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.
A retrospective study of factors associated with poor patient compliance with antituberculosis therapy was conducted in Taiping, Perak. 219 patients were studied. Male patients and hospital referrals were significantly more likely to default. Patients with tuberculous lymphadenitis alone had a greater rate of default, but this just failed to reach significance (0.05 less than p less than 0.10). Six of 7 male hospital referrals with tuberculous lymphadenitis alone defaulted. Patients treated as outpatients from the start were more compliant. Housewives were also highly compliant. It was noticed that patients who defaulted tended to do so during early stages of treatment.
Three years ago the Universiti Kebangsaan Malaysia medical school changed its curriculum from the traditional discipline based curriculum to the integrated organ-system approach. Once change was effected a process of 'refreezing' had to be initiated whereby new responses had to be reintegrated into the ongoing personality or emotional relationships of important people so that the change process will endure and become stable. During this refreezing process the faculty encountered several problems which could thwart further development of the new curricula if left unresolved. The nature of the problems seemed to indicate that curricular change involves more than just efforts at bettering the what and ways of student learning and assessment. A lot of energy was also spent on keeping things going, keeping people motivated, making sure the work was done (at least as well as it has in the past), looking for better ways to do things, weighing new solutions and to be alert to new problems. In ensuring the continuance of change it was important to ensure, from the outset the institutionalization of policies, programmes, procedures and practices for continuing reward, routinization, structural integration into the system, continuing evaluation and providing for continuing maintenance.
"The past 20 years have seen extensive elaboration, refinement, and application of the original Brass method for estimating infant and child mortality from child survivorship data. This experience has confirmed the overall usefulness of the methods beyond question, but it has also shown that...estimates must be analyzed in relation to other relevant information before useful conclusions about the level and trend of mortality can be drawn.... This article aims to illustrate the importance of data analysis through a series of examples, including data for the Eastern Malaysian state of Sarawak, Mexico, Thailand, and Indonesia. Specific maneuvers include plotting completed parity distributions and 'time-plotting' mean numbers of children ever born from successive censuses. A substantive conclusion of general interest is that data for older women are not so widely defective as generally supposed."
We conducted a prospective longitudinal study to determine the nature and prevalence of cardiac abnormalities in systemic lupus erythematosus and to study their natural history and relationship with disease activity. Forty consecutive inpatients with systemic lupus erythematosus were studied during their admission and subsequently 6 to 12 months later. On each occasion a clinical cardiovascular examination was carried out, disease activity was scored using the "Lupus Activity Criteria Count" and a Doppler echocardiographic examination was carried out. 72.5% of patients had an abnormal echocardiogram in the first study while 51.7% were abnormal during the follow-up study. Valvar disease occurred in 37.5% of patients. The mitral valve was most commonly affected. Libman-Sacks endocarditis was rare (2.5%). Pericardial effusions were seen in 36.2% of echocardiograms. The majority (76.0%) of these were associated with hypoalbuminaemia. 80.0% of patients had active disease during the first examination and 41.4% at follow-up. There was no correlation between activity of disease and prevalence of cardiac abnormalities at either examination. We conclude that cardiac disease is common in systemic lupus erythematosus. Prevalence of cardiac abnormality did not correlate with disease activity.
Although delays in seeking dental care among patients are frequently observed in daily practice, this problem has never been investigated in other utilization studies. This study attempts to establish the magnitude and severity of the problem of delay in a delivery system where cost is not a major barrier to utilization. 555 users of Government dental services were interviewed. Only 37% of them came promptly within 6 days of perceiving a dental need. The majority (63%) had delayed their dental visit for more than 1 week. In fact, the highest frequency of delay was for more than 1 month. Prompt attendance was found to be associated with people who regularly came for asymptomatic check-ups. In contrast, more than 50% of those who thought they needed fillings and extractions had delayed their visit for more than a month. The main causes of delays were attributed to work commitments and the lack of perceived need for urgent care. Barriers related to transport or financial problems were ranked very low. The implications of these findings are discussed.
