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
Osteopoikilosis is a rare bone dysplasia which is inherited as an autosomal dominant trait with a prevalence of less than 0.1 per million.1 It is characterised by dense ovoid or circular spots in cancellous bone which may appear at birth or during skeletal growth. It is usually found in the metaphyseal and epiphyseal regions of long bones, the carpals and tarsals, the end of large turbular bones and around the acetabula. It is clinically asymptomatic and occasionally associated with hereditary multiple exostosis and dermatofibrosis lenticularis disseminata. It is not associated with spontaneous fractures and treatment is unnecessary. However a case of osteosarcoma developing in a man with osteopoikilosis has been reported. The first case of osteopoikilosis was reported in Malaysia four years ago in a 25 years old lady who is also of Indian descent. It would be interesting to know if these two patients are related. Since the bone lesions could easily be mistaken for metastatic disease, it is important that family physicians be aware of the benign nature of this condition.
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.
Significant changes have occurred in relation to how chronic asthma is being treated. Emphasis has now shifted from viewing asthma as a condition of smooth muscle dysfunction to one of chronic inflammation. As such, anti-inflammatory therapy forming the cornerstone of treatment represents the first important milestone in the evolution of asthma treatment. For this purpose, inhaled corticosteroid (ICS) is by far the most effective anti-inflammatory therapy. Another important milestone is the recognition of the superiority of adding long-acting β2-agonist (LABA) to ICS over escalating ICS dose alone or other forms of add-on therapies in treating asthmatic patients not responding to regular ICS alone. The effectiveness of adding LABA to ICS in treating asthma logically led to combining the two drugs into one single inhaler (salmeterol/fluticasone and budesonide/formoterol) that has the attractiveness of being user-friendly and ensuring that ICS is not missed out. The unique property of formoterol that allows for repetitive flexible dosing paved way to the concept of using Symbicort for both regular maintenance dosing and as required rescue medication. This revolutionary approach has been recently shown to provide improved asthma outcome, achieved at an overall lower or at least comparable corticosteroid intake, and may represent another evolutionary step in the treatment strategy of chronic asthma.
Thyroid diseases are common in women, including at the time of pregnancies. Many typical features of hyperthyroidism are common in normal pregnancies and this may delay or mask the diagnosis. Uncontrolled thyrotoxicosis increases the rate of miscarriage, intrauterine growth restriction (IUGR), premature labour and perinatal mortality. Multi-disciplinary efforts are required to achieve optimal control of thyrotoxicosis. Anti-thyroid drugs are safe and should be used with the lowest possible doses. Radioiodine treatment is contraindicated during pregnancy and lactation. Indications of surgery include: compression symptoms, thyroid malignancy, non-compliance to medications or when the patient develop drugs side effects
Anaemia still constitutes a public health problem in the world, especially in the developing countries (1). Nutritional deficiency remains a major causative factor (2). During pregnancy, growth of the foetus, placenta and the larger amount of circulating blood in the expectant mother will lead to an increase in the demand for nutrients, especially iron and folic acid. Many women start their lives with insufficient iron stores, but also, because of inadequate child spacing, they have little time to build up their iron levels between pregnancies. In pregnancy, anaemia has been shown to be associated with an increased risk of maternal and fetal morbidity and mortality (3,4,5). Iron and folic acid supplementation is routinely given to pregnant mothers in Malaysia. It is anticipated that pregnant mothers who comply strictly with the prescribed iron supplement will maintain adequate iron stores at parturition. However, the compliance rate among rural mothers in Kelantan is often poor (6). Kelantan is also one of the most socio-economically underdeveloped
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.
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 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