A joint pilot project between the Ministry of Health and the Department of Social and Preventive Medicine, University of Malaya, to test the value of village aides in extending the health care system into isolated Iban communities was started in May 1979 in the Entabai District of Sarawak. A group of 15 village aides consisting of 11 traditional Iban manangs (medicine-men) and 4 youths were trained to provide primary health care including simple curative care, preventive care and to assist in the detection of malaria. Evaluation carried out 2 years later showed the following. In respect of curative care, the village aides were each, on the average, treating 70.6 patients per month, the most common illness being headaches (30.4 percent), which together with abdominal pain, constipation, bodyaches, diarrhoea, vomiting, fever, worm infestations, cough and sore throat, accounted for 89 percent of all illnesses seen by them. Subsequent to the introduction of village aides in the project area, the number ofseriously ill patients requiring admission to the rest beds of the klinik desa dropped by 43.8 percent and the number of emergency referrals to the back-up divisional hospitals fell by 46.1 percent showing that patients were coming to the klinik desa for treatment at an earlier stage. The 11 traditional Iban manangs, who had received training had, on their own accord, drastically reduced the use of traditional Iban modes of therapy in preference for "modern" medicine. During the 24 months immediately after the introduction of village aides into Entabai, 9 gravity feed water supply systems together with the related "health package" advocating general cleanliness, the use of latrines andfences were effected, whereas only 6 such systems were installed in the previous 24 months, indicating that it is likely that the village aides were of some assistance in mobilizing the community is respect of these self-help efforts. During the same period, the majority of longhouses in the area successfully established a number of vegetable gardens growing foods for home consumption, and continue to vigorously advocate breast feeding of infants in opposition to bottle feeding. During the 23 months after village aides were introduced, a total of 1,093 blood films were collected by the 15 village aides, the average number of blood films per village aide being 3.2 blood slides per month. Village aides are socially accepted by the Iban community who utilize their curative skills when mild illnesses disturb them, but who proceed directly to the klinik desa when more serious illnesses such as fevers strike them. The project has established clear lines of communication between the health team and the community, and has stimulated the community to organize itself to achieve an increasingly high level of health through community participation and self reliance. Plans have been approved in principle to train a further 2000 village aides in primary health care for the state of Sarawak.
Ameloblastomas formed 1.1 percent of all oral pathology cases reported. The race, sex and age group distribution of 133 cases are shown. The peak age incidence (70.6 percent) was between 11-40 years. The mandible was involved 9 times more commonly than the maxilla. The anatomical sites of distribution, clinical and radiological features, histological variants and their correlation are discussed. Twenty two patients (15 percent) had ameloblastomas associated with a dentigerous cyst and/or unerupted teeth. Ameloblastomas with the above clinical features represented a much less aggressive form of neoplasm. The authors could not correlate histological variants of ameloblastoma with recurrence rates. The various treatment methods and the respective recurrence rates are outlined. Radiotherapy and marsupialization as treatment of ameloblastoma are not recommended. The indications for enucleation curettage, resection en bloc, segmental resection and hemimandibulectomy
are emphasized. Ameloblastomas involving the maxilla should be treated by complete removal en bloc with a margin of normal tissue. Since ameloblastoma has the capacity to recur after several years of apparent cure patients who have been treated for ameloblastoma must be followed up periodically during their life time. So far no case of ameloblastoma in this study has shown evidence
ofmetastasis.
Serum human prolactin (hPRL) levels in Malay women during pregnancy, intrapartum and immediately postpartum have been invest£gated by means of a double-antibody radioimmunoassay technique. There was a progressioe rise of serum prolactin concentration from 31.9 ± 10.4 ng/ml in the first trimester to 242.0 ± 24.6 ng/ml at 36 weeks pregnancy unth. the mean values during the second and third trimester of 118.9 ± 12.7 ng/ml and 214.7 ± 10.3 ng/ml respectively. During intrapartum the concentration of hPRL was 191.9 ± 26.9 ng/ml and ithat of immediately postpartum was 178.3 ± 14.5 ng/ml. Suckling of the breast within 6 hours postpartum has resulted in a minor elevation of prolactin level, and this could have been due to the greater basal prolactin level, and/or the ineffectiveness of suckling as a potent stimulus during this period.
A case of neonatal meningitis caused by an unusual organism, Acinetobacter calcoaceticus var anitratus is reported. The source of the meningitis is probably a scalp abscess caused by the same organism. This patient was successfully treated with cotrimoxazole. Infections caused by Acinetobacter are rare and are briefly reviewed in this article
A case of perforation of the uterus by the Multiload CU250 Device is described. To date no perforation of the uterus by this device has been reported. The device was successfully removed under laparoscopic control.
