Feedback: gripe
"Painful and disgusted" sent in this gripe:
I am a regular patient of a certain clinic in ***** Cheras.In fact this is our panel doctor.Each time I am sick I will go to the clinic for medication.The doctor is really very good but his staff is not only ineffiecient but illiterate so much so a patient will have to wait for at least 10 minuets before the nurse can find your registration card. I wonder whether the nurse knows how to read or write.At one incident I was having a very high temperature and the nurse pretended not to see me. I waited at the counter for nearly 10 mins. when a chinese nurse attended to me I was happy to actually see a well-trained and efficient nurse .I enquired who the other nurse was and she told that it was the doctor's relative.I wonder why the doctor would even think of employing such people when he is putting his patient's life in jeopardy.How can a person who cannot read or write prescibe medication? A collague of mine had the same experience. He had met with an accident and his knee was bleeding, his wound needed cleaning and dressing,the same nurse refused to clean and dress the wound.When another nurse asked why she did not want to dress the wound, she told her that she was afraid of blood.The other nurse replied,then why do you choose to work here.The nurse said that she was only here to supervise as she was the relative of the doctor.How can an ignorant and illiterate person supervise when she herself does not even know the nature of her job as a nurse.I hope the doctor concerned will look into my complain seriously.The doctor who is a favourite of almost all his patient's will soon lose his business to his competitors.The relative of the doctor paints a very bad picture for she is not only fat ,ugly but also stupid.Such a handsome,witty and kind doctor has such a dumb and stupid relative,I hope that it is not his sister?
Well painful and disgusted,
1) Please provide feedback directly to the doctor concerned. That way he'll be aware of the problem you are facing
2) Clinic "nurses" in most clinics are not really trained RNs but clinic assistants. Don't use the word illiterate on someone unless you really mean he/she cannot read/write at all.
3) Don't judge someone by his looks. You wouldn't want to clinic assistant to say to you "we don't treat patients who are fat and ugly like you, please go somewhere else"
Malaysian Medical Resources
Wednesday, March 31, 2004
Tuesday, March 30, 2004
Breast cancer , a constant threat
In The Star, In-Tech
Reseachers in the UK found that a computer program initially used for patient selection into the IBIS trial (International Breast Cancer Intervention Study) had possible clinical usefulness in helping determine a woman's risk of developing breast cancer. In Malaysia, breast cancer remain the main killer in women. An excerpt of an article on the MMA website -
"In Malaysia, it is also the most common cause of death in women. The incidence of breast cancer in Malaysia is estimated to be around 27 per 100,000 population, with close to 3,000 new cases annually. The majority of women initially diagnosed with breast cancer are aged between 40 and 49."
The College of Radiology, Malaysia website has a good Breast Health Information Center webpage. They have also listed available Breast Clinics, a “one-stop” clinic for which diagnosis, treatment, counselling and all other specialties involved in the management of breast disorders can be assessed.
Breast and Endocrine Unit,
Hospital Kuala Lumpur
Jalan Pahang,
Kuala Lumpur
Tel: 603-2691 5555 (Gen Line)
Breast and Endocrine Unit
Hospital Putrajaya
62250 Putrajaya
Tel: 603-8888 0080/8888 0771/8888 0772
Fax: 603-8888 0137
Breast Clinic,
Department of Surgery,
University Malaya Medical Centre (University Hospital)
59100 Kuala Lumpur.
Breast Clinic,
Department of Surgery,
Hospital Universiti Kebangsaan Malaysia,
Jalan Tenteram,
Cheras,
Kuala Lumpur.
The International Islamic University has also set up its IIUM Breast Center.
IIUM Breast Centre
Kulliyyah of Medicine
International Islamic University Malaysia
P.O. Box 141, 25710 Kuantan
Pahang
Tel : 09-5132797
Fax : 09-5133615
Evaluating risk is essential but all women regardless of risk should learn to do breast self examinations. Learn how to do it here. They have a very good video presentation online!
In The Star, In-Tech
Computer Programme Evaluates Breast Cancer Risk Reuters Health By Patricia Reaney Tuesday, March 23, 2004 LONDON (Reuters) - Scientists have developed a computer programme to evaluate a woman's individual risk of developing breast cancer. Charity Cancer Research UK said the IBIS risk evaluator uses information about a woman's family history of the disease to determine whether she has a genetic propensity to develop it. Other factors including age, height, weight, use of hormone replacement therapy (HRT) and whether a woman has had children are included to give a projected risk. "For many women, particularly those who have a relative affected by breast cancer, it's their biggest health concern," said Professor Jack Cuzick, head of the research team. ................................. |
Reseachers in the UK found that a computer program initially used for patient selection into the IBIS trial (International Breast Cancer Intervention Study) had possible clinical usefulness in helping determine a woman's risk of developing breast cancer. In Malaysia, breast cancer remain the main killer in women. An excerpt of an article on the MMA website -"In Malaysia, it is also the most common cause of death in women. The incidence of breast cancer in Malaysia is estimated to be around 27 per 100,000 population, with close to 3,000 new cases annually. The majority of women initially diagnosed with breast cancer are aged between 40 and 49."
The College of Radiology, Malaysia website has a good Breast Health Information Center webpage. They have also listed available Breast Clinics, a “one-stop” clinic for which diagnosis, treatment, counselling and all other specialties involved in the management of breast disorders can be assessed.
Breast and Endocrine Unit,
Hospital Kuala Lumpur
Jalan Pahang,
Kuala Lumpur
Tel: 603-2691 5555 (Gen Line)
Breast and Endocrine Unit
Hospital Putrajaya
62250 Putrajaya
Tel: 603-8888 0080/8888 0771/8888 0772
Fax: 603-8888 0137
Breast Clinic,
Department of Surgery,
University Malaya Medical Centre (University Hospital)
59100 Kuala Lumpur.
Breast Clinic,
Department of Surgery,
Hospital Universiti Kebangsaan Malaysia,
Jalan Tenteram,
Cheras,
Kuala Lumpur.
The International Islamic University has also set up its IIUM Breast Center.
IIUM Breast Centre
Kulliyyah of Medicine
International Islamic University Malaysia
P.O. Box 141, 25710 Kuantan
Pahang
Tel : 09-5132797
Fax : 09-5133615
Evaluating risk is essential but all women regardless of risk should learn to do breast self examinations. Learn how to do it here. They have a very good video presentation online!
Ageing gracefully and independently
"Old age is an incurable disease."
- SENECA, Epistulae ad Lucilium
In Age with dignity, Mary Chen has written a nice article featuring Prof. Nathan Vytialingam a consultant occupational therapist who talks about the problems which affect the elderly from a Physical, Mental and Emotional perspective.
Nathan, who is the organising chairman of the 2nd Malaysian Conference & Exhibition on Healthy Aging scheduled for next month, intends to highlight the issue of services for the elderly including the concept of retirement villages.
He says that having communities where the elderly stay with their peers may be foreign to our Asian cultures, but the current alternatives are not beneficial for them.
“Our parents want to age with dignity. They want to retain their independence and not be a burden to their children."
Are we ready for retirement villages? It's a pretty Western concept but I think our "Asian" way of extended family & taking care of the older folk seems to be breaking down somewhat.
The 2nd Malaysia Conference on Healthy Ageing will be held from April 9 to 11 at the Berjaya Times Square Hotel and Convention Centre, Kuala Lumpur with the theme "Independence in Ageing".
For more details, visit the Malaysian Healthy Ageing Society's website. I have added this to the MMR's listing of Public Societies and Associations.
- SENECA, Epistulae ad Lucilium
In Age with dignity, Mary Chen has written a nice article featuring Prof. Nathan Vytialingam a consultant occupational therapist who talks about the problems which affect the elderly from a Physical, Mental and Emotional perspective.
Nathan, who is the organising chairman of the 2nd Malaysian Conference & Exhibition on Healthy Aging scheduled for next month, intends to highlight the issue of services for the elderly including the concept of retirement villages.
He says that having communities where the elderly stay with their peers may be foreign to our Asian cultures, but the current alternatives are not beneficial for them.
“Our parents want to age with dignity. They want to retain their independence and not be a burden to their children."
Are we ready for retirement villages? It's a pretty Western concept but I think our "Asian" way of extended family & taking care of the older folk seems to be breaking down somewhat.
The 2nd Malaysia Conference on Healthy Ageing will be held from April 9 to 11 at the Berjaya Times Square Hotel and Convention Centre, Kuala Lumpur with the theme "Independence in Ageing".
For more details, visit the Malaysian Healthy Ageing Society's website. I have added this to the MMR's listing of Public Societies and Associations.
Monday, March 29, 2004
Honey and wound healing
There was an interesting article in The Star today on honey and its beneficial effects. Indeed, it has been touted to be an ancient remedy. But as always we ask for evidence. And evidence we have for honey and its wound healing properties.
I managed to find a study on Malaysian honey as below :
Biochemical study on the efficacy of Malaysian honey on inflicted wounds : An Animal model
A. M. ALJADY
M. Y. KAMARUDDIN
A. M. JAMAL
M. Y. MOHD. YASSIM
Faculty of Medicine,
University of Malaya
SUMMARY: The efficacy of Malaysian honey on the healing of wounds in Sprague-Dawley rats was investigated on the basis of biophysical and biochemical changes. Equidimensional full-thickness excision wounds were created on the back of each animal and treated either by topical application or by a combination of topical and oral administration of honey. Control animals received only saline. Development of wound healing was evaluated by measuring the rates of wound contraction and epithelialization. Quantitative assays were performed to determine the amounts of uronic acid, hexosamine, DNA, and collagen content of the granulating tissues. The serum albumin level was also measured. The results obtained showed that honey accelerates wound healing by influencing cell division and proliferation, collagen synthesis and maturation, wound contraction and epithelialization. All theparameters measured showed remarkable consistency with the wound healing property of honey. Honey also improved the nutritional state of the animal when given orally.
Indeed there are many more studies involving different types of honey, that prove the effectiveness of honey as a material to promote wound healing. I am aware that there are several studies involving honey and wound healing in our local hospitals. One such research was in Mentakab Hospital's Orthopedic Department. The study is ongoing but not too sure when we can expect the study results to be out. From the last research proposal, they were using Australian honey as opposed to local honey due to the reportedly impure local honey.
Are you aware of any studies involving local honey being researched here?
There was an interesting article in The Star today on honey and its beneficial effects. Indeed, it has been touted to be an ancient remedy. But as always we ask for evidence. And evidence we have for honey and its wound healing properties.I managed to find a study on Malaysian honey as below :
Biochemical study on the efficacy of Malaysian honey on inflicted wounds : An Animal model
A. M. ALJADY
M. Y. KAMARUDDIN
A. M. JAMAL
M. Y. MOHD. YASSIM
Faculty of Medicine,
University of Malaya
SUMMARY: The efficacy of Malaysian honey on the healing of wounds in Sprague-Dawley rats was investigated on the basis of biophysical and biochemical changes. Equidimensional full-thickness excision wounds were created on the back of each animal and treated either by topical application or by a combination of topical and oral administration of honey. Control animals received only saline. Development of wound healing was evaluated by measuring the rates of wound contraction and epithelialization. Quantitative assays were performed to determine the amounts of uronic acid, hexosamine, DNA, and collagen content of the granulating tissues. The serum albumin level was also measured. The results obtained showed that honey accelerates wound healing by influencing cell division and proliferation, collagen synthesis and maturation, wound contraction and epithelialization. All theparameters measured showed remarkable consistency with the wound healing property of honey. Honey also improved the nutritional state of the animal when given orally.
Indeed there are many more studies involving different types of honey, that prove the effectiveness of honey as a material to promote wound healing. I am aware that there are several studies involving honey and wound healing in our local hospitals. One such research was in Mentakab Hospital's Orthopedic Department. The study is ongoing but not too sure when we can expect the study results to be out. From the last research proposal, they were using Australian honey as opposed to local honey due to the reportedly impure local honey.
Are you aware of any studies involving local honey being researched here?
Feedback: Quit clinic at other hospitals?
Shaharin wrote to ask:
Curious to know if there exist programmes such as yours in the Kelang Valley.
Thanks for asking Shaharin. I presume you mean the Quit smoking programmes? The MMR does not run them but I mentioned the Quit Smoking Clinic at the Institute of Respiratory Medicine in the Holy Smoke II blog earlier.
I reproduce the bit taken from The Star again:
At the Quit-Smoking Clinic in the Institute of Respiratory Medicine, patients undergo professional counselling as well as NRT. Since it was set up in 1998, Klinik Q (as it is commonly known) has been offering its services for free to all members of the public, even school students
There are 300 quit-smoking clinics based in general hospitals and government health clinics all over Malaysia. Klinik Q is situated in the Institute of Respiratory Medicine (before Hospital Tawakal), Jalan Pahang. It is open on Tuesdays (2.30-4.00pm) and Saturdays (8.30am-12.00pm). If you wish to register, you can walk in or call 03-4023 2966 to make an appointment. Treatment is absolutely free.
