Adequacy of diabetic management in 5 Perak outpatient departments was studied in April 1996. Two hundred diabetic patients' records were analysed. All doctors and 100 patients answered questionnaires on diabetes. Fifty five percent of doctors had adequate knowledge. Patients' knowledge varied between centres (13% to 80% adequacy). Most records had insufficient data to determine adequacy of early detection. Centres with screeners had adequate weight and blood pressure measurement. Overall control and monitoring of diabetes were inadequate. Referral of complications were delayed in 2 centres. Refresher courses for doctors, patient health education, protocols, screeners and physician visits are recommended.
Study site: Klinik kesihatan, outpatient clinics, hospitals, Perak, Malaysia
Allergic rhinitis causes an impairment of the mucociliary function in the nose. It is hoped that treatment of perennial allergic rhinitis would be able to revert mucociliary function to normal. This study aims to compare pre and post treatment mucociliary transport time in 3 different treatment modalities. Ninety-two newly diagnosed patients with allergic rhinitis were randomised into 3 groups and started on different treatment regimes. At the end of 8 weeks, the group treated with only intranasal beclomethasone showed some, though not significant, improvement in the mucociliary function. There were no changes in the mucociliary function in the other two groups treated with beclomethasone and loratidine or loratidine alone.
Study site: ENT clinic in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
UKM
The clinical features and aetiology of 100 consecutive symptomatic heterosexual male patients with urethritis were studied from March 1994 to August 1994 in the Genito-Urinary Medicine (GUM) Clinic, Kuala Lumpur Hospital. Gonococcal urethritis (GU) was found to be more common (53%) than non-gonococcal urethritis(47%). All patients with GU confirmed microbiologically had clinically evident urethral discharge. Almost half (41%) of the patients with GU developed post-gonococcal urethritis (PGU). The most common organism isolated in PGU was Ureaplasma urealyticum (37%) whilst only 4% had both Chlamydia trachomatis and Ureaplasma urealyticum. Of the 47% of patients with non-gonococcal urethritis (NGU), 50% had no microorganism isolated, 32% had Ureaplasma urealyticum, 7% Chlamydia trachomatis and 11% both Chlamydia trachomatis and Ureaplasma urealyticum.
Study site: Genito-Urinary Medicine (GUM) Clinic, Hospital Kuala Lumpur
Appropriateness of medical admissions from a Malaysian public primary care clinic (Outpatient Department, Hospital Ipoh) was assessed by two physicians using a modified appropriateness evaluation protocol. Of 122 admissions between 16/6/96 and 15/7/96, 107 records (88%) could be traced from the records office. Eighty percent (86/107) were found to be appropriate and 20% (21/107) inappropriate admissions. Inappropriate admissions included admissions to the wrong discipline and patients who could be investigated and stabilised as outpatients or could be referred to specialist clinics. Protocols, provisions for urgent referrals and medical updates for doctors are recommended.
Thirty-six patients with lupus nephritis (LN) attending the Nephrology Clinic, Hospital Kuala Lumpur were studied for the prevalence of anticardiolipin antibody (ACA) isotypes (IgG and IgM) and other associated antibodies, antinuclear antibody (ANA) and anti-ds DNA antibody and to determine the possible association between serological and clinical parameters. The study population consisted of 20 (55.6%) Malays, 15 (41.7%) Chinese and 1 (2.8%) Indian with a mean age of 31.4 +/- 11.3 years, range 14 to 60 years. The female to male ratio was 11:1. The average time between diagnosis and blood sampling was 4.4 years (range 0.25 to 15 years). Increased ACA levels were found in 20 (55.6%) patients where raised IgG ACA and IgM ACA were observed in 20 (55.6%) and 2 (5.6%) cases respectively. ANA and anti-ds DNA antibodies were detected in 22 (61.1%) and 4 (11.1%) individuals respectively, with the majority (82%) showing a speckled pattern of nuclear staining. However, neither the IgM ACA nor IgG ACA showed any significant association with thrombosis or any other clinical parametres. Our preliminary study indicates that ACA is a frequent finding in lupus nephritis and that the IgG isotype is more prevalent.
Study site: nephrology Clinic, Hospital Kuala Lumpu
The practice of breast self-examination (BSE) amongst 1,303 women registered with the Well Person's Clinic, Outpatient Department, Hospital Ipoh between April 1995 and March 1997 were assessed through a questionnaire. Majority (98.2%) were never taught and did not practise BSE, 17(1.3%) practised BSE while 6 (0.5%) were taught BSE but failed to put it into practice. Only 5.8% of 52 women with past/family history of breast cancer/lump and 2.9% of 207 women with past/family history of other cancers were practising BSE regularly. Three out of 64 women with breast lumps found on clinical breast examination discovered the lumps themselves. Five of the 64 women were subsequently confirmed to have breast carcinoma.
