Two hundred and three patients with psoriasis, who attended the skin clinic were studied to identify the pattern of sporiasis. The incidence was 4%. It was more common in Indians than in the other ethnic groups and this was found to be statistically significant. Males were affected twice as common, 12.5% gave a positive family history, the lower limbs and the scalp were the commonest site, and pruritus was frequent. The pattern appears similar to those in the west.
Study site: Skin clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Merital is a recently introduced antidepressant agent which is structurally unrelated to the traditional antidepressant agents and which is reported to have minimal side effects. This study aimed to establish the olerance of a single compared to a spaced dose .schedule of Merital. It was found that a single morrung dose of Merital 100 mgs compared to a similar dose of the drug given in two divided doses did not appreciably increase the frequency or severity of side effects.
This paper describes the characteristics of Malay psychiatric inpatients, their attitudes towards hospitalisation and their practice of consulting traditional healers (bomohs). The behaviour patterns which prompted hospitalisation were: acute disorganised behaviour directed at the community, behaviour of a less acute nature distressing the family and life-threatening crises. The social interaction life styles of urban and rural Malays are discussed in relation to the differences observed between urban and rural hospitalised patients. When the traditional healers were consulted there was a delay before hospitalisation, but there was an awareness of the need for hospitalisation shown by a small number of the traditional healers. Some patients who had consulted the traditional healers had the tendency to continue the consultations after leaving the hospital, but this practice became less frequent after each discharge from hospital.
Disease patterns among outpatients seen at static and travelling dispensaries, as well as among hospital admissions and hospital deaths are compared between 1959 and 1974. While disease patterns of patients seen by travelling dispensaries show no change, patients seen by static dispensaries and hospital admissions in 1974 show a marked relative decline in infective and parasitic diseases and an increase in accidents, poisonings and violence. Causes of death in hospitals in 1974 were different, there being relative increases in diseases of early infancy, diseases of circulatory system, neoplasms, and accidents, poisonings, violence while infective and parasitic diseases, and diseases of the digestive system declined.
Four strains of S. typhi isolated in Malaysia were found to show resistance to chloramphenicol and other antibiotics. In two of these strains it was possible to show that this resistance was transferable.
This problem which is widespread in neighbouring countries and undetected in Malaysia till recently has now been shown to exist in this country. Fears that the incidence of such strains will increase in the future are expressed and the need for vigilance is emphasised.
The effects of phentolamine and propranolol on contractural responses of guinea-pig superior mesenteric-portal vein to adrenaline and isoprenaline were investigated. Phentolamine was capable of completely abolishing the response to adrenaline and to isoprenaline while propranolol had no effect on responses to either agonist. It is suggested that Alpha receptors are the only type of adrenoceptor involved in adrenergic control of contraction of this vein and that isoprenaline is capable of stimulating these receptors.
In a prospective study of 300 infants with acute gastroenteritis 150 infants had enteropathogens in the stools, 58 being due to rotavirus, 130 to adenovirus, 32 to Sahnonella, 18 Shigella and 29 E. coli. Hypernatraemic dehydration was present in 11% and acquired carbohydrate intolerance in 30% of the infants. Protracted diarrhoea was observed in 8% of infants and was commoner in the bacterial than viral group. The study shows that clinical features and simple blood tests cannot be used as reliable indices of predicting the aetiology of AGE. Despite the diverse aetiology of acute gastroenteritis, rehydration by the oral or intravenous route remained the mainstay of therapy.
Keywords: Kuala Lumpur, university hospital,
Facts are presented which suggest that mosquitoes of the Anopheles barbirostris species group that gave me a very uncomfortable night in 1941, whilst serving with the Volunteer forces, were probably A. donaldi. This species is now known to be a vector of human filariasis and probably malaria. Some of the steps are described by which I was led, sixteen years later, to recognise and later name donaldi as a new species. Reasons are given for thinking that around 1918 A. donaldi was present in some numbers at the railway town of Gemas where malaria was a serious problem. H.P. Hacker made a survey at Gemas in 1918 and though the principal vector was probably A. maculatus, 'umbrosus' and 'barbirostris' were the commonest larvae he found.