Here's a famous quote for your amusement:
Quitting smoking is easy! I've done it 100 times
- Mark Twain
Shaharin wrote to ask:
Curious to know if there exist programmes such as yours in the Kelang Valley.
Thanks for asking Shaharin. I presume you mean the Quit smoking programmes? The MMR does not run them but I mentioned the Quit Smoking Clinic at the Institute of Respiratory Medicine in the Holy Smoke II blog earlier.
I reproduce the bit taken from The Star again:
At the Quit-Smoking Clinic in the Institute of Respiratory Medicine, patients undergo professional counselling as well as NRT. Since it was set up in 1998, Klinik Q (as it is commonly known) has been offering its services for free to all members of the public, even school students
There are 300 quit-smoking clinics based in general hospitals and government health clinics all over Malaysia. Klinik Q is situated in the Institute of Respiratory Medicine (before Hospital Tawakal), Jalan Pahang. It is open on Tuesdays (2.30-4.00pm) and Saturdays (8.30am-12.00pm). If you wish to register, you can walk in or call 03-4023 2966 to make an appointment. Treatment is absolutely free.
Here's a famous quote for your amusement:
Quitting smoking is easy! I've done it 100 times
- Mark Twain
Sunday, March 28, 2004
Food pantang
You know, many a time when discussing an illness with a patient, it will invariably end with a question from the patient or relative: "Doc, but what food can I eat or cannot eat?"
It's still such common place to find belief in certain foods being "cooling" or affecting wound healing or thought to be just not suitable for certain illnesses. I have seen cases where due to pressure from ill informed relatives, patients ended up with pretty deficient diets (pantang this, pantang that). These beliefs are mostly unfounded and have little scientific basis.
There's this interesting article in the NST titled Where is health and nutrition headed?
It features AFIC, the Asian Food Information Centre.
AFIC is a non-profit pan-Asian organisation that disseminates science-based information on health and nutrition across the Asia Pacific region. It was founded in 1998, and is funded by broad-based support from the food, beverage and agricultural industries. The centre employs a team of scientific, nutrition and comunications professionals to manage its programmes. AFIC maintains that it plays no role in the marketing of individual ingredients or products, and its programmes are not designed to benefit any particular company.
The NST did not mention the AFIC website but I located it with the help of Google. This looks like a great informative website. There are sections on Dietary guidelines, Food safety, Diet and the prevention of chronic diseases and much much more. Check it out.
You know, many a time when discussing an illness with a patient, it will invariably end with a question from the patient or relative: "Doc, but what food can I eat or cannot eat?"
It's still such common place to find belief in certain foods being "cooling" or affecting wound healing or thought to be just not suitable for certain illnesses. I have seen cases where due to pressure from ill informed relatives, patients ended up with pretty deficient diets (pantang this, pantang that). These beliefs are mostly unfounded and have little scientific basis.
There's this interesting article in the NST titled Where is health and nutrition headed?
It features AFIC, the Asian Food Information Centre.
AFIC is a non-profit pan-Asian organisation that disseminates science-based information on health and nutrition across the Asia Pacific region. It was founded in 1998, and is funded by broad-based support from the food, beverage and agricultural industries. The centre employs a team of scientific, nutrition and comunications professionals to manage its programmes. AFIC maintains that it plays no role in the marketing of individual ingredients or products, and its programmes are not designed to benefit any particular company.
The NST did not mention the AFIC website but I located it with the help of Google. This looks like a great informative website. There are sections on Dietary guidelines, Food safety, Diet and the prevention of chronic diseases and much much more. Check it out.
Saturday, March 27, 2004
New Health Minister
Heard the news "hot off the press" from Dobbs
Abdullah introduces eight new faces, drops Chua 12:49pm Sat Mar 27th, 2004
The cabinet reshuffle today saw the end of the road for MCA vice president Chua Jui Meng who was dropped as the health minister. He will be replaced by Johor MCA chief Dr Chua Soi Lek
Hmmm. One Chua for another. And both from Johor. Does this mean things won't change much?
Don't know if he is a Medical doctor or PhD doctor. Anyone know more about his background?
Addendum: Dobbs sources say Dr Chua Soi Lek is a medical graduate of University Malaya, Class of 1973. At least we have a real doctor now and not a lawyer pretending to be one ;)
Heard the news "hot off the press" from Dobbs
Abdullah introduces eight new faces, drops Chua 12:49pm Sat Mar 27th, 2004
The cabinet reshuffle today saw the end of the road for MCA vice president Chua Jui Meng who was dropped as the health minister. He will be replaced by Johor MCA chief Dr Chua Soi Lek
Hmmm. One Chua for another. And both from Johor. Does this mean things won't change much?
Don't know if he is a Medical doctor or PhD doctor. Anyone know more about his background?
Addendum: Dobbs sources say Dr Chua Soi Lek is a medical graduate of University Malaya, Class of 1973. At least we have a real doctor now and not a lawyer pretending to be one ;)
List of communicable diseases in Malaysia 2003 : Emerging problems
The following is the list of all the communicable and notifiable diseases in Malaysia that were notified for the year 2003 in descending order of frequency (ie new cases). Only the top 10 are listed.
1. Dengue Fever
2. Tuberculosis (all forms)
3. Food poisoning
4. Malaria
5. Viral Hepatitis (all forms)
6. HIV infection (all forms)
7. Hand,Foot & Mouth Disease/Myocarditis
8. Syphilis (all forms)
9. Gonococcal Infection
10. Typhoid and para thyphoid
(Note: data from Sabah for HIV, Dengue, Leprosy, Malaria and Tuberculosis is not available . Dengue fever includes dengue haemorrhagic fever)
There are some disease that are most probably under-reported especially Sexually Transmissible Diseases. Nevertheless, one thing to note is that tuberculosis is making a comeback, this time with vengeance. The resistance pattern is poorly defined but the emergence of multidrug resistant tuberculosis is of particular concern.
DOTS programme initiated by WHO needs strict implementation at all levels to ensure complete success. Malaysia's failure to decrease its tuberculosis incidence rates is multifactorial including high numbers of illegal immigrants especially those from Indonesia and the Philippines. Increasing rates of HIV infection will also no doubt contribute to our failure in bringing tuberculosis under control.
Our current obsession with measles leading to the implementation of mass vaccination programmes for our young children appears misplaced. The draining of precious human resource during this programme will be felt. Are we putting our troops in the right battlefields? Why can't we amass such strengths to battle dengue or tuberculosis?
Department of Public Health, MOH
The following is the list of all the communicable and notifiable diseases in Malaysia that were notified for the year 2003 in descending order of frequency (ie new cases). Only the top 10 are listed.
1. Dengue Fever
2. Tuberculosis (all forms)
3. Food poisoning
4. Malaria
5. Viral Hepatitis (all forms)
6. HIV infection (all forms)
7. Hand,Foot & Mouth Disease/Myocarditis
8. Syphilis (all forms)
9. Gonococcal Infection
10. Typhoid and para thyphoid
(Note: data from Sabah for HIV, Dengue, Leprosy, Malaria and Tuberculosis is not available . Dengue fever includes dengue haemorrhagic fever)
There are some disease that are most probably under-reported especially Sexually Transmissible Diseases. Nevertheless, one thing to note is that tuberculosis is making a comeback, this time with vengeance. The resistance pattern is poorly defined but the emergence of multidrug resistant tuberculosis is of particular concern.
DOTS programme initiated by WHO needs strict implementation at all levels to ensure complete success. Malaysia's failure to decrease its tuberculosis incidence rates is multifactorial including high numbers of illegal immigrants especially those from Indonesia and the Philippines. Increasing rates of HIV infection will also no doubt contribute to our failure in bringing tuberculosis under control.
Our current obsession with measles leading to the implementation of mass vaccination programmes for our young children appears misplaced. The draining of precious human resource during this programme will be felt. Are we putting our troops in the right battlefields? Why can't we amass such strengths to battle dengue or tuberculosis?
Department of Public Health, MOH
Shortage of Health Informatics Experts
In Revisiting Healthcare, Dr. HM Goh laments:
Though the e-Health endeavour has come a long way, the country is currently facing a shortage of domain experts or health informaticians in the design, development and deployment of the e-Health projects, says Dr H.M. Goh, secretary for both Malaysian Health Informatics Association and Asia-Pacific Association for Medical Informatics.
I think the point is, all the high tech machines are meaningless without qualified competent people to plan, run and maintain the system. During my days in the University as an Academician, it was frustrating to see the network frequently down and email servers not working. I believe things are still not running smoothly. I do go there as a visiting consultant on a weekly basis and the last trip, I couldn't access lab results because the LIS was down. It would be a nightmare to inject high tech IT into hospitals if there aren't enough competent people to make suer things run properly.
Reminder: eHealth Asia 2004 in 10 days!
In Revisiting Healthcare, Dr. HM Goh laments:
Though the e-Health endeavour has come a long way, the country is currently facing a shortage of domain experts or health informaticians in the design, development and deployment of the e-Health projects, says Dr H.M. Goh, secretary for both Malaysian Health Informatics Association and Asia-Pacific Association for Medical Informatics.
I think the point is, all the high tech machines are meaningless without qualified competent people to plan, run and maintain the system. During my days in the University as an Academician, it was frustrating to see the network frequently down and email servers not working. I believe things are still not running smoothly. I do go there as a visiting consultant on a weekly basis and the last trip, I couldn't access lab results because the LIS was down. It would be a nightmare to inject high tech IT into hospitals if there aren't enough competent people to make suer things run properly.
Reminder: eHealth Asia 2004 in 10 days!
Friday, March 26, 2004
Macaque Malaria Identified in Over Half of Infections Believed to be Plasmodium Malariae in a Section of Malaysia
Malaria is an endemic problem in Malaysia. It is a mosquito borne parasite that infects humans through its bites. There is a human reservoir for common malaria parasites , namely Plasmodium falciparum, P. vivax, P. ovale and P. malariae. Each of these parasites has its own individual characteristics.
In a recent study in Kapit, Sarawak, University Malaysia Sarawak identified a macaque malaria, P. Knowlesi in humans. Macaques are monkeys found in South east asia and Africa. The study came about as many patients previously diagnosed as having P malariae infection though microscopy, presented with atypical signs and symptoms. Nested PCR (Polymerase Chain Reaction) assays were used and did not identify P malariae in any of the samples collected. Instead, in 57.7% of these samples, P Knowlesi was detected.
P knowlesi was identified in 1931 in a long-tailed macaque. It is lethal in rhesus monkeys and was identified in 1932 as infectious to humans by inoculation of infected blood. Other than natural infections reported in 1965 and 1971 in 2 men who visited Malaysia, the authors note, there are "no other published records of naturally acquired P knowlesi infections in humans."
Further study is needed, to study if this strain has switched hosts and transmission, to enable better malaria prevention and control measures.
Lancet 2004;363:1017-24
Adapted from DocGuide
Malaria is an endemic problem in Malaysia. It is a mosquito borne parasite that infects humans through its bites. There is a human reservoir for common malaria parasites , namely Plasmodium falciparum, P. vivax, P. ovale and P. malariae. Each of these parasites has its own individual characteristics.
In a recent study in Kapit, Sarawak, University Malaysia Sarawak identified a macaque malaria, P. Knowlesi in humans. Macaques are monkeys found in South east asia and Africa. The study came about as many patients previously diagnosed as having P malariae infection though microscopy, presented with atypical signs and symptoms. Nested PCR (Polymerase Chain Reaction) assays were used and did not identify P malariae in any of the samples collected. Instead, in 57.7% of these samples, P Knowlesi was detected.P knowlesi was identified in 1931 in a long-tailed macaque. It is lethal in rhesus monkeys and was identified in 1932 as infectious to humans by inoculation of infected blood. Other than natural infections reported in 1965 and 1971 in 2 men who visited Malaysia, the authors note, there are "no other published records of naturally acquired P knowlesi infections in humans."
Further study is needed, to study if this strain has switched hosts and transmission, to enable better malaria prevention and control measures.
Lancet 2004;363:1017-24
Adapted from DocGuide
Going herbal
The local and global herbal mart is flourishing
The current value of the local market is RM3.8 billion, while the global market is estimated at US$80 billion (RM304 billion).
Boggles the mind doesn't it.
Herbal Asia Expo 2004 was recently launched in MidValley.
Herbal Asia 2004 is the first international herbal exhibition and trade show of its kind in Malaysia, bringing together international and local farmers, planters, manufactur-ers, retailers, researchers, agri-scientists and non-governmental or-ganisations.
It showcases the industry's herbal products, technology and services to the latest in alternative medicine, and provides a platform for producers and manufacturers, investors, health and industry-related professionals to meet, exchange ideas and promote this rapidly growing industry.
Rozali said traditional medicine continued to flourish, due also to the failure of modern medicine to treat AIDS and cancer.
"The belief is that herbal medicine is natural and bears less side-effects," he said.
