Gestational trophoblastic disease is a common gynaecological problem in Malaysia. The incidence of molar pregnancy is 2.8 per 1000 deliveries, being more common amongst the Chinese. The preferred method of evacuation is suction curettage; complete evacuation of the uterus was not achieved at the first attempt in 25 per cent of cases. Partial moles in our centre comprised 30 per cent of all moles. This is potentially malignant and needs follow-up for a complete mole. In the management of an invasive mole, chemotherapy should not be withheld in the presence of metastases and failure of regression of hCG. The role of prophylactic hysterectomy and prophylactic chemotherapy in the management of molar pregnancy is discussed "Selective preventive chemotherapy" in patients at "risk" appears appropriate. Chemotherapy remains the main modality of treatment for gestational trophoblastic tumours (GTT). We categorised our patients into low, medium and high-risk groups; survivals were 100, 98, and 61.7 percent respectively. These patients when categorised according to FIGO staging had survivals of 100, 80, 78.6 and 68.2 per cent respectively for stages 1, 2, 3 and 4 respectively. The reasons for the poor survival in the 'high-risk' group are discussed. Colour doppler blood flow studies are now being carried out; its role needs further evaluation. Surgery and radiotherapy have only a limited role in the management of these cases.
Matched MeSH terms: Choriocarcinoma/prevention & control
Intestinal parasites of importance to man are Enterobius vermicularis, the soil-transmitted helminthes (STH)--Ascaris lumbricoides Tricburis trichiura, bookworms (Necator americans/Ancylostoma duodenale) and Strongyloides stercoralis and the protozoa Entamoeba histolytica and Giardia duodenalis. Other protozoa such as Cryptosporidium sp. and Isopora sp. are becoming important in causing prolonged diarrhea in immunocompromised patients. It is estimated that almost 1 billion, 500 million and 900 million people worldwide are infected by the major nematode species--A. lumbricoides, T. trichiura and hookworms respectively. Most of the infections are endemic and widely distributed throughout poor and socio-economically deprived communities in the tropics and subtropics. Environmental, socio-economic, demographic and health-related behavior is known to influence the transmission and distribution of these infections. In giardiasis, one study indicates that age < or = 12 years and the presence of family members infected with Giardia were risk factors for infection. Most of the infections occur in children and both genders are equally affected. Epidemiological studies of STH infections have shown that the prevalence and intensity of infection are highest among children 4-15 years of age. The frequency of distribution of STH infections is over-dispersed and highly aggregated. areas reinfection can occur as early as 2 months post-treatment, and by 4 months, almost half of the population treated become reinfected. By 6 months the intensity of infection was similar to pretreatment level.
Matched MeSH terms: Intestinal Diseases, Parasitic/prevention & control
This paper attempts to integrate both a forward and reverse supply chain to design a closed-loop supply chain network (CLSC). The problem in the design of a CLSC network is uncertainty in demand, return products and the quality of return products. Scenario analyses are generated to overcome this uncertainty. In contrast to the existing supply chain network design models, a new application of a CLSC network was studied in this paper to reduce waste. A multi-product, multi-tier mixed integer linear model is developed for a CLSC network design. The main objective is to maximize profit and provide waste management decision support in order to minimize pollution. The result shows applicability of the model in the tire industry. The model determines the number and the locations of facilities and the material flows between these facilities.
Matched MeSH terms: Environmental Pollution/prevention & control
Treatment of oil-contaminated soil is a major environmental concern worldwide. The aim of this study is to examine the applicability of a green solvent, ethyl lactate (EL), in desorption of diesel aliphatic fraction within total petroleum hydrocarbons (TPH) in contaminated soil and to determine the associated desorption kinetics. Batch desorption experiments were carried out on artificially contaminated soil at different EL solvent percentages (%). In analysing the diesel range of TPH, TPH was divided into three fractions and the effect of solvent extraction on each fraction was examined. The experimental results demonstrated that EL has a high and fast desorbing power. Pseudo-second order rate equation described the experimental desorption kinetics data well with correlation coefficient values, R (2), between 0.9219 and 0.9999. The effects of EL percentage, initial contamination level of soil and liquid to solid ratio (L/S (v/w)) on initial desorption rate have also been evaluated. The effective desorption performance of ethyl lactate shows its potential as a removal agent for remediation of TPH-contaminated soil worldwide.
