The reasons for referral of 189 patients referred to the Primary Care Out-patient Clinics, University Hospital Kuala Lumpur, were studied. 55.6% of them were from private general practitioners. 51.0% of the referrals were for evaluation of symptoms and 46.5% were for management of diseases. The profile of the referrals helps in curriculum planning of Primary Care Medicine. Other applications of the results are discussed.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Hypertensive disorders of pregnancy is a major cause of fetal and maternal morbidity. Epidemiologic observations have shown an inverse association between calcium intake and incidence of eclampsia. Calcium supplementation has been reported to decrease blood pressure in pregnant women, although this remains controversial. The mechanism responsible for the effect of calcium on hypertinsion in pregnant women is unknown. This paper is a review of some of the recent calcium supplementation trials that have been carried out and their effectiveness in reducing systolic and diastolic blood pressure and decreasing the incidence of hypertensive disorders of pregnancy.
A study was conducted at the Outpatient Department (OPD) of Ipoh Hospital, an urban public primary healthcare facility, over a weekend, to determine the profile of patients attending the clinic, the reasons for encounter and the reasons for choosing after hours medical care. The data from this study would be useful in determining the need for and formulating a policy for after hours medical care at urban primary health care facilities in the country. The study showed there was a low proportion of acute illness in the weekend clinic. A total of 17% of the patients had an acute illness and a further 8% had aggravation of an existing illness. This group of patients requires access to weekend medical services. The main reason for choosing after hours care was social, that is the convenience of an off-day from work or school. Several options can be explored to provide after hours care, including volunteer government doctors or private general practitioners running the service. Another option is to direct public patients during the weekends to private general practitioners in their locality who will be subsidized. The cost of providing after hours care is expected to be higher. Misuse of services may have to be considered as the study showed 5 % of the patients were not ill during the encounter.
Study site: Outpatient Department (OPD) of Hospital Ipoh
Malaysia was ranked at 148 by World Health Organization (WHO) in suicide statistic for 2012, where males had a higher
tendency to commit suicide, recording a 4.7 per 100,000 in comparison to female (1.5 per 100,000). As hanging is one of
the most common methods to commit suicide, this retrospective study was conducted to observe the incidence of suicide
by hanging in Klang Valley from four different hospitals. The current study is conducted to provide local database of
suicide occurrence by hanging in Klang Valley. A total of 893 suicide cases by hanging from 2007 to 2016 were recorded
from post mortem records and analysed. Suicide rates in Klang Valley showed a rising trend from 2007 to 2016. Males
from age group 30 to 34 years old and females from 20 to 24 years old have the highest number of suicide fatalities
compared to other age groups. Meanwhile, fatalities from the age group of 10 to 14 years old and 80 years old and above
showed similar result which is only 7%. 78% of the fatalities were recognized as Malaysian and half of them were Indian.
Majority of the victims/cases (45%) who committed suicide by hanging are of Hindu religious denomination. Non-citizen
in Malaysia that have the highest suicide rates were from Nepal, Indonesia and Myanmar. Victims also committed suicide
more during the day and the peak hours being at 12.00 pm to 5.59 pm.
Creatinine clearance is calculated from 24 hour urine creatinine excretion. This method of measuring creatinine clearance is cumbersome. Many formulae have been proposed as an alternative method of obtaining predicted creatinine clearance and they have all shown satisfactory results. From our study using 4 formulae, the correlation coefficient using these formulae rangedfrom 0.71 - 0.75. The correlation clearance was even better at > 0.90. We therefore advocate the routine use of these formulae for predicting creatinine clearance by clinicians.
Study site: Nephrology clinic, Universiti Kebangsaan Malaysia unit at Hospital Kuala Lumpur, Malaysia
Group A streptococcus is an important cause of pharyngitis, skin infection and or its non-suppurative sequelae, i.e. rheumatic fever and post-streptococcal glomerulonephritis. The National Streptococcus Reference Laboratory was established in 1982 to collect data on various aspects of this infection.
