This review describes some of the mechanisms which are thought to be important in the causation of pain in chronic pancreatitis. Both medical and surgical techniques for treating this pain are described.
We report a case of total occlusion of the left main coronary artery (LMCA) in a patient with chronic, stable angina. Total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, there is usually also disease in other parts of the coronary arterial tree.
The author describes a new operative method for treating chronic recurrent subdural hematoma. The subdural pocket is exteriorized so that it is in continuity with the subgaleal space through a limited extradural pocket and an L-shaped linear craniectomy. This procedure has been carried out in two patients with recurrent chronic subdural hematoma, both of whom made complete recoveries despite initial recurrence of the subdural hematoma.
Depression is one of the leading causes of mortality and morbidity worldwide. In the year 2000 depression accounted for 4.4% of the global disability adjusted life years (DALYs). The Kingdom of Saudi Arabia (KSA) has a population of 28 million people and is one of the countries experiencing demographic transition in its population structure. Improvements in socioeconomic status have been shown to be associated with increased chronic diseases including chronic mental diseases like depression, but still there is no comprehensive review summarizing the various reports currently existing in the literature. Although individual studies within Saudi Arabia have reported prevalence rates and risks, the quality of such studies need to be subjected to rigorous assessment and their findings pooled to give combined weighted evidence that will provide basis for targeted intervention. Pooled risks have the advantage of adjusting inherent variations within sampled populations and therefore providing more reliable estimates even though there are concerns about possible magnification of smaller individual risks.
Non-communicable diseases (NCDs) represent among the most common and debilitating conditions seen in primary care. Patients’ care will often involves multiple providers and follow-up requires persistence by patients and clinicians alike, therefore ideal outcomes are often difficult to achieve. The need for better disease management policies and practice is growing. This is due to the changing demographic profile of the population, the increasing cost of managing people in acute care hospitals and the availability of new technologies and services. All these changes enable a different care paradigm which is more cost effective and provides people with chronic conditions an improved quality of life. Management of the NCDs therefore offers an excellent opportunity to practice chronic disease management - a systems approach designed to ensure excellent care.
The NCD team has developed a comprehensive approach to chronic disease care. We would like to describe the NCD Program in Ampangan Health Clinic which represents many typical government health clinics in Malaysia and the processes by which it was developed. Included are specific examples of the tools and how they can be used by individual clinicians in caring for patients. The integration of Chronic Disease Management Services into health care systems is the direction being undertaken to tackle the burden of chronic disease. Disease management supports the shift in healthcare from an emphasis on managing the acute episode to managing the entire disease course, highlighting both prevention and maintenance of wellbeing for patients with chronic diseases. Disease management promotes better integration and coordination of care across all aspects of the health sector.
Singapore health care has taken a major leap and invested a large amount of money and work force in chronic disease management. These changes attempt to integrate population perspectives and personcentred perspectives. Primary health care team can play a lead role in chronic illness care, but health care organisation system support and policy are critical to its success. (Copied from article).
Chemiluminescence assay was used to assess the respiratory burst activities of polymorpho-nuclear leukocytes from paediatric patients reported to manifest with several episodes of recurrent bacterial infections. From this group of patients evaluated, only 10 cases of severe recurrent bacterial abscess exhibited more than 80% depression in the phagocytic chemilumi-nescence responses. The assay, being a sensitive method, was able to provide further useful laboratory investigation in diagnosing 4 patients with chronic granulomatous disease.
A five-week-old infant presented with infantile acute lymphoblastic leukaemia. He devel-oped an early CNS and bone marrow relapse despite intensive treatment. This paper discusses infantile leukaemia and its treatment.
There is a high prevalence of chronic diseases in the community. Promoting health at the workplace is an effective measure to manage such diseases. This study shares the findings of country-wide company health screening program. The prevalence of high cholesterol among participants was 29 %, high blood pressure was 8% and high blood sugar was 3%. The prevalence of high cholesterol from workplace screening was higher than the community prevalence but the prevalence of high blood pressure and high blood sugar was lower than the community prevalence. The various factors influencing these findings are discussed.
Introduction: Scientific evidence indicates that higher dietary fibre consumption protects against various chronic diseases and leads to recovery enhancement. Young corn ear is very rich in total dietary fibre (TDF). The study objective was to evaluate the effects of young corn ear addition on the nutritional composition, textural properties and sensory attributes of conventional cake. Methods: Wheat flour used in the preparation of conventional cake was substituted with different percentages (0%, 5%, 10% and 15%) of young corn ear powder (YCP). Moisture, total ash, fat, protein and TDF content of conventional cake samples were investigated. Textural properties including firmness, cohesiveness, springiness, gumminess and chewiness were examined. The aroma, colour, chewiness, tenderness, flavour and overall acceptance of conventional cake were evaluated via sensory evaluation. Results: The conventional cake with addition of 15% YCP recorded the highest moisture content. There was no predictable trend observed in the ash and fat content following the incorporation of YCP. Addition of 15% of YCP increased the protein content significantly while TDF content of conventional cake increased proportionally (1.42%-2.88%) with the level of YCP added. The incorporation of YCP did not produce any trend on all the textural properties of conventional cake. Conventional cake with 10% of YCP was the most preferred manifested by the highest scores in chewiness, tenderness and flavour attributes. Conclusion: In conclusion, 10% of YCP could be recommended as the ideal formulation in order to produce a healthier conventional cake without jeopardising acceptability.
