The infectiousness with regard to HBV Infection of staff and patients in various units of the General Hospital, Kuala Lumpur
was assessed. It was found that all units, with the exception of the obstetric unit, were equally high risk areas. At least 50% of the patients in all these units had one or more of the markers. Among the medical staff, the anaesthetists had the highest
incidence of HBV markers (100%) while medical officers who had worked for three years or more were more likely to have to
have the HBV markers. The degree of infectiousness of the nurses In HDU and ICU/OT was found to be similar.
The severity of pulmonary aspiration depends mainly on the acidity of the aspirate. Mist magnesium trisilicate (MMT) has been used for many years at the maternity unit in General Hospital, Kuala Lumpur, to neutralise the acidic gastric contents in all obstetric patients requiring caesarian section. This preliminary study shows that a single dose of 15 mls of MMT before general anaesthesia raises the intragastric pH to above the critical level of 2.5 in 80% of the patients. Recently there have been doubts over the protective role of MMT. Sodium citrate which is the other antacid available may be a better alternative.
More than half of 174 patients with end stage renal disease (ESRD) treated by the Department of Nephrology, General Hospital Kuala Lumpur in 1982 presented for the first time in uraemia, with no known renal disease in the past. Although about half of all patients seen in 1982 were treated by dialysis or transplantation, the great majority of the estimated number of patients developing ESRD in Malaysia in 1982 did not receive definitive treatment.
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
The relationship between locus of control and reaction to illness is empirically examined in a group of patients on haemodialysis for chronic renal failure. Results of the study suggest that patients who perceive themselves as having personal control over life events tend to have stronger feelings that their illness has made them dependent on others. There is also a greater tendency for them to exhibit more information seeking behaviour, and to adopt an active, problem-solving and intellectual approach to cope with their chronic renal failure. Relevance of the findings and implication for treatment outcome are discussed.
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.
226 peritoneal dialyses were performed on 100 patients. 28 patients presented with acute renal failure. Uraemia was the most frequent indication for dialysis. Peritonitis was an important complication and Acinetobacter species accounted for 51.5% of the positive cultures. Other complications included poor dialysate drainage and hypokalemia. Mortality was mainly due to causes unrelated to peritoneal dialysis.
The results of 2449 investigations of the upper gastrointestinal tract were analysed to determine the incidence of disease. Abnormalities were detected in 53% of patients who had endoscopy, but were found in only 24% of patients who had barium studies (p <= 0.001). Altogether 916 patients had abnormal findings. Duodenal ulcer accounted for 42% of cases, gastric ulcer 16% and gastric cancer 9%. The prevalence of perforated ulcer was 13%. The annual incidence/1000 in males and females (>14 years) were respectively, for duodenal ulcer 1.66 and 0.42, for gastric ulcer 0.57 and 0.25, for perforated ulcer 0.36 and 0.05, and for gastric cancer 0.29 and 0.14. Most types of gastro-duodenal disease were less common in Malays than expected (p = <0.001). However oesophageal cancer and varices were more common in Indians compared to Malays and Chinese (p = <0.001). This study showed that the pallern of perforating ulcers was not the same as that of non-peforating ulcers, suggesting a differing pathogenesis. Identification of the factors causing a different prevalence of disease between the three ethnic groups would help in the understanding of the causes of upper gastrointestinal disease.
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.
We analysed clinical and histological diagnoses in patients admitted with liver-related illnesses in order to determine the spectrum ofliver disease in our community. In a total of 380 such patients, liver disease was sixfold more frequent in males than in females. Admissions for cirrhosis were more common amongst the Indian ethnic group. Indians constituted 39% of the admissions (expected 11. 7%), Chinese 37% (expected 51%) and Malays 21% (expected 36%) (~2 = 293, p = H 0.001). Liver histology from 179 of the patients was reviewed blind by one pathologist. Based on the histological findings, the pre-biopsy diagnosis was 'wrongin 75%of cases. The age standardized incidence rate of hepatocellular carcinoma was 22/100,000/year in males 225 and 5/100,000/year in females. However, the peak age of onset was in the seventh decade and the age specific incidence in males aged 60 years or older was 93/100,000/year. The ethnic group representation of patients with hepatocellular carcinoma did notshow a racial preponderance. This study highlights a public health problem related to acute viral hepatitis and alcohol abuse. It also confirms a high incidence of hepatocellular carcinoma
Review of the haemodialysis experience revealed patient survival between 1976 and 1982 to be 90%, 77% and 44% at one, three and six years respectively. This was similar to other published reports. Patients under the age of 50 years did better than those above 50 years, and diabetics did worst of all. There was a high rate of rehabilitation and return to employment or household responsibilities. Our policy of self-care dialysis allowed more patients to be treated without increasing the number of staff Dialysis encephalopathy and sudden deaths were important causes of death.
