19,983 cases of diarrhoea throughout Sabah, Malaysia from January 1971 to December 1978 were bacteriologically examined for Shigella. A total of 241 Shigella isolates representing 9 serotypes were encountered. S. flexneri and S. sonnei accounted for 69.7% and 29.5% of the isolates respectively. S. flexneri type 2 was very common and comprised 47% of the flexneri strains. S. flexneri types 5.6 and Y were rarely found. Only two cases of S. boydii were isolated. S. dysenteriae was not encountered. Isolation rates ranged from 0.64% to 1.73% while the percentages or cases of diarrhoea bacteriologically examined in relation to the number notified range from 13.7 to 29.6. Kota Kinabalu. Tawau and Sandakan accounted for 50.6%. 21.2% and 8.2% of Shigella isolates respectively. However. no isolations were made from Lahad Datu, Semporna and Victoria [Labuan Island]. S. flexneri type 5 was only found in Sandakan while S. flexnert type Y was isolated from Kota Kinubulu. No S. Sonnel was found in Ranau and Tenom.
The code of ethics derived from the Hippocratic Oath needs to be supplemented by a formal curriculum in Medical Ethics and Medical Humanities in our Medical schools. The need and justification for it, a review of the medical ethics curricula in American. European. British and Australian Universities, together with an outline of the proposed curriculum is described.
This was a retrospective study of 177 patients above the age of 45 who were admitted to the Psychiatric Unit, University Hospital Petaling Jaya during the period October 1975 to October 1978. The available socio-demographic and clinical data from the case files were studied. The patients were divided into two groups - those with effective illnesses and those with non-affective illnesses. The differences in socio-demographic background and clinical symptomatology between the two groups and how the data compares with that in other studies was reported. The sick elderly person is an economic and psychological liagility to .his family and society. Absence of illness in the elderly not only fosters their continued independence but also improves the quality of their individual life. Though no definite correlations or conclusions could be arrived at, this study has sought to bring into awareness the necessity of delineating possible illness precipitating stress factors in the social and domestic environment of patients in later life.
Improvements in the overall treatment of patients with aggressive, large tumours involving the bone have made it possible to preserve and salvage limbs instead of amputating them. Each patient is unique in his clinical presentation and social circumstance. The different reconstructive options available allow us to choose the most appropriate method suited to the particular patient and with minimal delay, even when resources are limited. The patient and the relatives actively participate in the choice. The early experience of the different techniques for reconstructing these bone defects at our hospital are presented in this paper.
The aim was to determine the differences in parents' perceptions of boys' and girls' body shapes and the explanations for the emphasis on body shape care of children. Subjects were low-income parents (n = 158) of preschoolers attending preschools in Kuala Lumpur, Malaysia. Parental perceptions of children's body shapes were assessed based on their rankings (scale of 1 to 7) of four attributes (ideal, healthy, fat and thin) for boy and girl figures. Parental responses to five questions on the importance of body shape were also obtained. Parental rankings of ideal and healthy body shapes were significantly lower for girls than boys (p < 0.001). However, mothers' and fathers' rankings of boys' and girls' body shapes were not significantly different. for both boys and girls, parental ratings for ideal body shape were significantly lower than for healthy body shape (p < 0.001). The majority of parents indicated that children's body shape is important for their future health, self enhancement, social interaction and career. With the increasing prevalence of body dissatisfaction among Malaysian children, these findings contribute to the understanding of parental roles in the development of body image and perhaps, in the etiology of body dissatisfaction among children.
The aim of this study was to assess the effects of treating lower urinary tract symptoms (LUTS) on the quality of sexual function in a one-year follow up. A total of 116 patients with LUTS received alpha-blocker treatment, 111 patients underwent transurethral resection of the prostate (TURP) and 70 patients with renal stones, with no or mild symptoms served as a control group. The patients were assessed at baseline, three months, six months and twelve months using the International Index of Erectile Function (IIEF-15). The surgical group exhibited some changes in the domain of IIEF-15. Patients in the medical group showed improvement in erectile function and intercourse satisfaction, while orgasmic, overall sexual satisfaction and sexual drive were relatively unchanged. In contrast, the surgical group suffered retrograde ejaculation and overall sexual dissatisfaction after undergoing TURP. TURP has been found to be associated with retrograde ejaculation intercourse and overall sexual dissatisfaction.
We report here a case of a kidney transplant recipient in whom the ureter was initially implanted into the peritoneum. Excessive ultrafiltration volume and reversal of serum vs dialysate creatinine ratio when the patient was recommenced on continuous ambulatory peritoneal dialysis first suggested the diagnosis which was subsequently confirmed by a plain abdominal x-ray demonstrating placement of ureteric stent in the peritoneum. This rare complication was successfully corrected with surgical re-implantation of ureter into the bladder and 5 years later, the patient remains well with good graft function.
