Vaginal hysterectomy for the large uterus is seldom performed in Malaysia. The traditional operation is abdominal hysterectomy. This is a personal series of vaginal hysterectomies for enlarged uterus of more than 12 weeks size (>280g) carried out in a private hospital between 1/1/97 to 30/9/2000. A total of 40 cases were done with the weights of the uterus ranging from 290g to 790g. The mean weight of the uterus was 434g. The average operating time was 92.1 min. The complications were minimal with 2 cases of blood transfusion for intra-operative hemorrhage, 1 case of fever and 1 case of bladder perforation. This series demonstrates feasibility and safety of the operation. The excellent recovery due to the absence of an abdominal scar should be a strong incentive for specialists to learn the skill.
Generally there is a significant delay before optimized performance of mammography is fully realized in the developing countries. To evaluate the status of mammographic performance, a survey of mammographic image quality and exposure was performed in nine hospitals from four selected South East Asian countries. The entrance exposure on the surface of the American College of Radiology (ACR) mammographic phantom (ACR-RMI model 156) was made using both thermoluminescent dosimeters (TLDs) and an ionization chamber. The TLDs were mailed from the University of Wisconsin Radiation Calibration Laboratory (UWRCL) to the cooperating hospitals. The surveyed hospitals processed the images and returned them to the UWRCL for subsequent evaluation of the image quality of the mammographic phantom. Machine-specific data, technique factors and sensitometric data were also obtained. At 28 kVp, the mean entrance exposure is 0.91 R (0.46 to 2.6 R), mean glandular dose is 1.61 mGy (0.90 to 4.15 mGy), mean optical density is 1.37 (0.66 to 2.30), mean total phantom image score is 9.1(4-12). Only three of the nine hospitals tested achieved an acceptable score above the minimum 10. Results for 25 and 30 kVp showed similar trend. The variation between the ion chamber measurements and TLD measurements ranged from 4 to 24%. There is a wide variation in the image quality and entrance exposure among hospitals in South East Asia. There is a need for a quality assurance program. The factors that cause low score in the phantom images must be corrected. Calibration and the use of appropriate ionization chambers for mammography is important.
The number of women in the workforce in increasing. A substantial proportion are in the reproductive age which brings to attention the problem of work exposures that adversely affect reproductive outcome. These exposures include chemicals, radiation, strenuous physical activity and infections. They affect reproduction by effect on the germ cells, through hormonal distribution which in turn affects transport of germ cells or zygote, implantation and development. Some of these exposures are teratogenic. At present, some regulations and policies seem to be directed at women workers while there is evidence to show that women are not the only victims. Paternal exposures have also been reported to be associated with infertility, spontaneous abortions and other adverse outcomes. There is insufficient information about reproductive effects of work exposures and hence further research is required in this area.
A cross sectional study was carried out in Negeri Sembilan to identify factors associated with job satisfaction of doctors serving in Ministry of Health and their intentions to resign. All Ministry of Health doctors currently working in Negeri Sembilan were included in the study and data collection was done via a self-administered postal questionnaire. The response rate was 69.4%. Out of those who responded, only 31.3% had global job satisfaction, with the majority dissatisfied. Intention to resign was high among 32.7% of the respondents. Factors found to be significantly associated with job satisfaction were age, job designation, income, duration of service and intention to resign. Intention to resign was found to be significantly associated with ethnicity and income. From logistic regression, predictors of job satisfaction identified were age, place of first graduation, and satisfaction with status and autonomy, satisfaction with career development, satisfaction with workload and satisfaction with transfers. Predictors of intention to resign were race, income and global job satisfaction.
A comparative study was carried out to assess Year I and Year III student nurses' attitudes and knowledge of the elderly. Significantly more Year I students disagreed that the elderly had a capacity to learn (chi 2 = 11.08, p = 0.0006). Year III students were significantly more likely to obtain information about the elderly from the mass media, agencies, and relatives but not from health personnel. Nearly all respondents (96.25%) in the study wanted to know more about the elderly. Only 3 of the 14 questions on ageing revealed significant differences in knowledge between the two groups. The basic course in gerontology should be expanded and revised to dispel erroneous attitudes, allow better understanding of the ageing process, and ensure entry-level competence in caring for older people.
Blood pressure examination was done manually in 1756 healthy school children aged 6-12 years. Korotkoff 1 represented the systolic blood pressure (SBP) and Korotkoff 5 was taken as the diastolic blood pressure (DBP). Blood pressure percentile charts were then drawn up based on age group and sex regardless of ethnicity. There was a significant correlation between both SBP and DBP to increasing height, weight and body mass index.
The process of development in Malaysia has brought about significant socioeconomic and demographic transformations. Reduction in fertility and mortality, have resulted in increasing survival of populations to later life. Thus the proportion of the elderly is increasing. Population ageing, the most salient change affecting the demographic profile of Malaysia, will have a significant impact on the patterns of socio-economic development. In order to anticipate and respond in time to the far reaching socio-economic and humanitarian implications of ageing, it is imperative that the magnitude and the
momentum of its occurrence need to be recognised.