Therein lies the most common fallacy: "If it is natural, it must be safe and free of side effects"
This couldn't be further from the truth. Poison Ivy is also natural. Some of the strong anti-cancer drugs are derived from plants. In fact there is evidence now that some herbs have toxic effects and some may even be carcinogenic.
I would like to see more scientific validation of both the safety and efficacy of herbs. But sadly, people only see the $$$$ and continue to peddle herbs based on this false belief that "natural=safe".
You might be interested to read the False Tenets of Paraherbalism and The Herbal Minefield
Oh and Encik Rozali FYI, modern science has made great leaps and bounds in the treatment of AIDS and the various types of cancer (cancer is not one disease but every cancer is a different disease).
A study has been done which shows that Alternative medicine used by cancer patients is associated with shorter survival compared to those who do not.
As for AIDS, it was modern science which identified the virus, and for Encik Rozali's information, I think patients are far better off nowadays with HAART therapy and I wouldn't suggest herbal treatment for AIDS.
The local and global herbal mart is flourishing
The current value of the local market is RM3.8 billion, while the global market is estimated at US$80 billion (RM304 billion).
Boggles the mind doesn't it.
Herbal Asia Expo 2004 was recently launched in MidValley.
Herbal Asia 2004 is the first international herbal exhibition and trade show of its kind in Malaysia, bringing together international and local farmers, planters, manufactur-ers, retailers, researchers, agri-scientists and non-governmental or-ganisations.
It showcases the industry's herbal products, technology and services to the latest in alternative medicine, and provides a platform for producers and manufacturers, investors, health and industry-related professionals to meet, exchange ideas and promote this rapidly growing industry.
Rozali said traditional medicine continued to flourish, due also to the failure of modern medicine to treat AIDS and cancer.
"The belief is that herbal medicine is natural and bears less side-effects," he said.
Therein lies the most common fallacy: "If it is natural, it must be safe and free of side effects"
This couldn't be further from the truth. Poison Ivy is also natural. Some of the strong anti-cancer drugs are derived from plants. In fact there is evidence now that some herbs have toxic effects and some may even be carcinogenic.
I would like to see more scientific validation of both the safety and efficacy of herbs. But sadly, people only see the $$$$ and continue to peddle herbs based on this false belief that "natural=safe".
You might be interested to read the False Tenets of Paraherbalism and The Herbal Minefield
Oh and Encik Rozali FYI, modern science has made great leaps and bounds in the treatment of AIDS and the various types of cancer (cancer is not one disease but every cancer is a different disease).
A study has been done which shows that Alternative medicine used by cancer patients is associated with shorter survival compared to those who do not.
As for AIDS, it was modern science which identified the virus, and for Encik Rozali's information, I think patients are far better off nowadays with HAART therapy and I wouldn't suggest herbal treatment for AIDS.
Thursday, March 25, 2004
New CPR instructions for the untrained
In the United States this month, 911 despatchers will be issuing new instructions in performing CPR for the untrained rescuer. For the first time, mouth to mouth resuscitation will be excluded and only chest compressions will be done. This came about due to several reasons.
First, it takes too much time for the despatcher to explain how mouth to mouth resuscitation is done. Most untrained rescuers also spend too much time on positioning the head that chest compressions are inadequate. Instructions for chest compressions only procedure takes on average 1.4 minutes less than that if mouth to mouth resuscitation is included according to one study.
Secondly, studies have shown no increase in survival by doing mouth to mouth as compared to chest compressions alone. CPR must be done within 4 minutes of cardiac arrest to increase the survival of that individual. Any delay may prove fatal.
These guidelines are only for adult patients as cardiac arrest in children are mainly due to respiratory problems and managing the airway first in children is a priority.
The emergence of viruses have also made the public reluctant to perform CPR. However, if CPR is prolonged rescue breaths will have to be given to oxygenate the blood.
The procedures for paramedics and doctors remain the same ie ventilation first ... then perfusion. CPR courses are also unaffected.
Malaysians are poorly trained in CPR as well. I was thinking that adopting the US guidelines for the untrained rescuer may make resuscitation easier and more acceptable, at least until the arrival of help. Having said that, our emergency services are still uncoordinated and poorly trained. Our despatchers are on some occasions non existent.
What are your views on this?
Some interesting links regarding emergency care and services
Learn CPR
Malaysian Red Crescent Society
St John's Ambulance of Malaysia
In the United States this month, 911 despatchers will be issuing new instructions in performing CPR for the untrained rescuer. For the first time, mouth to mouth resuscitation will be excluded and only chest compressions will be done. This came about due to several reasons.
First, it takes too much time for the despatcher to explain how mouth to mouth resuscitation is done. Most untrained rescuers also spend too much time on positioning the head that chest compressions are inadequate. Instructions for chest compressions only procedure takes on average 1.4 minutes less than that if mouth to mouth resuscitation is included according to one study.Secondly, studies have shown no increase in survival by doing mouth to mouth as compared to chest compressions alone. CPR must be done within 4 minutes of cardiac arrest to increase the survival of that individual. Any delay may prove fatal.
These guidelines are only for adult patients as cardiac arrest in children are mainly due to respiratory problems and managing the airway first in children is a priority.
The emergence of viruses have also made the public reluctant to perform CPR. However, if CPR is prolonged rescue breaths will have to be given to oxygenate the blood.
The procedures for paramedics and doctors remain the same ie ventilation first ... then perfusion. CPR courses are also unaffected.
Malaysians are poorly trained in CPR as well. I was thinking that adopting the US guidelines for the untrained rescuer may make resuscitation easier and more acceptable, at least until the arrival of help. Having said that, our emergency services are still uncoordinated and poorly trained. Our despatchers are on some occasions non existent.
What are your views on this?
Some interesting links regarding emergency care and services
Learn CPR
Malaysian Red Crescent Society
St John's Ambulance of Malaysia
TB Awareness
Tuberculosis patients once occupied one third of all hospital beds in Malaya in the 50's and 60's. It was thought to have been eradicated but made a serious come-back in the last few years with 15,000 new cases every year. What's alarming is also the emergence of resistant strains of TB.
24 March is World TB day. The World TB Day website has the details.
Are you old enough to remember the vans which went round the country to screen for TB using miniature Xrays?
In conjunction with the Sporty Healthy Lifestyle Exhibition at Subang Parade from 26th March 2004 to 25 April 2004 there will be FREE consultation on TB Prevention
Talks on TB Awareness
27 March 3.00 to 3.30 pm
by Dr B.Venugopalan, General Health Specialist (Epidemiology)
4 April 2.00 to 2.30 pm
by Dr I. Kuppusamy, Senior Consultant, Chest Physician & Head of
Respiratory Medicine
I have added the Malaysian Association for the Prevention of TB's website to the MMR listing of Public Socieities and Associations.
Tuberculosis patients once occupied one third of all hospital beds in Malaya in the 50's and 60's. It was thought to have been eradicated but made a serious come-back in the last few years with 15,000 new cases every year. What's alarming is also the emergence of resistant strains of TB.
24 March is World TB day. The World TB Day website has the details.
Are you old enough to remember the vans which went round the country to screen for TB using miniature Xrays?
In conjunction with the Sporty Healthy Lifestyle Exhibition at Subang Parade from 26th March 2004 to 25 April 2004 there will be FREE consultation on TB Prevention
Talks on TB Awareness
27 March 3.00 to 3.30 pm
by Dr B.Venugopalan, General Health Specialist (Epidemiology)
4 April 2.00 to 2.30 pm
by Dr I. Kuppusamy, Senior Consultant, Chest Physician & Head of
Respiratory Medicine
I have added the Malaysian Association for the Prevention of TB's website to the MMR listing of Public Socieities and Associations.
Wednesday, March 24, 2004
Renal calcifications : A mystery
I thought I would share this. A 50 year old man presented with vague complaints of abdominal discomfort for several months. He had otherwise been well and had no urinary symptoms. Physical examination was unremarkable. A urine FEME (Fine Examination and Microscopic Examination) was ordered and revealed haematuria, proteinuria and the presence of leucocytes. A KUB (Kidney, Ureter & Bladder) view was ordered and the patient was treated as a urinary tract infection.(left picture)
If Dr Liew were to see this, he would have said "WTF"! Indeed, it caught me by surprise. I did not know what to make of it. The Xray showed multiple focus of calcification involving the entire right kidney. The left kidney was visible and appeared normal. Other bony structures in the view also appeared normal.
Could it be massive renal stones? or Perhaps calcified renal cell carcinoma? Or perhaps hyperparathyroidism? Renal Tuberculosis? It will most likely be a local condition as only one kidney is affected. The other side appears completely normal! There was also no abnormal calcifications of the surrounding bony structures that was visible on the Xray. Renal function was also normal. I was lost for thoughts.
A referral to a surgeon was made. Anyone with any ideas?... It is indeed an interesting case and I am anxiously awaiting the final outcome.
I thought I would share this. A 50 year old man presented with vague complaints of abdominal discomfort for several months. He had otherwise been well and had no urinary symptoms. Physical examination was unremarkable. A urine FEME (Fine Examination and Microscopic Examination) was ordered and revealed haematuria, proteinuria and the presence of leucocytes. A KUB (Kidney, Ureter & Bladder) view was ordered and the patient was treated as a urinary tract infection.(left picture)If Dr Liew were to see this, he would have said "WTF"! Indeed, it caught me by surprise. I did not know what to make of it. The Xray showed multiple focus of calcification involving the entire right kidney. The left kidney was visible and appeared normal. Other bony structures in the view also appeared normal.
Could it be massive renal stones? or Perhaps calcified renal cell carcinoma? Or perhaps hyperparathyroidism? Renal Tuberculosis? It will most likely be a local condition as only one kidney is affected. The other side appears completely normal! There was also no abnormal calcifications of the surrounding bony structures that was visible on the Xray. Renal function was also normal. I was lost for thoughts.
A referral to a surgeon was made. Anyone with any ideas?... It is indeed an interesting case and I am anxiously awaiting the final outcome.
Aquascams
"The wars of the twenty-first century will be fought over water."
Dr Ismail Serageldin, the chairman of the World Water Commission
Water is important no doubt. We need to drink enough each day. Your needs vary according to the amount of insensible water loss (how much you sweat etc.)
What really gets me is the promotion going around of fantastic claims of "special" types of water which can do wonders for your health.
Junk science in the marketplace has the take on debunking these ridiculous claims.
Magnets and "catalysts" for softening water, magnetic laundry balls, waters that are "oxygenated", "clustered", "unclustered" or "vitalized" (purporting to improve cellular hydration, remove toxins, and repair DNA), high zeta-potential colloids and vortex-treated waters to raise your energy levels, halt or reverse ageing and remove geopathic stress— all of these wonders and more are being aggressively marketed via the Internet, radio infomercials, seminars, and by various purveyors of new-age nonsense. The hucksters who promote these largely worthless products weave a web of pseudoscientific hype guaranteed to dazzle and confuse the large segment of the public whose limited understanding of science makes them especially vulnerable to this kind of exploitation.
Filtering and boiling your water is fine. But please don't be suckered by any other devices which claim to "alter" the properties of water and which claim fantastic health benefits. These devices abound in shopping complexes in Malaysia. We really need enforcement. Any device which claims health benefits effectively becomes a medical device. That should come under the the Health authorities who aren't doing enough to stop the Aquascams.
"The wars of the twenty-first century will be fought over water."
Dr Ismail Serageldin, the chairman of the World Water Commission
Water is important no doubt. We need to drink enough each day. Your needs vary according to the amount of insensible water loss (how much you sweat etc.)
What really gets me is the promotion going around of fantastic claims of "special" types of water which can do wonders for your health.
Junk science in the marketplace has the take on debunking these ridiculous claims.
Magnets and "catalysts" for softening water, magnetic laundry balls, waters that are "oxygenated", "clustered", "unclustered" or "vitalized" (purporting to improve cellular hydration, remove toxins, and repair DNA), high zeta-potential colloids and vortex-treated waters to raise your energy levels, halt or reverse ageing and remove geopathic stress— all of these wonders and more are being aggressively marketed via the Internet, radio infomercials, seminars, and by various purveyors of new-age nonsense. The hucksters who promote these largely worthless products weave a web of pseudoscientific hype guaranteed to dazzle and confuse the large segment of the public whose limited understanding of science makes them especially vulnerable to this kind of exploitation.
Filtering and boiling your water is fine. But please don't be suckered by any other devices which claim to "alter" the properties of water and which claim fantastic health benefits. These devices abound in shopping complexes in Malaysia. We really need enforcement. Any device which claims health benefits effectively becomes a medical device. That should come under the the Health authorities who aren't doing enough to stop the Aquascams.
Tuesday, March 23, 2004
Hormonal Replacement Therapy(HRT) : A continuing dilemma
HRT which contains estrogen and progesterone in combination, has been widely prescribed to peri and post menopausal women until several years ago when fresh data (in particular the Women's Health Initiative study) suggests an increase in cardiovascular and stroke risk. HRT has been useful in alleviating disturbing menopausal symptoms, eg hot flushes and irritability. The increased risk of breast and endometrial cancer(if estrogen given alone) has also been noted. Thus it appears that the recent revelation has been the final nail in HRT's coffin.
