In a 3 year period 73 cases of perforated peptic ulcers were treated by simple closure. The overall mortality of 3.77 percent is acceptable when compared with other reports. There was a marked male preponderance (11 males: female 1). Biopsy results confirmed the operatiue findings that perforations were seven times more common in gastric peptic ulcers than duodenal ones. The disease affected young adults, the middle aged and elderly, the peak incidence occurring between the fifth and seventh decades oflife. Simple closure was an effective surgical procedure for our group of patients.
Thirty girls who had been detained in a remand home on suspicion of prostitution were examined in the University Hospital, Kuala Lumpur. All except two were below 21 years old. Endocervical and high vaginal swabs were taken for cultures. A sample of blood was taken for serology. Eleven of the girls [37%] had no evidence of a sexually transmitted disease. The others [63%] had one or more of the following: 5 with positive serology for syphilis, 3 had gonorrhoea, 6 with trichomonas, 2 with candidiasis.rl with Chlamydia trachomatls, 2 with Ureaplasma urealyticum and 1 with C. vaginale. With such a high incidence of STD in these young girls with a history of prostitution, it is recommended that a more regular and comprehensive screening be carried out on such high risk women.
Study site: University Malaya Medical Centre (UMMC)
Although those Malaysian secondary schoolchildren who have never used drugs are consistent in their support for legal and social sanctions against drug use, it is argued that such sanctions are a relatively unimportant factor in the decision whether or not to use drugs. Non-drug users inhabit a social world separated from their drug-using contemporaries; they rely on information from public rather than direct social sources, and claim to have been little interested in information received. However, there is evidence that, for a minority of the drug-using sub-sample, public information campaigns have made them more rather than less interested in experimenting with drug substances.
PIP: While Malaysia's National Family Planning Board is primarily responsible for family planning activities, several organizations and ministries, both governmental and voluntary, participate in various service programs. Current population policy attempts to go beyond family planning. Population education, treatment of infertility, and cancer screening are offered as well as family planning, to make the program more useful to greater numbers of people. The government also wishes to improve the status of women thereby giving them alternative choices of lifestyle. Rural women are reached through the Ministry of Agriculture's community development program. While the National Family Planning Board receives only 0.12% of the national budget, this figure is not expected to increase. Tables giving vital rates show that population fell below the 30 per 1000 mark for the first time in 1977. A higher rate of fertility decline has taken place between 1967 - 1977 than occurred from 1957 - 1967. Current demographic objectives are to reduce crude birthrate to 28.2 per 1000 by 1980. This goal would require 817,963 new acceptors. While the pill accounts for 80% of acceptor's choice, the proportion using condoms has increased from 1.4% during 1969 - 1970 to 11.4% in 1979. Despite reported side effects with the pill and the illegality of induced abortions, virtually all acceptors are well satisfied with the program in its current form.
This is a report of migraine from Malaysia. 17 migraineurs are studied with respect to age, sex, ethnic group, occupation, age of onset, length of disease,' precipitating factors, relieving factors and family history. Similarities and differences between Malaysians and Caucasians are discussed.
Study site: Neurology clinic, Hospital Kuala Lumpur, Malaysia
A pilot study on the epidemiology of hypertension was carried out in 3 out of the 8 districts in the state of Selangor, namely Klang, Sabak Bernam and UIu Langat. stratified random sampling, 435 households were selected for the study. Eventually 312 (72%) households were surveyed: 963 (94%) out of the 1,030 persons aged 15 years and above living in the selected households were interviewed, and 957 of them were examined. The mean age of the respondents was 33 years. Taking a systolic pressure of more than 140 mmHg and/or diastolic pressure of more than 90 mmHg as hypertension, 1 in every 7 of those equal and mor.e than 15 years of age had hypertension, i.e. 140/0. 5.40/0 had a systolic pressure of equal and more than 160 mmHg, and 4.7% had a diastolic pressure of equal and more than 95 mmHg. The study showed that there was a significant rise in the prevalence rates with age in both sexes. There was no significant difference in the prevalence rates among. the sexes, ethnic groups (Malays, Chinese and Indians) and urban and rural areas. The mean systolic pressure ranged from 112-147 mmHg and diastolic from 69 - 73 mmHg. Hypertension was significantly more common among smokers (18.1%) than nonsmokers. There was no significant relationship between hypertension and tea, coffee and alcohol consumption. Hypertension was significantly more common among those with no physical activity (34.8%) as compared with those with physical activity (13.5%). 67% of the hypertensives were aware of their illness but only 36.1% of them were under treatment.
