Eleven maternal deaths were recorded in Hulu Terengganu between 1981-1985. This represents a high average maternal mortality rate of 1.4 per thousand deliveries annually over the five years. Nine of the 11 women were high priority pregnancies, but only three had hospital deliveries. The most common cause of death was post-partum haemorrhage (PPH), and PPH with a retained placenta. Hospital deliveries constitute only a low proportion of total deliveries in the district. In a survey of women with high priority pregnancies attending antenatal clinics in Hulu Terengganu, it was found that 79 (69%) out of 115 respondents were resistant to advice for hospital delivery. Grandmultiparae were a significant proportion of this group.
Study site: Maternal Child Health Centre (Klinik Kesihatan), Hulu Terengganu, Malaysia
The eye harbours bacteria from the time of birth throughout life. Owing to its antibacterial properties, the normal conjunctival flora plays a significant role in the defence against superficial ocular infections. In view of its protective action as well as its probable role in causing ocular disease under certain circumstances, the study of the normal flora and its pattern of antibiotic susceptibility could provide useful information in the prevention and treatment of post-surgical infections. While several such surveys have been reported from various parts of the world, no data is available for the Malaysian population. This survey seeks to establish the pattern of bacterial flora in healthy conjunctivae of Malaysians. In addition, the bacterial flora of a nondiabetic population was compared to that of a diabetic population to see if there were any differences.
Only 8.4% of 1,286 Chinese boys and girls from the ages of 5-12 years in Pulau Ketam were infected with soil-transmitted helminths. The majority of these children had single infections with Trichuris or Ascaris alone. Mixed infections made up less than 5% of all infected cases. The worm burdens of infected children were very low. There was no definite pattern of distribution of infection among children of different ages and no differences in the distribution of infection between boys and girls. The main factors for the low prevalence and intensity of infection were the absence of suitable soil for the development and survival of infective helminth stages and the lack of contact with contaminated soil on this island. These two factors acted as very effective barriers to the transmission of soiltransmitted helminths on Pulau Ketam.
Scrub typhus is an endemic problem in Malaysia. Yet its diagnosis appears to depend heavily on the Wetl-Felix test as the more sophisticated diagnostic procedures are not available routinely. We therefore reviewed our experience with scrub typhus patients treated at the Melaka General Hospital from 1983 to April 1986, to identify those clinical features which are diagnostic of this rickettsial illness. Based on the clinical presentation of our patients and the dramatic response of scrub typhus to Doxycycline, we propose a clinical approach to diagnosis until more specific and cheap diagnostic procedures become available in our laboratories. Otherwise, this rickettsial illness will continue to be under-recognised.
A prospective clinical study comparing 74 cases of rotavirus-associated diarrhoea and 100 cases of non-rotavirus-associated diarrhoea revealed a higher incidence of vomiting to be the only significant difference in the former. Bloody stools were seen in about 5-10%, fever in about two-thirds and respiratory symptoms in a quarter of cases regardless of aetiology. The overwhelming majority had mild dehydration of the isonatremic type. Hypokalemia was noted in a quarter of the cases in both groups.
Keywords: General Hospital Kuala Lumpur
There is universal concern on the current inequitable coverage and low quality of health care. The lead roles of medical practitioners in health care and how they are prepared for such roles are being re-examined in many countries. This paper attempts to rationalise the need to reorientate medical education towards primary health care, and to suggest possible emphasis and direction for change.
Malaria is the most important communicable disease in the field for the Malaysian soldier. His chief weapon is chemoprophylaxis. This was proguanil hydrochloride in the '50s, changed to Daraclor in 1962; since late 1985, Fansidar only is used. The incidence of malaria over the years has fluctuated widely and had its peak in 1977 at 29.7/1,000 soldiers and since then has shown a downward trend. Studies carried out to study the problem are noted briefly. Antimalarial discipline in the field, continued surveillance and integrated control measures in the base are emphasised in the fight against malaria.
Coronary atheroma is the principal cause of ischaemic heart disease. Among the factors considered to predispose to atheroma formation is raised plasma cholesterol and although it is regarded as a minor risk factor by some, others see its contribution as one of major importance. Whichever the view, the debate on plasma cholesterol and coronary heart disease (CHD) has long moved out of the exclusive domain of the scientific journal to the public arena and is reflected in the increasing frequency with which doctors are consulted by patients on the subject. The incidence of CHD in South-East Asian countries is also rising. For the practising clinician, the problem resolves itself into deciding if the evidence incriminating plasma cholesterol as a predisposing factor is strong enough, and if it is, what prophylactic and therapeutic steps are of value in reducing the incidence of CH D. An updated and brief review of lipid metabolism and the relationship of lipids to CHD is now necessary in view of the rapid accumulation of data from recent trials and prospective studies.
Demonstration of arrested intracerebral blood flow is the ultimate evidence of brain death. Computerized radionuclide cerebral flow study was done on 18 patients diagnosed clinically as brain dead. Correlation was made with clinical neurophysiological and EEG findings. The criteria for diagnosis of arrested intracerebral perfusion using radionuclide flow study were: non-visualization of blood flow activity in the intracranial arteries during the arterial phase, diffused cerebral activity during the capillary phase and non-filling of venous sinuses during the venous phase; visualization of typical 'hot nasal' activity; the time activity curve over the cerebral hemispheres lacks a bolus effect and instead shows a delayed gradual rise of activity. These features are pathognomonic of brain tamponade.