The recently concluded 11th World Congress of Gynecological Endocrinology held in Florence, Italy, discussed HRT at length. THe controversies surrounding the recently published studies remain. However, there is a trend to look for alternatives that are superior to conventional HRT.
One alternative drug is the Selective Estrogen Receptor Modulators (SERMs) namely Raloxifene. It is a synthetic compound that binds to estrogen receptors at different sites and can be both pro or anti estrogen depending on the target tissue. In the bones, it prevents bone resorption, increases bone mineral density and decreases the incidence of spinal fractures as shown by the MORE study (Multiple Outcomes of Raloxifene trial). Most importantly, it has little effect on the endometrium or the breast. However , the effects on the cardiovascular system needs further evaluation. As SERMs do not alleviate menopausal symptoms, the drug may not be well received by patients. Perhaps for long term protection, SERMs may have its best advantage.
Tibolone(livial) has long been available in Malaysia. Tibolone is a synthetic steroid that can display estrogenic, androgenic, or progesterone-like effects, depending on the target tissue. It alleviates vasomotor symptoms, improves BMD, and has no significant endometrial and breast effects. Its cardiovascular safety has not been established in large trials. Experiences of family members on Tibolone has been marred by elevated liver enzymes on routine investigations , thus discontinuation of this drug adn the return of liver enzymes to normal values.
The combination of estradiol and drospirenone, a synthetic progestin, was also mentioned and is associated with favorable vasomotor, cardiovascular, skeletal, and quality-of-life effects.It is available in Malaysia as Yasmin tablet.
Remifemin, a CIMICIFUGAE RHIZOMA EXTRACT is a traditional compound that has positive effects on menopausal symptoms.(see table below) Nevertheless it has no protective effects on the bone and heart and probably neutral effects on the breast and endometrium. However, experiences of my patients on Remifemin was not as dramatic as those on conventional hormonal replacement therapy.
However, conventional HRT cannot be totally ignored. It will still serve its purpose and remains the best agent in alleviating menopausal symptoms. Its other previously stated benefits remain under the microscope. The best strategy may be to start early , even in the peri menopausal period and not exceed 10 years of therapy or discontinuation earlier if menopausal symptoms do not recur. There is no right or wrong in this scenario and only time will tell if we have been doing the right things for our patients. "God guide us!", we pray.
Medscape
Pubmed
HRT which contains estrogen and progesterone in combination, has been widely prescribed to peri and post menopausal women until several years ago when fresh data (in particular the Women's Health Initiative study) suggests an increase in cardiovascular and stroke risk. HRT has been useful in alleviating disturbing menopausal symptoms, eg hot flushes and irritability. The increased risk of breast and endometrial cancer(if estrogen given alone) has also been noted. Thus it appears that the recent revelation has been the final nail in HRT's coffin.
The recently concluded 11th World Congress of Gynecological Endocrinology held in Florence, Italy, discussed HRT at length. THe controversies surrounding the recently published studies remain. However, there is a trend to look for alternatives that are superior to conventional HRT.
One alternative drug is the Selective Estrogen Receptor Modulators (SERMs) namely Raloxifene. It is a synthetic compound that binds to estrogen receptors at different sites and can be both pro or anti estrogen depending on the target tissue. In the bones, it prevents bone resorption, increases bone mineral density and decreases the incidence of spinal fractures as shown by the MORE study (Multiple Outcomes of Raloxifene trial). Most importantly, it has little effect on the endometrium or the breast. However , the effects on the cardiovascular system needs further evaluation. As SERMs do not alleviate menopausal symptoms, the drug may not be well received by patients. Perhaps for long term protection, SERMs may have its best advantage.
Tibolone(livial) has long been available in Malaysia. Tibolone is a synthetic steroid that can display estrogenic, androgenic, or progesterone-like effects, depending on the target tissue. It alleviates vasomotor symptoms, improves BMD, and has no significant endometrial and breast effects. Its cardiovascular safety has not been established in large trials. Experiences of family members on Tibolone has been marred by elevated liver enzymes on routine investigations , thus discontinuation of this drug adn the return of liver enzymes to normal values.
The combination of estradiol and drospirenone, a synthetic progestin, was also mentioned and is associated with favorable vasomotor, cardiovascular, skeletal, and quality-of-life effects.It is available in Malaysia as Yasmin tablet.
Remifemin, a CIMICIFUGAE RHIZOMA EXTRACT is a traditional compound that has positive effects on menopausal symptoms.(see table below) Nevertheless it has no protective effects on the bone and heart and probably neutral effects on the breast and endometrium. However, experiences of my patients on Remifemin was not as dramatic as those on conventional hormonal replacement therapy.
| Therapeutic efficacy and safety of Cimicifuga racemosa for gynecologic disorders.Liske E. Schaper & Brummer GmbH & Co. KG, International Sales Division, Salzgitter-Ringelheim, Germany. The reproducible quality of phytopharmaceuticals--herbal medicines--is an essential prerequisite for good efficacy and tolerability in the treatment of functional disorders. In clinical trials and scientific investigations, standardized assessments (i.e., validated, internationally recognized and accepted scales) provide the basis for establishing clinical efficacy and tolerability. Extracts (ethanolic and isopropanolic aqueous, Remifemin) of the rootstock of the herb Cimicifuga racemosa (black cohosh) are active ingredients developed for the treatment of gynecologic disorders, particularly climacteric symptoms. Drug-monitoring and clinical studies documenting experience with C. racemosa rootstock extracts comprise the database of this herbal treatment for menopausal symptoms (e.g., hot flashes, profuse sweating, sleep disturbances, depressive moods). These studies show good therapeutic efficacy and tolerability profiles for C. racemosa. In addition, clinical and experimental investigations indicate that the rootstock of C. racemosa does not show hormone-like activity, as was originally postulated. |
However, conventional HRT cannot be totally ignored. It will still serve its purpose and remains the best agent in alleviating menopausal symptoms. Its other previously stated benefits remain under the microscope. The best strategy may be to start early , even in the peri menopausal period and not exceed 10 years of therapy or discontinuation earlier if menopausal symptoms do not recur. There is no right or wrong in this scenario and only time will tell if we have been doing the right things for our patients. "God guide us!", we pray.
Medscape
Pubmed
Site update
Added the Islamic Specialist Doctors Association Of Malaysia website to the MMR's list of Professional Societies and Associations.
I note there is another religio-centric doctors' Association in the Catholic Doctors Association of Malaysia
Am I missing the Christian, Buddhist, Hindu Doctors Association websites? Let me know.....
Added the Islamic Specialist Doctors Association Of Malaysia website to the MMR's list of Professional Societies and Associations.
I note there is another religio-centric doctors' Association in the Catholic Doctors Association of Malaysia
Am I missing the Christian, Buddhist, Hindu Doctors Association websites? Let me know.....
Monday, March 22, 2004
Excessive Foetal Movements during pregnancy : A concern?
On most occasions, we advice mothers to notice if there is a decrease in foetal movements as a sign of foetal distress. However, excessive foetal movements can also indicate a problem in pregnancy.
Perhaps a case study will prove the above :
Adapted from Pregnancy Institute
Case Report: 18 y/o G1P0 Received prenatal care starting at ten weeks. By 21 weeks cord entanglement was documented by ultrasound and tracked over time.
The patient was counseled regarding the ultrasound findings and instructed on fetal movement circadian rhythms. Being aware of fetal movements in 6hr internals, decreased movement or excessive movement was noted. At 39 wks fetal excessive movements occurred at bed time. The patient was monitored on L&D the next day and variables were noted suggesting cord compression. Maternal bedtime/sleep monitoring demonstrated fetal heart rated decelerations at 5am. (graph below). Induction was decided due to the change in movement and fetal heart rate patterns.
This baby eventually went for Caesarean section due to poor progress of induction of labour and persistent foetal arrhythmias. The result - "cord around neck"
So yes, excessive foetal movement can be an ominous sign of foetal distress. But foetal movements are so subjective. How do we actually quantify excessive foetal movements? Can we draw a line and mention the number of foetal movements per day as being excessive? Or should we just do an ultrasound and CTG for every mother that complains of excessive foetal movements? My search of the web provided me with no definite answers. Perhaps the readers can. :)
On most occasions, we advice mothers to notice if there is a decrease in foetal movements as a sign of foetal distress. However, excessive foetal movements can also indicate a problem in pregnancy.
| Is sudden increase in fetal activity a concern? After 34 weeks of relative quiet, today my baby started kicking, punching and stretching like crazy and hasn't stopped or slowed down for almost 15 hours. Should I be concerned? This sudden surge of activity calls for you to see your health-care provider immediately. Sometimes mothers report excessive fetal movement before cessation of all fetal movement. It is possible for a baby to get tangled in the cord, or a knot can develop in the cord, slowing or stopping blood flow to the baby. A non-stress test can be done that would monitor your baby's heart rate and uterine and fetal activity for 30 to 45 minutes. Though your baby may just be going through a very active period, I think this is worth getting checked out for your peace of mind. ParentsPlace.com |
Perhaps a case study will prove the above :
Adapted from Pregnancy Institute
Case Report: 18 y/o G1P0 Received prenatal care starting at ten weeks. By 21 weeks cord entanglement was documented by ultrasound and tracked over time.
The patient was counseled regarding the ultrasound findings and instructed on fetal movement circadian rhythms. Being aware of fetal movements in 6hr internals, decreased movement or excessive movement was noted. At 39 wks fetal excessive movements occurred at bed time. The patient was monitored on L&D the next day and variables were noted suggesting cord compression. Maternal bedtime/sleep monitoring demonstrated fetal heart rated decelerations at 5am. (graph below). Induction was decided due to the change in movement and fetal heart rate patterns.
This baby eventually went for Caesarean section due to poor progress of induction of labour and persistent foetal arrhythmias. The result - "cord around neck"
So yes, excessive foetal movement can be an ominous sign of foetal distress. But foetal movements are so subjective. How do we actually quantify excessive foetal movements? Can we draw a line and mention the number of foetal movements per day as being excessive? Or should we just do an ultrasound and CTG for every mother that complains of excessive foetal movements? My search of the web provided me with no definite answers. Perhaps the readers can. :)
Feedback and Site Update
Ee-Van wrote:
HI, Jus tto inform you that he SLE site is not avialable. pls do the nessasary follow up as even the phone number is still 7 DIGITS!!!
Hi Ee-Van. If you are referring to the Unofficial Website of the SLE Association listed in the MMR's Public Societies and Associations page, yes it is out of date (as far as the contact numbers go) but I decided to leave the link there since it still has some other useful information on SLE. I recall some SLE patients mentioning that they were keen to start up an official website but to date, I am still waiting for this.
The SLE association of Malaysia is based in Hospital UKM and the MMA's list of NGOs has this address:
THE MALAYSIAN SLE ASSOCIATION
c/o Klinik SLE/Nefrologi
Klinik Pakar Perubatan
UKM
Jalan Raja Muda Abdul Aziz
50300 Kuala Lumpur
Tel No : 03-4405479
Fax No : 03-2982180
Yup even their telephone number listed is out of date! Converting 4405479 (using my Palm Telephone Converter) I get the new 8 digit number as 03-40405479.
Perhaps the SLE Association can eventually get it's act together and come out with an Official Website? An Association is there for a purpose - to inform, educate, disseminate information and to support members. The WWW is an excellent medium for this.
Dr Azmi wrote to ask me to delete his AIDs Information webpage from the MMR's General Info website listing as he is no longer maintaining it. Sadly I have done so as requested. The website of the Malaysian AIDS Council and Malaysian AIDS Foundation also seems to be down for the moment. Hopefully not permanently as there is scarce information on AIDS for Malaysians on the WWW.
Lest you think AIDS Education can take the back-seat for now, read this article It's Saturday: 600 S'pore men hit Batam... for sex
Sigh, seems like people in this region still need to be educated. Or is it all futile as its the other little head which does the thinking?
They account for seven or eight out of every 10 men who go to the Riau island - an hour's ride away by ferry - for a sex romp, according to a non-governmental organisation that helps sex workers there.
Most of these Singaporeans are Chinese men - ranging from teenagers to grandfathers clutching walking aids - looking for $50-a-night sex partners.
Hmmm, what a sight. Horny old men with walking sticks. Obviously their third leg is still working (I learnt this term from Doc Liew's blog) ;)
Ee-Van wrote:
HI, Jus tto inform you that he SLE site is not avialable. pls do the nessasary follow up as even the phone number is still 7 DIGITS!!!
Hi Ee-Van. If you are referring to the Unofficial Website of the SLE Association listed in the MMR's Public Societies and Associations page, yes it is out of date (as far as the contact numbers go) but I decided to leave the link there since it still has some other useful information on SLE. I recall some SLE patients mentioning that they were keen to start up an official website but to date, I am still waiting for this.
