A pilot study on the epidemiology of hypertension was carried out in 3 out of the 8 districts in the state of Selangor, namely Klang, Sabak Bernam and UIu Langat. stratified random sampling, 435 households were selected for the study. Eventually 312 (72%) households were surveyed: 963 (94%) out of the 1,030 persons aged 15 years and above living in the selected households were interviewed, and 957 of them were examined. The mean age of the respondents was 33 years. Taking a systolic pressure of more than 140 mmHg and/or diastolic pressure of more than 90 mmHg as hypertension, 1 in every 7 of those equal and mor.e than 15 years of age had hypertension, i.e. 140/0. 5.40/0 had a systolic pressure of equal and more than 160 mmHg, and 4.7% had a diastolic pressure of equal and more than 95 mmHg. The study showed that there was a significant rise in the prevalence rates with age in both sexes. There was no significant difference in the prevalence rates among. the sexes, ethnic groups (Malays, Chinese and Indians) and urban and rural areas. The mean systolic pressure ranged from 112-147 mmHg and diastolic from 69 - 73 mmHg. Hypertension was significantly more common among smokers (18.1%) than nonsmokers. There was no significant relationship between hypertension and tea, coffee and alcohol consumption. Hypertension was significantly more common among those with no physical activity (34.8%) as compared with those with physical activity (13.5%). 67% of the hypertensives were aware of their illness but only 36.1% of them were under treatment.
A forty-four year old wife of an alcoholic husband with irregular employment sought repeated medical care for her headache, bodyache, chest pain and alleged falls at home. The family backgrounds of the battered wife and the violent husband, his alcoholism and their financial problems all contributed to the violence in marriage. Their six children had lived in fear and two of them had behaviour problems. Awareness of the multiple problems associated with a battered wife should prompt cooperation between medical, social and other workers involved in the management.
Study site: medical outpatients clinic of
T.H. Woon
M.B., B.S., M.D., M.R.A.N.Z.C.P.
Associate Professor and Head
Department of Psychological Medicine
Faculty of Medicine
University of Malaya
Kuala Lumpur, 22-11
and
Shirley George
M.B., B.S., M.P.M.
Psychiatrist
Psychiatric Unit
General Hospital, Seremban.
Running Title:
Battered wife - psychodynamics and social background of a
Malaysian family - alcoholic husband - medical symptoms -
multidisciplinary management.
University Hospital to the psychiatric Walk- inClinic
A case-control study was carried out to determine the child-minding practices and their relationships with nutritional status of children between 6 and 12 months old. Sixty-five percent of the mothers go to the farm and 25 percent of, them bring their children with them. Only 42.8 percent of the children were looked after by their mothers. The odds of being malnourished were greater among children who were not looked after by their mothers. It is suggested that nutrition education be given in the village so that the other child-minders can benefit from it.
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.
Grandmultiparity is an ill defined term, but it is generally believed that increasing parity after the fifth delivery increases the risks of child bearing for both the mother and fetus. Four hundred seventy-seven women aged less than 35 years of parity 5 and above who delivered during one year period at the University Hospital, Kuala Lumpur were studied. There were 406 women of parity 5 and 6 and 71 women of parity 7 and above. The 2 groups as a whole comprised 7.5% of the obstetric population for that year. Obstetric performance in the 2 groups of grandmultipara was compared with 1,135 women, aged 25 to 34 years, having their second baby during the same period. Women of parity 7 and above were significantly more likely to be from lower socioeconomic groups, and suffer from anaemia, hypertension and pre-eclampsia. They were also significantly at risk of preterm delivery and delivering infants weighing less than 2.5 kg. In addition, the perinatal mortality rate was significantly greater in the highly parous group (Para greater than 7) than in women of parity 5 and 6 or the control group. Apart from a significant increase in the incidence of anaemia, women of parity 5 and 6 had a similar obstetric performance and perinatal outcome to that of the control group. We conclude that grandmultiparity per se is not an obstetric risk factor until after the seventh delivery. These findings have implications for those who plan the provision of obstetric services for the community.
Malignant neoplasms diagnosed histologically in the state of Sabah during the period November 1983 to October 1988 were analysed to determine the distribution of malignant neoplasms according to site, age, sex and major ethnic groups. The five commonest malignant neoplasms in males were carcinomas of the nasopharynx, stomach, skin, lung and liver. In females the five commonest malignant neoplasms were carcinomas of the cervix uteri, breast, ovary, thyroid and skin. There was variation in these frequencies among the major ethnic groups. The most striking of these was the high frequency of nasopharyngeal carcinoma among Kadazan and Chinese males but not in males of the other indigenous groups. A significant number of patients with nasopharyngeal carcinoma was found in the younger age groups and most of the patients in the younger age groups were Kadazans. A relatively high frequency of carcinoma of the stomach, skin and liver was seen among Kadazans and other indigenous groups while carcinoma of the lung was seen relatively frequently among Chinese males. Among females carcinomas of the breast and cervix uteri were the most frequent malignant neoplasms in all the main ethnic groups. Possible reasons for these findings are discussed.
Twelve cases of primary hyperparathyroidism operated by the Universiti Kebangsaan Malaysia Surgical Team from 1978 to 1989 were reviewed. There was a preponderance of Indian females in this series. The majority of the cases presented late and with complications. Renal calculi and bone disease were the commonest complications noted. Of the 12 patients, 9 had single parathyroid adenoma of which 4 were ectopically located, and 2 had hyperplasia of the parathyroids. These were all successfully operated. The remaining patient had 2 failed neck explorations. Failure at initial exploration was due to ectopic location of the glands. Meticulous surgical technique, knowledge of the anatomical variations of location of the parathyroid glands and availability of frozen section facility are essential for successful outcome.