A preliminary survey of Aedes aegypti was carried out in 6 areas in the state of Selangor, Malaysia. The densities of Ae. aegypti and Ae. albopictus in the areas were discussed. Results indicated that the distribution of larval habitats varied with the housing type. The most ommon indoor larval habitat in urban areas is the bathroom tank. In both urban and rural areas, outdoor preference is for the earthenware jars. Anttraps have decreased in importance as larvae breeding habitats. The accuracy of house searches can be increased by increasing the number of larvae examined per container to 5 or more. Further study is required to determine whether the findings of this survey is peculiar to the areas surveyed or is representative of the whole country, and whether there is a seasonal fluctuation in the types of preferred larval habitats.
A case report of right below-knee amputation successfully performed under acupuncture anaesthesia, supplemented with parenteral valium and. pethidine, is described.
A' brief' of an attempt in integration of health education of patients as a part and parcel of treatment and management in hospitals in Kelantan is outlined. The methodology used in the context of local situation is described, problems and short-comings highlighted, and a few suggestions made including recommendations for further such trial efforts in other hospitals in the country.
The peculiar anatomical features render the common peroneal nerve particularly susceptible to injury at the knee. The present investigation revealed that the deep division of the nerve is more inclined to be injured when compared to the superficial division.
The diagnosis and management of brain death is discussed in this paper. Criteria recommended by the Conference of Medical Royal Colleges and their Faculties in U.K. were used in the diagnosis of brain death. It is felt that brain death should be considered as death of the individual and a plea is made to draw up guidelines on management of patients with brain death.
A study of completed in-patient suicides at the University Hospital Kuala Lumpur (UHKL) and Hospital Bahagia Ulu Kinta (HBUK) between 1st January 1967 to 31st December 1987 were conducted. Records of completed in-patient suicides during the period were exhaustively studied. Only 18 cases were from UHKL and 23 cases were from HBUK. It was found that the suicide patients were mainly young Chinese males from the lower socio economic group. The main reasons for suicide were interpersonal conflicts and physical illness. Alcohol was not an important factor unlike patients in the West.. Suicidal intent was also important. Many of the suicides were committed during the early hours of the morning and they usually occurred at inaccessible places. The method was strongly influenced by availability. To the best knowledge of the author, this is the first study of in-patient suicides in Malaysia.
Damage to the lower ureters during pelvic surgery is a serious and well-recognised complication. This iatrogenic injury, when undetected intra-operatively, continues to give rise to significant patient morbidity. In 1987, this Department was referred 18 cases of iatrogenic ureteric injuries. 16 patients were from gynaecologic surgery and 2 patients were from general surgery. Only 4 cases (24%) were detected and referred intra-operatively. 13 patients presented post-operatively with various symptoms viz., anuria, loin pain and urinary leak per vagina. Good recovery of urinary function was achieved in all cases after urological intervention, usually by ureteric re-implantation.
Eight general practitioners participated in a survey of content of general practice. This is useful as an indicator or morbidity in the community as well as of workload of general practice. A total of 3164 consultations were recorded, of which 2764 (87%) were because of an illness and the rest (13%) for other reasons like medical examinations, antenatal check, family planning advice, pregnancy tests, pap smear and vaccination. The old and the young have high consultation rates for an illness, men consulted as often as women. The most common illness seen was upper respiratory tract infections, accounting for 37% of all illnesses. Other common minor illnesses were skin infections (6%), genito-urinary infections (5%), minor musculoskeletal (6%) and gastrointestinal (6%) complaints as well as minor injuries and cuts (4%). Major disorders form an unusually low proportion (18%) of all illnesses seen, in comparison with figures from United Kingdom. The common major disorders seen were hypertension, asthma, chronic rheumatic disorders and diabetes. Circulatory disorders were remarkably rare, accounting for only 1% of illnesses. Psychological disorders, both major and minor, were also rarely seen, accounting for only 1% of illnesses which is in marked contrast with figures from the United Kingdom. Factors contributing to these notable findings are discussed.
A young male who developed ipsilateral pulmonary oedema on two occasions as a complication of treatment of pneumothoraces involving the left lung is reported. The importance of large pneumothoraces, the rapidity of decompression and the application of suction to the pleural space as factors predisposing to the development of re-expansion pulmonary oedema is well demonstrated by this case. The re-expansion pulmonary oedema was more severe on the second occasion when the lung had collapsed for a longer duration compared to the first pneumothorax which was of more recent onset.