The author spent 6 months as director of a major university hospital accident and emergency department in Kuala Lumpur, Malaysia. A brief summary of this experience is provided, followed by a series of recommendations based on the experience that may provide some guidance in future efforts to establish emergency medicine in developing areas of the world.
A study was carried out to determine the chemical composition of bulk precipitation, throughfall and stemflow in an urban forest in Kuala Lumpur, Malaysia. The mean weekly rainfall recorded during the period of study was 63.2 mm. Throughfall, stemflow and canopy interception of incident precipitation were 77.1%, 1.2% and 21.7% respectively. Bulk precipitation, througfall and stemflow were acidic, the pH recorded being 4.37, 4.71 and 4.15 respectively. In all cases the dominant ions were NO3, SO4, Cl, NH4, K, Ca and Na. Of the ions studied Ca, K, Cl, SO4, Mg and Mn showed net increases in passing through the forest canopy, while NH4, Na, NO3, Zn, H and Fe showed net retention. This study shows that the urban environment of Kuala Lumpur contributes considerable amounts of materials to the atmosphere, as reflected by the high ionic contents in bulk precipitation, throughfall and stemflow.
Knowledge of local antimicrobial resistance patterns of bacteria is a valuable guide to empirical antimicrobial therapy. This paper reports the resistance patterns of more than 36,000 bacteria isolated between August 1991 and July 1992 in six Malaysian hospitals and discusses the implications of the results. A customized menu driven software programme was developed to analyse the results. Generally, resistance to the commonly used antibiotics like ampicillin, cloxacillin, cephalosporins, gentamicin, cotrimoxazole and tetracycline was high. Some differences in resistance rate amongst the six hospitals were also noted. Continuous surveillance of antimicrobial resistance in hospitals is encouraged for the effective control of the emergence of antimicrobial resistance.
Three building complexes in Kuala Lumpur were surveyed for the presence of legionellae in cooling towers. The organisms were grown from 12 out of 46 samples of water collected from 30 towers. L. pneumophila serogroups 1 and 7 were the commonest serogroups isolated. None belonged to the Pontiac subgroup of L. pneumophila serogroup 1.
Preliminary analysis of the short-term impact of a running headlights intervention revealed that there has been a significant drop in conspicuity-related motorcycle accidents in the pilot areas, Seremban and Shah Alam, Malaysia. This paper attempts to look in more detail at conspicuity-related accidents involving motorcycles. The aim of the analysis was to establish a statistical model to describe the relationship between the frequency of conspicuity-related motorcycle accidents and a range of explanatory variables so that new insights can be obtained into the effects of introducing a running headlight campaign and regulation. The exogenous variables in this analysis include the influence of time trends, changes in the recording and analysis system, the effect of fasting activities during Ramadhan and the "Balik Kampong" culture, a seasonal cultural-religious holiday activity unique to Malaysia. The model developed revealed that the running headlight intervention reduced the conspicuity-related motorcycle accidents by about 29%. It is concluded that the intervention has been successful in improving conspicuity-related motorcycle accidents in Malaysia.
Women in an urban, Malay population reported menstrual period lengths that tended to coincide with the lengths of the calendar months in which the periods began. This pattern may be related to the calendar-month pay periods for the population.
A total of 73 localities covering 4,894 premises and 26, 712 breeding habitats were surveyed in 1980 to determine and establish the density and distribution pattern of Aedes aegypti and Aedes albopictus in Sarawak. A similar pattern has been observed in the density of the Aedes aegypti and Aedes albopictus. The number of houses positive with Aedes larvae were found to be highest in the coastal areas followed by the inland rural areas. The Aedes aegypti Breteau Index (B.I.) of 0-525 in the coastal areas is the highest followed by 0-207.5 in the inland rural areas. The study undertaken has now revealed that both the Aedes aegypti and Aedes albopictus are widespread in the State.
Chronic lymphocytic leukaemia (CLL) is rare locally. Seven CLL patients which constituted 0.9% of the total 747 cases of leukaemic patients were diagnosed over a 5 year period. They had similar haematological profiles as Western patients though most of them had advanced disease at presentation. Treatment of CLL patients was palliative and should be reserved for symptomatic patients and/or patients with progressive disease.