The SLE association of Malaysia is based in Hospital UKM and the MMA's list of NGOs has this address:
THE MALAYSIAN SLE ASSOCIATION
c/o Klinik SLE/Nefrologi
Klinik Pakar Perubatan
UKM
Jalan Raja Muda Abdul Aziz
50300 Kuala Lumpur
Tel No : 03-4405479
Fax No : 03-2982180
Yup even their telephone number listed is out of date! Converting 4405479 (using my Palm Telephone Converter) I get the new 8 digit number as 03-40405479.
Perhaps the SLE Association can eventually get it's act together and come out with an Official Website? An Association is there for a purpose - to inform, educate, disseminate information and to support members. The WWW is an excellent medium for this.
Dr Azmi wrote to ask me to delete his AIDs Information webpage from the MMR's General Info website listing as he is no longer maintaining it. Sadly I have done so as requested. The website of the Malaysian AIDS Council and Malaysian AIDS Foundation also seems to be down for the moment. Hopefully not permanently as there is scarce information on AIDS for Malaysians on the WWW.
Lest you think AIDS Education can take the back-seat for now, read this article It's Saturday: 600 S'pore men hit Batam... for sex
Sigh, seems like people in this region still need to be educated. Or is it all futile as its the other little head which does the thinking?
They account for seven or eight out of every 10 men who go to the Riau island - an hour's ride away by ferry - for a sex romp, according to a non-governmental organisation that helps sex workers there.
Most of these Singaporeans are Chinese men - ranging from teenagers to grandfathers clutching walking aids - looking for $50-a-night sex partners.
Hmmm, what a sight. Horny old men with walking sticks. Obviously their third leg is still working (I learnt this term from Doc Liew's blog) ;)
Sunday, March 21, 2004
Election day in hospital
Today is the day to vote. After my ward round this morning (yeah, doctors work on Sunday in case you didn't know) I was wondering if hospitalised patients should also be given a chance to vote. I mean after all shoolchildren sometimes sit for exams whilst in hospital so why not allow postal votes for hospitalised patients? Why limit this only for the armed forces or uniformed personnel? Some margins of victory are so narrow they are less than the number of hospital beds in the larger centres!
For those recuperating and with masochistic tendencies, you could also cast your vote in Xtreme pain :)
I recall one funny incident years ago whilst taking medical students on teaching rounds. History taking (students like Adelinegong struggling in this area take note!) is an art and indeed if well taken, you can make the diagnosis 90% of the time from the history alone.
So this poor victim er medical student was asked to demonstrate a Mental status examination on an elderly Indian woman patient in Klang General hospital. (Klang for those who don't know is a town which has a relatively high number of Malaysians of Indian ethinc origin).
Student: (goes thru the ritual of orientation to time place person blah blah routine)
Sweet old Indian lady: Answers slowly but appropriately thus far
Student: (assessing General knowledge here) "So who is the Prime Minister of Malaysia?"
Sweet old Indian lady: (absolutely serious in her answer) Why, Samy Velu of course!
I had a hard time not breaking out in laughter.
So who are you voting for? Some I know are voting for flying kites :)
Today is the day to vote. After my ward round this morning (yeah, doctors work on Sunday in case you didn't know) I was wondering if hospitalised patients should also be given a chance to vote. I mean after all shoolchildren sometimes sit for exams whilst in hospital so why not allow postal votes for hospitalised patients? Why limit this only for the armed forces or uniformed personnel? Some margins of victory are so narrow they are less than the number of hospital beds in the larger centres!
For those recuperating and with masochistic tendencies, you could also cast your vote in Xtreme pain :)
I recall one funny incident years ago whilst taking medical students on teaching rounds. History taking (students like Adelinegong struggling in this area take note!) is an art and indeed if well taken, you can make the diagnosis 90% of the time from the history alone.
So this poor victim er medical student was asked to demonstrate a Mental status examination on an elderly Indian woman patient in Klang General hospital. (Klang for those who don't know is a town which has a relatively high number of Malaysians of Indian ethinc origin).
Student: (goes thru the ritual of orientation to time place person blah blah routine)
Sweet old Indian lady: Answers slowly but appropriately thus far
Student: (assessing General knowledge here) "So who is the Prime Minister of Malaysia?"
Sweet old Indian lady: (absolutely serious in her answer) Why, Samy Velu of course!
I had a hard time not breaking out in laughter.
So who are you voting for? Some I know are voting for flying kites :)
Osteoarthritis reloaded
Dr Cheah just blogged about Glucosamine. I haven't personally been too impressed with clinical responses with this drug though I must admit I haven't used it extensively. I agree the benefits take time and one must be patient. We shouldn't neglect non-pharmacological management though and a very important aspect actually is exercise - something Malaysian patients often fail to do. Strengthening the muscles around the affected joints will go a long way towards helping arthritis in general.
The Arthritis Foundation of Malaysia has recently launched a free exercise video (in VCD format). Contact them for your free copy! Did you know that The AFM has also set up a fund to assist those who require a joint replacement but lack the means to purchase the prosthesis?
The AFM is listed together with other Public Societies and Associations in the MMR.
Dr Cheah just blogged about Glucosamine. I haven't personally been too impressed with clinical responses with this drug though I must admit I haven't used it extensively. I agree the benefits take time and one must be patient. We shouldn't neglect non-pharmacological management though and a very important aspect actually is exercise - something Malaysian patients often fail to do. Strengthening the muscles around the affected joints will go a long way towards helping arthritis in general.
The Arthritis Foundation of Malaysia has recently launched a free exercise video (in VCD format). Contact them for your free copy! Did you know that The AFM has also set up a fund to assist those who require a joint replacement but lack the means to purchase the prosthesis?
The AFM is listed together with other Public Societies and Associations in the MMR.
Glucosamine Sulphate : Improving osteoarthritis
Osteoarthritis is a degenerative joint disease that affects a large proportion of aging adults. It causes joint pain especially after prolonged immobility and also after
excessive activity. In some, it can cause frustrating disability to even perform the simplest of tasks. It can affect any joint in the body but a commonly affected one is the knee joint where joint space narrowing can be seen on X rays. (picture)
Treatment has largely been directed at pain control. Among drug agents used are non-steroidal anti-inflammatories(NSAIDS) and steroids. This only provides temporary relief and has no "disease-modifying" effects ie it will not change the course of the disease. Furthermore, NSAIDS can cause problematic gastritis and in some impairment of renal function. Prolonged use of oral steriods has undoubtedly its own side effects as well. Even joint injections are prone to complications if not carefully done or if done repeatedly. The only permanent solution is a joint replacement surgery which entails a prolonged recovery phase.
In comes oral Glucosamine sulphate. Glucosamine sulphate is a constituent of glycosaminoglycans in cartilage matrix and synovial fluid, has the potential to promote pharmacological actions in articular cartilage and joint tissues. Many recent studies have now concluded that Glucosamine suphate not only improves symptoms but also causes improvement in joint structure. In a study published recently in Menopause, even improvement in joint space is evident. Perhaps this has been the wonder drug we have been waiting for.
Personally, I have put several patients on glucosamine sulphate. Unfortunately, as this medication takes several months if not years to exert its "disease-modifying" effects, most patient opt to discontinue this drug due to its high cost and perceived improvement in symptoms. There are cheaper generic-type drugs (eg Donna capsules) but can be costly in the long run when you have to take multiple doses daily! But glucosamine has certainly given physicians more control over osteoarthritis and decrease their dependance on troublesome NSAIDS, steroids and of course surgery. :)
Medscape
Information on Viartril
Osteoarthritis is a degenerative joint disease that affects a large proportion of aging adults. It causes joint pain especially after prolonged immobility and also after
excessive activity. In some, it can cause frustrating disability to even perform the simplest of tasks. It can affect any joint in the body but a commonly affected one is the knee joint where joint space narrowing can be seen on X rays. (picture)Treatment has largely been directed at pain control. Among drug agents used are non-steroidal anti-inflammatories(NSAIDS) and steroids. This only provides temporary relief and has no "disease-modifying" effects ie it will not change the course of the disease. Furthermore, NSAIDS can cause problematic gastritis and in some impairment of renal function. Prolonged use of oral steriods has undoubtedly its own side effects as well. Even joint injections are prone to complications if not carefully done or if done repeatedly. The only permanent solution is a joint replacement surgery which entails a prolonged recovery phase.
In comes oral Glucosamine sulphate. Glucosamine sulphate is a constituent of glycosaminoglycans in cartilage matrix and synovial fluid, has the potential to promote pharmacological actions in articular cartilage and joint tissues. Many recent studies have now concluded that Glucosamine suphate not only improves symptoms but also causes improvement in joint structure. In a study published recently in Menopause, even improvement in joint space is evident. Perhaps this has been the wonder drug we have been waiting for.
Personally, I have put several patients on glucosamine sulphate. Unfortunately, as this medication takes several months if not years to exert its "disease-modifying" effects, most patient opt to discontinue this drug due to its high cost and perceived improvement in symptoms. There are cheaper generic-type drugs (eg Donna capsules) but can be costly in the long run when you have to take multiple doses daily! But glucosamine has certainly given physicians more control over osteoarthritis and decrease their dependance on troublesome NSAIDS, steroids and of course surgery. :)
Medscape
Information on Viartril
Saturday, March 20, 2004
Fetal MRI
Obstetrical management has been revolutionised by the advent of the ultrasound. Ultrasounds are now frequently used in obstetric practice, from dating a baby to diagnosing abnormalities in utero. It is now easily available even in the remotest of areas as there are now portable units. It has proven to be an extremely useful tool.
However, for those who frequently do ultrasounds, there are limitations. Visual images are sometimes blurry especially in obese patients. Small abnormalities are also often missed on an ultrasound. Diagnosing pulmonary hypoplasia for example, is close to impossible. Even diaphragmatic hernias can be missed.
So a better tool to complement the ultrasound is needed. Introducing the fetal MRI. MRI is Magnetic Resonance Imaging where water molecules are realigned using magnetic forces to produce an image. Fetal MRI has proven to be useful in diagnosing certain congenital abnormalities that were previously impossible with ultrasound.
Diagphramatic hernias that could previously be missed on an ultrasound can now be clearly visualised on a fetal MRI. (right picture) Even visualisation of the brain is clearer and not obstructed by shadows from the skull. I still can remember how difficult it is, even for seasoned ultrasonographers to visualise certain structures in the brain. How about facial profile?
Nevertheless, it has been noted that fetal MRI will never supplant the ultrasound in obstetrics. The MRI still needs further evaluation to determine its role in patient management. However, the usefulness of MRI in antenatal diagnosis is undeniable and the addition of another tool is as always, indeed exciting.
Obstetrical management has been revolutionised by the advent of the ultrasound. Ultrasounds are now frequently used in obstetric practice, from dating a baby to diagnosing abnormalities in utero. It is now easily available even in the remotest of areas as there are now portable units. It has proven to be an extremely useful tool.
However, for those who frequently do ultrasounds, there are limitations. Visual images are sometimes blurry especially in obese patients. Small abnormalities are also often missed on an ultrasound. Diagnosing pulmonary hypoplasia for example, is close to impossible. Even diaphragmatic hernias can be missed.
So a better tool to complement the ultrasound is needed. Introducing the fetal MRI. MRI is Magnetic Resonance Imaging where water molecules are realigned using magnetic forces to produce an image. Fetal MRI has proven to be useful in diagnosing certain congenital abnormalities that were previously impossible with ultrasound.Diagphramatic hernias that could previously be missed on an ultrasound can now be clearly visualised on a fetal MRI. (right picture) Even visualisation of the brain is clearer and not obstructed by shadows from the skull. I still can remember how difficult it is, even for seasoned ultrasonographers to visualise certain structures in the brain. How about facial profile?
Nevertheless, it has been noted that fetal MRI will never supplant the ultrasound in obstetrics. The MRI still needs further evaluation to determine its role in patient management. However, the usefulness of MRI in antenatal diagnosis is undeniable and the addition of another tool is as always, indeed exciting.
No-Claim Bonus
Spotted this interesting news item in the BMJ.
The Dutch government is supporting plans to introduce a no-claim system into health insurance, giving patients a financial incentive to consume less health care
Health minister Hans Hoogervorst, who this week called for 10% or €bn efficiency savings in health care, has said the scheme would encourage patients "not to visit their doctor for every little trifle."
That's a novel idea but do you think it'll work?
I think the state of medical insurance in this country is pretty pathetic. There are good medical insurance plans and bad ones. On the other side, there are people who may abuse the system too and make unnecessary claims.
One example of a worrying trend now is for insurance companies to withold payment for an admission till post-discharge diagnosis. This puts the patient into a quandry. What if the insurance company refuses to pay? I hope we won't ever see a situation like the anectdotal account I was told of an HMO in the USA when called up for authorisation for an emergency CT Scan of the brain for a patient coming to the ER for a severe headache" "if the scan is abnormal we'll pay, if normal we won't pay"!!