Study site: Outpatient clinic, Hospital Ipoh, Perak, Malaysia
The efficacy of inhaled nedocromil sodium (NS) for children with a persistent cough was studied. Children aged 4-12 years with a persistent cough for >1 month were recruited and entered a 2-week baseline period during which an asthma diary was kept. Children with a cough score of >20 received inhaled NS via a spacer, 4mg qid for 2 weeks followed by 4mg bd for another 4 weeks. Twenty-two (42%) of 52 children recruited fulfilled treatment criteria. Four children were withdrawn from the study (2 developed wheezing and 2 were not compliant). The baseline cough score (29.1 +/- 13.6) improved after 2 weeks of treatment (15.2 +/- 9.3, p < 0.01) and improvement was sustained after 6 weeks (14.2 +/- 13.0, p = 0.01). Parents and patients had a more favourable perception of its efficacy compared to physicians (72% vs 50%, p = 0.01) Inhaled NS may be considered for treatment of persistent cough in children.
Study site: Paediatric clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The results of a prospective study of 94 patients with history of ear, nose or aerodigestive tract foreign bodies were analysed. Sixty six to 94% of patients presented within 24 hours to a primary care doctor, 80 to 94% was referred to the ENT Department within 24 hours and 89 to 93% of patients had their foreign bodies removed within 24 hours. Overall, 58% of aural foreign bodies, 67% nasal foreign bodies and 94% of aerodigestive tract foreign bodies were removed within 48 hours of insertion. As a result of the prompt removal of foreign bodies in the majority of patients, no significant complications occurred. Foreign bodies in the aerodigestive tract tend to present earlier and more promptly removed compared with ear and nose foreign bodies. There was a significantly higher proportion of foreign body in the right ear and nostril compared to the left.
We attempted to compare the accuracy of our clinical examination and the usage of magnetic resonance imaging (MRI) in evaluating patients suspected of having internal derangement of the knee who were seen in our Orthopaedic clinic. This was done using the findings of arthroscopy as the 'gold standard'. The accuracy of MRI in detecting cruciate ligament tears was between 80-96% against 82-93% for clinical examination. MRI accuracy for meniscus injuries was 80-84% compared to 48-65% for clinical examination. We thus propose that MRI examination is an effective first-line investigation for patients with suspected internal knee derangement, especially menisci injuries; allowing arthroscopy to be reserved for patients in whom surgery is truly indicated.
Study site: Orthopedic clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
This paper reports the result of a brief therapy attempt at treating panic in a busy outpatient psychiatric clinic. The patients were cases of panic referred from the various outpatient clinics within the hospital complex. The patients were divided into three groups at random using one of three modalities of treatment, i.e. cognitive behaviour therapy (CBT), CBT and Fluvoxamine (FVX), and FVX alone. The therapy was aimed for a maximum of nine sessions after which the patients were to be discharged. There were 14 patients in each group. The results show that all the groups were similar in the severity and scores pre treatment but after the different types of treatment there was a significant difference among them. The FVX alone group, showed significant improvement from the pretreatment levels but did not show as much improvement as the other groups and the mean score was only 9.07 after nine sessions. The best group was the CBT in combination with FVX. This indicates that the best way to treat panic is to combine drug treatment and psychological treatment. It is also shown from the study that the combination group requires less FVX than the FVX alone group. This finding has implications for the treatment of panic at the family physician clinic.
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia
Asthma knowledge an important components of asthma education.
Objective: To determine the levels of asthma knowledge in parents of asthmatic children and factors that may influence it.
Methods: This is a prospective study done between March 1998 and July 1998. Sixty-seven parents were interviewed using the 31 item asthma knowledge questionnaire that had been validated and translated. The children asthma severity was classified. The questionnaire includes biodata of children and parents, types of medication and dosage duration of asthma, exposure to cigarette smoke, acute asthma admission and patient’s economic status.
Results: This mean score for asthma knowledge was 15.5. The total score was 31. Asthma knowledge was significantly higher in parents whose children were using steroids [p=0.03, CI (-3.85, -0.02)]. It correlated significantly with steroid dosage (r=0.29, p=0.02), and was significantly higher in parents of higher economic status. Patient’s asthma knowledge had no association with children’s asthma status, age of the child or parents, exposure to cigarette smoke, frequency of admission of asthma duration.