This is a report of clinical features of migraine in Malaysians. Seventeen migraineurs were studied with respect to age, sex, length of disease, headache, aura, nausea, frequency, remission, precipitating factors, relieving factors, family history, coexisting symptoms, coexisting disease, and type of migraine. Similarities and differences between Malaysian and Caucasian migraineurs are discussed.
38 episodes of peritonitis in 28 patients were recorded among 97 patients undergoing a total of 159 peritoneal dialysis at the Nephrology Unit, General Hospital, Kuala Lumpur between November 1979 to June 1980. Of these only 14 episodes were associated with a positive bacterial culture. Organism of the Moraxella-Acinetobacter group were responsible in 8 episodes. There were 16 positive cultures in patients who had no clinical evidence of peritonitis. The interpretation of bacterial peritonitis in patients undergoing peritoneal dialysis must be made on the basis of clinical findings and bacteriological reports.
The clinical presentation of patients with bilateral stones is discussed. The majority of patients presenting to the Nephrology Unit were in renal failure. Aggressive medical treatment allowed
diagnostic procedures and definitive surgery to be performed in uraemic patients. Most patients presenting in uraemia benefitted from treatment.
Study Site: Urology Unit, General Hospital, Kuala Lumpur, Malaysia
One hundred and fifty two patients were treated for acute renal failure in 1976-1978. Overall mortality was 46 (30.3 percent) and was highest among the surgical patients 15 (51.7 percent) and lowest in patients with outflow tract obstruction 2 (8.7 percent) uncontrolled sepsis was the commonest cause of death.
This paper reviews the pattern of glomeruler disease from 163 renal biopsies performed at the Institute of Urology and Nephrology. Nephrotic syndrome formed the largest group of patients. There is a high prevalence of SLE nephritis in our community. The histopathologic findings in our series were comparable to those from Western countries except for the lower incidence of membranous and membranoproliferative glomerulonephritis.
Hypoxic cells in tumors are proposed to consist of at least 2 types, depending on whether they remain hypoxic for long (chronic hypoxia) or short (acute hypoxia) periods. Experimental evidence of the possible presence ofacutely-hypoxic cells in one type of murine tumour is presented. Finally, the possible implications for radiotherapy and chemotherapy of the presence of acutely-hypoxic cells in human tumors is discussed briefly.
Despite the high prevalence of oral ulcers little is known about what causes them and how best they can be treated. Recurrent aphthous stomatitis (RAS) is a' chronic inflammatory disease characterized by painful recurring ulcerations of the oral mucosa. RAS can be clinically subdivided into four varieties viz - minor aphthous ulcer, major aphthous ulcer, herpetiform ulcers and Behcet's syndrome. A report on 134 patients with RAS is reported. Minor aphthous ulcer (63%) followed by major aphthous ulcer (29%) were the most frequent. A review of current research on RAS is summarized.
Study site: Department of Stomatology, Institute for Medical Research, Kuala Lumpur, Malaysia
The total and differential leucocyte counts were estimated in 100 consecutive cases operated for acute appendicitis. Leucocytosis was seen in 52% of cases. 480/0 of patients had a leucocyte count below 10000 per c. mm. A study of the differential count was also made to see if this parameter could be used as a specific diagnostic aid. Though the neutrophil count was high in 74% of the cases, the comparative count among the below 10000 per c.mm. group was not significant. It is concluded that the total and differential counts are of limited value in the assessment of these patients. It is suggested that such estimation be used as a supportive aid only. In those doubtful cases with normal or low counts, frequent clinical reviews should be done and reliance placed on clinical assessment rather than laboratory information.
Strict precautions were taken in our methodology to exclude any monocytes from being included in the total T and B cell estimation. There is a progressive drop in the percentage of T and B cells with age, but no significant differences between the races nor between the sexes of the same age group. Aberrancies of T and B cell percentages were noted in most infections, malignancies and even malnutrition.
The tremendous research advances in recent decades in the three widely used methods of fertility regulation (family planning), namely hormonal steroidal contraception, sterilisation and legal abortion, have been presented and discussed. The considerable health benefits accruing to the woman, in particular, and to the society, in general, from the practice of these fertility regulation methods. especially in the context of developing countries, have been reviewed. Recent research advances in the area of fertility augmentation (infertility management) have been presented and discussed. The manner in which some of the future trends in fertility regulation are likely to develop has been briefly stated.
Radioisotope detection and localisation of myocardial infarction is discussed. Its clinical value and pitfalls are also discussed. The clinical application of this safe, simple, sensitive, repeatable, reproducible and non-invasive method in Malaysian patients performed during the period October 1978 to April 1979 at the University Hospital is reviewed. The main value of 99mTc labelled phosphate scan is in the demonstration and localisation of recent myocardial infarctions in patients where the electrocardiogram or serum enzymes changes are unhelpful.