Then there are pretty stupid people who think all "tests" are routine and therefore not eligible. Can't they get it into their thick skulls that some tests are imperative in the managment of problems and required in order to establish the diagnosis?
Tests are also not infallible. I had a call from an insurance agent who wanted to know why the diagnosis was Dengue fever when the dengue serology was negative? Try explaining to a non-medical person that serology can be negative, particularly in the early stages of the illness. The diagnosis can be confidently made on the basis of the clinical features - if you have a classical rash, dropping following by rising platelet counts and the accompanying other clinical features (fever, headache, bodyache etc). We could do repeat serology but that would drive up your cost - would you like that?
Insurance companies should also learn that they can save costs by supporting more outpatient care versus in-patient care. It's pretty stupid having to admit patients say for endoscopic procedures when they can have this done as outpatient and save on costs.
OK. That's my medical insurance rant for the day.... Have you had problematic encounters with your Medical insurance claims? I would be interested to hear feedback.
Spotted this interesting news item in the BMJ.
The Dutch government is supporting plans to introduce a no-claim system into health insurance, giving patients a financial incentive to consume less health care
Health minister Hans Hoogervorst, who this week called for 10% or €bn efficiency savings in health care, has said the scheme would encourage patients "not to visit their doctor for every little trifle."
That's a novel idea but do you think it'll work?
I think the state of medical insurance in this country is pretty pathetic. There are good medical insurance plans and bad ones. On the other side, there are people who may abuse the system too and make unnecessary claims.
One example of a worrying trend now is for insurance companies to withold payment for an admission till post-discharge diagnosis. This puts the patient into a quandry. What if the insurance company refuses to pay? I hope we won't ever see a situation like the anectdotal account I was told of an HMO in the USA when called up for authorisation for an emergency CT Scan of the brain for a patient coming to the ER for a severe headache" "if the scan is abnormal we'll pay, if normal we won't pay"!!
Then there are pretty stupid people who think all "tests" are routine and therefore not eligible. Can't they get it into their thick skulls that some tests are imperative in the managment of problems and required in order to establish the diagnosis?
Tests are also not infallible. I had a call from an insurance agent who wanted to know why the diagnosis was Dengue fever when the dengue serology was negative? Try explaining to a non-medical person that serology can be negative, particularly in the early stages of the illness. The diagnosis can be confidently made on the basis of the clinical features - if you have a classical rash, dropping following by rising platelet counts and the accompanying other clinical features (fever, headache, bodyache etc). We could do repeat serology but that would drive up your cost - would you like that?
Insurance companies should also learn that they can save costs by supporting more outpatient care versus in-patient care. It's pretty stupid having to admit patients say for endoscopic procedures when they can have this done as outpatient and save on costs.
OK. That's my medical insurance rant for the day.... Have you had problematic encounters with your Medical insurance claims? I would be interested to hear feedback.
Friday, March 19, 2004
Measles campaign
In April this year, about 4.5 million schoolchildren aged between seven and 15 will receive free measles vaccinations in a nationwide campaign.
The Medical Tribune has the story:
Health Minister Dato’ Chua Jui Meng told reporters that the campaign would cover children below 15 as many would not yet have received a booster vaccination. The current immunization practice for measles, where jabs are given at age one and seven, was only introduced in 2002; previously, booster doses were not given.
The national immunization program successfully reduced the number of cases from almost just over 9,000 in 1982 to about 500 in 1990. In the 1990s, the average number of cases was 300 to 615 per year. However, about a decade later, the rate increased to 6,200 with seven deaths.
These outbreaks began in children who were not immunized or did not obtain adequate protection from the vaccination.
According to Chua, measles remains the biggest killer of children of all the vaccine-preventable diseases.
I was wondering if there were Malaysian morbidity and mortality statistics available on the 'net for communicable diseases. Lo and behold, the Ministry of Health has published online data up to 2001.
You can view the INCIDENCE RATE AND MORTALITY RATE OF COMMUNICABLE DISEASES PER 100,000 POPULATION, 2001
So what is the #1 problem in the table?
In terms of per 100,00 population, Dengue and Dengue haemorrhagic fever ranks as the #1 problem with an incidence of 68.46 and mortality of 0.21
Measles ranks only #9 in that table with an incidence of 9.19 and mortality of 0.02.
While efforts to curtail preventable diseases are commendable, I hope to see more effort from everyone to tackle the real #1 problem. Those of use who work in hospitals regularly (every day in fact) see patients admitted for dengue. I notice too that many adult patients have severe hepatitis in this current spell. I saw an unfortunate man whose liver enzymes exceed 60,000 iu/l - the highest I have ever seen!
I hope to see a vaccine for dengue in the near future too.
You can read more about
Measles
and Dengue
from the WHO.
In April this year, about 4.5 million schoolchildren aged between seven and 15 will receive free measles vaccinations in a nationwide campaign.
The Medical Tribune has the story:
Health Minister Dato’ Chua Jui Meng told reporters that the campaign would cover children below 15 as many would not yet have received a booster vaccination. The current immunization practice for measles, where jabs are given at age one and seven, was only introduced in 2002; previously, booster doses were not given.
The national immunization program successfully reduced the number of cases from almost just over 9,000 in 1982 to about 500 in 1990. In the 1990s, the average number of cases was 300 to 615 per year. However, about a decade later, the rate increased to 6,200 with seven deaths.
These outbreaks began in children who were not immunized or did not obtain adequate protection from the vaccination.
According to Chua, measles remains the biggest killer of children of all the vaccine-preventable diseases.
I was wondering if there were Malaysian morbidity and mortality statistics available on the 'net for communicable diseases. Lo and behold, the Ministry of Health has published online data up to 2001.
You can view the INCIDENCE RATE AND MORTALITY RATE OF COMMUNICABLE DISEASES PER 100,000 POPULATION, 2001
So what is the #1 problem in the table?
In terms of per 100,00 population, Dengue and Dengue haemorrhagic fever ranks as the #1 problem with an incidence of 68.46 and mortality of 0.21
Measles ranks only #9 in that table with an incidence of 9.19 and mortality of 0.02.
While efforts to curtail preventable diseases are commendable, I hope to see more effort from everyone to tackle the real #1 problem. Those of use who work in hospitals regularly (every day in fact) see patients admitted for dengue. I notice too that many adult patients have severe hepatitis in this current spell. I saw an unfortunate man whose liver enzymes exceed 60,000 iu/l - the highest I have ever seen!
I hope to see a vaccine for dengue in the near future too.
You can read more about
Measles
and Dengue
from the WHO.
Thursday, March 18, 2004
Positive Parenting
Positive Parenting is an educational magazine just launched by the Malaysian Paediatric Association.
Involving the collaboration of the Obstetrical and Gynaecological Society of Malaysia (OGSM), the Nutrition Society of Malaysia as well as consultants in other related disciplines, the magazine covers common parental concerns that emerge especially during pregnancy and the first 10 years of life.
These include a normal pregnancy and safe childbirth, caring for newborns and infants, providing adequate nutrition for children, protecting them from infections, diseases and injury, and promoting their cognitive, intellectual, emotional and social development.
The information and advice is consistent with contemporary Malaysian family lifestyles and time-honoured values and is presented in a parent-friendly style.
The article Preparing to Conceive in The Star is also taken from Positive Parenting.
Positive Parenting will be published once every two months and will be available free at clinics and hospitals where MPA and OGSM members are based.
Parents who wish to have the magazine delivered to their homes can request accordingly at a cost of RM2 per issue to cover postage and handling. For further information, call the Positive Parenting secretariat at 03-5621 1408.
Good show MPA. Hope that this will be an enduring publication.
Positive Parenting is an educational magazine just launched by the Malaysian Paediatric Association.
Involving the collaboration of the Obstetrical and Gynaecological Society of Malaysia (OGSM), the Nutrition Society of Malaysia as well as consultants in other related disciplines, the magazine covers common parental concerns that emerge especially during pregnancy and the first 10 years of life.
These include a normal pregnancy and safe childbirth, caring for newborns and infants, providing adequate nutrition for children, protecting them from infections, diseases and injury, and promoting their cognitive, intellectual, emotional and social development.
The information and advice is consistent with contemporary Malaysian family lifestyles and time-honoured values and is presented in a parent-friendly style.
The article Preparing to Conceive in The Star is also taken from Positive Parenting.
Positive Parenting will be published once every two months and will be available free at clinics and hospitals where MPA and OGSM members are based.
Parents who wish to have the magazine delivered to their homes can request accordingly at a cost of RM2 per issue to cover postage and handling. For further information, call the Positive Parenting secretariat at 03-5621 1408.
Good show MPA. Hope that this will be an enduring publication.
Erectile Dysfunction(ED) : Sildenafil vs tadalafil vs vardenafil
ED is an under-discussed problem between patients and their doctors. Unfortunately most doctors themselves are uncomfortable discussing about sexual problems with their patients. The prevalence of ED in Malaysia is not known but I would suspect little difference with other countries. In the United States, up to 26% of males are said to be suffering from moderate to severe forms of ED. The aetiology of ED is numerous from organic (eg vascular compromise due to smoking or diabetes) to psychogenic problems. Some have mixed aetiologies.
The treatment of ED has revolutionised over the past decade with the introduction of Sildenafil (Viagra). Since its advent, second generation ED drugs have surfaced namely talalafil (Cialis) and Vardenafil(levitra). These are drugs that competitively inhibit the enzyme Phosphodiesterase (PDE), specifically PDE-5 which is mainly found in smooth muscle and vascular tissues. For the benefit of all, here is some physiology about erection.
Upon sexual stimulation, the parasympathetic nerves release nitric oxide which then diffuses into smooth muscle cells before binding to enzyme guanylate cyclase there. Guanylate cyclase converts GTP to cGMP. cGMP then binds to Protein Kinase G which then causes smooth muscle cells to relax allowing blood to flow through the sinosoids of the corpus cavernosum producing an erection. PDE-5 causes the breakdown of cGMP. Therefore by inhibiting PDE-5, cGMP could produce its effects for a longer period of time.
With the recent introduction of tadalafil(Cialis) in Malaysia, which would be a better choice? Viagra or Cialis? There are at this moment no comparator studies between the two. So no one can say one is better than the other. But doubleblind placebo controlled studies have shown both to be efficacious.
Viagra has a shorter half life (4-6 hours) and its onset of action is approximately 30 minutes. Studies have shown and proven its safety , even in heart patients. But side effects are dose dependant ie the higher the prescribed dose, the greater its side effects. Because Viagra inhibits PDE-6(present in the eye) at high doses, it could produce colour visual disturbances. Other side effects, headaches, diarrhoea and flushing are similar with other groups of PDE inhibitors as well. It is contraindicated in patients using nitrates (also a vasodilator) and caution in patients with heart disease. Although data from some studies actually show a cardioprotective effect from Viagra!
Vardenafil(Levitra) has a similar profile to sildenafil due to its slosely similar chemical structure.
Cialis on the other hand,which has a slightly different chemical structure, has a longer half life, up to 24 hours. It is said to be more specific for PDE-5 although it is known to also inhibit PDE-11 which is found in the testes and heart. The effect of this is unknown pending post marketing studies. Due to its long half life, the chances of side effects from it is much higher. However the benefit of tadalafil is said to be that, it is not significantly affected by renal or liver impairment. The onset is also claimed to be as fast as 15 minutes in responsive patients!!
The verdict? Personally, i would prefer a more well tested drug ie Viagra. The shorter half life is more comforting as compared to a longer one. Until further studies show a superior safety profile of Cialis, Viagra would be the preferred choice. Perhaps a head to head comparator study needs to be done, pitching Pfizer, Bayer and Lilly! That would certainly be the next big thing ... after Lord of the Rings!
Medscape
Viagra
Cialis
Levitra
ED is an under-discussed problem between patients and their doctors. Unfortunately most doctors themselves are uncomfortable discussing about sexual problems with their patients. The prevalence of ED in Malaysia is not known but I would suspect little difference with other countries. In the United States, up to 26% of males are said to be suffering from moderate to severe forms of ED. The aetiology of ED is numerous from organic (eg vascular compromise due to smoking or diabetes) to psychogenic problems. Some have mixed aetiologies.
The treatment of ED has revolutionised over the past decade with the introduction of Sildenafil (Viagra). Since its advent, second generation ED drugs have surfaced namely talalafil (Cialis) and Vardenafil(levitra). These are drugs that competitively inhibit the enzyme Phosphodiesterase (PDE), specifically PDE-5 which is mainly found in smooth muscle and vascular tissues. For the benefit of all, here is some physiology about erection.
Upon sexual stimulation, the parasympathetic nerves release nitric oxide which then diffuses into smooth muscle cells before binding to enzyme guanylate cyclase there. Guanylate cyclase converts GTP to cGMP. cGMP then binds to Protein Kinase G which then causes smooth muscle cells to relax allowing blood to flow through the sinosoids of the corpus cavernosum producing an erection. PDE-5 causes the breakdown of cGMP. Therefore by inhibiting PDE-5, cGMP could produce its effects for a longer period of time.