Conclusion: The low asthma knowledge level indicates the need to increase the effort in educating parents. The main indicator for higher knowledge was steroid usage and dosage. Higher asthma knowledge in the high-income group was probably related to levels of education.
Keywords: parent, asthma, knowledge, Kuala Lumpur, Malaysia
Study site: Respiratory clinic, Institut Pediatrik, Hospital Kuala Lumpur, Malaysia
Two hundred outpatients (115 females and 85 males) attending the University Malaya Medical Center (UMMC) eye clinic, aged 20 years and above and without any ocular surface disorder were recruited for this study. Their tear film status was determined subjectively by their symptoms and quantitatively by the cotton thread test, Schirmer's test, marginal tear film meniscus assessment, fluorescein corneal staining and tear break-up time. Dry eye was considered present if at least one symptom was experienced often or always, within the past 3 months. Dry eye was also considered present if one of these tests was positive; Schirmer's test < 5 mm, Phenol red thread (PRT) test < 10 mm and tear film breakup time (BUT) < 8 seconds. The prevalence of dry eye in this sample population as defined by presence of symptoms and an abnormal test result is 14.5%. Presence of dry eye as detected by clinical testing is higher in the Chinese race (p < 0.01), in the group 40-59 years (p = 0.024). There is no difference between females and males. A lower BUT score was more strongly associated with presence of dry eye symptoms (p = 0.02). Elderly patients have a lower BUT and Schirmer's score. There is lack of agreement between PRT and Schirmer's test, although both are measures of tear quantity.
Study site: Eye clinic, University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia
This is a prospective study of clinical questions generated in primary care consultations and a comparison of two approaches to answering those clinical questions. Twenty-one doctors in a university-based primary care clinic submitted 78 clinical questions arising from patient consultations during 24 clinic days (0.01 question per patient encounter). These doctors subsequently found answers to 40% of their questions but were satisfied with only 67% of these answers. The investigators were able to provide answers for 95% of the questions asked and the doctors rated these answers as satisfactory in 86% of instances. Answers obtained by investigators had significantly higher satisfaction score than those obtained by doctors' search (p = 0.002). The two main findings of this study are (1) almost all questions arising in clinic setting could be answered by intensive search; (2) answers found by intensive searches were judged to be more satisfactory than those found routinely by doctors. Provision of an information retrieval service in addition to training in the searching and appraisal of medical literature are possible solutions to the information needs of busy clinicians.
Study site: Primary Care Clinic,
University Hospital Kuala Lumpur i
The best therapeutic choice in the treatment of lupus nephritis remains open to debate. In addition, there have been little data on the treatment of lupus nephritis in Asian patients. The objective of this study was to look at the response rate and complications of treatment given for lupus nephritis in a group of South East Asian patients with systemic lupus erythematosus (SLE). This was a retrospective, cross-sectional study of 103 patients with lupus nephritis. Detailed analysis was done on 58 patients with Class IV disease. The median time to remission was 12.1 months for azathioprine (AZA), 15.01 months for oral cyclophosphamide (CPM) and 15.25 months for intravenous (i.v.) CPM. The percentage of patients achieving remission after the first course of treatment was 42.9% with AZA, 83.3% with oral CPM and 90.9% with i.v. CPM. Overall, 41/58 (70.7%) of patients went into remission following the first course of treatment. Seventeen (41.5%) subsequently relapsed, requiring a second course of treatment. Fifty-two (50.5%) of all patients had drug-related complications from their treatment. The most frequent complication for the group was amenorrhoea (23.3% of all patients, 40% of those who had CPM previously), which was significantly more frequent in patients given CPM. In conclusion, more patients achieve remission when treated with CPM compared with AZA alone but this is associated with a higher complication rate, especially amenorrhoea.
Objective: To assess if children with Down's Syndrome have a higher prevalence of otological abnormality compared to their normal counterparts in Malaysia.
Methodology: Thirty children with Down’s Syndrome and normal children underwent otoscope ear examination and impedance test in the ENT outpatients clinic in University Hospital Kuala Lumpur, Malaysia.
Results: The study showed that children with Down’s Syndrome had higher ontological disorders. Forty four percent had impacted wax compared to 14.4% in normal children. Twenty one percent of ears in the study group had refracted drums compared to 6.6% of control. Fifteen percent of ears in the study group had middle ear effusion compared to 3.4% in controls, 55% had a type B tympanogram compared to 8.3% in controls and 73.4% had auditory canal stenosis compared to 14.4% in controls.