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
We report a case of systemic lupus erythematosus complicated by transverse myelopathy and hyperphagia. To our knowledge the latter has not been reported before.
Nonfermentative Gram-negative bacilli were commonly isolated from clinical material in a Malaysian hospital over a two year period of study. Pseudomonas aeruginosa, Acinetobacter sp and other Pseudomonas were the most common organisms seen. Although these bacteria occurred regularly in clinical specimens their pathogenetic role could be established in only a small proportion of cases. Most 01 these organism were either contaminants or
commensals 01 the normal bacterial flora. It is important to interpret the isolation of a nonfermentative Gram-negative bacillus with caution, and in the light of clinical findings. Failure to do so may result in the unnecessary use of antibiotics.
A retrospective study of 37 intraocular foreign bodies treated over a five-year period is presented. Their aetiology, complications and visual results are discussed in the light of recent development in the management of serious ocular trauma.
Study site: Hospital Kuala Lumpur, Malaysia (UKM unit)
594 intravenous urograms done at the General Hospital, Ipoh, from January 1981 to March 1985 were reviewed for renal papillary necrosis (RPN). 11 cases (1.8%) of RPN were detected. Of these three were due to diabetes mellitus;eight were due to analgesic nephropathy. There was an equal incidence
in males and females, contrary to the experience in the West and Australia. RPN was observed mainly in the older age groups. Five of the 11 cases of RPN presented as renal colic.
The clinical syndrome of dialysis encephalopathy which has been observed all over the world has also been seen here. The clinical syndrome and clinical course are reported; it has been associated with high levels of aluminium in untreated water used for haemodialysis. Since the introduction of water treatment, this disease has not been observed.
The feasibility of using a computer database management system based on an 8·bit microcomputer for storing, retrieving and analysing patient data in a limited setting (oesophago·gastro-duodenoscopy records from a peripheral general surgical department over a 1 year period) is presented. A program developed by the author was used to enter the relevant records of 208 patients undergoing the above examination, and to retrieve and analyse any desired data. Compatible statistical and graphics software packages can be used to access and analyse the data and display or print out the results. The limitations and scope for further expansion of the system are discussed.
A study was carried out on 16 cases of leptospirosis with acute renal failure (ARF) detected in adult patients admitted into the Medical and Nephrology wards of the General Hospital, Kuala Lumpur, over a four-year period from 1980 to 1983. Most of the cases were male, Malays and older adults. The predominant infecting serovars were L. celledoni (of the serogroup L. javanica and L. pomona (of the L. pomona serogroup]. All the cases survived, including those who required peritoneal dialysis. The sensitised erythrocyte lysis (SEL) antibody prevalence rate of the chronic renal failure cases (10.4%) was found to be similar to that of the healthy population in West Malaysia (12. 7%), confirming the observation by other workers that leptospirosis is not an important cause of chronic renal failure.
A total of 45 patients with IgA nephropathy were seen at the Department of Nephrology, General Hospital, Kuala Lumpur and the Department of Medicine, Universiti Kebangsaan Malaysia (National University ofMalaysia) between January 1982 to June 1985. This represents an incidence of 10.7% of all primary glomerulopathies. There does not appear to be any racial predilection and the clinicopathological features generally conforms with those reported elsewhere. However it seems to be as common in females as in males but the latter have a worse prognosis. The high incidence of renal failure and hypertension in our patients within the short follow-up period is noteworthy.