31 cases of ocular toxoplasmosis were seen at the Ophthalmology Clinic, Uniuersiti Kebangsaan Malaysia, Kuala Lumpur during a one-and-a-half year period. All these cases were diagnosed as congenital ocular toxoplasmosis. As this condition appears not to be uncommon in. Malaysia, greater effort should be made towards its prevention especially among pregnant women.
Study site: Ophthalmology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
In February to March 1982 at the psychiatric emergency service of the University Hospital, Kuala Lumpur, some data on 491 patients (92% of 531 patients seen) were collected. Two-hundred and eighty-three patients had received psychiatric treatment and 65 had previously received medical treatment. Fifty-three per cent of the patients have schizophrenic disorders, 5.1% had situational reactions and 1.63% had chronic alcoholism. Of the 111 patients presented with either physical complaints or insomnia, eleven of them were admitted to the psychiatric wards. Three-hundred and eleven patients were followed-up in the psychiatric outpatient clinics. The availability of a psychiatric emergency service in a general hospital can contribute towards early psychiatric case findings and preventive Intervention. II provides an opportunity for liaison and consultation with other medical colleagues in the care of patients with physical complaints and attempted suicides.
Study site: Universiti Malaya Medical Centre (UMMC)
Two children with Juvenile Rheumatoid Arthritis (JRA) and severe growth suppression from corticosteroid therapy are described. Prolonged 'tailing-off' of steroids occurred during outpatients follow-up and this may be related to the high turnover of doctors involved. Suggestions for improving such follow-ups and caution against the continuous use of steroids are made.
Study site: Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
This study presents the demographical characteristics of 271 cases of parasuicide seen at the Psychiatric Clinic, General Hospital, Kuala Lumpur, during 1982. The majority of cases were women in the 20 - 30 year age group, from a lower economic class, with minimal education. About one-half were single and 61.5% were actively religious. The racial breakdown was Indians 55%, Chinese 32% and Malays 13%. Self-poisoning using easily available drugs was the most common method employed and more than one-half intended to die at the time of the suicidal act. Most attempts were impulsive, carried out while alone, inside the
house. The findings are discussed and compared with earlier studies of attempted suicides in Malaysia and Singapore.
PIP:
A total of 552 women in 1983 have undergone laparoscopic sterilization under local anesthesia with sedation in the family planning clinic at Maternity Hospital and the Specialist Center at Batu Complex. A review was made to evaluate the risks, benefits, and safety of outpatient surgery in view of the shortage of anesthetic personnel, operating theaters and costs to patients if general anesthesia were to be used instead. Anesthetic complications (0.9%) were found to be of a very minor nature, not requiring hospitalization. Surgical complication was higher at 3.8%. There was a high rate (21%) of difficulties encountered at operation, 15% for medical officers and trainees but only 6% for specialists. In summary, a very low complication rate was encountered with local anesthetics. The use of local anesthesia with sedation is advocated. This cuts down on costs, hospitalization and recovey time and overcomes the perennial problem of shortage of anesthetic staff and operating theaters. The rate of the surgical complications was related to the surgeon's experience.
Study site: family planning clinic at Maternity Hospital and the Specialist Center at Batu Comple
This study examines the primary reasons for attempting suicide as described by the 271 parasuicidal patients assessed at the Psychiatric Clinic, General Hospital, Kuala Lumpur during 1982. The reasons in order of frequency were: marital problems; family problems; boyfriend, girlfriend problems; a medical illness; a psychiatric illness; and others, The types of marriage, family, and love problems experienced by each of the three major Malaysian racial groups are discussed. Indians presented with family problems more frequently than the other racial groups and Indian females were more frequently battered before the suicidal attempt. Suggested treatment measures based on the findings include employing a crisis intervention model for suitable patients, interviewing the patients on the Medical Wards, and involving more Psychiatric Social Workers in their management.
The reasons why 860 patients visited the general medical clinic at the University Hospital, Kuala Lumpur were studied. 75.3% of the patients came for evaluation of symptoms; 12.4% sought checkups for chronic diseases; 4.9% requested diagnostic checkups and screening tests; 4.8% came to renew prescription. Few visits were made for evaluation of injuries, receiving test results or for administrative examination. This profile reflected the function of the clinic as an acute diagnostic centre. Other applications of the results are discussed.
Study site: General Medical Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The W.H.O. self reporting questionnaires were distributed to 50 psychiatric outpatients with neurotic disorders and 50 medical staff as controls. This pilot study shows that it can differentiate between normal and neurotic patients and that if a cut off point of 3 is taken, there Is a very good chance that no psychiatric case in any epidemiological study will be missed. This study also picked up the 10 most sensitive items in the S.R.Q. which will be validated In future studies.
Study site: Psychiatric clinic, Hospital Kuala Lumpur, Malaysia
The efficacy of SEBA-MED. a synthetic detergent recommended for use on eczematous skin (especially seborrhoeic eczema), acne vulgaris, furunculosis and mycosis, was evaluated as an adjunctive agent in the management of childhood eczema. 50 patients with eczema from the Paediatric Skin Outpatient Clinic, University Hospital, were studied. Preliminary results of this trial show that SEBA-MED is well-tolerated as a cleansing agent in childhood eczema with no side effects noted. However, as atopic eczema is associated with dry skin in the majority of cases, the concomitant use of 'refatting' agents (such as SEBA-MED cream/lotion) is recommended.
