There is a high incidence of tetanus in the Malaysian state of Kelantan. Out of 162 reported cases of tetanus in Peninsular Malaysia during 1979 - 1984, 62 cases were from Kelantan, i.e. 38% of the total reported cases in Peninsular Malaysia. Thus a retrospective study was carried out to analyse the possible factors responsible for this high incidence. 62 cases of tetanus admitted to the General Hospital, Kota Bharu, over a period of 1979 - 1984 were studied.
Neonatal tetanus, though still existing, had been considerably reduced compared to the preceding five-year period (1975-1979). There was notable absence of cases in the two months to four-year age group, 24% of the cases occurred in the 10 - 20 years, and 29% in the age group 25 - 40 years. Since tetanus is a disease preventable by active immunization. l every effort must be taken to improve immunization coverage and increase the public awareness to prevent unnecessary loss of lives.
An outbreak of Dengue and Dengue Harmorrhagic Fever occurred in Lawas District in 1983. A total of 134 cases were notified with 74 cases serologically confirmed. The epidemic which lasted for three months starting from week 20 and peaking in week 24 before being brought under control in week 35 is the first to occur in the district. At the end of the epidemic, 54 localities were affected starting from areas within the vicinity of the town before spreading further inland with the movement of the population.
Entomological investigation in all the infected areas revealed a high density of Aedes albopictus which was the sole vector present. Effective control of the epidemic was achieved through proper planning, active participation of various agencies and intensive outdoor spraying with malathion 2% or ULV concentrates.
A review of the home haemodialysis programme at the General Hospital, Kuala Lumpur between 1977 and 1984 revealed that out of 194 patients accepted into the programme, 187 completed home training and continued haemodialysis at home, seven died before having started on the training programme. The majority of patients required less than four months to be trained; 107 patients performed dialysis independently and 24 required assistance only for the insertion of needles. Patient survival was 93%, 80% and 69% at one, three and five years, respectively. Rehabilitation has been excellent and few social problems were encountered. Our experiences with home haemodialysis have shown that the majority of patients were able to assume responsibility for their own dialysis, and this has contributed to the good survival and excellent rehabilitation. Home haemodialysis was started in Boston in 1963, in Seattle and London in 1964 for the treatment of end stage renal disease (ESRD). It is now well-established as a therapy for patients with ESRD. Home haemodialysis has been practised in Malaysia since 1977. This report reviews the experiences of patients accepted for treatment between 1977 and 1984. All patients were treated by the Department of Nephrology, General Hospital, Kuala Lumpur, which supervises patients living all over the country.
In recent years, female enrollment into medical faculties almost all over the world has increased tremendously. In the UKM, female medical students constitute 47.6% of the total enrollment for 1985; in the first year, they form 61.1% of the medical class. Once accepted, a woman has an equal if not better chance of graduation. However, it is during the later years of the career of female doctors that cause most concern because it has been shown that fewer women than men acquire additional qualifications. In view of their increasing enrollment, career aspirations of female doctors will have an important impact on the health services. A survey was conducted among 149 final-year medical students in 1985. This study revealed that irrespective of sex, the majority of medical students do wish to pursue postgraduate education. However, of those who do not wish to undergo further training, the majority are female students. The pattern of choice of speciality also differs in that females do not choose surgical-based disciplines.
MeSH terms: Career Choice*; Data Collection; Education, Medical, Undergraduate; Female; Humans; Malaysia; Medicine; Specialization; Students, Medical/psychology*
The Middlesex Hospital Questionnaire (later known as The Crown - Crisp Experiential Index) was used on medical students of the Universiti Kebangsaan Malaysia, Kuala Lumpur. It was found that Year II medical students scored the highest; the female students scored higher than male students in all classes. The female students were more anxious, phobic, obsessional, hypochondriacal and depressive than male students.
A retrospective study of the pathology seen in 1,000 consecutive appendicectomy specimens with a pre-operative diagnosis of acute appendicitis, was made in an attempt to find common factors which might throw light on the aetiology of the disease. Acute inflammation was seen in 775 cases. In 225 cases where no inflammation was seen, 168 appendices were associated with other pathology, i.e., lymphoid hyperplasia, fibrosis and tumour. In 57 cases the appendix was not inflamed. Acute inflammation was seen more in males and in patients aged below 30 years, while normal appendices were more commonly seen in females of reproductive age.
This article is an analysis of seven patients who presented to the Gynaecology Unit, General Hospital, Ipoh, during the period 1984-1985 with vaginal injury sustained during normal coitus.
Four patients were between 22-34 years of age. The remaining three were in the 51-64 year group; all the three had undergone previous gynaecological surgery.
History of coitus as the precipitating cause was elicited in all our patients and having reached a diagnosis, subsequent management was fairly straightforward. Two patients presented with clinical features of haemorrhagic shock and required initial resuscitation with blood transfusion. Five patients required definitive surgical repair of the vaginal injuries, and in only two patients was conservative management possible. Both these patients were in the menopausal age group.