A total of 38 cases of fireworks related injuries from Hospital USM over a 5-year period from 1986 to 1990 during Hari Raya festival were analysed. The majority (68.5%) of the patients were teenagers, between 10 to 19 years of age. All the cases were Malays and most of the accidents occurred before the Hari Raya Idilfitri festive seasons. Fourteen cases were caused by self-made fireworks and another 16 cases were due to modified fire-works. Twenty-four cases suffered permanent disabilities mostly finger amputations. Such injuries could be prevented by law enforcement coupled with public health education to modify social behaviour especially when the ban against the use of fireworks is lifted on religious grounds.
Matched MeSH terms: Blast Injuries/prevention & control
A high frequency of nonhemolytic hereditary ovalocytosis in Malayan aborigines is thought to result from reduced susceptibility of affected individuals to malaria. Indeed, Kidson et al. recently showed that ovalocytes from Melanesians in Papua New Guinea are resistant to infection in culture by the malarial parasite Plasmodium falciparum. In order to determine if protection against parasitic invasion in these ovalocytes might be the result of some altered membrane material property in these unusual cells, we measured their membrane and cellular deformability characteristics using an ektacytometer . Ovalocytic red cells were found to be much less deformable in comparison to normal discoid red cells. Similar measurements on isolated membrane preparations revealed a marked reduction in ovalocytic membrane deformability. To produce equal deformation of ovalocytic and normal membranes, ovalocytes required an 8-10-fold increase in applied shear stress, indicating that their membrane was capable of deforming under sufficient stress. To test the possibility that this increased membrane rigidity might confer resistance to parasitic invasion, we performed an in vitro invasion assay using Plasmodium falciparum merozoites and Malayan ovalocytes of varying deformability from seven different donors. The level of infection of the ovalocytes ranged from 1% to 35% of that in control cells, and the extent of inhibition appeared to be closely related to the reduction in membrane deformability. Moreover, we were able to induce similar resistance to parasitic invasion in nonovalocytic normal red cells by increasing their membrane rigidity with graded exposure to a protein crosslinking agent. Our findings suggest that resistance to parasite invasion of Malayan ovalocytes is the result of a genetic mutation that causes increased membrane rigidity.
Field trials were conducted in two residential areas of Petaling Jaya Municipality to test the adulticidal and larvicidal effects of malathion 96% TG and Resigen on Aedes aegypti. Malathion is the currently used insecticide in Malaysia for the control of dengue. The Leco HD ULV machine was used throught the trials. For malathion the flow rate was 90 ml/minute at a vehicle speed of 8kph and for Resigen the flow rate was 200 ml/minute at the same vechicle speed. Malathion was more effective giving higher mortality rates when compared with Resigen. The mortality rate of adult Ae. aegypti outdoor was higher than in the living room and kitchen. Both insecticides did not show promising larvicidal effects.
Once-yearly, mass deworming with broad spectrum anthelmintics over a period of five years among four types of communities in Malaysia resulted in an overall education in the prevalence of soil-transmitted helminthiases by one-third to two-thirds. The reduction in prevalence of infection was highest among inhabitants in semi-urban settlements (65.5%), followed by those in the rural estates (53.0%) and high-rise flats (43.9%). Soil-transmitted helminthiases were only reduced by 35.5% in the urban slums. Reduction in infection with Trichuris trichiura was better than that with Ascaris lumbricoides whereas hook-infection was completely eliminated in some of the communities surveyed. The reduction in prevalence ofsoil-transmitted helminthiases by long-term, once-yearly deworming alone, without other supplementary interventions, reinforces the potential and feasibility of regular mass-deworming as an immediate and effective measure for the control ofsoil-transmitted helminthiases. This is of great public health significance especially in highly endemic communities where some form of intervention is urgently needed and facilities for other control measures such as the improvement of environmental sanitation and nutritional status and health education are neither feasible nor possible nor immediately available.
