The first report of dengue haemorrhagic fever was in 1962 in Penang. Subsequently several outbreaks had been reported. A high index of suspicion is needed for early recognition.
MeSH terms: Dengue; Fever; Malaysia; Severe Dengue
The population of Malaysia is approximately 14 million and theoretically 1 in 2500 marriages are between heterozygotes for thalassaemia and 1 in 10,000 children can be expected to have thalassaemia major. Hypertransfusion is not possible because of insufficient blood supplies and each child requires an iron chelator, Desferal, at US$5800 a year for life: this high cost makes it sizeable proportion of the 'active reproductive' population. Abortion is not legal and antenatal diagnosis has not bee established. An approach to the prevention of this disease would be public education and identification of carriers. Numerous techniques have been utilised in population screening for traits of thalassaemia and haemoglobinopathy. These include osmotic fragility tests; blood smear examination for basophilia, microcytosis, and hypochromia; and genetic studies. Blood smear examinations are extremely subjective and interpretations depend upon the skills of a trained technologist. Osmotic fragility tests although cheap are cumbersome and require accurate preparations of saline solutions. Genetic studies are not available in the region. The medical examination for entrance to colleges and institutions includes investigative procedures such as chest x-ray and urine examinations. In addition a blood sample could be analysed for the red cell parameters. A similar study could be attempted for all secondary school leavers. The current estimated cost on the Coulter S as in this study was 80 cents (U.S.) in contrast to the prohibitive costs of managing a case of transfusion-dependent thalassaemia. These two groups would cover a sizeable proportion of the 'active reproductive' population. Analysis of the red cell parameters provides useful information for the identification of carriers of alpha-, beta-, delta-beta-thalassaemia and HbE. Additional studies which include haemoglobin analysis and serum ferritin would provide the necessary evidence for the confirmation of these findings.
MeSH terms: Child; Malaysia; Mass Screening; Reference Values; Thalassemia
Hereditary haemolytic anaemias, in particular, thalassaemia and the haemoglobinopathies, have been found to be a significant cause of hereditary haemolytic disease in West Malaysia. Theoretically 1 in 2500 marriages are between heterozygotes for beta-thalassaemia and 1 in 10,000 children can be expected to have thalassaemia major. An approach to the prevention of this disease would be public education and identification of carriers: to develop some approach to the identification and genetic counselling of beta-thalassaemia trait.
Group A streptococcus is an important cause of pharyngitis, skin infection and or its non-suppurative sequelae, i.e. rheumatic fever and post-streptococcal glomerulonephritis. The National Streptococcus Reference Laboratory was established in 1982 to collect data on various aspects of this infection.
5% of hospital admissions in Malaysia each year consist of patients suffering from renal diseases; from these 600 new cases of chronic renal failure will be diagnosed. The common causes of chronic renal failure in Malaysia in order of frequency are chronic glomerulonephritis, diabetic nephropathy, obstructive uropathy, malignant hypertension, chronic pyelonephritis, SLE nephritis and gouty nephropathy. Prevention of renal diseases require good control of the underlying conditions.
Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 27-30