Background: Based on studies and some clinical practice pneumatic dilatation utilizing the widely available wire guided polyethylene pneumatic dilator system using a 30mm balloon inflated for 15 seconds upon loss of waist noted (during fluoroscopy) at 7 to 10psi obtains optimal disruption of the lower esophageal sphincter. We employed this technique till August 2001 without any complications (notably perforation) with good clinical outcome and durability.
Aims: To study the efficacy of pneumatic dilatation with the pneumatic balloon dilated only till loss of waist.
Materials and Methods: A total of 10 treatment naïve achalasia patients enrolled from August 2001 till July 2002 were dilated till loss of waist and the outcome and durability was compared with our historical controls.
Findings: A total of 10 patients with age 45±18 (range 22-67) years with 8 females: 2 males and 5 Malays: 5 Chinese with 3 patients with megaoesophagus underwent pneumatic dilatation using a 30 mm Rigiflex® pneumatic dilator till loss of waist was noted during fluoroscopy at 7psi and the balloon deflated immediately. All the patients reported symptomatic improvement in dysphagia, regurgitation and demonstrated a 3-12 month post procedural weight gain of 6±5 (range: 1-15) kg. One patient required a second dilatation only after 13 months. All the remaining patients remain well till today after the initial single dilatation. The durability of the dilatation was 27±7 months (range: 13-33) months. There were no complications noted. There were no complaints of excessive reflux. This data was compared with our historical control (patients before August 2001), i.e. the pneumatic dilator inflated for 15 seconds upon loss of waist, and there was no difference in clinical outcome, or the durability of dilatation or the duration of stay post procedure.
Conclusion: Forceful disruption of the lower esophageal sphincter utilizing the pneumatic dilator is effective but is associated with a 1-5% risk of perforation. We obtained identical results without loss of clinical improvement or durability utilizing our technique compared to the traditional method. Since August 2001 all our dilatations were performed in our unit utilizes this simplified method. We have yet to report a perforation after pneumatic dilatation.
Introduction: Megaesophagus is defined as an esophagus measuring 8cm or larger on the barium swallow examination in a patient with Achalasia cardia. Its existence defines a late stage of achalasia and therapy will include an esophagectomy in its management. The latter carries a high morbidity and mortality.
Materials and Methods: We reviewed retrospectively all treatment naïve patients with Achalasia from 1st January 2000 and identified 10 patients with megaesophagus and these patients were analysed.
Findings: The average presenting age is 52±15 (range 20-73) years with 4 males: 6 females with 5 Malays:3 Chinese:2 Indians. The duration of illness before diagnosis was 7±5 (range 1-16) years. All patients had dysphagia, regurgitation and weight loss. All 10 patients demonstrated aperistalsis but interestingly 8 patients failed Lower Esophageal Sphincter (LES) intubation during Standard Esophageal Manometry due to coiling of the catheter. Failure to elicit Failure of LES relaxation translates as a high technical failure of manometry (80%) in the diagnosis of Achalasia. A confident diagnosis of Achalasia was made on barium swallow in 9 cases (90%). All 10 patients underwent pneumatic dilatation. Eight patients required only single dilatation. However two patients required two dilatations. The durability of the twelve pneumatic dilatation 27±13 (Range: 9-44) months with good symptomatic relieve and an objective post procedural weight gain of 10±6 (range:1-19) kg over a period of 3-12 months. There was no complications noted post procedure.
Conclusion: In advanced cases of achalasia, barium swallow is superior to manometry for obtaining the diagnosis. Pneumatic dilatation is an effective and safe procedure for patients with megaesophagus.
Report on 174 cases of tetanus neonatorum collected between 1946 and 1950 in the General Hospital, Singapore. There is a marked reduction in the incidence, which is attributed to a better maternity service. The results of treatment are bad – with a mortality of 90% of cases.