This paper looks at demographic trends, disease profile as well as health policy implications of ageing in Malaysia.
This paper highlights two cases of paediatric familial hyperlipidaemia (hypercholesterolaemia and hypertriglyceridaemia). The first case was an 11 year old Chinese boy, a "homozygous" (Type II) hypercholesterolaemic patient. He had extremely high blood cholesterol level (19.4 mmol/l), severe multiple xanthoma and abnormal resting electrocardiogram. He had repeated heart attacks and died at the age of 15 in spite of early intervention, treatment and follow up. The second case was a 2 1/2 years old girl who had severe hypertriglyceridaemia. She had raised cholesterol (6.2 mmol/l) and extremely high triglycerides (14.8 mmol/l). The patient did not resemble Type I lipoproteinaemia which is classically seen in childhood. On the contrary, the patient exhibited clinical and biochemical manifestations of a Type V lipoproteinaemia which often occurs in adults. Apart from a Type V lipoprotein pattern, the patient had low post hepatic lipase activity (PHLA), Apo C II and Apo E2/E3 phenotype. In addition, the lipid profile of her family members (both the parents and brothers) had raised triglycerides and thus ruled out the Type I lipoprotein inheritance pattern, which is an autosomal recessive condition. The issue of paediatric hyperlipidaemia, their management and treatments are discussed.
This study aims to investigate the incidence and causes of hyponatraemia in hospitalised elderly patients. There was a total of 407 new patients. 55 (13.5%) patients were found to have at least one episode of hyponatraemia during their hospitalization. There were 58 deaths. Fifteen out of 55 (27.3%) patients who had hyponatraemia died compared to 43 out of 352 (12.2%) normonatraemic patients (chi-square significant, p < 0.01). The three most common causes of hyponatraemia were syndrome of inappropriate antidiuretic hormone secretion (SIADH), poor oral intake and diuretics. The two most common causes of SIADH were lower respiratory tract infection and stroke.
This is a review of the positive biopsy rate of nonpalpable breast lesions detected on mammography. The histology of 130 hookwire excision biopsy from 1990 to 1995 and the cytology of 39 stereotactic fine needle aspiration cytology in 1995 were reviewed. The yearly positive biopsy rate of each procedure was determined. In 1990, the positive biopsy rate for hookwire excision biopsy was 15%, in 1991 20%, in 1992 11%, in 1993 17%, in 1994 33% and in 1995 39%. In 1995, the positive biopsy rate for stereotactic fine needle aspiration cytology was 21%. The positive biopsy rate for hookwire excision biopsy had improved from 15% in 1990 to 39% in 1995.
A 25-year-old lady presented with a severe normocytic anemia (Hb 5.3 g/dl) and a sideroblastic marrow at the end of her first pregnancy. Six months into the puerperium, after the transfusion of a total of 8 units of red cells, there was apparent spontaneous improvement and then she was lost to follow-up. After a second pregnancy without clinical problems, she presented during a third pregnancy, at the age of 30 years, with similar hematological findings. Twenty-two months later she was well with a normal blood count. One possible reason for relapse in pregnancy is the increased demand for pyridoxine that occurs, but only one other case of sideroblastic anemia relapsing during pregnancies has been reported.
Eccrine cylindroma is a benign tumour arising from sweat glands in the skin. It favours the face, forehead and scalp involving the turban area and hence is called a turban tumour. Amongst a variety of tumours originating from adnexal skin structures, which may appear in the ear canal, eccrine cylindroma forms a very rare entity. We present such a case and discuss its pathological and clinical features.
The susceptibility of three strains of Aedes aegypti (L.) to four strains of Ascogregarina culicis were studied under laboratory conditions. The parasite was found to be pathogenic to the mosquito; although pathogenicity varied among geographical strains of A. culicis and susceptibility varied among geographical strains of Ae. aegypti. In addition to affecting the survival of the mosquito larvae, infection with the parasite was found to shorten larval development time. Selected strains of A. culicis may be useful as a biological control agent against Ae. aegypti.
A high-resolution G-banding technique was used to identify five metacentrics that characterize Suncus murinus from Sri Lanka. These metacentrics were shown to be the product of Robertsonian fusion of acrocentric chromosomes identical to those in the standard karyotype defined by M.B. Rogatcheva et al. Two of the metacentrics in the Sri Lankan shrews (Rb(10.12) and Rb(14.15)) were the same as those reported by C.H. Sam et al. in Malayan populations of S. murinus. This finding provides strong support for the suggestion of T.H. Yosida that metacentric-carrying shrews colonized Malaya from Sri Lanka and hybridized with individuals of standard karyotype, generating the Robertsonian polymorphism now observed. In addition to the Robertsonian variation in S. murinus, we have used our high resolution technique (G- and C-banding) to characterize variants on chromosome 7, the X chromosome, and the Y chromosome.