This is an interesting comparison between the types of leprosy seen among Chinese, Malays and Indians in Malaya, based on a large experience. The disease is most virulent among Chinese and least so among Indians, three-fourths of the cases among the latter being of mild tuberculoid disease with a tendency to self-healing, but among the Chinese only one-third are of the tuberculoid type. The climate of Malaya is of the hot humid type, in which leprosy flourishes. On the other hand, a higher standard of living than in India tends to hinder the spread of the disease. The age incidence is important. Among, the Chinese, early macules are commonly found in children of 5 to 15 years of age, most of which tend to clear up, but in about one-fourth tuberculoid lesions develop and may go on to the lepromatous condition, especially if the onset of the tuberculoid stage occurs early. When a reliable history is obtained in Chinese, in nearly every lepromatous case a tuberculoid stage was first observed, commonly in the age group 16-40. In a smaller number of persons of over 40 years of age, the proportion of tuberculoid cases is very much higher, but the tendency to become lepromatous is very much less. Major tuberculoid cases are more liable than minor to become lepromatous, but nerve thickening in tuberculoid leprosy is less evident in Chinese than in Indians and it is rare in children and in those over 40. In view of the foregoing peculiarity of the evolution of leprosy in tuberculoid cases in Chinese subjects, active treatment is necessary, in order to prevent them becoming lepromatous. For this purpose, intradermal injections are of little value and they tend to obscure any evolutionary changes. Hydnocarpus oil or esters (deep subcutaneous injections) should therefore be pushed to the limit of tolerance in doses of 1 cc. per 10 pounds body weight twice weekly, or 30 cc. per week, for a patient of 150 Ibs. as a minimum and increased by at least fifty per cent, in acute or reacting cases, when improvement may be expected within three months. Some years' experience of this intensive treatment as compared with weekly injections of 1-5 cc. has shown much more marked improvement and much less incidence of lepromatous change with the high doses. In lepromatous cases, reactions should be avoided, but dosage should be as high as possible short of producing increased erythrocyte sedimentation and plantar pain on heavy stroking. Surveys of school children are of great importance in finding the early macular stage and their discovery may lead to the detection of infective adults who require to be segregated. L. Rogers.
Despite evidence showing that structured rehabilitation after stroke improves functional outcomes, providing seamless rehabilitation from hospital to community has been elusive. The service provided should be able to accommodate variable degree of impairments and needs of the stroke survivors. This study aimed to assess the outcome of a multidisciplinary-based outpatient rehabilitation service for stroke patients living in the community. Patients who were discharged from Universiti Kebangsaan Malaysia Medical Centre after an acute stroke were referred to the Combined Stroke Rehabilitation Clinic (CSRC). Post stroke patients were assigned individually designed programs which were problem based and used task specific activities to achieve desired goals. Patients were reviewed on a regular basis either up to completion of the 2 year program, or are able to be discharged to the community, whichever is earlier. Modified Barthel Index (MBI) and Berg Balance Scores (BBS) were used for monitoring. A total of 68 patients were managed in CSRC for two years since its initiation, with mean age of 62.4 years (SD 12.4) with the mean duration of stroke when first reviewed in CSRC was 11.5 months (SD 11.9). Majority of patients (64.7%) received either two or three types of intervention. Both MBI and BBS demonstrated significant improvement over 12-months period (p value of 0.006 and 0.017 respectively). CSRC proved that structured rehabilitation intervention was beneficial in terms of functional status and improvement in balance to post-stroke patients.