The author during a long tropical service has seen a distressing number of cases of tropical neurasthenia including a number that ended in suicide. The condition is common in Malaya of which he is writing. In a group of rubber plantations with an average staff of 75 (presumably Europeans) in the past two years, one has committed suicide, eight have been repatriated for nervous breakdown, and two have been sent on home leave for the same reason. In a series of 33 invalidings analysed by SQUIRES [no reference given] 45 per cent. [15] were for psychological reasons. Neurasthenia in the tropics differs from that seen in practice in temperate countries by the predominance of cerebral over spinal symptoms. The mild cases show increased irritability with occasional outbursts of uncon rolled rages, restlessness, and moderate amnesia. In the intermediate cases these symptoms are worse and periods of worry and depression occur, often amounting to delusions of persecution with insomnia. In the severe cases, the depression is predominant; to this is added procrastination and indecision, loss of confidence, fear of insanity and of loss of employment, which constitute a vicious cycle that may end in suicide. The author classes the causes as personal and environmental, the former being the more important; the prominence of the personal factor is due to the tendency for social misfits and others who are dissatisfied with home conditions to seek employment in the tropics where they hope to find life easier. The environmental factors are (i) Exile from one's own country and loss of firm roots in a place that one calls home, (ii) The excessive stimuli of the tropics; under this heading the author includes the direct effects of the climate and discusses the sexual factor, (iii) Overwork and excessive responsibility, (iv) Isolation and monotony; under this last heading [the sequence of thought is obscure to the reviewer] he includes a suggestion that the recent increased rate of breakdown in Malaya may be due to years of war strain and present economic and political difficulties. The preventive measures he advocates include more careful selection of candidates for service in the tropics and the suggestion that a psychiatric assessment as well as a physical examination should be made; more frequent home leave; annual local leave to a hill station; shorter office hours; more security of tenure of appointments in commercial undertakings; and freedom to marry early in his service. Finally, the author suggests that, since this problem is an admittedly serious one, the Malayan branch of the British Medical Association should make a study of its aetiology and prevention, and convey their conclusions to the Government and to commercial and industrial associations. L. E. Napier.
Citation: Tan YL, Foong K. Implementing Pictorial Health Warnings in Malaysia: Challenges and Lessons Learned. Bangkok, Thailand: Southeast Asia Tobacco Control Alliance; 2010
Citation: ITC Project (March 2012). ITC Malaysia National Report. Findings from Wave 1 to 4 Surveys (2005–2009). University of Waterloo, Waterloo, Ontario, Canada; Universiti Sains Malaysia, Pulau Pinang, Malaysia; and Ministry of Health, Putrajaya, Malaysia
This report presents results of Waves 1 to 4 (2005 – 2009) of the ITC Malaysia Survey – a face-to-face and telephone survey of a cohort of approximately 2,000 adult smokers and, 1,000 youth smokers and non-smokers. Waves 1 to 3 also included a cohort of 1,500 adult non-smokers. The key findings contained in this report provide evidence regarding the attitudes and behaviours of adult and youth smokers and non-smokers to assist policy makers in implementing effective tobacco control policies in Malaysia.
Citation: Hussin S, Lai CC, Md Firdaous H, Abu Talib P. Smoking among teenagers in Malaysia - a socio-psychological study. Shah Alam, Selangor: Karisma Publication; 2004
Citation: Chee HL. Health and nutrition of the Orang Asli: The need for primary health care amidst economic transformation. In: Abd Rashid MR (editor). Indigenous Minorities of Peninsular Malaysia: Selected Issues and Ethnographies. Kuala Lumpur : Intersocietal and Scientific; 1995, p48-73
Negritos of Peninsular Malaysia have physical features which strongly resemble the African pygmies rather than any of the other main South East Asian ethnic groups. In addition, their features are also completely different from the two other large sub-groups of the Peninsular Malaysia Orang Asli, i.e. Senoi and Proto-Malay. In this study, we genetically screened three African-specific markers, Glucose-6 Phosphate Dehydrogenase (G6PD) gene PvuII Type 2 polymorphism and A- mutation; and Sickle Cell trait in 103 unrelated individuals with G6PD deficiency. None of the Negritos’ samples carried A- and Sickle cell mutations but all males and females have the PvuII Type 2 polymorphism. The same results were seen in all DNA samples of the Malaysian’s Malay, Chinese and Indians. Additionally, all females in this study were homozygous for PvuII Type 2 polymorphism. Thus, we concluded that this polymorphism is widespread in all Malaysian population and is not unique to just Africans. However, these findings indicated that the polymorphism was widely conserved and can be used to study the African descendant in any world population hitherto supporting the ‘Out of Africa’ theory.
This paper reported a preliminary study on Mat Rempit's activities and illegal motorcycle racing. Mat Rempit activities are becoming very popular among teenagers especially in major cities and towns in Malaysia. This phenomenon has created a new sub-culture amongst Malaysian teenagers. This study focused on psycho-social factors that encourage teenagers to involve in illegal motorcycle racing and to survey racing backgrounds (eg. racing types, time, places, prizes, etc.). Data was obtained through interview and live observations at the racing scene. One hundred racers and ex-racers had cooperated as respondents to feed this research with information. Results showed that Malay teenagers between 17-22 years old are the most involved in this activities. Also, moderating factors have been identified which are psychological factors where neurotic and extrovert personality traits and high level of self-esteem are found to correlate with racing involvement. Meanwhile, sociological factors such as peers, greatness flaunting culture and prizes are encouraging teenagers' involvement in illegal racing activities. Family and community roles to curb these unhealthy activities are suggested.