Pharyngeal carriage of group A streptococcus was determined in 432 primary school children between the ages of 6 and 8 years. Beta-haemolytic streptococci were isolated from throat swab culture of 71 pupils, with a carrier rate of 16.4% (71/432) of which 9.4% (39/432) belonged to Lancefield's group A. Serogrouping of the isolates was determined by the coagglutination method and Lancefield's hot acid extraction method. 54.9% (39/71) of the total beta-hemolytic streptococci isolated belonged to group A , 25.3% (18/71) to group G, 15.4% (11/71) to group C and 1.4%(1/71) to group F. T typing pattern of group A streptococcus was determined by the standard agglutination method. Sensitivity to antibiotics was determined by the disc diffusion technique (comparative method). All group A streptococcal isolates were sensitive to penicillin and erythromycin, 6 strains (15.4%) were resistant to tetracycline and 1 strain (2.5%) was resistant to cephaloridine.
The surge in tropical bed bug Cimex hemipterus (Fabricius) (Hemiptera: Cimicidae) infestations has led to an increase in genomic studies. In this study, the population genetics and breeding patterns of 22 Malaysian populations were analyzed, including genetic differentiation and genetic distance. For seven microsatellite loci, the number of alleles varied from 6 to 14. The allelels per loci contrasted sharply between the overall population and within the populations. The average observed and expected heterozygosity was 0.280 and 0.828 for the overall population and 0.281 and 0.657 among the populations, respectively. Based on polymorphic information criteria, the markers with a value >0.5 were highly polymorphic. In the Hardy-Weinberg equilibrium, the loci of Ch 09ttn, Ch 01dn, and Ch 13dn of the overall population showed signs of a null allele. The stutter peaks caused no scoring errors; large allele dropouts were not detected for any loci; and a correlation imbalance was not indicated. The genetic differentiation among populations was moderate, with a coefficient of genetic differentiation (FST) of 0.144. The bed bug populations showed strong inbreeding, with highly positive coefficients of inbreeding (FIS). The molecular variation attributed to inbreeding was 83% within the populations, compared with 17% among the populations. The admixture individuals in STRUCTURE and neighbor-joining phylogenetic trees also indicated weak genetic structure in the geographical populations, suggesting moderate gene flows between populations. Thus, moderately active dispersion and human-mediated transport shaped the genetic structure of C. hemipterus populations in Malaysia.
Facial anthropometric data has significant ethnic variation. East Asia, comprised of fourteen countries, represents a significant proportion of the global population. This systematic review presents the facial anthropometric data collected from these countries. The systematic review was conducted in accordance with PRISMA guidelines. An electronic search of the MEDLINE database returned 3054 articles. Twenty articles were considered eligible for inclusion. Nine studies were conducted in China, 1 in Indonesia, 2 in Japan,3 in Korea, 4 in Malaysia, and 1 was a multicentre study conducted in China, Japan, Thailand, and Vietnam. Qualitative and quantitative parameters were extracted from the20 studies. No data was found for the other East Asian countries. There is a paucity of facial anthropometric data for East Asian countries despite their high burden of craniofacial anomalies and a strong demand for cosmetic facial surgery, both of which would benefit from the collection of robust craniofacial norms. It is in the interest of both the craniofacial surgeon and the East Asian patient to collect baseline facial anthropometric data for this population.
An innovative health information system can be used to support the control of tuberculosis (TB) in Malaysia. The existing system of MyTB has helped in the national TB information management and decision-making process. However, the system can be further enhanced by producing a prototype of Geospatial Tuberculosis Information System (GeoTBiS). It is a geospatial decision support system that was initially proposed in Shah Alam, Selangor. Geospatial data has spatio-temporal characteristics that can be used to understand the basic elements of TB aetiology, while geospatial operations are employed to collect, manage and disseminate the data in a geographical information system (GIS) environment. The disease map and epidemiological risk analysis are produced using a global positioning system (GPS), satellite imagery, geostatistical analysis and web mapping services. This GeoTBiS has demonstrated the geospatial capabilities in enhancing the current system functions, and several recommendations towards a practicable application.