Growth hormone (GH) levels were measured after a 75g oral glucose load (OGTT) in normal adults, patients with impaired glucose tolerance (IGT), insulin-dependent diabetes mellitus (IDDM) and acromegaly. Nadir GH levels at 2-hour post-OGTT in normal subjects ranged from 0.4 to 8.4 mIU/L, the 95% confidence interval being 0.4-4.4 mIU/L. In IGT and IDDM subjects basal fasting GH levels were not significantly different from normal and did not alter during OGTT. The high fasting GH level measured in one each of the IGT and IDDM patients was suppressible at 1-hour after glucose intake. In contrast, acromegalic patients had elevated fasting GH levels (11.8-178 mIU/L) although in 3 patients, the levels were mildly elevated and overlapped with normal. OGTT failed or only partially suppressed GH secretion in all acromegalics. Therefore, elevated fasting GH levels are not diagnostic and OGTT is required for accurate diagnosis and assessment of treatment of acromegalic patients.
The results of treatment using a locally-designed external fixator in 20 patients are presented. Open fractures were the main indications for external fixation. Pin tract infection occurred in 8 patients. Only 2 patients had unstable fixation which required removal of the device. One third of patients developed malunion exceeding 15 degrees and two thirds had joint stiffness after conversion to plaster cast. This external fixator is adequate in the treatment of most open fractures of the tibia. However, improved techniques of pin insertion and cast application upon removal of the external fixator may help to reduce the incidence of pin tract infections and malunion.
A turnaround time study was conducted for bacteriological culture tests in seven Malaysian general hospitals. The turnaround times were determined using a specially designed form that was completed by the ward staff. Doctors at these hospitals were also polled to find out whether they were satisfied with the promptness of bacteriological test reporting in their hospitals. The turnaround times obtained from this survey were found to be satisfactory taking into account the constraints of laboratory methods employed. Nevertheless only about a third of doctors expressed satisfaction with the timeliness of the bacteriological test reporting. Doctors and microbiologists should get together and agree on acceptable standards of turnaround times that are practical and reasonable.
To evaluate the effects of simple compensated fixed-dose iodine-131 therapy for thyrotoxicosis, the long-term results for 74 patients treated with a fixed dose of iodine-131 ranging from 5 to 12 mCi (185 to 444 MBq) were evaluated in the first 2 years of a trial. The dose selected was loosely based on the gross size of the thyroid gland. Routine antithyroid drug therapy was given for a minimum of 3 months after iodine-131 therapy. The mean (+/- SD) duration of follow-up was 74.5 +/- 42 months. The results indicated that roughly 25% of patients treated in this way will become hypothyroid after 5 years and that 85% are cured (need no further therapy during the follow-up period) using a single dose of iodine-131. Of those cured using a single iodine-131 dose, 81% were no longer receiving drugs after 6 months and 85% after 1 year. Such a regimen seems currently to be among the best available where prolonged periods of medication-free euthyroidism after therapy are sought.
Complications resulting from the penetrating percutaneous foreign bodies almost always arise in the early post injury period. Delayed presentations of previous asymptomatic foreign bodies are rare. In this case report, symptoms of tracheal irritation arose seven years following the initial penetrating shrapnel injury to the neck. Computed tomography scans enabled localisation of the foreign body at the tracheal wall and carotid sheath interface. The usefulness of this radiologic modality in the evaluation of the penetrating soft tissue injury is highlighted. A review of the phenomenon of the migrating and asymptomatic foreign body follows.
In a coastal village in northwest Malaysia, 3231 fed Anopheles females of eight to 10 species were collected, marked with fluorescent dust, and released on three consecutive nights. In collections made on the 10 nights after the first release, 58 mosquitoes of three species, An. lesteri paraliae, An. subpictus and An. vagus, were recaptured; the recapture rates were 3.42%, 1.19% and 0.97%, respectively. The data for An. subpictus and An. vagus were insufficient for further analysis. Those for An. l. paraliae were plotted against time of recapture and, from the regression coefficient, an estimate of 0.68 was obtained for the daily survival rate. An independent estimate based on the parous rate during the previous year was 0.55. The temporal distribution of the recaptures strongly suggested a gonotrophic cycle and oviposition cycle of two days.
