A quality assurance exercise for non-insulin dependent diabetes mellitus in the Family Practice Clinic, University Hospital Kuala Lumpur, was conducted using HbA1c as an indicator. We found that about 60% of the 163 patients with non-insulin dependent diabetes mellitus had fair to optimal control. The HbA1c correlated well with fasting and post-prandial blood glucose level (r=0.79 and r=0.54, respectively, p<0.001). The mean HbA1c was significantly higher in Malay compared to the other races, in those with longer duration of diabetes and in patients on two types of oral hypoglycaemic agent.
Study site: Family Practice Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
This article highlighted the recent development in the prevention and management of child abuse in Malaysia. There is now a willingness to recognise the conlplex social, moral, medical, educational, legal and economic problems related to child abuse. Multidisciplinary research, comprehensive and longitudinal targeted services to prevent child abuse and neglect are needed.
A prospective case controlled study was conducted to determine the incidence of asymptomatic bacteriuria in pregnancy (ASB), causative organisms and fetal outcome. Out of 510 antenatal mothers screened, 46 (9%) had ASB. The main organisms isolated were E. coli (16%), Staphylococcus aureus (15%) and Beta-Haemolytic Streptococcus (11%). Oral Nitrofurantoin and Cefuroxime axetil achieved sensitivity levels of 96%. There was no significant difference in period of gestation at birth and birthweight between the control and study groups. The reasons for routine antimicrobial therapy for ASB are discussed.
In the evaluation of the infertile couple, male factors account for up to 50% of causes. These factors may occur alone or in combination with female causes. Transrectal ultrasound has allowed imaging of the urogenital tract to be less invasive. New assisted reproductive techniques (ART) have revolutionised management. Many previously "hopeless" cases now have a good chance of fathering a child. Such ART include microscopic epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI).
985 medical certificates issued by primary care doctors at the Klinik Perubatan Masyarakat and the staff health clinic at Universiti Sains Malaysia were analysed. Most common diagnoses were URTls, conjunctivitis, and gastro-enteritis. Mean duration of absence ranged from 1.3 to 3.4 days. HUSM staff with skin infections were given certificates nearly twice more often than the public. Backache earned more time off for the staff compared to the public. There is a need to formulate guidelines for medical certificates.
Study site: Klinik Perubatan Masyarakat and the staff health clinic at Universiti Sains Malaysia
Bicycle fatalities constituted 5% of road fatalities in 1995. A helmet, properly worn, is the most effective measure to prevent head injury to a cyclist in the event of a crash. We studied the knowledge, attitude and practice of children in two secondary schools (Ipoh and Kulim) with respect to bicycle helmet use before instituting a program for helmet use. Although there were no major differences in knowledge, attitude and practice of students in the two groups, children in the Ipoh program failed to wear helmets while the children in the Kulim program complied over a one year period. The main reason for failure of the helmet progranl in Ipoh were negative peer influence. The Kulim helmet program was integrated with a bicycle safety course conducted by dedicated teachers. The quasi experimental study resulted in increased awareness of the importance of bicycle helmets among school children in Kulim Keywords: Bicycle helmet, road traffic injury, prevention.
A 32 year old HIV positive intravenous drug user (IVDU) with a promiscuous lifestyle in the past presented with altered behaviour and was diagnosed to have pulmonary tuberculosis, tuberculous meningitis and tuberculous osteomyelitis. After initial response to anti-tuberculous therapy, his symptoms recurred with the appearance of cerebral mass lesions. A presumptive diagnosis of toxoplasma encephalitis was made based on clinical, serological and radiological evidence. He showed clinical improGement with anti-toxoplasmic therapy.
Medical therapy is effective in patients with mild to moderate symptoms of benign prostatic hyperplasia. Selective alpha-1 blockers (e.g. terazosin) and 5 alpha reductase inhibitors (e.g. finasteride) are the main drugs used. Alpha blockers reduce the dynamic component of obstruction while the later reduces the size of the prostate.
Ischemic heart disease is a leading cause of morbidity and mortality in Malaysia. Management strategies for this disease have changed dramatically. This article, based on discussions of real cases, reviews current treatment methods for various patient subsets, with acute myocardial ischemia.
This study aimed to established baseline data on patients' demographic and morbidity patterns over three months in the Outpatients Department (OPD) Ipoh Hospital. Entry of the first ten thousand patients into a computerised database for analysis showed that the majority were unemployed and from the low income group. There were more Malays and Indians, less Chinese. Respiratory infections accounted for 18.5 % while major chronic diseases (hypertension, diabetes mellitus, asthma) were common. Overall a wide spectrum of illnesses were seen. A career structure for OPD doctors and incorporation of Family Medicine concepts were proposed to improve primary care in OPD.
Study site: Outpatients Department (OPD), Hospital Ipoh, Perak, Malaysia