Agricultural expansion is one of the leading causes of deforestation in the tropics and in Southeast Asia it is predominantly driven by large-scale production for international trade. Peninsular Malaysia has a long history of plantation agriculture and has been a predominantly resource-based economy where expanding plantations like those of oil palm continue to replace natural forests. Habitat loss from deforestation and expanding plantations threatens Malaysian biodiversity. Expanding industrial plantations have also been responsible for drainage and conversions of peatland forests resulting in release of large amounts of carbon dioxide. The demand for palm oil is expected to increase further and result in greater pressures on tropical forests. Given Malaysia's high biophysical suitability for oil palm cultivation, it is important to understand patterns of oil palm expansion to better predict forest areas that are vulnerable to future expansion. We study natural forest conversion to industrial oil palm in Peninsular Malaysia between 1988 and 2012 to identify determinants of recent oil palm expansion using logistic regression and hierarchical partitioning. Using maps of recent conversions and remaining forests, we characterize agro-environmental suitability and accessibility for the past and future conversions. We find that accessibility to previously existing plantations is the strongest determinant of oil palm expansion and is significant throughout the study period. Almost all (> 99%) of the forest loss between 1988 and 2012 that has been converted to industrial oil palm plantations is within 1 km from oil palm plantations that have been established earlier. Although most forest conversions to industrial oil palm have been in areas of high biophysical suitability, there has been an increase in converted area in regions with low oil palm suitability since 2006. We find that reduced suitability does not necessarily restrict conversions to industrial oil palm in the region; however, lack of access to established plantations does.
Tropidolaemus wagleri is a species of Asian pitviper with a geographic range including Thailand, Vietnam, Malaysia, Singapore, Bruniei, parts of Indonesia, and the Philippines. Tropidolaemus is a member of the Crotalinae subfamily, within Viperidae. The genus Tropidolaemus includes five species, and was once included within the genus Trimeresurus. While some osteologic characteristics have been noted a comprehensive description of cranial elements has not been produced for T. wagleri. An in-depth description of the cranial skeleton of Tropidolaemus wagleri lays the foundation for future projects to compare and contrast other taxa within Crotalinae and Viperidae. The chosen reference specimen was compared to the presumed younger specimens to note any variation in ontogeny. The study here provides a comprehensive description of isolated cranial elements as well as a description of ontogenetic change within the specimens observed. This study contributes to the knowledge of osteological characters in T. wagleri and provides a foundation for a long term project to identify isolated elements in the fossil record.
Anaemia still constitutes a public health problem in the world, especially in the developing countries (1). Nutritional deficiency remains a major causative factor (2). During pregnancy, growth of the foetus, placenta and the larger amount of circulating blood in the expectant mother will lead to an increase in the demand for nutrients, especially iron and folic acid. Many women start their lives with insufficient iron stores, but also, because of inadequate child spacing, they have little time to build up their iron levels between pregnancies. In pregnancy, anaemia has been shown to be associated with an increased risk of maternal and fetal morbidity and mortality (3,4,5). Iron and folic acid supplementation is routinely given to pregnant mothers in Malaysia. It is anticipated that pregnant mothers who comply strictly with the prescribed iron supplement will maintain adequate iron stores at parturition. However, the compliance rate among rural mothers in Kelantan is often poor (6). Kelantan is also one of the most socio-economically underdeveloped
A survey of laws and regulations governing the practice of radiology by general practitioners in Malaysis and ten other selected countries wascarried out. It showedvaryingdegrees oflegal restrictions on the use of x-ray machines in the countries studied. Most regulations reflected the concern of radiation protection forpatients andstaff. Only some countries provide training for non-medical persons in the use of x-ray machines. Radiology has an important role in primary care. Undergraduate and post-graduate education should ensure competence in basic radiological practice. KEYWORDS: X-ray, general practice, regulations.
Mass vaccination of all newborns against hepatitis B virus infection has been implemented in Malaysia since January 1989. The significance of perinatal transmission of hepatitis B virus and the prevention of the disease are discussed. Routine screening of 6443 mothers in the University Hospital showed an overall carrier rate of 1.9%; whilst this was high amongst the Chinese (4.7%), a significant number of Malays were also infected (1.6%). The mechanism of perinatal transmission of hepatitis B and the important role of routine screening of antenatal mothers in eradicating the disease are discussed.
Contact lenses provide an alternative to spectacles for many people. However, the hazard of bacterial corneal ulcers exists. This article describes a soft contact lens wearer who developed a bacterial corneal ulcer. Prompt diagnosis and treatment is essential for eradication of the infection and prevention of loss of vision.
There had been increased and strong public interests in rare diseases and orphan drugs as well as the issue of
compulsory licencing for expensive medications in Malaysia in the mass-media and social media. We reviewed
the issues of orphan drugs and the challenges faced in many countries in developing appropriate health financial
modelling as well as getting accurate data on rare diseases. We also reviewed the old off-patent medications
and the developments on how policy-makers can intervene to make expensive treatment affordable and
sustainable for patients and the country.