Rapid enzyme microassays for the detection of resistance due to organophosphate and carbamate in individual field-collected strains of Culex quinquefasciatus adults were conducted. These tests allowed accurate differentiation by eye, on the basis of color changes of susceptible and resistant individuals. Two separate tests were conducted for the biochemical assays. In the insensitive acetylcholinesterase (AChE) test, acetylthiocholine iodide (ACTH) and 5,5-dithiobis-(2-nitrobenzoic acid) (DTNB) were used as substrate and coupling agent respectively. The resulting yellow chromophore indicated AChE activity. Test results showed that the color intensity decreased as increasing concentrations of propoxur were added, thereby confirming the susceptibility of the enzyme to inhibitor. Assay of non-specific esterase however, indicated elevated levels which were correlated with degree of malathion resistance. Electrophoretic data revealed the presence of 2 esterase bands in all strains. It was concluded that such a pattern was not contributory to malathion resistance in adults.
Mice were chronically infected with cysts of ME49 strain of Toxoplasma gondii. At different periods post-infection, their spleens were removed and single cell suspensions were made. Lymphocyte transformation experiments were performed on the lymphocyte suspensions using three different kinds of antigens of ME49 strain of T. gondii, namely soluble, excretory/secretory and cystic forms. The results showed that the pattern of lymphocyte responsiveness was dependent on the kind of antigen employed for induction of the blastogenesis. Using soluble and cystic forms of the antigen, different periods of lymphocyte suppression and lymphocyte proliferation were demonstrated. However, with the use of excretory/secretory antigen, no significant suppression of lymphocyte stimulation was noted throughout the course of infection. Thus excretory/secretory antigen may be the best form of antigen for stimulation of the cell-mediated immune response and hence it appears to be a good candidate for vaccine in toxoplasmosis.
The medicaments used in this study were buffered glutaraldehyde and formocresol. Schiff's reagent was used in the quantification of aldehyde released into the collecting medium. The results of this study clearly show that formocresol diffused throughout the dentine and cementum within fifteen minutes following a pulpotomy procedure, whereas no diffusion of buffered glutaraldehyde was observed.
This report examines Malaysian women's perceptions of the contraceptive effect of breastfeeding, the determinants of their perceptions, and any effect these perceptions might have on nursing duration and contraceptive use. The report also considers whether women are consciously replacing breastfeeding with modern contraceptive methods. Data from the 1976 Malaysian Family Life Survey are analyzed, and the author concludes that Malaysian women do perceive that breastfeeding has a contraceptive effect, but that this perception is not universal. Ethnicity and desire for a particular family size are the most significant determinants of this perception. Finally, Malaysian women's recognition of the contraceptive effect of nursing does not influence either the duration of their breastfeeding or their adoption of contraception. Malaysian women may not be abandoning breastfeeding to adopt contraception. More probably, breastfeeding declines and contraceptive prevalence increases with modernization.
We have evaluated the effects of a B2 receptor antagonist (B5630) of kinins on BK and captopril-induced acute hypotensive responses in anaesthetized SHR. Intravenous treatment of BK (1.0 microgram) and captopril (0.3 mg/kg) caused significant (p < 0.05) fall in the SBP and DBP. Whereas BK caused greater fall in the SBP (p < 0.05), DBP (p < 0.01) and duration of hypotension (p < 0.05) when administered after captopril (Fig 1 and 2). All the hypotensive effects of BK and captopril were significantly antagonised (p < 0.05) in the presence of B5630 (2.0 mg/kg). Further, the duration of hypotensive responses of BK and captopril were blocked (p < 0.05) by B5630. The agonists and BK-antagonist did not cause significant (p > 0.05) alterations in HR during the entire investigation. These findings provide evidence to support the suggestion that B2 receptor might be involved in the regulation of the hypotensive actions of BK and captopril. Kinins should also have valuable functions in the antihypertensive property of captopril-like drugs.
This study investigates the unusual relationship between breastfeeding and waiting time to conception in Malaysia as reported in Goldman et al. (1987). Using data from the Malaysian World Fertility Survey (MWFS), Goldman and her colleagues (1987) find that noncontracepting Malaysian women have an unusually long waiting time to conception, given their relatively short durations of breastfeeding. This study provides a similar analysis using data from the Malaysian Family Life Survey (MFLS) and finds a more typical relationship. I conclude that the distinction between full and partial breastfeeding made to respondents of the MFLS probably led to more reliable responses to questions about breastfeeding duration, especially for women who breastfeed for long durations.