This study was conducted to identify factors which influence the safety of children in day-care centres and home-based nurseries in the state of Kelantan. A total of 20 registered day care centres (DCC) and 40 home-based nurseries (IIBN) identified in 3 districts in the state were included in the study. Problems identified which could affect the safety of children cared-for in these nurseries were inadequate and unsafe facilities, inappropriate location of nurseries, lack of trained workers and their ignorance of necessary safety measures.
The prevalence of hypertension in Malaysia is alarmingly high. The National Survey in 2006 showed 43% of people aged ≥30 had hypertension and among treated patients, only 26% reached the target blood pressure (BP) of <140/90 mmHg. We evaluated BP control in tertiary institutions in Malaysia and the difference in hypertension control between genders and within specific cardiovascular risk factor groups. This cross-sectional study aimed at determining BP control among hypertensive patients attending three specialist institutions in Malaysia, located in Kuala Lumpur, Kuantan and Kota Bharu. A total of 950 patients with known hypertension for at least 6 months were recruited between January 2007 and July 2008. There were more males (n=548, 57.7%) with a mean age of 60.3±10.5 (±s.d.) years. The mean systolic BP (SBP) and diastolic BP were 138.8±20.3 mmHg and 79.6±11.3 mmHg, respectively. In total, 48.5% of all the patients had good BP control (<140/90 mmHg). Males had better SBP control compared with female (SBP: 135.9±18.7 vs. 142.8±21.7 mmHg, P<0.001). Overall, 54.6% of the patients had ischemic heart disease (IHD), 24.2% had undergone coronary revascularization, 50.1% were diabetic, 68.6% hyperlipidemic, 17.3% smokers and 27.5% had renal impairment. Males and small numbers of antihypertensives used were independently associated with better treatment outcome. In summary, our data reveal a poorer BP control, secondary to higher SBP levels in women. Moreover, the gender difference is more pronounced in patients with concomitant diabetes mellitus, renal impairment and IHD.
Infective endocarditis (IE) is the one of the most important causes of increased mortality and morbidity among haemodialysis patients. The reason for this increasing prevalence of infection among these patients is the use of haemodialysis catheters during dialysis, as these patients are highly susceptible to infections that are easily transmitted via blood access points. The present case was a geriatric end stage renal disease (ESRD) patient who was readmitted to the hospital two days after her scheduled haemodialysis session with symptoms of nosocomial endocarditis. Her concurrent medical complications were hypertension, non-insulin dependent diabetes mellitus, and ischemic heart disease. Based on her previous medical history and current examination, the patient was suspected to have IE due to catheter related infection. The goal of therapy is to manage the comorbidities and infection by provision of appropriate treatment based on close monitoring of the patient condition.