Retinoblastoma was clinically diagnosed in 38 patients in the University Hospital between 1968 to 1988. White pupil or cat's eye reflex, found in 25 patients, was the most common symptom. Four patients refused any form of treatment. Of the 27 histopathologically confirmed cases, 16 were males and 11 were females. There was no ethnic group predominance, although a male preponderance was observed among Malay patients (M:F 3:1, p less than 0.05). Treatment in cases with unilateral disease, without extra ocular extension consisted of enucleation of the involved eye, with close examination of the contralateral eye in follow-up. In cases presenting with bilateral tumour the worse eye was removed. Of 20 cases of histopathologically proven unilateral retinoblastoma treated surgically, 12 patients survived for a mean period of 4.5 years (Range: 1-19 years). The defaulter rate for this group of patients was 55%. None of the 7 cases of bilateral retinoblastoma survived beyond 5 years (Mean survival 2.5 years).
A seven-month-old female child presenting with a large abdominal mass was found on investigation to have a duplex right kidney with a non-functioning obstructed upper moiety and a right ureterocele. The grossly dilated and tortuous upper moiety ureter presented as a large cystic mass on ultrasound and computed tomographic scans.
This paper presents a study of cycles with spontaneous luteinizing hormone (LH) surge in superovulatory Malay women during in vitro fertilization and gamete intrafallopian transfer programmes. Sixteen Malay women underwent ovarian stimulation for ovum pick up at the National Population and Family Development Board, Malaysia. Two cycles showed spontaneous LH surge, and comparisons were made between these two cycles and the cycles without surge. Further observations were made in their characteristics and differences in these two cycles as well as the relationship between progesterone and LH at the time and before the surge.
Six of 16 patients presenting to the University Hospital Kuala Lumpur with unilateral recurrent laryngeal nerve paralysis were treated with teflon injection of the paralysed vocal cord. The results are presented and the role of surgical therapy, in particular teflon injection is reviewed.
In a cross-sectional study of 7 to 12-year-old primary school children in Kuala Lumpur, the prevalence of chronic cough and/or phlegm, persistent wheeze, and doctor-diagnosed asthma were 8.0%, 8.0% and 8.7%, respectively. The prevalence of asthma (defined as persistent wheeze and/or doctor-diagnosed asthma) was 13.8%. 4.3% experienced at least one episode of chest illness that resulted in inactivity for at least 3 days in the previous year. The mean age of commencement of symptoms in the doctor-diagnosed asthma group was 2.75 years. The prevalence of chronic cough and/or phlegm and persistent wheeze were highest among Indian children (p less than 0.05). More Malays had been diagnosed as having asthma than the other ethnic groups but the differences were not statistically significant. The patients' fathers' low levels of education were associated with chronic cough and/or phlegm (p less than 0.05) but not with other complaints. Asthma was significantly more common among boys than girls. No age differences were noted. Further analysis showed that persistent wheeze and doctor-diagnosed asthma were associated with increased likelihood of other respiratory illnesses or doctor-diagnosed allergy before the age of 2 years.
There are several reports of beneficial effects of ACE inhibitors in both primary and secondary pulmonary hypertension. However the effect of ACE inhibitors in mitral stenosis is not documented. The authors report three patients with severe mitral stenosis in whom surgery was delayed. They had initial symptomatic improvement with diuretics and sodium restriction, but had recurrence of their symptoms while on treatment. Enalapril not only relieved their symptoms in particular exertional dyspnoea and haemoptysis but prevented recurrence and improved their effort tolerance without causing excessive fall of blood pressure or impairment of renal function.
Adenocarcinoma of the fallopian tube is a rare clinical entity. The incidence of primary tubal carcinoma has been reported as varying from 0.1 to 1.0 percent of all gynaecological malignancies. In Malaysia the incidence is unknown. A case of primary adenocarcinoma of the fallopian tube is reported.
A 60 year old woman with chronic duodenal ulcer not responding to Cimetidine, was changed to Ranitidine. She had symptomatic improvement, but had bilateral breast engorgement and tenderness for which treatment was discontinued. A therapeutic trial on a second occasion had the same side effect which came on more rapidly and quickly. This complication in such severe form and recurrence on rechallenge requiring withdrawal of drug was observed for the first time with any H2 receptor antagonist.
Eighty-six children diagnosed as child abuse and/or neglect were admitted to the Paediatric wards of the General Hospital, Kuala Lumpur during 1985 and 1986. Of these cases, 62 were of physical abuse, six of sexual abuse, one case of both physical and sexual abuse and 17 of neglect. There were 25 boys and 61 girls. Thirty-four of these children were Malays, 16 Chinese, 26 Indians, three mixed and seven illegal immigrants. Twenty-one were below the age of one year, 24 from one to four years, 25 from five to nine years and 16 were ten years and above. The abusers were mainly close members of the family. Of these children, 24 were sent back to their parents and 11 to their relatives home. Twenty-seven were taken into care by the Ministry of Social Welfare and the remaining seven children who were illegal immigrants, were deported with their parents. Only one child was successfully fostered. Eleven children were taken away from the hospital by their parents or guardians without the knowledge of the health staff. There were five deaths in the series.
Thirty-nine displaced fractures of the lateral humeral condyle in children were followed for an average of 5 (2-5) years. The results were evaluated from functional and cosmetic aspects. Patients treated within 2 weeks by open reduction and internal fixation did well. Those operated on after 6 weeks did not do better than nonoperated on cases. Complications included cubitus varus and valgus deformities, osteonecrosis, nonunion and malunion, and loss of motion. We recommend that patients presenting late be left alone and any sequelae evaluated at a late stage.
Paraventricular calcification not previously reported in systemic lupus erythematosus was seen in cranial computed tomograms of two patients with this disorder.