The following factors influencing vocational success or failure were selected and studied for their predictive value in a Rehabilitation Centre, age, family background, educational level, work history and work level, motivation, mental ability and physical disability. Graded numerical scores from 1 to 3 were assigned to these factors according to Lane et al. A cut-off score was tested and found to distinguish the successful from the unsuccessful groups. The individual factors found to differ significantly in the two groups were work history and skill, motivation, and physical disability. Mental ability, however, could not be tested adequately.
Cholera has been in existence in Sarawak for many years and since 1873 many major epidemics have occurred. The epidemics usually occur during the dry months of May, June and July and the population affected are those in coastal areas. As in other outbreaks the areas affected were those which had poor environmental sanitation, poor water supply, poor refuse disposal and indiscriminate disposal of faeces. Malays are more affected as in Peninsular Malaysia outbreaks. The classical biotype was common prior to 1961. In later years the El Tor (biotype) has been responsible for most outbreaks.
Two episodes of El Tor cholera outbreak occurred in Tumpat, Kelantan between the 13th of January and the 16th of May 1990. Every case and carrier reported were investigated to determine the source and mode of transmission and to identify specific preventive measures to break the chain of transmission. There were 109 cases and 85 carriers involved in this study. The first episode of one case only was of Inaba serotype while the second episode was caused by the imported Ogawa serotype. Two foci of spread were identified from cluster occurrence but the majority of infection had no discernible link between them. The outbreak became both explosive and protracted indicating poor basic sanitation and personal hygiene. Person-to-person transmission via food and water was the main mode of spread. The Kelantan river water and river clams were confirmed sources of reservoir during the outbreak. Recommendations for prevention are intensified surveillance throughout the year,urgent upgrading of potable water supply and concerted effort in public health education especially against the use of river water and the consumption of raw food.
A Brain laryngeal mask was assessed in fifty patients undergoing general anaesthesia who required controlled ventilation. The mask was inserted in all patients without any difficulty and the satisfactory seal obtained enabled ventilation in all patients in a wide range of positions. Airway obstruction occurred in seven patients secondary to downfolding of the epiglottis and this was rectified by reinsertion. The incidence of sore throat was 10%. The Brain laryngeal mask is a safe alternative to the tracheal tube for controlled ventilation during general anaesthesia.
We evaluated the usefulness of therapeutic drug monitoring (TDM) for gentamicin and the use of a two-point peak and trough pair concentration method to adjust its dose. Of the 194 patients included, initial concentrations were appropriate in only sixty nine. In the seventy one cases of dosage adjustments using this method, those attaining therapeutic levels increased overall from 38% to 67%. It is concluded that TDM for gentamicin with dosage adjustment using this simple pharmacokinetic approach is useful and adequate in monitoring for gentamicin therapy.
A review of eclampsia in Kelantan was undertaken from 1983-1988. There were 146 documented cases in the state (66 per 100,000 deliveries). Eight maternal deaths occurred. Sixty seven (45.9%) were primigravida. Six of the 79 multiparous women developed eclampsia for the first time following remarriages to new partners. The multisystem dysfunction resulting from eclampsia resulted in varied maternal complications. Fatal cerebral haemorrhage (3 cases), acute pulmonary oedema (8 cases), acute renal failure (6 cases), HELLP Syndrome (8 cases) and acute abruptio placentae were the commoner complications. The average number of convulsions per patient was 1.3. The mean gestation of mothers who delivered prematurely (28.2%) was 34.6 weeks and that for those at term (71.8%) was 39.1 weeks. The caesarean section rate was 42.5%. The perinatal mortality rate was 185.9 per 1000. The implications of this high maternal and fetal mortality and morbidity are discussed in the light of the health delivery system and patient education. A team approach to medical management of eclampsia with the need for intensive care monitoring is suggested.
A survey was done to determine the prevalence of diabetes mellitus, hypertension and renal disease, as well as extent of diabetic control, amongst the workers of Malaysian Railways. The prevalence of diabetes was high at 6.6%, with 3.8% of these being insulin dependent diabetes. The highest prevalence was in Indians (16.0%) followed by Chinese (4.9%) and Malays (3.0%). Using HbA1 measurements, diabetic control was poor in 70.6% of the diabetics. Hypertension was found in 37% and proteinuria in 35%. Renal impairment was present in 30% of the diabetics. This survey shows that diabetes, hypertension and renal disease are high amongst the railway workers in Malaysia.
A case of delayed haemorrhage after conservative surgery for ectopic pregnancy is presented. Brief pathophysiology of the condition is presented. The importance of beta-subunit human chorionic gonadotrophin monitoring of the serum in this patient is highlighted. Surgical procedures to prevent this complication are also discussed.
Two cases of ovarian hyperstimulation syndrome (OHSS) following the GIFT procedure are reported. This article highlights the potential dangers of this condition and discusses the classification and management.
The concept of conversion hallucination is a relatively new one, however there have been several articles written on this phenomena, some attesting to it being a special form of hallucination while others dismissing it altogether. But currently this concept is slowly being accepted among psychiatrists and as such it is important for us to understand some of the concepts. In this case report, the patient presented with clear conversion hallucinations. The case is followed by a discussion on true and pseudo-hallucinations, previous case reports and finally a discussion of conversion hallucinations, viz. the clinical features and the conversion hypothesis.
