In the last four years, Malaysia has had three outbreaks of chikungunya virus infection. The first two occurred in Perak in 2006.The third began in Johor in early 2008. The genome of the viruses suggests that on each occasion a different virus was introduced into the population. The first outbreak in Bagan Panchor was due to an Asian genotype virus. The second in the Kinta district of Perak in late 2006 was due to a Central/East African genotype virus. Contact tracing was even able to discover the patient who was the source of the virus from the Indian subcontinent. The third outbreak in Johor was also of a Central/East African strain of virus, but introduced independently. The epidemiology of that outbreak is described in this issue of the MJM.
Leptospirosis is a re-emerging zoonotic infection. In developing countries large outbreaks have occurred in urban slums and following floods. Individuals from developed nations are also now more frequently exposed to the infection as a result of international travel and greater participation in certain outdoor recreational activities. Leptospirosis remains a diagnostic challenge since it often presents as a non-specific febrile event and laboratory diagnosis is still currently inadequate. Rapid tests may not be sufficiently sensitive in early disease and culture facilities are not widely available. A severe pulmonary haemorrhagic form of the infection is increasingly being encountered in many countries including Malaysia. The control of leptospirosis is largely dependent on general hygienic measures and rodent control. An effective human vaccine is still not available. There remains much that is unknown about this disease and there is scope and opportunity for good quality research.
Infectious diarrhoea is the second most common cause of morbidity and mortality worldwide. The WHO estimates that about 2.5 million people die annually as a result of infectious diarrhoea, most of them children. In 2002 about 1.6 million children under the age of five in developing countries died from diarrhoeal disease. In the United States between 211- 375 million episodes of diarrhoeal disease occur annually resulting in 73 million physician consultations and 1.8 million hospitalisations with over 3,000 deaths.
Data from the National Cancer Registry of Malaysia for 2004 provide an age-standardised incidence rate (ASR) of 46.2 per 100,000 women. This means that approximately 1 in 20 women in the country develop breast cancer in their lifetime. However, the rate differs between the three main races, the Malays, Chinese and Indians. The age standardized incidence in Chinese is the highest, with 59.7 per 100,000, followed by the Indians at 55.8 per 100,000. The Malays have the lowest incidence of 33.9 per 100,000. This translates into 1 in 16 Chinese, 1 in 16 Indian and 1 in 28 Malay women developing breast cancer at some stage in their lives. The commonest age at presentation is between 40-49 years, with just over 50% of the cases under the age of 50 years, 16.8% below 40, and 2% under 30. Some 55.7% of all cases were found to be ER positive. The commonest presenting symptom was a lump in the breast in over 90% of cases, generally felt by the woman herself. The mean size of the lump was 4.2 cm, and on average, the women waited 3 months before seeking medical attention. Over the 12-year period from 1993 to 2004, about 60-70% of women presented with early stage (Stages 1-2) while 30-40% presented with late breast cancer (Stages 3-4). Especially Malays present at later stages and with larger tumours. Consequently their survival is worse than with Chinese and Indian women. The challenge in Malaysia is to be able to provide a comprehensive service in the diagnosis and treatment of breast cancer, and this requires training of a team of health professionals dedicated to breast health, such as breast surgeons, radiologists specializing in breast imaging, breast pathologists, plastic surgeons specializing in breast reconstruction, medical and radiation oncologists, psycho-oncologists, counselors, and breast nurses. Advocacy can play a role here in galvanizing the political will to meet this challenge.
Matched MeSH terms: Breast Neoplasms/epidemiology*; Malaysia/epidemiology
The aim of study was to investigate the role of climate on the Malaria Incidence Rates (MIR) in some regions in of Yemen. For such purpose, the monthly (MIR) were calculated from the records of the hospitals' laboratories and centers of the Malaria Rollback centers in the main cities of the governorates Hudeidah, Taiz, Sana'a and Hadramout for the period 1989-1998. The readings of the climatic factors (CF) particularly the average monthly temperature (T), relative humidity (RH), volume of rain fall (RF) and wind speed (WS) for the same period of time were also collected from different weather and climatic information resources. Descriptive statistics, simple linear regression and multiple linear regression techniques were used to analyse the relationship between MIR and CF. The analysis shows highly significant relationship between MIR and the CF in these regions of Yemen (p-value 0.001).
