Breast cancer is the leading cause of cancer deaths in Malaysian and Singaporean women. A study done to compare the epidemiology of the disease, as well as to compare the rate of conservative surgery between Malaysian and Singaporean women was carried out. The results show that the median age at presentation was the same in both countries, and the incidence was lower among the Malays. However, there was a significant difference in the stage at presentation and the tumour size; Singaporean women presented at earlier stages and with smaller tumours compared to Malaysian women. This led to a lower rate of conservation surgery in Malaysian women.
We performed a vision screening of 1883 Chinese schoolchildren from 4 schools around Kuala Lumpur in June 1990. The group contained 1083-males and 800 females. Visual acuity, refractive error, oculomotor balance, and axial length were measured. The prevalence of myopia in Chinese schoolchildren was found to be 37% in the 6- to 12-year age group and 50% in the 13- to 18-year age group. Approximately 63% of the sample had unaided visual acuity of 6/6 or better and 24% had unaided acuity of 6/12 or worse. Six hundred twenty-five students (33%) failed the vision screening test and were referred for further examinations. The group which failed the vision screening test and had the highest rate of referral (46%) was the 11- to 12-year-old age group. The most common visual disorder was uncorrected myopia, accounting for 38% of the referrals (235 students). Only 26% of the sample were wearing a spectacle correction.
A total of 89 histopathologically proven ocular tumours and tumour-like lesions treated in Hospital University Sains Malaysia, Kubang Kerian, Kelantan over a period of nine years were reviewed for their age distribution, site of lesion and histological type. The tumours were observed in all age groups with a maximum prevalence in the first decade. Twenty lesions were malignant and 69 were benign. The eyelid was the most frequent location (51%), followed by the conjunctiva (32%). Retinoblastoma was the most common malignant tumour (10 cases) and dermoid cyst was the most common tumour-like lesion (16 cases).
The efficacy of a single-dose 400 mg albendazole to treat Ascaris, Trichuris and hookworm infection was studied in Orang Asli community. Kato-Katz examination was performed on fecal samples which were collected before treatment, 1 and 4 months after treatment. A total of 123 children were involved in all three surveys. The cure rate of Ascaris infection was 97.4% and the egg reduction after treatment was 99.9%. The cure rate for hookworm infection was 93.1% with 96.6% egg reduction. Although the cure rate was low in Trichuris infection (5.5%), egg reduction was more evident (49.1%). The reinfection rate at 4 months after treatment was 54.5%, 3.6% and 10.3% for Ascaris, Trichuris and hookworm infection, respectively. Within 4 months after treatment almost one-fifth children with Ascaris and hookworm infection reached pre-treatment intensity infection. In Trichuris infection, however more than half of the children reached their pre-treatment intensity infection at 4 months after treatment. Findings suggest that 4-monthly targeted periodic treatment with 400 mg single-dose albendazole in highly endemic areas can have a significant impact on intensity infection of Ascaris and hookworm, but not on Trichuris infection.
Records of 183 patients with renal stones managed at Hospital Universiti Sains Malaysia between 1985 and 1995 were retrospectively evaluated. The commonest symptom was lumbar pain which may be associated with either frequency, blood stained urine or dysuria. One hundred and sixty-one patients (88%) had upper tract stones while the remainder had lower tract stones. Positive urine cultures were seen in 33 patients. The commonest organism isolated was Escherichia coli followed by Klebsiella aeruginosa and Staphylococcus aureus. Almost all of our patients had renal impairment at presentation and 70% of them progressed to chronic renal failure. In contrast to previous findings, the pattern of renal stone in this region is similar to that described in Western society. Its effect on renal function is serious and hence warrant special attention.