A total of 38 cases of fireworks related injuries from Hospital USM over a 5-year period from 1986 to 1990 during Hari Raya festival were analysed. The majority (68.5%) of the patients were teenagers, between 10 to 19 years of age. All the cases were Malays and most of the accidents occurred before the Hari Raya Idilfitri festive seasons. Fourteen cases were caused by self-made fireworks and another 16 cases were due to modified fire-works. Twenty-four cases suffered permanent disabilities mostly finger amputations. Such injuries could be prevented by law enforcement coupled with public health education to modify social behaviour especially when the ban against the use of fireworks is lifted on religious grounds.
Malignant neoplasms diagnosed histologically in the state of Sabah during the period November 1983 to October 1988 were analysed to determine the distribution of malignant neoplasms according to site, age, sex and major ethnic groups. The five commonest malignant neoplasms in males were carcinomas of the nasopharynx, stomach, skin, lung and liver. In females the five commonest malignant neoplasms were carcinomas of the cervix uteri, breast, ovary, thyroid and skin. There was variation in these frequencies among the major ethnic groups. The most striking of these was the high frequency of nasopharyngeal carcinoma among Kadazan and Chinese males but not in males of the other indigenous groups. A significant number of patients with nasopharyngeal carcinoma was found in the younger age groups and most of the patients in the younger age groups were Kadazans. A relatively high frequency of carcinoma of the stomach, skin and liver was seen among Kadazans and other indigenous groups while carcinoma of the lung was seen relatively frequently among Chinese males. Among females carcinomas of the breast and cervix uteri were the most frequent malignant neoplasms in all the main ethnic groups. Possible reasons for these findings are discussed.
Twelve cases of primary hyperparathyroidism operated by the Universiti Kebangsaan Malaysia Surgical Team from 1978 to 1989 were reviewed. There was a preponderance of Indian females in this series. The majority of the cases presented late and with complications. Renal calculi and bone disease were the commonest complications noted. Of the 12 patients, 9 had single parathyroid adenoma of which 4 were ectopically located, and 2 had hyperplasia of the parathyroids. These were all successfully operated. The remaining patient had 2 failed neck explorations. Failure at initial exploration was due to ectopic location of the glands. Meticulous surgical technique, knowledge of the anatomical variations of location of the parathyroid glands and availability of frozen section facility are essential for successful outcome.
JE is neither classified as an entity in the Malaysian Medical records system nor is it a notifiable disease but is grouped under the broad umbrella of viral encephalitis. There is no centralised program by the Ministry of Health specially for JE surveillance and control. JE is endemic, occurs sporadically throughout the country all year round. Asymptomatic inapparent infections have been found to be more frequent than acute clinical encephalitis cases, judging from results of previous serosurveys (Pond et al., 1954). JE vaccination has never been tried in Malaysia. In a relative sense, JEV infection unlike dengue virus infection, does not appear to be much of a problem in Malaysia. Perhaps, the laboratory confirmed cases represent only a small proportion of the total hospitalised cases that actually occurred. The reasons may be that these cases could not be confirmed by laboratory tests due to improper timing or failure to obtain the second serum specimen, or failure to perform lumbar puncture on patient's refusal. Attempts to improve the case detection rate of JE in Malaysia should be made namely, by increasing clinical index of suspicion, instituting better specimen collection procedures and by adopting rapid diagnostic tests.