Conclusion: Children with Down’s Syndrome thus have a higher incidence of ontological disorders.
Study site: ENT outpatient clincs, University Malaya Medical Centre (UMMC)
DRE has been used as a diagnostic and screening tool for prostate cancer for decades. However these are based on Western data and its local applicability has yet to be verified. We held a Prostate Health Awareness Week in August 1998 and a total of 2086 men were screened. All men aged 50 years old and above were included for the study. The subjects were evaluated on DRE findings, PSA levels and if indicated a TRUS-guided biopsy results. We concluded that DRE per se might have limited role in the screening of prostate cancer in Malaysia. Screening using DRE and PSA combined are still recognized as the most cost-effective means. Neither DRE nor PSA alone has high enough specificity for diagnosis of prostate cancer cases. Combining DRE and PSA will definitely increase the specificity significantly.
Study site: e Urology
Clinic of Kuala Lumpur Hospital
We prospectively evaluated the effect of the treatment of lower urinary tract symptoms (LUTS) on sexual function. The patients were assessed by using the International Index of Erectile Function (IIEF-15) inventory at baseline and three months after medical (alpha-blockers) or surgical treatment (transurethral resection of the prostate, TURP). Following treatment, there were improvement in erectile function and intercourse satisfaction while orgasmic, overall satisfaction and sexual drive were relatively unchanged in the medication group. Patients who had surgical treatment suffered retrograde ejaculation, dissatisfaction in sexual intercourse and overall sexual satisfaction compared to patients who were on alpha-blockers.
Study site: Urology ward and clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
An analysis of 105 consecutive patients with chronic hepatitis C at the gastroenterology outpatient's clinic in Hospital Kuala Lumpur was performed. The clinical, laboratory and virological data was prospectively recorded in the case notes and comprised of data on patient characteristics, risk factors, clinical features, laboratory features, virology screen and management. Chronic Hepatitis C cases accounted for 2.1% of the total number of cases seen at this clinic during the entire period. There were 78 (74%) males and 27 (26%) females. The ethnic breakdown consisted of Chinese (44.2%), Malays (39.4%), Indians (15.4%) and others (1%). There was higher male preponderance in all the ethnic groups. The main mode of transmission was blood transfusion comprising 51 patients (48.8%). A total of 35.2% of cases underwent treatment, of which a proportion had interferon monotherapy for 6 or 12 months and a subsequent group of naïve patients and non-responders underwent combination therapy with interferon and ribavarin.
A two years retrospective analysis of patients diagnosed as contact allergic dermatitis with positive patch test attending the Dermatology clinic was performed. Of the 346 patients with a positive patch test, 14% had occupational dermatitis. This condition affected mainly young and inexperienced workers. An inverse relationship was seen between age and prevalence of occupational allergic dermatitis. Allergic hand dermatitis was the commonest presentation in occupational allergic dermatitis. This was followed by dermatitis of the exposed skin (face, neck, hands and forearms). The common sensitising agents identified were rubber chemicals and nickel. The two main groups at risk were factory workers and medical personnel. The common allergens found in factory workers were epoxy resin, pewter, nickel and rubber chemicals. Exposure dermatitis occurred in patients working in the pewter industry. Two thirds of medical personnel with hand dermatitis were allergic to rubber gloves. One year follow up after patch testing showed that 19% of patients still suffered from chronic dermatitis. Dermatitis improved in 34% of patients. Forty-seven percent were cured and stopped attending the clinic after patch testing and adequate counselling.
Study site: Dermatology Clinic, Hospital Kuala Lumpur
Ignorance is not bliss when it comes to sexuality. Psychosexual problems lead to shame, fumbling, needless fears, low-self esteem and even subfertility. The demands for help appears to be increasing; as the general population become more aware of its presence and the treatment options available through the mass media and better health education. Sex therapy has traditionally been the realm of the psychiatrist but with the gynaecologist as the first contact for most women, the number of women seeking advice directly from their doctors will only increase with time. A total of 243 new cases of sexual dysfunction were treated at the sexual problem clinic in Kandang Kerbau Hospital between January 1994 and November 1996; majority of which were self-referrals (48.5%). The patient pool consisted of more males than females although the clinical setting is in an obstetrics and gynaecology teaching institute. Vaginismus and erectile problems constituted the main complaints. Erectile problems are more common in the patients above 40 years old (p < 0.001). We report here our experience of such a sexual problem clinic and hope to provide insight into this area of medicine from the perspective of a practising gynaecologist.