Study site: Skin clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
This paper discusses the spectrum of rheumatic diseases seen over a 24-month period from January 1986 to December 1987. Rheumatoid arthritis was the commonest rheumatic disorder seen, comprising of 47.1 % of all cases and ankylosing spondylitis was among the least frequent (0.9%). Most of the rheumatic diseases reported in the West are also seen in Malaysia. However, results of this study which is based on the hospital population may not be representative of the spectrum of rheumatic diseases in the our population.
Key words: Epidemiology, occurence, rheumatic diseases, Malaysia
Study site: Rheumatology clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
The Department of Primary Care Medicine was established in UHKL in 1987. This article examines the philosophy of primary care, the clinical services provided by UHKL Family Practice Clinic and the quality assurance activities.
Sixty four percent (104 patients) of Malay patients attending the Psychiatric Clinic for the first time were interviewed. A similar number from the general Out-patients Department (O.P.D.) randomly chosen, served as the control group. Seventy six (73.1%) psychiatric patients had consulted a bomoh prior to their visit to the clinic as compared to 26 (25%) O.P.D. patients. The number of bomohs consulted was significantly higher among the psychiatric patients than the O.P.D. patients. The strength of social support, the availability of a bomoh and the belief of the patients, friends and/or relatives in the bomoh have been suggested as the main factors that influenced the Malay patients in seeking bomoh treatment. The belief that mental illness is due to supernatural causes is firmly held by bomohs who reinforce this notion in those who seek their advice. The importance of understanding the patient's cultural background in treating psychiatric patients is highlighted.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
The severity of anxiety and depression in 72 patients presenting with somatic complaints to the psychiatric clinic were assessed after excluding organic illnesses. Majority of the patients were females, between 15 to 34 years of age and came from lower socio-economic background. A high percentage of patients were brought up by dominant mothers and the married patients had passive husbands or active wives controlling the family. Generally the severity of depression was correlated with the severity of anxiety (C.C = 0.704, P less than 0.01). Majority of the patients were found to have both mixed anxiety depressive symptoms and the anxiety symptoms masking the underlying depressive symptomatology.
Study site: Psychiatric Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
The reasons underlying the need for extraction of 2765 permanent teeth carried out over a 6 month period in the Out-patient Clinic in the Dental Faculty, University of Malaya, was investigated. The present study showed that dental caries (67.4%) is the leading cause for extraction followed by periodontal disease (19.6%). Caries accounted for the highest proportion of extractions up to the age of 50 whereas periodontal disease becomes the major factor beyond this age. The highest frequency of extractions carried out was between the ages of 21-30.
Six cases of children of divorced parents are discussed. Their presentations are described and other relevant findings are mentioned. It is interesting to note that in the majority of the cases, the caretakers had difficulties in looking after the children and hence brought them to seek treatment.
Study site: Psychiatric clinic, Universiti Kebangsaan Malaysia
An audit of diabetes care was done in a hospital to assess its effectiveness. The results revealed that diabetic patients received less than adequate care. Only 9% of the patients achieved good glycaemic control; 39% had hypertriglyceridemia and 65% had undesirable weight gain while on treatment. The average duration of diabetes in this group of young diabetic patients under study was only 4.5 years, yet 12% of them had evidence of diabetic retinopathy. Few patients possessed adequate knowledge and skills of diabetes self-care. No patients could draw up and mix insulin adequately. Only one patient could self-inject insulin correctly. Few understood the nature of hypoglycaemia, hence few took adequate precaution against it. Patients had frequent hypoglycaemia; 61% had at least one episode per week and 56% of the diabetic drivers admitted to occurrence of hypoglycaemia while driving. No patient understood the principle of diabetic diet therapy, nor did they carry out regular home-monitoring of their diabetes. Good diabetes care requires organisation with supportive patient education. The less than adequate standard of care achieved by the hospital under study is probably explained by the absence of both.
Study site: Outpatient clinic, Hospital Mentakab, Pahang, Malaysia
The value of tuberculin skin testing in the diagnosis of active tuberculosis remains uncertain. Interpretation of tuberculin tests would be easier if the tuberculin test profiles in different communities were accurately known. We reviewed 468 Mantoux test reactions in patients coming to Hospital Universiti Sains Malaysia with suspected tuberculosis. Eighty six percent of patients with active tuberculosis had a positive Mantoux test. Forty two percent of the cases of positive Mantoux test did not have evidence of active tuberculosis. Most of these cases had evidence of past infection with tuberculosis. We conclude that Mantoux test is a sensitive but a non-specific test in the diagnosis of active tuberculosis.
Study site: outpatients, inpatients; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
The use of pressurised metered dose inhalers was assessed among 93 asthmatic patients attending the respiratory out patient clinic between January to October 1989. They were regular users of the inhalers prior to the assessment. 62.4% of the patients were found to use the inhalers incorrectly. Forty three percent made more than one error. The commonest error observed was the failure to actuate and inhale the aerosol together in 41.9%. There was no difference in the occurrence of incorrect performance between different sexes, age groups, duration of inhaler used and previous supervision or no supervision by the doctors.
Study site: Respiratory clinic, Hospital Kuala Lumpur (UKM), Malaysia
A retrospective study of 300 tuberculosis patients on short course chemotherapy registered in 1985 at the Chest Clinic, General Hospital Alor Setar, Kedah was carried out with the purpose of identifying patient characteristics, determining incidence of side-effects and modifying treatment regimens in order to minimise these side-effects. One hundred and sixteen (38.7%) patients developed side effects. Twenty seven (9%) had side effects severe enough to warrant a change in treatment regimen. Treatment modifications and ways to minimise or control side effects are discussed.
Study site: Chest clinic, Hospital Alor Setar, Kedah, Malaysia