Perforation with extravasation of barium is a rare complication of contrast enema examination of the large bowel with a high associated mortality rate. The experience of performing a re-laparotomy in a patient previously exposed to barium peritonitis is even less common. We describe an elderly male patient with a Hartmann's procedure performed a year previously, presenting with peritonitis following barium enema evaluation of the proximal colon via an end descending colon stoma. Emergency laparotomy, segmental bowel resection and liberal peritoneal toilet resulted in a satisfactory outcome. The patient had a subsequent successful reversal of his Hartmann's procedure nine months later despite the presence of dense barium induced adhesions. This potentially preventable iatrogenic complication is discussed in this report, which is supplemented by a brief review of the English literature.
We report the case of an infant who was found dead in the toilet of a nursery. Examination of the scene revealed an element of neglect in the care of the child. Postmortem showed evidence of drowning. Her blood sample showed a toxicologic evidence of alcohol exposure.
A 25-year old primigravida at 11-weeks period of amenorrhoea presented with bilateral optic neuritis following Varicella Zoster viral (VZV) infection. She was serologically positive for systemic lupus erythematosus but negative for virus. The exact pathogenesis of the patient's severe optic neuritis, adduction and neurological deficit was unknown. The initiation of high dose steroids for optic neuritis was a big clinical dilemma in a pregnant patient with viral infection. The patient was treated with high dose steroids after three days of commencement of antiviral treatment. At 6 months after presentation, her visual acuity in the right eye was 6/36 with perception to light in the left.
Choroid plexus carcinoma is a rare intracranial neoplasm, affecting mainly very young children. The commonest site is within the lateral ventricles and the prognosis is very poor. We report a seven month old baby boy who presented with raised intracranial pressure and seizures. Brain CT scan showed large intraventricular mass with calcification and hydrocephalus. Total macroscopic resection of the tumour was performed and diagnosis of choroid plexus carcinoma was made. However, the patient died 11 days after the tumour excision. The histopathology of this rare childhood neoplasm is discussed.
Gastric cancer is an important cause of death among patients with malignancies in Malaysia. Survival of patients with gastric cancer is dependent on the stage at which diagnosis is made. We report our experience in dealing with gastric cancer in a major Ministry of Health Hospitals in Malaysia. A retrospective review of two hundred and fifty consecutive histologically proven gastric adenocarcinoma at Hospital Ipoh for the period January 1988 to 1998 was performed. The study confirms that gastric cancer is a disease of the elderly and has a male preponderance. It is also identifies the Chinese and Indians to be at increased risk of gastric cancer when compared to the Malays. The most striking finding in this study was the very late stage of disease at time of presentation. Eighty-two percent of the patients presented with stage IV disease and curative surgery was offered only to a 16% of them. In a substantial number of patients not even a palliative procedure was offered. Early detection is the key to improving survival in gastric cancer patients. There is an urgent need for clinicians to change their approach to the management of the disease. Patients with dyspeptic symptoms should be investigated early rather then wait for classical symptoms of gastric cancer.
Recurrent vaginal candidiasis is one of the most common reasons for patients visiting their primary care doctors. Majority of the cases are caused by Candida albicans. Controlling of risk factors such as diabetes mellitus, used of broad spectrum antibiotics, contraceptive pills and steroid therapy helps in managing recurrent vaginal candidiasis. Initial 14-day course of oral azoles and followed by 6 months maintenance are effective in treating majority of the cases. Failure to treat recurrent vaginal candidiasis can lead to various bio-psycho-social complications.
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system (CNS) that is known to occur spontaneously in association with specific and non-specific viral illnesses and after vaccination against various pathogens. Although it is often a self-limited monophasic illness, the fatality rate is estimated to be as high as 20%, and many patients suffer residual neurologic impairment 1. The diagnosis is mainly based on clinical and radiological findings. The clinical presentation varies from merely, an asymptomatic condition to loss of consciousness, seizures, ataxia, optic neuropathy, cranial nerve palsies, and motor dysfunction. MRI of the brain is the single most important diagnostic radiological investigation and can facilitate early diagnosis and prompt treatment. This case report describes a patient with ADEM presenting with only seizures after vaccination with anti-tetanus toxin.
Pancytopaenia is a rare clinical presentation of severe leptospirosis. We would like to report a case of severe leptospirosis that progressed to pancytopaenia despite initial penicillin therapy. The patient needed a second course of antibiotic with doxycycline to improve his persistent symptoms and cytopaenia. Persistent pancytopaenia in severe leptospirosis and its management were reviewed.
We present an elderly patient with a squamous cell carcinoma over the subcutaneous aspect of the leg involving the tibia. En bloc resection of the tumour together with a 10 centimetre segment of the tibia was done. The resected bone was autoclaved, replaced in its original position and stabilized with bone cement and a locked nail. This allowed early ambulation with minimal cost.