Study site: Hospital Ipoh, Perak, Malaysia
Three cases of pseudomembranous colitis seen over the past one year in the Medical Unit, University Hospital, Kuala Lumpur, are reported.
The historical background, spectrum of clinical presentation, diagnosis and treatment of the disease are discussed. Early and wider use of sigmoidoscopy in patients with predisposing factors to pseudomembranous colitis have resulted in increased diagnosis of the condition.
Two cases of enteroumbilical fistula presenting in the neonatal period are reported. Both developed complications which required surgical intervention. A brief discussion on clinical features and management follows.
A case of metastatic malignant schwannoma of the right orbit is presented here. Although the patient had disseminated disease, it was the eye problems which were striking and most symptomatic.
The orbital lesion was at first thought to be the primary tumour until a history of an excised right wrist mass was probed into and the histology traced.
This report is written as malignant schwannoma is an uncommon tumour. The difficulty in diagnosing malignant schwannoma is mentioned. The importance of diagnosis of an orbital metastatic lesion is also pointed out as this is often misdiagnosed.
MeSH terms: Adult; Humans; Male; Neurilemmoma/pathology; Neurilemmoma/secondary*; Orbital Neoplasms/pathology; Orbital Neoplasms/secondary*; Wrist*
This article consists of two selected case reports of a recently named odontogenic tumour, unicystic ameloblastoma. The clinical and radiographic findings of the two cases mimic that of odontogenic cysts but not dentigerous cysts as in most reported, cases. Histologically, either a normal or ameloblastomatous cyst lining is evident. Other features of ameloblastoma are present within the cyst wall or as luminal nodules within the cystic space. A review of the literature indicates that this is a non-aggressive tumour with a low recurrence rate.
Repeatedly catheterising the internal jugular vein percutaneously through the same site, between the heads of the sternomastoid, resulted in soft tissue cleavage planes. The catheter entered the pleural cavity from the superior vena cava, a site remote from the percutaneous entry.
The internal jugular line can be misplaced in spite of respiratory fluctuation, free flow, and reflux with the container lowered below cardiac level. Radiological confirmation is mandatory.
MeSH terms: Adult; Catheterization, Central Venous/adverse effects; Catheterization, Central Venous/methods*; Humans; Jugular Veins*
In a prospective study performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur, over a period of 14 months from January 1982, we documented 12 new cases of analgesic nephropathy (AN). Since then up to July 1986, we have documented a further 16 cases of AN giving a total of 28 cases over a four-and-a-half-year period.
MeSH terms: Asia; Asia, Southeastern; Demography; Developing Countries; Evaluation Studies as Topic*; Family Planning Services; Health Planning; Malaysia; Organization and Administration; Patient Acceptance of Health Care*; Population; Population Dynamics; Postnatal Care*; Sterilization, Reproductive*; Time Factors*; Program Evaluation*
PIP: Knowledge about contraception was examined in relation to selected socioeconomic variables. A total of 2567 currently married women aged 15-49 years residing in Kuala Lumpur and Petaling Jaya were interviewed. The majority of the women knew of at least 1 contraceptive method. An index termed Contraceptive Knowledge Score (CKS) was used to measure the level of knowledge about contraception. The CKS achieved differed significantly by age, area of residence and ethnic group. The other socioeconomic variables significantly associated with CKS are schooling, occupation, income, childhood residence and age at marriage. These relationships persisted even after adjusting for differences in age, ethnicity and area of residence. Overall the CKS attained have a wide range and there is no significant difference of the mean CKS attained, between users and non-users of contraceptives.
MeSH terms: Asia; Asia, Southeastern; Behavior*; Cross-Sectional Studies; Data Collection; Demography; Developing Countries; Economics; Family Planning Services*; Health Planning; Health Knowledge, Attitudes, Practice*; Malaysia; Patient Acceptance of Health Care*; Population; Population Characteristics; Research; Sampling Studies; Socioeconomic Factors*; Urban Population*; Knowledge*
PIP: In Peninsular Malaysia, while the female population aged 15-19 years registered a growth of some 240,000 persons between 1966-1984, the number of births occurring to teenage mothers has decreased by 15,176 from 33,348 to 18,172 during the same period. In 1966, teenage births constituted some 10.8% of the total births but has declined to 4.7% by 1984. A breakdown of the 1984 data by detailed age groups shows that only 0.9% of the teenage births had actually occurred among those below 15 years of age. The declining trend in teenage births, particularly the higher order births among the very young mothers, augurs well for the improvement in family welfare. However, in order to safeguard the health and welfare of mothers and children, concerted efforts should continue to be undertaken to integrate population, family health and family life education into the school curriculum.
MeSH terms: Adolescent*; Age Factors*; Asia; Asia, Southeastern; Demography; Developing Countries; Fertility*; Malaysia; Maternal Age*; Parents; Population; Population Characteristics; Population Dynamics; Pregnancy*; Pregnancy in Adolescence*; Reproduction; Sexual Behavior*