Current asthma treatment is directed by severity of symptoms and lung function. In Malaysia, spirometry is not widely available and therefore not used in most medical consultations. In 163 asthmatic patients [mean (95% CI) age: 41 (38-44) yrs; 29% male; 32% Malays, 32% Chinese, 34% Indians] who were being followed up in a State Hospital medical outpatient clinic and a large urban-based health clinic, we studied the effect on Global Initiative for Asthma (GINA) disease severity classification and the appropriateness of currently prescribed treatment when forced expiratory volume in one second (FEV1) was considered together with symptom severity. We showed that 52% of the patients were upgraded to a higher severity classification and 71% of the patients were under-treated. If based on symptoms alone to assess severity, 39% of the patients were still under-treated. We concluded that the disease severity in many asthmatic patients might have been underestimated and therefore not adequately treated, because spirometry was not available or used to assess asthma severity. The use of spirometry should be advocated more widely among clinicians treating asthma in Malaysia.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan; Klinik Kesihatan Seremban, Malaysia
A 45-year-old Malay housewife was seen at a health clinic with the chief complain of recurrent lower abdominal pain for 9 months. The pain was colicky in nature and occasionally it radiated to the back. There was no history of fever, vaginal discharge or any urinary or bowel symptoms. She had been using an intrauterine contraceptive device (IUCD Cu250) for the past 5 years. The last change of the IUCD was 2 years ago. Her annual pap smear results were normal. She had been to many primary care clinics and was reassured by the doctors that her symptom was due to her IUCD. She was prescribed mefenamic acid repeatedly for the past 9 months. However her symptoms worsen and she was worried because prior to this she did not have similar problems. Her physical examination was unremarkable. On pelvic examination, the IUCD string was visualised, indicating that her IUCD was still in-situ. Her cervix was pink and healthy. There was no abnormal vaginal discharge.
This study aimed to established baseline data on patients' demographic and morbidity patterns over three months in the Outpatients Department (OPD) Ipoh Hospital. Entry of the first ten thousand patients into a computerised database for analysis showed that the majority were unemployed and from the low income group. There were more Malays and Indians, less Chinese. Respiratory infections accounted for 18.5 % while major chronic diseases (hypertension, diabetes mellitus, asthma) were common. Overall a wide spectrum of illnesses were seen. A career structure for OPD doctors and incorporation of Family Medicine concepts were proposed to improve primary care in OPD.
Study site: Outpatients Department (OPD), Hospital Ipoh, Perak, Malaysia
Between 2/10/2000 and 30/1/2001, the organizational structure and management in 4 general practice (GP) clinics & 2 health centers (HC) in Kinta District were studied by 14 Level 4 medical students of Perak College of Medicine. Data collected from work process files and staff interviews / shadowing showed that GPs in the study had more working experience with postgraduate qualifications than HC doctors. All HC nurses but only one GP clinic nurse had formal training. HC organization was more complex with documentation. GP organization was simple and lacked documentation. HC management was by a group while GPs handled all management aspects. This study enhanced students' understanding of Malaysian primary care system.
Objectives: The objectives of this study were to screen for psychiatric symptomatology in Form 4 students in Ipoh, Perak and to determine demographic characteristics, contributing factors and the key person consulted for psychiatric / emotional problems. Methods: Between December 1997 and March 1998, 84 Form 4 students selected by random sampling from 2 Ipoh schools (one co-educational - S1 and one all boys - S2) were screened using the 30-item Malay version General Health Questionnaire (GHQ-30) and a demographic questionnaire. S1 students were interviewed by a psychiatrist (second author) to assess for anxiety / depression / somatization using DSM IIIR criteria. Results: Eighty three students (98.8%) completed their questionnaires. Twenty four students (28.9%) had high GHQ scores (8 and above). There was no significant association found between GHQ scores and gender, race, parental occupation and marital status / situation, number of siblings, frequency of illness and Penialian Menengah Rendah (PMR) results. A significant association was found between the GHQ scores and the students' birth order and perceived performance in the past 6 months as compared to PMR. Fifty percent consulted their friends for emotional problems, 29.2% their parents, 4.9% their siblings. None consulted their teacher / school counselor. Conclusion: Further studies are recommended to look into the prevalence of psychiatric symptomatology amongst our Malaysian secondary school students and into the possible use of the Malay version GHQ-30 as a screening tool in this age group.
A study was conducted to determine the prevalence of fungal infection in cancer patients warded at the Hospital Kuala Lumpur. There were 138 patients included in the study: 74 with haematological malignancies and 64 with solid tumours. Serological results showed that for candidiasis 16/138 (11.5%) and 10/134 (7.5%) were greater than 1:8 reactive for antigen and antibodies respectively. For aspergillosis, 29/122 (23.8%) sera were antigen reactive. Only 1/133 each (O.SO/o) was reactive for cryptococcal antigen and antibody. The types of malignancies, the age of the patient, a history of neutropenia, the duration of the cancer, the number of courses of chemotherapy or radiotherapy were not predictive of fungal infections. In view of the high serological evidence of fungal infection and the lack of a reliable diagnostic test, empirical antifungal treatment must be considered in all febrile neutropenic cancer patients.
The reasons for referral of 189 patients referred to the Primary Care Out-patient Clinics, University Hospital Kuala Lumpur, were studied. 55.6% of them were from private general practitioners. 51.0% of the referrals were for evaluation of symptoms and 46.5% were for management of diseases. The profile of the referrals helps in curriculum planning of Primary Care Medicine. Other applications of the results are discussed.
Study site: Primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
A case of NSAID-induced hyperkalaemia in a fifty year old man with chronic renal failure is presented. This paper highlighted the mechanism and clinical importance of this form of drug-induced hyperkalaemia. Keywords: NSAID, hyperkalaemia, chronic renal failure