With the recent introduction of tadalafil(Cialis) in Malaysia, which would be a better choice? Viagra or Cialis? There are at this moment no comparator studies between the two. So no one can say one is better than the other. But doubleblind placebo controlled studies have shown both to be efficacious.
Viagra has a shorter half life (4-6 hours) and its onset of action is approximately 30 minutes. Studies have shown and proven its safety , even in heart patients. But side effects are dose dependant ie the higher the prescribed dose, the greater its side effects. Because Viagra inhibits PDE-6(present in the eye) at high doses, it could produce colour visual disturbances. Other side effects, headaches, diarrhoea and flushing are similar with other groups of PDE inhibitors as well. It is contraindicated in patients using nitrates (also a vasodilator) and caution in patients with heart disease. Although data from some studies actually show a cardioprotective effect from Viagra!
Vardenafil(Levitra) has a similar profile to sildenafil due to its slosely similar chemical structure.
Cialis on the other hand,which has a slightly different chemical structure, has a longer half life, up to 24 hours. It is said to be more specific for PDE-5 although it is known to also inhibit PDE-11 which is found in the testes and heart. The effect of this is unknown pending post marketing studies. Due to its long half life, the chances of side effects from it is much higher. However the benefit of tadalafil is said to be that, it is not significantly affected by renal or liver impairment. The onset is also claimed to be as fast as 15 minutes in responsive patients!!
The verdict? Personally, i would prefer a more well tested drug ie Viagra. The shorter half life is more comforting as compared to a longer one. Until further studies show a superior safety profile of Cialis, Viagra would be the preferred choice. Perhaps a head to head comparator study needs to be done, pitching Pfizer, Bayer and Lilly! That would certainly be the next big thing ... after Lord of the Rings!
Medscape
Viagra
Cialis
Levitra
Liver cancer
Someone who requested not to be identified sent in feedback for information on Liver cancer.
In Malaysia, Liver cancer commonly arises from a background of chronic hepatitis B infection though there are other causes. Given the mass vaccination of Hepatitis B to newborns being carried out now, Hepatitis B as a cause of liver cancer wil be less common in the future (this is an example of an effective anti-cancer vaccine program)
For patients who are unfortunate enough to get liver cancer, proper care in a good tertiary centre is important. Selayang Hospital is an excellent referral centre for patients with liver cancer. It's listed together with the other Public hospitals in the MMR.
I often recommend patients surf over to Cancernet which is an excellent source of information on the various types of cancer for both patients and doctors.
Someone who requested not to be identified sent in feedback for information on Liver cancer.
In Malaysia, Liver cancer commonly arises from a background of chronic hepatitis B infection though there are other causes. Given the mass vaccination of Hepatitis B to newborns being carried out now, Hepatitis B as a cause of liver cancer wil be less common in the future (this is an example of an effective anti-cancer vaccine program)
For patients who are unfortunate enough to get liver cancer, proper care in a good tertiary centre is important. Selayang Hospital is an excellent referral centre for patients with liver cancer. It's listed together with the other Public hospitals in the MMR.
I often recommend patients surf over to Cancernet which is an excellent source of information on the various types of cancer for both patients and doctors.
Wednesday, March 17, 2004
Site & Blogroll update
You might have noticed - the MMR has a new co-blogger. Please welcome Dr Cheah who also has his own cool personal homepage. I thought that the MMR could do with more contributors and you get to see more varied thoughts and opinions. I might even rope in Doc Liew if he promises not to blog about watches, burgers, Mimaland, jammed VCRs and his RPCNs (for that you gotta go to Doc Liew's hilarious blog) - just stick to Medical stuff, especially Malaysian Medical topics.
YP sent me a couple more Medical Student blogs. I have added Adelinegong (she who can blog during a lecture!!! and I didn't know Breastfeeding is a form of liposuction!!! ) and Life of Noob to the MMR's Blogroll. Needless to say, these are IMU students...
You might have noticed - the MMR has a new co-blogger. Please welcome Dr Cheah who also has his own cool personal homepage. I thought that the MMR could do with more contributors and you get to see more varied thoughts and opinions. I might even rope in Doc Liew if he promises not to blog about watches, burgers, Mimaland, jammed VCRs and his RPCNs (for that you gotta go to Doc Liew's hilarious blog) - just stick to Medical stuff, especially Malaysian Medical topics.
YP sent me a couple more Medical Student blogs. I have added Adelinegong (she who can blog during a lecture!!! and I didn't know Breastfeeding is a form of liposuction!!! ) and Life of Noob to the MMR's Blogroll. Needless to say, these are IMU students...
Sadism, NOT Sexual asphyxia
In The Star today :
Sexual asphyxia is often unheard of, even among the medical fraternity. It involves acts that decreases the supply of oxygen to the brain which in turn creates varying degrees of hypoxic euphoria, diminished ego controls, giddiness, light-headedness, and exhilaration. This is said to enhance masturbation sensations and orgasm intensity. Such acts can include putting a ligature around one's neck or perhaps a plastic bag over the head. This is usually done to enhance the sexual pleasure of the "asphyxiated" one and is voluntary. If there is no partner to assist in the process of asphyxiation then it is termed "autoerotic asphyxia", ie one asphyxiate oneself for one's own sexual pleasure. Death is accidental due to "over-asphyxiation".
It has been reported that 500-1000 young adolescents in the United States die annually due to autoerotic ashyxiation. This is said to be an underreported figure due to the fact that most cases are classified as teen suicide. Emergency personnel , the police and even doctors are usually unfamiliar with this term.
In Canny Ong's case, sexual asphyxia should not even be mentioned as it is no doubt against the will of Canny Ong. She did not derive any pleasure from it. In actual fact, she most probably suffered throughout the ordeal. The sexual pleasure belonged to the perpetrator. This brings me to the term "sadism".
In the DSM IV , Sadism is defined as:
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.
B. The person has acted on these urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
This fits perfectly with the intention in Canny Ong's murder trial. So, yes, we can rule out sexual asphyxia based on the circumstances surrounding the case although asphyxiation as the cause of death remains tenable. Perhaps those involved could take note. :)
In The Star today :
| Canny's death not the result of a sexual act BY RAPHAEL WONG SHAH ALAM: A pathologist told the High Court that Canny Ong’s possible cause of death by strangulation was not the result of a sexual act. Prof Dr Kasinathan Nadesan, 57, said that based on the totality of his findings, Ong did not die in a state of sexual asphyxia. The term, he said was a state of a lack of oxygen experienced by a person when a piece of rope or ligature was tied around the person's neck to create a condition of helplessness which was believed to be sexually erotic. However, when asked by defence counsel Haniff Khatri Abdulla whether he could completely exclude sexual asphyxia as a cause of Ong’s death, the consultant forensic pathologist of Universiti Malaya Medical Centre said he could not. .............. |
Sexual asphyxia is often unheard of, even among the medical fraternity. It involves acts that decreases the supply of oxygen to the brain which in turn creates varying degrees of hypoxic euphoria, diminished ego controls, giddiness, light-headedness, and exhilaration. This is said to enhance masturbation sensations and orgasm intensity. Such acts can include putting a ligature around one's neck or perhaps a plastic bag over the head. This is usually done to enhance the sexual pleasure of the "asphyxiated" one and is voluntary. If there is no partner to assist in the process of asphyxiation then it is termed "autoerotic asphyxia", ie one asphyxiate oneself for one's own sexual pleasure. Death is accidental due to "over-asphyxiation".
It has been reported that 500-1000 young adolescents in the United States die annually due to autoerotic ashyxiation. This is said to be an underreported figure due to the fact that most cases are classified as teen suicide. Emergency personnel , the police and even doctors are usually unfamiliar with this term.
In Canny Ong's case, sexual asphyxia should not even be mentioned as it is no doubt against the will of Canny Ong. She did not derive any pleasure from it. In actual fact, she most probably suffered throughout the ordeal. The sexual pleasure belonged to the perpetrator. This brings me to the term "sadism".
In the DSM IV , Sadism is defined as:
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person.
B. The person has acted on these urges with a nonconsenting person, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.
This fits perfectly with the intention in Canny Ong's murder trial. So, yes, we can rule out sexual asphyxia based on the circumstances surrounding the case although asphyxiation as the cause of death remains tenable. Perhaps those involved could take note. :)
Feedback : Specialist details
Winston sent in this email:
A very strange thing is happening on the web-sites of our local private hospitals; the majority of them lack details such as the names of their specialists and their medical quailfications.
This is so even when the govt has lifted the ban on such info.
I have approached a few and they are reluctant to even consider it although they have web-sites.
Perhaps you can change their mind set? Thank you.
Thanks for your feedback Winston. In the past and even now, doctors are bound by a Code of Ethics which precludes advertising themselves. I understand regulations for hospitals are less stringent nowadays but I am not aware of any changes in regulation for individual doctors.
Winston sent in this email:
A very strange thing is happening on the web-sites of our local private hospitals; the majority of them lack details such as the names of their specialists and their medical quailfications.
This is so even when the govt has lifted the ban on such info.
I have approached a few and they are reluctant to even consider it although they have web-sites.
Perhaps you can change their mind set? Thank you.
Thanks for your feedback Winston. In the past and even now, doctors are bound by a Code of Ethics which precludes advertising themselves. I understand regulations for hospitals are less stringent nowadays but I am not aware of any changes in regulation for individual doctors.
Tuesday, March 16, 2004
Feedback & Organ donation
TYW sent in this email:
Rujuk kepada pesakit-pesakit di hospital dimana mereka sedang menunggu sukalelawan menderma organ-organ atau tisu mereka yang boleh menyelamatkan mereka. Ini adalah menyakitkan hati saya apabila keluarga mereka bersusah payah menjaganya. Oleh itu saya dengan sukalelanya ingin menderma organ-organ, tisu-tisu atau bahagian badan yang boleh menderma kepada orang yang memerlukannya tanpa sebarang balasan.
Sila memberi panduan atau rujukan kepada saya, apa yang perlu dijalankan oleh saya. Seperti borang hendak isi,
laporan .....
Terima kasih.
The jist of the email, is that TYW would like to be an organ donor and would like know more information about organ donation.
Well, TSW, you can get more information from the Pusat Sumber Transplan Nasional (or the National Transplant Resource Cente) .
You can sign up as a volunteer donor from this site and also this site.
Some time back I posted the organ donation info in Bahasa Malaysia and you can read it here
Isu mengenai kematian serta pendermaan organ adalah sesuatu yang sukar untuk di perkatakan. Apalah lagi untuk mereka yang kehilangan orang yang tersayang. Ia juga merupakan perkara yang rumit bagi kakitangan perubatan yang sentiasa berusaha untuk menyelamatkab nyawa seseorang pesakit. Keputusan untuk mengizinkan pendermaan organ & tisu seseorang yang disayangi apabila beliau meninggal dunia, bukan sesuatu yang mudah. Ia membangkitkan beberapa kemushkilan bagi keluarga simati. Untuk meringankan beban mental keluarga kita, semasa kematian haruslah kita membuat pengakuan untuk persetujuan untuk menderma organ & tisu semasa hayat kita.
Dengan mendaftarkan diri kepada Daftar Penderma Organ Nasional, anda akan membenarkan organ dan tisu anda digunakan bagi tujuan transplan, selepas anda meninggal dunia. Ini akan mengubahkan kehidupan beberapa orang yang mengalami kegagalan organ supaya menjadi lebih selesa dan sempurna serta dapat menyelamatkan nyawanya dari maut.
There are more links to General Information in the MMR.
You can also read more information from this US organ donation website
TYW sent in this email:
Rujuk kepada pesakit-pesakit di hospital dimana mereka sedang menunggu sukalelawan menderma organ-organ atau tisu mereka yang boleh menyelamatkan mereka. Ini adalah menyakitkan hati saya apabila keluarga mereka bersusah payah menjaganya. Oleh itu saya dengan sukalelanya ingin menderma organ-organ, tisu-tisu atau bahagian badan yang boleh menderma kepada orang yang memerlukannya tanpa sebarang balasan.
Sila memberi panduan atau rujukan kepada saya, apa yang perlu dijalankan oleh saya. Seperti borang hendak isi,
laporan .....
Terima kasih.
The jist of the email, is that TYW would like to be an organ donor and would like know more information about organ donation.
Well, TSW, you can get more information from the Pusat Sumber Transplan Nasional (or the National Transplant Resource Cente) .
You can sign up as a volunteer donor from this site and also this site.
Some time back I posted the organ donation info in Bahasa Malaysia and you can read it here
Isu mengenai kematian serta pendermaan organ adalah sesuatu yang sukar untuk di perkatakan. Apalah lagi untuk mereka yang kehilangan orang yang tersayang. Ia juga merupakan perkara yang rumit bagi kakitangan perubatan yang sentiasa berusaha untuk menyelamatkab nyawa seseorang pesakit. Keputusan untuk mengizinkan pendermaan organ & tisu seseorang yang disayangi apabila beliau meninggal dunia, bukan sesuatu yang mudah. Ia membangkitkan beberapa kemushkilan bagi keluarga simati. Untuk meringankan beban mental keluarga kita, semasa kematian haruslah kita membuat pengakuan untuk persetujuan untuk menderma organ & tisu semasa hayat kita.
