The high incidence of primary liver cancer in Malaysian males is not observed in childhood, where it constitutes 0.16 per 1000 paediatric hospital admissions and 3.20/0 of all childhood malignancies at the University Hospital, Kuala Lumpur. This frequency is comparable to that reported from several developed countries. The commonest liver tumour in children is the hepatoblastoma which is probably of embryonal origin and has a similar world wide "incidence. The relative infrequency of hepatocellular carcinoma in childhood and its association with cirrhosis, the hepatitis B antigen and its prevalence in the older age group helps to substantiate an acquired environmental aetiology.
Susuks or charm needles are a form of talisman inserted and worn subcutaneously, in the face and other parts of the body, in the belief that they will enhance or preserve the wearer's beauty, youth, charisma, strength or health, or bring success in business. This mystic practice is found among some south-east Asian people, especially Malayan and Muslim females. Most susuk wearers are secretive about their hidden talismans, but these gold or silver needles are being discovered with increasing frequency now that radiographs are used more widely. An understanding of this practice and an awareness of its existence is important to avoid misdiagnosis and mismanagement of these patients. The practice of susuk wearing and its relevance to dentistry is discussed. Nine cases of facial susuk wearers are presented and previous reports are reviewed.
The combined epithelial odontogenic tumour represents a hybrid lesion comprising primarily areas of adenomatoid odontogenic tumour intermixed with foci of calcifying epithelial odontogenic tumour. Five such cases retrieved from the files of the Division of Stomatology, Institute for Medical Research, Kuala Lumpur, and four others from the existing literature were analysed. A mean age of 18.8 years, a female preponderance (66.7%) with a male to female ratio of 1:2 and predilection for the mandible (55.6%) were observed. All cases were treated by conservative surgery and the lack of recurrence confirmed the innocuous nature of this lesion.
A questionnaire was administered in class to a sample of physical education students at a Malaysian University in order to determine their beliefs and use patterns regarding vitamin supplementation. About a quarter of the subjects (24.6%) had practised vitamin supplementation for the past two years prior to the study, 14.9% of them being females as opposed to only 9.7% males. The most frequently used vitamin supplements, in rank order, were multivitamins (used by 57.6%), vitamin C (24.2%), the B-Complex vitamins (9.1%), and vitamin E (6.1%). Among vitamin supplementeers, the most frequently cited reasons for using vitamin supplements, in rank order, were 'to supplement the daily diet' (33.3%), 'to prevent colds' (27.3%), and 'to prevent fatigue or lethargy' (21.2%). Among non-supplementeers, the three reasons most frequently mentioned for not using vitamin supplements were 'vitamin needs are adequately supplied by daily meals' (50.5%), 'I am healthy enough and therefore I do not need extra vitamins' (27.2%), and 'fear of insidious side effects' (9.9%). In general, both supplementeers and non-supplementeers tended to believe in the purported health benefits of vitamin supplementation. However, on the whole, supplementeers were willing to change their supplementation habits.
Twenty two Muslim diabetic patients on oral hypoglycaemic agents were studied during the fasting month of Ramadan to determine the effect of fasting on their diabetic control. All the patients completed their fast during the month. Their mean (+/- standard deviation) blood glucose, serum fructosamine and body weight before the fasting month were 10.7 +/- 4.6 mmol/l, 6.64 +/- 3.64 mmol/l and 60.5 +/- 12.6 kg and by the end of the fasting month were 10.9 +/- 4.4 mmol/1,4.34 +/- 1.08 mmol/l and 59.8 +/- 12.3 kg respectively. There was no significant difference between the blood glucose levels but there were significant reductions in the mean body weight and fructosamine values (p = 0.01 and p = 0.03 respectively). The mean decrease in body weight and fructosamine were 0.7 +/- 1.3 kg and 2.29 +/- 3.09 mmol/l respectively. There were also statistically significant differences between the mean daily calorie content before the fasting and during the fasting month (1480 +/- 326 vs 1193 +/- 378 Cal/day - p less than 0.005) and between the mean daily carbohydrate content (389 +/- 298 vs 187 +/- 46 gm/day - p less than 0.005). In conclusion, fasting was safe for diabetic patients on oral hypoglycaemic agents and it was associated with weight reduction and improvement in the overall diabetic control. This was most likely due to decrease in food intake.
On the basis of a questionnaire on smoking behaviour, knowledge and attitudes administered to medical students in the University of Malaya in July 1987, the prevalence of smoking was found to be low (10%) among medical students. Smokers and non-smokers were equally well informed about common smoking complications. Most students, irrespective of smoking status, felt that they would as future doctors, often advise sick smokers against smoking. In contrast, less than half would do so for healthy smokers who do not themselves raise the question of smoking. The students' personal smoking behaviour also influenced their view of their professional role. Appropriate values, attitudes and a preventive approach towards smoking need to be further developed in the medical students' thinking and behaviour.
A survey was conducted to investigate the prevalence of Enterobius vermicularis in 1352 Chinese children between the ages of 6-12 years from the three National Type Chinese Primary Schools in Pulau Ketam in 1988, using the scotch-tape technique on three successive days. The overall prevalence was high (56.88%). The prevalence in Sin Bin School was significantly lower (50.86%) compared to the other two schools (56.60% and 61.04%). Prevalence was significantly higher amongst the 6-7 years age group (61.61%-70.18%) compared to other age groups (47.9%-59.29%). There was no difference in the prevalence between the boys and girls being 56.15% and 57.55% respectively.