Evidence of traumatized permanent incisors was recorded as part of a national oral health survey of schoolchildren in Malaysia. A total of 4,085 schoolchildren aged 16 years were examined. The prevalence of injury was 4.1% and it was significantly higher in males than females, with a ratio of 2:1. Almost 75% of the subjects had one tooth affected. Out of a total of 200 fractured teeth, 78.0% involved the maxillary central incisors. A high level of untreated traumatized teeth (89%) was noted. However, of the untreated traumatized teeth, only 9% presented with problems such as discoloration of tooth, sinus or abscess formation.
Gastro-oesophageal reflux disease (GORD) occurs more frequently in Europe and North America than in Asia but its prevalence is now increasing in many Asian countries. Many reasons have been given for the lower prevalence of GORD in Asia. Low dietary fat and genetically determined factors, such as body mass index and maximal acid output, may be important. Other dietary factors appear to be less relevant. Increased intake of carbonated drinks or aggravating medicines may influence the increasing rates of GORD in some Asian countries but no strong evidence links other factors, such as the age of the population, smoking or alcohol consumption, to GORD. The management of GORD in Asia is similar to that in Europe and North America but the lower incidence of severe oesophagitis in Asia may alter the approach slightly. Also, because Asians tend to develop stomach cancer at an earlier age, endoscopy is used routinely at an earlier stage of investigation. Gastro-oesophageal reflux disease is essentially a motility disorder, so short-term management of the disease can usually be achieved using prokinetic agents (or histamine (H2)-receptor antagonists). More severe and recurrent GORD may require proton pump inhibitors (PPI) or a combination of prokinetic agents and PPI. The choice of long-term treatment may be influenced by the relative costs of prokinetic agents and PPI.
An emerging infection is defined as an infection which has newly appeared in a population while a re-emerging infection is one which has existed in the past but its incidence is rapidly increasing. The reasons for the emergence and re-emergence of infections are not well understood but appear to be associated with factors that involve the pathogen, the host and the environment. These factors are often inter-related and act together in a complex manner to bring about changes in patterns of infection. Pathogens are extremely resourceful and possess mechanisms to adapt to new hosts and environments as well as to acquire new virulence traits. Host factors include herd immunity, social behaviour and demographics. Environmental factors like the climate, deforestation and new technologies have an impact on the emergence of infections. The challenge is to contain an infection when it emerges but more importantly to prevent its emergence in the first place. As the emergence of an infection is complex and multifactorial, a multidisciplinary approach is required. Health based strategies alone are insufficient. Social, economic and environmental measures and the political will to implement appropriate policies are equally important.
The social class distribution in 147 patients confirmed to have endometriosis at laparoscopy was done to see if the disease was associated with affluence. Two hundred and eighty-one patients confirmed not to have endometriosis was used as controls. The patients were derived from a background population for which the social class characteristics was known. Endometriosis was significantly (p < 0.001) associated with social class 1 and 2. However there was no association between social class distribution and the severity of the disease developed.
Data on number of cases of acute asthma seen at casualty department in 1987 as well as daily metereological data for 1987 were obtained and analysed for relation between climatic factors and acute asthma. Ambient temperature was significantly associated with acute asthma; the lower the temperature, the more the number of cases of asthma were seen. No association however was observed between asthma and the other climatic factors viz, rainfall, humidity, daily change in humidity and daily drop in temperature. We further discuss our finding.
A study has been conducted on 198 employees of a steel-mill industry. These participants were examined for mucosal lesions in the oral cavity and including the commissures and vermillion borders of the lips. The prevalences of 16 types of lesions are reported.