to fast prior to blood taking. The diagnosis of MDD was made based on Diagnostic Statistical Manual Version IV (DSM-IV) while the metabolic syndrome diagnosis was made using the International Diabetes Federation (IDF) criteria based on the patients’ waist circumference, blood pressure, serum glucose level and lipid profile.
Results: The rates of metabolic syndrome was 37.5% (n = 27). The results showed significant associations between metabolic syndrome and race (p = 0.043), illness duration (p = 0.043) and pre-existing hyperlipidaemia (p = 0.032). Interestingly, lifestyle factors like physical activity (p = 0.762), dietary intake (p = 0.671), severity of depression (p = 0.161) and the different types of medications (p = 0.242 to 1.000) were not found to significantly associated with metabolic syndrome among the study sample.
Conclusions: Metabolic syndrome was found to be disproportionately high among depressed patients. Two significant factors associated with this syndrome were race and long duration of depression (ten years or more). This study suggests that early screening and identification can be beneficial to be incorporated in the management of depression in anticipation of future complications.
Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Background : The management of chronic disease during flood seems to be one of the main challenges to the health care service. Chronic disease becomes worst during flood. Poor condition at the relief centres, loss of assets, fear, and lack of functional health facilities contribute to the morbidity and mortality during and after flood. Poor chronic disease management, especially on severe and uncontrolled hypertension, may threaten lives of victims during flood. In addition, comprehensive treatment cannot be delivered due to destroyed infrastructure, shortage of doctors on duty and delay in getting drug supply. Therefore, all aspects of chronic disease management shall be reviewed and included in the disaster preparedness in order to control and prevent acute incidence and complications of the chronic diseases. Previous Action Plan did not address this issue effectively which had caused many patients not getting their treatment adequately. The aim of this writing is to share experiences in managing chronic disease patients particularly hypertensive patients.
Methodology : A retrospective study based on data collection by health personnel while conducting health screening, clinical examination and giving treatment to flood victims at the relief centres. Hypertensive patients were identified when the victims came for treatment and while the medical team conducting medical rounds. New hypertensive cases as well as uncontrolled cases with no complication were treated and monitored at the relief centres.
Result : It was found that 34,530 cases of non communicable disease (11.1% of the total number of the flood victims) including hypertension and diabetes mellitus were reported in Johor. Kota Tinggi reported a total number of 5,317 cases of chronic disease. There was no data collection on specific chronic diseases collected at the state level during the floods thus the findings representing Kota Tinggi cases only. In retrospective search of 150 flood victims with hypertension in Kota Tinggi, only 95 cases had complete data. Among them 71.6% (68 cases) were hypertensive cases already on treatment and 28.4% (27 cases) were new cases. Also it has been found that 67.4% (64 cases) were uncontrolled hypertension and 32.6% (31 cases) were controlled hypertension. Four cases had been found diagnosed as uncontrolled hypertension with complications and have been referred to hospital.
Conclusion : Comprehensive health strategy for flood victims shall not be focused only on saving lives and giving emergency treatment to patients but also to update and strengthen an overall chronic disease management. Many factors contributed to increase in blood pressure during flooding. Good hypertensive treatment at the relief centres is needed to minimise morbidity and mortality. Information on care and treatment received by flood victims having chronic disease is vital in assessing their health needs during disaster and in formulating disaster preparedness in the future.
Chloroquine pressure was applied over a 22 month period on a somewhat isolated, malarious rubber estate by examination of residents at 4-week intervals and treatment of parasitaemias with chloroquine. During this time the monthly attack rate for P. falciparum rose four-fold to an average of nearly 18% per month, while that of P. vivax remained relatively constant at about 8%. Eight in vivo chloroquine resistance studies, which allowed both detection of late recrudescing R-I resistance and estimation of the risk of reinfection, showed an apparent rise in the drug resistance rate, from 12% to 20% prior to the study to the range of 40-50%. Virtually all resistance encountered was R-I in nature. There was no convincing evidence of chloroquine resistance among 148 tested P. vivax infections.