Arrested intracranial circulation was seen in 16 patients (ten had electrocerebral silence; one had extremely abnormal EEG with small voltage activity and five had no EEG done). In the remaining two patients, some cerebral blood flow was demonstrated (one had no definite cerebral activity and the other had diffused EEG activity).
Radionuclide cerebral flow study is a very sensitive, accurate, safe, simple, rapid and non-invasive modality in confirming brain death and is especially useful in patients on "brain-protection" regime, in hypothermia or in certain metabolic states where diagnosis based on clinical and EEG criteria is difficult. EEG need not be a required procedure once brain death is established by the demonstration of arrested intracranial circulation.
The morphology, incidence and distribution of hyaline cells in ten cases each of pleomorphic adenoma, adenoid cystic carcinoma, adenocarcinoma and mucoepidermoid tumour were studied by conventional light microscopy. Results showed that the hyaline cells were identified in 60% of pleomorphic adenoma and in 20% of mucoepidermoid tumours, but were absent in adenoid cystic carcinoma and adenocarcinoma. Relative area estimation of hyaline cells in pleomorphic adenomas showed that this may range from 2.2% to 30.4% of the total tumour area. The usefulness of the hyaline cell as a diagnostic criteria in distinguishing between some of the salivary gland tumours was also discussed.
When referring to amputation, the immediate association tends to be amputation related to trauma. There is little doubt that injury is by far the commonest cause of amputation, but one must not forget that babies might also be born with amputations of the upper limb. This latter group of amelia composes the various types of congenital amputations.
Serological markers were used to determine the infective agents causing acute viral hepatitis in 246 patients. The frequencies of the five viral infections investigated were: non-A, non-B hepatitis - 99 patients (40.2%); hepatitis A - 98 patients (39.8%); hepatitis B - 43 patients (17.5%); cytomegalovirus - 4 patients (1.6%); and Epstein-Barr virus - 2 patients (0.8%). The log mean ages of presentation for the three predominant infections were: hepatitis A - 18 years; hepatitis B - 25 years; and non-A, non-B hepatitis - 30 years (F = 18.8, p =< 0.001). 52% of all cases were Malays (expected 32. 7%); 32% Chinese (expected 54.6%); and 16% Indians (expected 1l.5%) (X2 = 53, p = < 0.001). Hepatitis A virus infection was more common amongst Malays whilst non-A, non-B hepatitis was more frequent amongst Chinese and Indians. 28% of children <16 years) and 50% of adults had serological markers of previous hepatitis B infection. The variation in frequency for the different forms of hepatitis amongst the three main ethnic groups would suggest that socioeconomic and/or cultural factors are important in the propagation of acute viral hepatitis in Malaysia. HBsAg-negative chronic liver disease in our community may be a product of the high incidence of non-A, non-B hepatitis.
An uncommon problem that can present as a surgical emergency is described and the aetiology of priapism and its management is alluded to in the light of simpler surgical measures that are presently available.
The common chromosome abnormalities that are encountered in the various types of leukemia are discussed here. Chromosome abnormalities in leukemia are non-random and certain chromosomal changes are now becoming recognised as being rather specific for certain leukemia types.
One of the important functions of the Coronary Care Unit (CCU) is the continuous and intensive monitoring of cardiac function. To date, many monitoring techniques have been developed and tested. In this paper, both the conventional and computerised monitoring techniques are reviewed and evaluated. It is shown that a computerised system has several defirute advantages over the conventional system, e.g. lower false alarm rate, accurate and fast data processing, retrospective studies. However one also ought to be aware of the limitations,
A survey was conducted on three different groups of population viz. inpatients in the medical wards of General Hospital, Kuala Lumpur, the people of Kampong Pandan and two rubber estates as to their analgesic consuming habits. It is found that 0.5 to 2.0% of the people surveyed had consumed more than 2 kg of analgesics and 4.6 to 9.6% of the people surveyed had consumed more than 250g of analgesics. The commonest analgesic consumed is paracetamol followed by Chap Kaki Tiga and Chap Harimau. The commonest reason for consuming analgesic is headache. The implications of the above findings are discussed.
Perforated appendix is a serious surgical condition that carries a high morbidity. Antibiotic treatment is often started before the availability of bacteriological reports. The choice of antibiotics would depend on the bacteriology associated with perforated appendix. In a retrospective survey of the bacteriology of peritoneal pus obtained from cases of perforated appendix at the General Hospital, Kuala Lumpur, E. coli was found to be the most commonly encountered organism. This was followed in order of decreasing frequency by streptococci, Bacteroides species, Klebsiella-Enterobacter group and Pseudomonas aeruginosa. From the results of the antibiotic sensitivities an antibiotic regimen comprising of a combination of gentamicin, metronidazole and penicillin is recommended as appropriate chemotherapy in perforated appendix.