Maximal static inspiratory and expiratory mouth pressures (PI,max and PE,max, respectively) enable the noninvasive measurement of global respiratory muscle strength. The aim of this study was primarily to obtain normal values of PI,max and PE,max for adult Chinese, Malays and Indians and, secondarily, to study their effect on lung volumes in these subjects. Four hundred and fifty two healthy subjects (221 Chinese, 111 Malays, 120 Indians) were recruited. Measurements of PI,max from residual volume (RV), PE,max from total lung capacity (TLC) and forced vital capacity (FVC) were obtained in the seated position. There were significant ethnic differences in PI,max and PE,max measurements obtained in males, and FVC measurements in both males and females. Chinese males had higher PI,max values (mean (+/-SD) 88.7+/-32.5 cmH2O) and higher PE,max values (113.4+/-41.5) than Malay males (PI,max 74.0+/-22.7 cmH2O, PE,max 94.7+/-23.4 cmH2O). Chinese males had higher PE,max than Indian males (PI,max = 83.7+/-30.0 cmH2O, PE,max 98.4+/-29.2 cmH2O). There were no significant differences among Chinese females (PI,max 53.6+/-2.3 cmH2O, PE,max 68.3+/-24.0 cmH2O), Malay females (PI,max 50.7+/-18.3 cmH2O, PE,max 63.6+/-21.6 cmH2O) and Indian females (PI,max 50.0+/-15.2 cmH2O, PE,max 60.7+/-20.4 cmH2O). In both sexes, the Chinese had a higher FVC compared with Malays and Indians. After adjusting for age, height and weight, race was still a determinant for PE,max in males, and FVC in both sexes. The FVC only correlated weakly with PI,max and PE,max in both sexes. Ethnic differences in respiratory muscle strength, and lung volumes, occur among Asians. However, respiratory muscle strength does not explain the differences in lung volumes in healthy Asian subjects.
All post-neonatal children with acute non-traumatic coma admitted over an 8-month period were analysed and followed up for 18-24 months to determine the aetiology and outcome of their coma. One hundred and sixteen children, 72 boys and 44 girls, were recruited. Half the children were under 1 year of age and only 16 (14%) were more than 6 years of age. Eighty cases (69%) were due to infection, 15 (13%) to toxic metabolic causes, six (5%) to hypoxic ischaemic insults, four (3.5%) had intracranial haemorrhage, nine (7.8%) were due to miscellaneous causes and in two (1.7%) the cause was unknown. Seven cases were lost to follow-up. Of the remainder, 39 (35.7%) died, 32 (29.3%) developed permanent neurological deficit, and 38 (35%) were discharged well. The outcome was worst in the infectious group. Age of onset and sex did not significantly affect outcome. Our findings are similar to experience in Japan, where infection accounts for 74% of non-traumatic coma, but differ considerably from Western data on childhood coma where only a third of cases are due to infection.
This is a descriptive epidemiologic study that was done retrospectively for the years 1990-1996. The objective was to determine whether tumours less than 4 cm in diameter are common and thereafter suitable for radiosurgical treatment. The results showed that the incidence of brain tumours less than 4 cm in diameter was 73.3% and about 20% were situated in the eloquent area.
The aim of this retrospective study was to characterise the clinical presentation and disease associations of Oriental patients with gout seen in our hospital over a six-month period. One hundred patients comprising of 77 males and 23 females [89% Chinese, 7% Malays, 2% Indians and 2% others; mean age was 50.9 years (range 18 to 82 years), mean age at onset of disease was 43.7 years (range 16 to 78 years)] were studied. The disease was familial in 18% and 44% of patients had a history of alcohol ingestion. Co-morbid conditions included hypertension (36%), hyperlipidaemia (25%), renal failure (17%), ischaemic heart disease (13%), diabetes mellitus (4%), systemic lupus erythematosus (3%), psoriasis (2%) and ankylosing spondylitis (1%). The majority of patients (68%) had at least one associated disease. At the onset of disease, the joints commonly involved were the ankles (39%) and knees (27%) whilst the first metatarsophalangeal (MTP) joint was affected in only 26% of cases. Polyarticular onset was uncommon (n = 6). The precipitating factors reported by the patients included food (n = 23), alcohol (n = 12), drugs (n = 4), trauma (n = 3) and surgery (n = 2). Eleven patients had a history of renal calculi and 15% had tophaceous gout. Majority of patients (71%) had been treated with urate-lowering drugs (allopurinol). We concluded that gout in Singapore predominantly affects middle-aged men who often have an accompanying illness.
This paper presents the results of a clinical study of 150 patients in Singapore with ankylosing spondylitis (AS) and reviews recent developments locally with regards to the disease. The patients were predominantly males (ratio 7:1) and Chinese (n = 147). The onset of disease is usually in the early twenties and there was a mean delay of 6.3 years before diagnosis was made. Peripheral joint involvement is common but apart from uveitis (17%), extra-articular manifestations are rare. AS patients have abnormal lipid profiles and lower bone mineral density compared to healthy controls. HLA*B2704 is the predominant subtype in our Chinese patients whilst HLA*B2706 was found only in healthy controls. Intensive group physiotherapy is beneficial for patients with spondyloarthropathy.