Four cases of acute viral myocarditis were diagnosed within three weeks. The clinical features, electrocardiography, cardiac enzymes and other laboratory investigations are described.
Twenty patients undergoing various surgical procedures were anaesthetised using hypotensive anaesthesia using labetalol and halothane. The technique is safe, predictable and cheap. This technique also offers the advantage of usage of less blood, thus minimising the complications of transfusion induced diseases like hepatitis and AIDS.
A 44 year old lady with primary hypothyroidism presented with massive pericardial effusion without cardiac tamponade. Pericardial tap was done twice and the effusion resolved as the hypothyroid state improved. She remained hypertensive despite the euthyroid state. She was discharged well with L-thyroxine and anti-hypertensive therapy.
Malay parents of 40 infants and preschool children were interviewed using translations of temperament questionnaires by Thomas and Chess, and by Carey. Similarities and differences between Malay children and previously studied American children are discussed, and relationships suggested among temperament ratings and Malay child-rearing practices and values.
In this paper, urolithiasis is remarked from the standpoint of descriptive epidemiology, which examines the frequency distribution of a given disease in a population in terms of time, place and personal characteristics with an aim of identifying risk factors or some clues to the etiology. Some descriptive epidemiological features of urolithiasis are summarized. Prevalence rate is around 4% (4-15% in males and 4-8% in females), and incidence rate varies from area to area: 53.2 per 100,000 population in 1975 in Japan, 364 in 1976 in Malaysia, and 540 in 1979 in West Germany. Prevalence and/or incidence rates have, in general, increased in the developed countries since World War II and in the developing countries as well, where upward trends are quite analogous to the trends observed in the nineteenth century in Europe. Recurrence rate, which is much higher in males than in females, ranges from 31% to 75%, depending on the follow-up periods. In the industrialized countries, upper urinary (renal and ureteral) stones account for more than 90% of total stones, which are ordinarily calcium complexes in composition. More common in the developing countries are lower urinary (bladder and urethral) stones, frequently composed of magnesium ammonium phosphate, which indicates a close association with urinary tract infections. Variations in frequency are evident by season and by region within a country. Age and sex differentials in urinary stone formers are substantial: more common in males 30-40 years old in the industrialized countries and in children under 10 years old in the developing countries. Racial differentials are also noted; blacks appear to suffer less frequently than whites. Stone formers experience more frequent episodes of stone formation in their family members, particularly father and brothers, than non-stone formers. These findings on racial differentials and family preponderance suggest the possible relevance of genetic factors in stone formation. Stone formers are more likely to be occupationally sedentary and socially affluent. This observation and differentials by age and sex suggest the probable relevance of lifestyle and environmental factors in stone formation. Epidemiological factors incriminated for stone formation will be discussed in a separate paper.
Over an 18 month period, 34,495 livebirths were delivered in the Kuala Lumpur Maternity Hospital. 36 neonates (1.044 per 1000 livebirths) had Down's syndrome. The observed rates of Down's syndrome per 1000 livebirths by single year intervals of maternal age were calculated. By using the discontinuous slope model, our study showed that the incidence of Down's syndrome among the Malaysian liveborns increased markedly when the maternal age exceeded 35 years. This study also suggested that the Malay mothers had increased risk of producing babies with Down's syndrome at a later age than the Chinese and the Indians. However, a larger number of babies in each racial group needs to be studied to confirm this.
Several new concepts are used to describe contraceptive use histories for nearly 1200 women in Peninsular Malaysia. These histories are summarized by 81 episode histories. Transition matrices provide useful summaries of the changes women make in their contraceptive practice from one pregnancy interval to the next. Data from the mid-1940s to mid-1970s, during which period there was a dramatic increase in contraceptive use, reveal considerable inertia in individual couples' contraceptive practice. Persistence with a method was greater the less effective the method: while 86% of couples using no method in one interval used no method in the next, only 56% of couples using the pill in one interval also used it in the next. Virtually all transitions are of three types: continuation with the same method, a change from no method to some method, or a change from some method to no method. For only 1% of all pregnancies did couples use one contraceptive method before a pregnancy and a different method after the pregnancy. Differences are examined by calendar year and education.
A double-blind randomized study in 230 Malaysian patients with duodenal ulcer was conducted to compare the proton-pump inhibitor, omeprazole 20 mg, given once daily in the morning, with ranitidine 300 mg, administered once daily at night. After 2 and 4 weeks of treatment, 222 and 220 patients, respectively, were evaluable according to the study protocol. Omeprazole produced significantly higher healing rates than ranitidine at both 2 weeks (75% versus 46%, respectively, P less than 0.0001) and 4 weeks (97% versus 83%, respectively, P = 0.001). Ulcer symptoms were relieved more rapidly by omeprazole than ranitidine. After 2 weeks, daytime epigastric pain was reported by 30% of ranitidine-treated patients but only by 15% of omeprazole-treated patients, which is a statistically significant difference (P = 0.004). No major clinical or biochemical side effects were recorded for either omeprazole or ranitidine. In conclusion, omeprazole 20 mg was found to be superior to ranitidine 300 mg administered once daily for the treatment of duodenal ulcer as measured by ulcer healing and pain relief.
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
Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. The major presenting symptom was pain but an abdominal mass was palpable in 79.4% of cases. Torsion was more common on the right ovary and 50% were gangrenous at laparotomy. Most of the tumors were benign cystic teratomas. Only 8.7% of the tumors were malignant.