Study site: Combined Stroke Rehabiltation clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The purpose of this study is to determine the standard value of corneal thickness (CCT) and its relationship with the degree of myopia amongst one sample of myopic students in Malaysia. Eighty-four myopic subjects (168 eyes) were examined in this study. Ocular examination included subjective refraction, keratometry (Shin-Nippon, Japan) and optical pachometry (Sonogage INC). Corneal thickness was measured at five different locations i.e. central, superior, inferior, nasal and temporal of the cornea. However, only association of CCT with myopia is reported in this article. Mean age of subjects was 21.42 ± 1.47 years old (20.34 ± 1.15; 22.46 ± 0.88). Mean refractive error in spherical equivalent for the whole sample was –3.50 ± 2.10 DS. Mean corneal curvature for the all subjects was 7.74 ± 0.52 mm and mean value of CCT was 594.62 ± 66.51 mm. Significant differences (p < 0.05) were found between mean CCT of low myopes (-4.00DS and below) and higher ones (-4.25DS and above), but not with mean of keratometer readings. Poor correlations were obtained between refractive error and CCT (r = 0.125, p > 0.05) and between refractive error and corneal curvature (r = 0.24, p > 0.05). It was concluded from this study that high myopic subjects has significantly thinner CCT than lower ones. Measurement of CCT should be considered when undertaking procedures such as LASIK and orthokeratology.
A cross-sectional study was conducted in May 2007 on stress and stress self management among the prisoners and wardens of a prison in Selangor. This study was conducted as part of an elective posting for second year medical students and the topic was chosen to add on to the body of knowledge on stress among prisoners and wardens. A self administered questionnaire was distributed by random sampling and the respondents consisted of 100 prisoners and 97 wardens. Majority of the prisoners did not have stress with reference to interpersonal factors such as conflict with cellmates, conflict with wardens and conflict with inmates, For interpersonal factors, majority of the prisoners experienced stress because they felt bored (78%), thought they had no bright future (63%) and they also had no visitors (61%). Stress resulted in physical effects, whereby 67% admitted that they experienced health problems and 64% experienced sleep disturbance. Emotional effects of stress experienced by the prisoners were sadness (67%), anxiousness (63%) and confusion (56%). The major spiritual effect was regret (84%) followed by feeling closer to God (78%) and feeling high spirited (59%). The major social effects experienced by
the prisoners were low self esteem (63%) and embarrassment (58%). Methods of stress self management were prayers and conduct of religious activities (87%), sharing problems with friends (78%), doing recreational activities (77%), sleeping (72%) , doing a hobby (68) and seeking help from doctors (57%). As for the wardens, with reference to interpersonal factors, high level of stress was experience with reference ta prisoners behavior (82.5%) and problems with higher authorities (83.5 %), For intrapersonal factors, sleep disturbances (64%), career problems (76.3%), financial problems (73.2%) and feeling bored (75.3%) highly contributed to stress. Wardens physical effects were 38.1% health problems and 29.9% sleep disturbances. For emotional effects, must of them were depressed (54.6%), anxious (67%), angry (63.9%), confused (64.9%), frustrated (59.8%), threatened (53.6%) and patriotic (51.5%). The spiritual effect were feeling closer to God (86.6%), feeling responsible for duties (82.5%), regret doing the job (74.2%), feeling high spirited (58.8%). For social effects, low self esteem is the highest effect experienced (68%). Wardens managed stress by praying and conducting religious activities (91.8%), recreational activities (88.7%), doing a hobby (85.6%), sleeping (74.2%), and sharing problems (68%).
Home phototherapy treatment has been available in the Klang Valley (comprising Petaling ]aya, Kuala Lumpur; Shah Alam and Klang) since 2003. This study was conducted to create awareness of the existence of home phototherapy and its usage in Malaysia. This was a retrospective study using 1297 informed consent forms that parents had to read and sign prior to the commencement of home phototherapy. lt was found that the majority ofthe babies was males (41.2%), at or over 36 weelds gestation (97.2%), from areas in Selangor (57.4%), fully breastfed (53 %) and referred by doctors (98%). The mean age of the babies at initiation of lwme phototherapy was 6. 7 days. The mean bilirubin level at the start of home phototherapy was 243.8 umoVL and the mean bilirubin level at the end of home phototherapy 5 was 139.3 umoVL. The mean decrease in bilirubin level was 103.12 umoVL and the mean number of days of usage was 3.5 days which is a daily decrement of about 29 umoVL (29.46 + 13.8). Home phototherapy remains a viable clinical option for full term babies with physiological jaundice.