Parasitic infections have been reported to be relatively common among the Southeast Asian labourers in Taiwan. This study, conducted in 1992-6, was designed to determine the temporal changes of the prevalence. Faecal specimens were examined by the formalin-ethyl acetate sedimentation technique and blood samples screened using the quantitative buffy coat technique and confirmed by Giemsa stained blood smear. The overall prevalence of intestinal parasitic infections was 10.3%. The annual prevalence decreased from 33.3% in 1992-3 to 4.6% in 1995-6. The Thai (12.0%) and Indonesian (11.1%) had a higher prevalence than the Malaysian (6.7%) and Filipinos (5.9%). Opisthorchis viverrini was the most important parasite in the Thai and Trichuris trichiura in the remaining groups. Moreover, no blood parasites were found in the labourers. The dramatic temporal decline in the intestinal parasitic infections suggests that limiting the entry of infected persons, periodic follow-ups, and immediate treatment of sporadic cases are necessary in preventing transmission of non-indigenous parasites through large population change.
A prospective observational study was carried out at the Emergency Department, Hospital Kuala Lumpur to determine the proportion of accidental head injury among children and the circumstances of injury. The study was carried out from November 1993 to January 1994 on all children below 14 years who presented to the Emergency Department with accidental head injury. Accidental head injury made up (4.75%) of all cases seen at the Casualty Department. The ratio of boys to girls was 2:1. The mean age of head injured children was 5.2 (S.D. 3.63) years. The leading cause of head injury was fall (63%) followed by road traffic accidents (RTA) in (30.7%) while the rest were due to 'impact' (injury caused by flying object or missiles) injuries. More than half (54.4%) of those injured in RTA were pedestrians. Pedestrian injury was particularly important in the 5-< 14 years age group, where adult supervision was lacking in two thirds of the children. None of the patients who were involved in vehicle-related injuries had used a suitable protective or restraining device. All three patients who died were from this group. This study emphasises the need for stricter enforcement of laws related to the use of protective devices and measures to decrease child pedestrian injury. The issues of lack of adult supervision, both in and outside the home need to be addressed.
The Gibbs canonical ensemble of statistical mechanics is used to describe the probability distribution of the age classes of mothers of new-borns in an age-structured population. The Malthusian parameter emerges as a Lagrange multiplier corresponding to a generation time constraint, while a new perturbation parameter appears as the Lagrange multiplier corresponding to a maternity constraint. Classical Lotka stability reduces to the unperturbed case of the more general canonical ensemble model. The model is used in a case study of the female (peninsular) Malaysian population of 1970. The Malthusian parameter and perturbation are calculated easily by linear regression. Use of the model identifies an anomaly in the population due to the effects of World War II.
The main objective of this study was to survey the prevalence of hypertension in Malaysians aged 55 years and above who responded to a public health screening campaign in Kuala Langat district, Selangor, Malaysia. The relationship between the detection, treatment and control in the study population was also examined. An epidemiological survey of the elderly was conducted in Kuala Langat, a rural district in Malaysia for a consecutive period of six weeks. The survey was conducted using a standardized questionnaire and interview by trained research assistants. The medical students and nurses were trained on the correct protocol of measuring blood pressure based on the recommendations of the British Hypertension Society. Newly detected persons with blood pressure readings 160/95 mmHg and above, were given a green card to return to the nearest health center for a further 2 visits to check his/her blood pressure. A total of 1,392 people with a mean age of 65 years and comprising of 53.1% males and 46.9% females responded to the health survey. Based on the history 335 (24.1%) of the respondents were known hypertensives and 82.1% of this hypertensive group were on regular treatment. However good control of hypertension was achieved only in 161 (48.1%) of them. Newly detected hypertension was found in 204 (14.6%) of the respondents. The overall prevalence of hypertension in our sample of respondents was 25.6%. There was no significant difference between the sexes and the races in terms of their detection, treatment and control. However there was a significant difference between the persons aged less than 65 years of age and those older than 65 years. There was a large proportion of previously known hypertensives among the survey population. Of those detected, not all were on regular medications and the majority on medications were not well controlled. Education of the public through intensive public health campaigns is vital to improve their knowledge on hypertension and the need for effective control. More community studies are needed to formulate better methods in the detection, treatment and control of hypertension.
A study on prevalence and risk factors of Giardia duodenalis infection was conducted in rural communities of Malaysia. A total of 917 individuals between 2-70 years old (431 males and 486 females), participated in this study. The overall prevalence of G. duodenalis infection was 19.2%. The prevalence was significantly different between different age groups, but not genders. Our study indicated that age < or = 12 years old and the presence of family members infected with G. duodenalis were the risk factors of infection. Person-to-person contact within the family members was the possible mode of transmission. Health education on personal hygiene, together with the treatment of the infected people, may help in reducing and controlling this infection in these communities.