A 30 year old Malay male developed bilateral choroiditis followed by vitiligo, poliosis and canities. CT scan showed nodular thickening of the optic nerves. Characteristic abnormalities were seen in visual and brainstem auditory evoked potentials and fluorescein angiography. These findings were in keeping with the diagnosis of Vogt-Koyanagi-Harada syndrome. Treatment with dexamethasone resulted in complete recovery of vision and partial improvement in skin and hair lesions.
The Phase I and Phase II undergraduate teaching programmes of the School of Medical Sciences were reviewed at the end of the 1985/86 academic year. It was found that deviations from the School's philosophy had crept into the implementation process. Modifications were therefore made in Phase I and Phase II programmes with a view to:--(i) reducing content, (ii) promoting integration, (iii) improving clinical examination skills of students, and (iv) providing more opportunities to students for self learning, reinforcement and application of knowledge. The number of assessment items in Phase I and the frequency of assessment in Phase II were also found to be inappropriate and so modifications in assessment were made to rectify this situation.
Thirty one cases of malignant tumours of the maxillary sinus presenting to the Department of Otolaryngology, Universiti Kebangsaan Malaysia over a four year period from 1982 to 1986 are reviewed. 18 cases (58.1%) were squamous cell carcinoma while seven cases (22.5%) were Non-Hodgkin's lymphoma. There were four cases (12.0%) of adenoid cystic carcinoma while in two cases (6.5%) the tumours were undifferentiated. Presentation was generally late. Nasal obstruction, facial swelling and epistaxis were the main presenting symptoms. Nasal involvement was found in 61.3% of cases, while 51.6% had involvement of the palate as well. Metastasis to the cervical lymph node were uncommon (6.5%). Surgery and radiotherapy with or without chemotherapy were the main modes of treatment in the management of malignant tumours of the maxillary sinus.
A retrospective study of 1000 cases of microscopically diagnosed head and neck cancers in the University Hospital, Kuala Lumpur was done. Head and neck neoplasms comprise 7.1% of all tumours diagnosed in this Hospital and the commonest sites of involvement are the nasopharynx (29.1%), cervical lymph nodes (22.6%), oral cavity (10.2%), thyroid (8.2%) and skin (6.5%). Histologically, 87% of tumours are epithelial in nature. The results of this study show that nasopharyngeal carcinoma is commonest in Chinese males, while oral and laryngeal malignancies occur more frequently in Indians.
Cord blood from 8,975 babies delivered in Hospital Sultanah Aminah Johor Bahru over a period of eight months (1st August 1985 to 31st March 1986) were screened for G6PD deficiency. The overall incidence was 4.5% in Chinese, 3.5% in Malays and 1.5% in Indian babies. One hundred of these babies were observed in the nursery for seven days and their daily serum bilirubin recorded. The serum bilirubin peaked at 96 hours to a value of 12mg%. None of the babies in the nursery developed a serum bilirubin level of more than 15mg%. Six of the babies with G6PD deficiency that were sent home were readmitted with hyperbilirubinaemia that needed exchange transfusion.
Sixty four percent (104 patients) of Malay patients attending the Psychiatric Clinic for the first time were interviewed. A similar number from the general Out-patients Department (O.P.D.) randomly chosen, served as the control group. Seventy six (73.1%) psychiatric patients had consulted a bomoh prior to their visit to the clinic as compared to 26 (25%) O.P.D. patients. The number of bomohs consulted was significantly higher among the psychiatric patients than the O.P.D. patients. The strength of social support, the availability of a bomoh and the belief of the patients, friends and/or relatives in the bomoh have been suggested as the main factors that influenced the Malay patients in seeking bomoh treatment. The belief that mental illness is due to supernatural causes is firmly held by bomohs who reinforce this notion in those who seek their advice. The importance of understanding the patient's cultural background in treating psychiatric patients is highlighted.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Bladder stones in men are thought to be almost exclusively due to outflow obstruction. We studied the incidence of operations for urinary outflow obstruction and bladder stone to establish the relationship between these two conditions in Kelantan. In only 48 (31%) of 154 men undergoing removal of bladder stones was a procedure for outflow obstruction performed. Thus the remaining 69% had no clinical obstruction to account for their stones. Bladder stones were more common in prostatectomy patients than expected (42/193: 22%). We suggest that other causes may be important in the aetiology of bladder stones in Kelantan.
Over a seven month period in 1986, 164 (1.1%) of a total 15,131 neonates delivered in the Maternity Hospital, Kuala Lumpur were born to mothers with prolonged rupture of the fetal membranes. Septic work-ups were performed on 163 of these babies shortly after birth, 77 of them had no bacteriological, radiological or other clinical evidence of infection. The remaining 86 had additional history of illness. Nine of these 86 babies had proven infection: four with septicemia, one with meningitis and four others with congenital pneumonia. This study showed that neonates had risk of infection only when maternal history of prolonged rupture of the fetal membranes was associated with other clinical evidence of infection. However, even in this group of neonates at risk, 89.5% of them were not infected. Therefore, there is still a need to develop a simple, rapid, reliable and cheap laboratory method to help early identification of the infected from the non-infected neonates in order to prevent unnecessary antibiotic treatment and hospital stay.