The main purpose of this study was to evaluate the effectiveness of toothbrushing in 124 six year-old uninstructed schoolchildren. The toothbrushing conditions were made to closely simulate the toothbrushing procedure carried out at home. The amount of plaque before and after toothbrushing was assessed using the Modified Personal Hygiene Performance Index. An overall reduction of 54.0 per cent in plaque score was observed following toothbrushing. This reduction was much more favourable than other reported studies using subjects of similar age group. However most of the plaque that remained following brushing were accumulated in the gingival areas. The highest prebrushing score and the least effective toothbrushing ability was observed among the Malay schoolchildren. The pre and postbrushing scores among the Chinese and Indians were comparable. There was no statistically significant difference in toothbrushing ability between boys and girls at this age. The children brushed their anterior teeth better than their posterior and the facial surfaces better than the lingual. The greatest percentage reduction in plaque score was observed in the occlusal/incisal areas with the gingival areas being the least accessible. The conclusions of this study points to the lack of manual dexterity of children of this age group to effectively brush their teeth and the need for proper parental supervision in assisting them to carry out the toothbrushing procedure.
In 1954, with the assistance of the World Health Organization and the United Nations Children's Fund, a campaign against yaws was initiated in Malaysia with the formation of a yaws elimination unit in the Ministry of Health. Between 1954 and 1975, the reported annual incidence of yaws fell from 140.85 to 1.25 per 100,000 population. When rates dropped to less than two per 100,000, the program was merged with the general health services. Currently when cases are reported, contacts are traced, school and village surveys are carried out, and appropriate treatment is given. The major problems facing the control program today are a loss of interest in control activities; a smaller number of health workers experienced in the diagnosis, management, and control of the disease; and a growing reluctance to treat asymptomatic contacts with penicillin for fear of anaphylactoid reactions. Despite these problems, it is not an unreasonable expectation that, with continued stimulation from the individuals responsible for infectious disease control, yaws will eventually be eliminated.
The significance of high blood pressure to cardio- and cerebrovascular disease is well recognized. The associated mortality and morbidity risks call for multiple approaches to control the development of high blood pressure. Recent studies have shown that precursors of cardiovascular disorders may be apparent from a young age, and that these can persist and contribute to disease in later life. With regard to blood pressure, the phenomenon of persisting at the same rank has been referred to as tracking. This allows for the possible identification of high-risk groups, for whom early intervention can be initiated. In this paper, some of the findings of studies on blood pressure tracking are reviewed.
Most of Asian Countries are still developing. Hence there are constraints in cancer treatment. There are those countries with fully equipped and fully distributed like western world such as Japan, Korea and Singapore. Other with some comprehensive cancer centers but confine to only big cities with poor coverage of the population resulting in a lot of late cases of cancer patients seen. Such countries are Bangladesh, China, India, Indonesia, Malaysia, Sri-Lanka, Thailand and etc. Still a lot of countries have no facilities to cope with cancer patients such as Brunei, Kampuchea, Laos, Nepal, Vietnam and etc. International collaboration and supports are needed.
For any health education to succeed, the people's perception of the disease, their beliefs and cultural practices are of utmost importance as these have tremendous influence on their acceptance of new ideas. It is therefore essential to develop appropriate health education packages based on the understanding of the traditional and socio-cultural belief systems of the people. Thus on the basis of anthropological studies, health education packages were developed for the leprosy control programme in Sarawak, aimed at both adults and children. Newspaper articles, cartoon tape-slides, cartoon story books as well as posters were developed for both Chinese as well as other groups such as Malays, Ibans and Kayans. These were field tested and are now used in the Rejang Valley of Sarawak.
Over two years cord blood from 27 879 babies was screened for glucose-6-phosphate dehydrogenase (G6PD) deficiency. The overall incidence was 3.1% in boys and 1.6% in girls. Sixty nine babies had severe jaundice (bilirubin concentration greater than 380 mmol/l (20 mg/100 ml], and exchange transfusion was performed. Parents were given written and verbal instructions to avoid herbs and drugs that trigger kernicterus, which reduced the incidence of kernicterus and thereby prevented mental retardation. G6PD deficiency is common in all three ethnic groups (Malays, Chinese, and Indians) in Malaysia and screening is recommended.
Matched MeSH terms: Kernicterus/prevention & control