The paper discusses on the complexity of the issues surrounding a patient with subluxation of cervical spine in a Down syndrome child. Several relevant issues are discussed including consent in a minor, conflicting decision making between parents and doctors, end-of-life issues, supporting handicapped child with minimal co-morbidities, community ethics, neglect of care by the caregiver and decision making after allowing zonal of parental discretion. Despite the difficulties surrounding parental actions, there are still ethical priorities which have to be considered individually to alleviate the suffering of the patients and the family members. Dealing with patients with chronic illnesses is a challenge for any medical doctors. The case warrants sensitive approach to allow appropriate respect for parental decision despite in disagreement with the clinical team. The term ‘zone of parental discretion’ refers to a controversial area of decision making; and has still many potential conflicts on day to day clinical cases, especially among the conservative society in the East Coast of Peninsular Malaysia.
Introduction : Despite the number of information generated by researchers, cardiovascular diseases problem has not clearly declined and perhaps in certain situation it is gradually increasing, affecting people who are previously at low risk. There is a tendency to believe that favourable outcomes can always be expected once intervention activities, like exercise promotion, are carried out, but practical experience gives rise to serious doubt.
Methods : A greater understanding of the socialization mechanisms operating in the adoption of physical activity in CVD control and allow specific exercise prescriptions for communitybased prevention and control is important. This paper highlighted the author’s feeling about controlling chronic diseases by mean of community intervention.
Results : This analysis has strongly believed that the important impetus of any community intervention approach should be oriented in the form of “from people to people”.
Conclusion : More emphasis needs to be placed on effective management and parameters for assessment of its management success.
Introduction : Studies on stress among diabetic patients with complications are not much conducted locally. In this study the researchers would like to find out the magnitude of the problem among the Malaysian.
Methodology : A cross- sectional study was conducted to determine the prevalence of stress and its associated factors among the diabetes mellitus patients with complications at Raja Perempuan Zainab II Hospital, Kota Bharu, Kelantan. The translated Personal Stress Inventory questionairse was used to measure the stress among the respondents.
Finding : The prevalence of stress was 36.8%. The study showed that the employment status of respondents has significant association with stress in which higher numbers of unemployed respondents were stressed as compared to the employed respondents. Other sociodemographic factors, namely duration of having diabetes mellitus and type of complications developed by the patients were not significant.
Conclusion : Once the poor and unemployed patients were diagnosed to have diabetes mellitus either with or without complication, the health staffs should refer them immediately to the relevant agencies for help. By doing so, these patients could be prevented from having stress later. Outreach programmes in the community should be carried out regularly for an early detection and treatment of chronic diseases including diabetes mellitus to prevent patients from developing any complication.
Surprisingly little was known about the importance of touch in life which was placed at a lower emphasis than the rest-namely visual, auditory, olfactory sense and etc. This writing aimed to decipher the significances of interpersonal touch, its culture, practices, barriers and challenges, which were then conveyed to the public as a form of health promotion. Methodology includes narrative review where the suitable literatures used were searched using ScienceDirect database under the keywords of “Interpersonal Touch”, “Oxytocin” and “Touch”. In this review, we have highlighted some of the most critical points which should have been promoted to the public. For example, touch satisfies individual psychosomatic and psychosocial needs. It forms a non-verbal communication culture which interacts about emotions, trust, compliance and more. Furthermore, it has been linked to the secretion of multifunctional bioactive chemical-oxytocin which was well-known in its therapeutic advantages for a wide range of commonest chronic diseases and social ills. Although some dysfunctional consequences may be resulted, incorporating genuine interpersonal touch into today’s efforts is undeniably viewed as a good option in solving many social problems.
Irritable bowel syndrome (IBS), a common gastrointestinal disorder involving the gut-brain axis, and inflammatory bowel disease (IBD), a chronic relapsing inflammatory disorder, are both increasing in incidence and prevalence in Asia. Both have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum. We examined the similarities and differences in IBS and IBD, and offer new thoughts and approaches to the disease paradigm.
To study the process of establishment, and evaluate the outcome of participation, in a self-help support group for people with chronic nonmalignant pain, members of a newly-established, consumer-led group participated in two interviews 5 months apart and a researcher observed group meetings. Participants reported significant benefits from participating in the group. They had a significant increase in functional ability and activity, and reported decreased recourse to health professionals, particularly family physicians. This study indicates that pain support groups can play a valuable role for people in pain, assisting with support and rehabilitation, and meeting needs that health professionals are often not appropriate or able to provide.
Chronic urticaria includes several different subsets with distinct pathophysiologies, and with important implications for investigation and treatment. Chronic 'idiopathic' urticaria represents a special challenge, which, until recently, was not taken up by dermatological or immunological investigators. However, it has now emerged that at least 30% of patients possess histamine-releasing autoantibodies against Fc epsilon R1, or less commonly IgE itself. These autoantibodies are causative. Recent work implicates complement activation in most cases. Functional (i.e. histamine releasing) autoantibodies are specific to chronic urticaria. However, immunoreactive (non-histamine-releasing) anti-Fc epsilon R1 autoantibodies can be found in sera of patients with physical urticarias and with autoimmune connective tissue and bullous diseases. The reason for the occurrence of this disease type in some individuals but not others is unclear. One possibility is the development, in genetically predisposed persons, of autoantibodies by molecular mimicry - perhaps against lipopolysaccharide of Helicobacter pylori, an organism frequently infecting the upper gastrointestinal tract of chronic urticaria patients.