Information from the national drug abuse monitoring system was analysed to determine the trends in extent and pattern of drug dependence in Malaysia over the period 1970 to 1986. The annual incidence and prevalence rates of reported drug dependents increased by many folds when compared to the early seventies. Generally, the profile of drug dependents identified has remained relatively stable throughout the years. A stable pattern of drug abuse was also noted over this period. Factors influencing the trend patterns are discussed, as well as the implications of these findings for policy purposes.
In 1954, with the assistance of the World Health Organization and the United Nations Children's Fund, a campaign against yaws was initiated in Malaysia with the formation of a yaws elimination unit in the Ministry of Health. Between 1954 and 1975, the reported annual incidence of yaws fell from 140.85 to 1.25 per 100,000 population. When rates dropped to less than two per 100,000, the program was merged with the general health services. Currently when cases are reported, contacts are traced, school and village surveys are carried out, and appropriate treatment is given. The major problems facing the control program today are a loss of interest in control activities; a smaller number of health workers experienced in the diagnosis, management, and control of the disease; and a growing reluctance to treat asymptomatic contacts with penicillin for fear of anaphylactoid reactions. Despite these problems, it is not an unreasonable expectation that, with continued stimulation from the individuals responsible for infectious disease control, yaws will eventually be eliminated.
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.
Features of the typical ameloblastoma of the mandible are outlined. Three cases managed by conservative surgical treatment maintaining the continuity of the mandible are described. The factors taken into consideration when instituting this method of treatment are discussed. Results obtained are encouraging.
A study was carried out to identify some of the cultural factors in the epidemiology of filariasis in an endemic community in Malaysia. The viewpoint of the community, data an responses on knowledge of illness and filariasis, host related factors, health examination, vector study were analysed and discussed. The observations noted on cultural factors were: Occupational pattern: Different agricultural occupations seemed to related to transmission in terms of body exposure. Activities not related to production of crops: Play groups in late afternoon, bathing of household members near and after sunset, congregations at prayer houses very much exposed the population to mosquito bites in different degree in terms of length of time spent outside the house. Knowledge of filariasis: Filariasis was understood in terms of elephantiasis, the chronic stage of the disease. Other signs of disease-adenolymphangitis, red lines running down one or both legs and abscess were generally recognized but not often annonated with specific disease. Attitude toward disease: Filariasis was not seen as a health problem and the idea of filarial worms was still hard to believe. Knowledge on disease causation: Biological causes were generally recognized, though the idea of bacteria was not widespread.
Two hundred and twelve of undescended testes were operated on in the Department of Surgery, Singapore General Hospital between the years 1974 through 1980. There was a 51.9% incidence of right undescended testis, 34.9% left undescended testis and 13.2% were bilateral. The method of treatment was surgical exploration with orchidopexy wherever technically feasible or orchidectomy if the testis was found to be severely hypoplastic. Of the total series, 42% were operated on before the age of 5 years. The oldest patient undergoing orchidopery was aged 40. Failure of orchidopexy to secure the scrotal position for the testis was noted in 14 cases. This was probably due to inadequate mobilisation at the first operation. There was no mortality and no significant morbidity following surgical treatment in this series.
This study was proposed to identify specific radiological appearances in Malaysian patients with bronchial asthma. All consecutive patients, seen in the Medical Unit, Universiti Kebangsaan Malaysia between 1976 and 1979, satisfying the American Thoracic Society [1962] criteria for bronchial asthma formed the subjects of this study. Analysis of 207 patients led to the following conclusion. There are specific radiological changes present in a proportion of bronchial asthmatics during the acute episode. These changes are more frequent in the younger age group and in those in which the age of onset are early, The duration of asthma seems to have some bearing to the radiological changes.
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.