Dengan mendaftarkan diri kepada Daftar Penderma Organ Nasional, anda akan membenarkan organ dan tisu anda digunakan bagi tujuan transplan, selepas anda meninggal dunia. Ini akan mengubahkan kehidupan beberapa orang yang mengalami kegagalan organ supaya menjadi lebih selesa dan sempurna serta dapat menyelamatkan nyawanya dari maut.
There are more links to General Information in the MMR.
You can also read more information from this US organ donation website
The cost of medicine
It's spiralling. I was just talking to a patient with Hypereosinophilic syndrome which is a relatively uncommon blood disorder. If response to prednisolone and hydroxyurea is not so good, then we may have to resort to Glivec which has been recently reported to work well in this condition.
Unfortunately, it costs RM75 per 100mg capsule, so even at the minium dose of 100mg per day, this treatment will cost over RM2000 per month. Hardly affordable.
Want to talk about AIDS treatment? Why do you think the Malaysian Government is also resorting to "generics"?
I think the whole drug pricing issue is going crazy. "Globalisation" does not take into account dollar parity. I mean US$1 can buy in the USA what roughly RM1 can buy in Malaysia. Yet the price of Glivec is RM(4x the US$ price). In actual fact it should be 1/4 the price.
Now companies want to defend their pricing. There's outcry even in the US. See the Yahoo news item:
Pharmaceutical giant GlaxoSmithKline PLC on Monday launched an advertising campaign touting the company's research and scientists as it attempts to explain to increasingly frustrated consumers why prescription drugs are so expensive.
Pennsylvania is among a handful of states suing Glaxo and a dozen other major pharmaceutical firms and related entities, accusing them of inflating prices in an alleged scheme estimated to have cost the government, insurers and consumers hundreds of millions of dollars.
At least people are making noise now and not sitting back and taking the punches.
It's spiralling. I was just talking to a patient with Hypereosinophilic syndrome which is a relatively uncommon blood disorder. If response to prednisolone and hydroxyurea is not so good, then we may have to resort to Glivec which has been recently reported to work well in this condition.
Unfortunately, it costs RM75 per 100mg capsule, so even at the minium dose of 100mg per day, this treatment will cost over RM2000 per month. Hardly affordable.
Want to talk about AIDS treatment? Why do you think the Malaysian Government is also resorting to "generics"?
I think the whole drug pricing issue is going crazy. "Globalisation" does not take into account dollar parity. I mean US$1 can buy in the USA what roughly RM1 can buy in Malaysia. Yet the price of Glivec is RM(4x the US$ price). In actual fact it should be 1/4 the price.
Now companies want to defend their pricing. There's outcry even in the US. See the Yahoo news item:
Pharmaceutical giant GlaxoSmithKline PLC on Monday launched an advertising campaign touting the company's research and scientists as it attempts to explain to increasingly frustrated consumers why prescription drugs are so expensive.
Pennsylvania is among a handful of states suing Glaxo and a dozen other major pharmaceutical firms and related entities, accusing them of inflating prices in an alleged scheme estimated to have cost the government, insurers and consumers hundreds of millions of dollars.
At least people are making noise now and not sitting back and taking the punches.
Monday, March 15, 2004
Are you well maintained?
I'm sure most of you send your cars for regular servicing - every 5000 or 10,000km depending on your car users' service manual.
Ironically some people take care of the cars better than their own bodies. Would you forgo regular servicing and see a mechanic only when your car breaks down?
A preventive approach to disease is far better than a "fix when broke" concept since you may be too broken to be fixed like Humpty Dumpty. Early detection of diseases like various types of Cancer is imperative to greater chance of cure.
Recently the Kelinik Nur Sejahtera has opened - it is a clinic that will provide health screenings as well as educate women in preventive diseases. Specialists would provide the services free of charge, or at a very affordable cost. Well done to everyone involved. The New Straits Times and Malay Mail have the story.
A reminder to all: wellness screening is not about blood tests alone - you need a clinical examination and screening procedures (e.g. Pap smears, mammograms for women) which cannot be replaced by blood tests.
I'm sure most of you send your cars for regular servicing - every 5000 or 10,000km depending on your car users' service manual.
Ironically some people take care of the cars better than their own bodies. Would you forgo regular servicing and see a mechanic only when your car breaks down?
A preventive approach to disease is far better than a "fix when broke" concept since you may be too broken to be fixed like Humpty Dumpty. Early detection of diseases like various types of Cancer is imperative to greater chance of cure.
Recently the Kelinik Nur Sejahtera has opened - it is a clinic that will provide health screenings as well as educate women in preventive diseases. Specialists would provide the services free of charge, or at a very affordable cost. Well done to everyone involved. The New Straits Times and Malay Mail have the story.
A reminder to all: wellness screening is not about blood tests alone - you need a clinical examination and screening procedures (e.g. Pap smears, mammograms for women) which cannot be replaced by blood tests.
Sunday, March 14, 2004
Holy smoke II
Back in February I posted a pessimistic blog about the possibly suboptimal impact the "Tak Nak" campaign was having in getting the younger generation avoid taking up the nicotine habit.
Well, the good news is the Government is not quitting and the programme goes on as detailed in this article from The Star.
What nasty things does cigarette smoke do to you?
“Smoking causes 90% of all cancers. It is a major cause of throat cancer, stroke, coronary heart disease and erectile dysfunction,” says Dr Kuppusamy Iyawoo, Head of the Institute of Respiratory Medicine.
“Smoking is also dangerous to family and friends. About 75% of cigarette smoke is released into the environment as second-hand smoke, which increases the risk of lung cancer,” he adds
If that is not enough, some vivid images of blackened lungs might do the trick to scare the daylights out of the hard core smokers.
It was a picture of blackened, diseased lungs that finally drove the point home for Muniandy. The shocking revelation that he was putting himself and his loved ones in danger made him decide to quit.
In case you didn't know, it's the nicotine which is addictive.
“The nicotine is the addictive factor – it is what gives you that pleasurable sensation. Nicotine itself is not that harmful. It is the 3,999 other chemicals that are harmful!” says Dr Kuppusamy.
At the Quit-Smoking Clinic in the Institute of Respiratory Medicine, patients undergo professional counselling as well as NRT. Since it was set up in 1998, Klinik Q (as it is commonly known) has been offering its services for free to all members of the public, even school students
There are 300 quit-smoking clinics based in general hospitals and government health clinics all over Malaysia. Klinik Q is situated in the Institute of Respiratory Medicine (before Hospital Tawakal), Jalan Pahang. It is open on Tuesdays (2.30-4.00pm) and Saturdays (8.30am-12.00pm). If you wish to register, you can walk in or call 03-4023 2966 to make an appointment. Treatment is absolutely free.
Apparently, the whole Tak Nak campaign costs something like RM50 million and I sure hope this expensive effort does not go down the drain. Jeff Ooi's Screenshots has a "behind the scenes" commentary on the Tak Nak campaign.
Back in February I posted a pessimistic blog about the possibly suboptimal impact the "Tak Nak" campaign was having in getting the younger generation avoid taking up the nicotine habit.
Well, the good news is the Government is not quitting and the programme goes on as detailed in this article from The Star.
What nasty things does cigarette smoke do to you?
“Smoking causes 90% of all cancers. It is a major cause of throat cancer, stroke, coronary heart disease and erectile dysfunction,” says Dr Kuppusamy Iyawoo, Head of the Institute of Respiratory Medicine.
“Smoking is also dangerous to family and friends. About 75% of cigarette smoke is released into the environment as second-hand smoke, which increases the risk of lung cancer,” he adds
If that is not enough, some vivid images of blackened lungs might do the trick to scare the daylights out of the hard core smokers. It was a picture of blackened, diseased lungs that finally drove the point home for Muniandy. The shocking revelation that he was putting himself and his loved ones in danger made him decide to quit.
In case you didn't know, it's the nicotine which is addictive.
“The nicotine is the addictive factor – it is what gives you that pleasurable sensation. Nicotine itself is not that harmful. It is the 3,999 other chemicals that are harmful!” says Dr Kuppusamy.
At the Quit-Smoking Clinic in the Institute of Respiratory Medicine, patients undergo professional counselling as well as NRT. Since it was set up in 1998, Klinik Q (as it is commonly known) has been offering its services for free to all members of the public, even school students
There are 300 quit-smoking clinics based in general hospitals and government health clinics all over Malaysia. Klinik Q is situated in the Institute of Respiratory Medicine (before Hospital Tawakal), Jalan Pahang. It is open on Tuesdays (2.30-4.00pm) and Saturdays (8.30am-12.00pm). If you wish to register, you can walk in or call 03-4023 2966 to make an appointment. Treatment is absolutely free.
Apparently, the whole Tak Nak campaign costs something like RM50 million and I sure hope this expensive effort does not go down the drain. Jeff Ooi's Screenshots has a "behind the scenes" commentary on the Tak Nak campaign.
Dementia Hotline
Think that your memory is not as good as it should be? Worried that it might be an early sign of dementia or even Alzheimer's?
From the Medical Tribune
Universiti Malaya Medical Centre (UMMC) recently launched a 24-hour hotline to screen for people with memory problems as part of the hospital’s Dementia Intervention and Early Treatment (DIET) program.
The hotline is operated by an interactive voice response (IVR) computer program in the hospital.
The automated questionnaire, which is available in Bahasa Malaysia, English and Mandarin, requires caregivers to answer multiple-choice questions on demographic data and symptoms.
Speaking to the press at the launch of the hotline, UMMC psychogeriatrician Dr. Esther Ebenezer said the test had good sensitivity and specificity and was an easy means of picking up dementia cases.
Callers who answer “Yes” to a certain number of questions on symptoms will be encouraged to take their charge to a memory clinic.
If I am not mistaken, this is the first interactive diagnostic voice program implementation in the country. Well done! Now if only they could also put up a web page with a similar questionnaire. That would help those also hard of hearing and who can't use the telephone efficiently. But I appreciate the ubiquity of the telephone and the fact that the Internet penetration in this country is still relatively poor, the phone is a better solution for the time being.
The memory clinics are only open for appointments during office hours and are situated in UMMC, Hospital Kuala Lumpur, Hospital Melaka, Hospital Seremban and Hospital Sultanah Aminah Johor Bahru. Plans are afoot to expand the service to other states as well.
Although there are no statistics for dementia prevalence in Malaysia, it is estimated that the condition affects about 40,000 of the population, said Ebenezer.
Hotline: (03) 7953 5628
Some interesting links:
Diagnosis and management of Alzheimer's disease - an update
New Cognitive Screening Test
The Alzheimer's Disease Foundation of Malaysia is listed in the MMR Public Societies and Associations listing but unfortunately this website has "lost it's memory" I'm afraid and is down. I hope it'll be revived otherwise I'll have to put the "cobwebsite" label soon.
Think that your memory is not as good as it should be? Worried that it might be an early sign of dementia or even Alzheimer's?
From the Medical Tribune
Universiti Malaya Medical Centre (UMMC) recently launched a 24-hour hotline to screen for people with memory problems as part of the hospital’s Dementia Intervention and Early Treatment (DIET) program.
The hotline is operated by an interactive voice response (IVR) computer program in the hospital.
The automated questionnaire, which is available in Bahasa Malaysia, English and Mandarin, requires caregivers to answer multiple-choice questions on demographic data and symptoms.
Speaking to the press at the launch of the hotline, UMMC psychogeriatrician Dr. Esther Ebenezer said the test had good sensitivity and specificity and was an easy means of picking up dementia cases.
Callers who answer “Yes” to a certain number of questions on symptoms will be encouraged to take their charge to a memory clinic.
If I am not mistaken, this is the first interactive diagnostic voice program implementation in the country. Well done! Now if only they could also put up a web page with a similar questionnaire. That would help those also hard of hearing and who can't use the telephone efficiently. But I appreciate the ubiquity of the telephone and the fact that the Internet penetration in this country is still relatively poor, the phone is a better solution for the time being.
The memory clinics are only open for appointments during office hours and are situated in UMMC, Hospital Kuala Lumpur, Hospital Melaka, Hospital Seremban and Hospital Sultanah Aminah Johor Bahru. Plans are afoot to expand the service to other states as well.
Although there are no statistics for dementia prevalence in Malaysia, it is estimated that the condition affects about 40,000 of the population, said Ebenezer.
Hotline: (03) 7953 5628
Some interesting links:
Diagnosis and management of Alzheimer's disease - an update
New Cognitive Screening Test
The Alzheimer's Disease Foundation of Malaysia is listed in the MMR Public Societies and Associations listing but unfortunately this website has "lost it's memory" I'm afraid and is down. I hope it'll be revived otherwise I'll have to put the "cobwebsite" label soon.
Saturday, March 13, 2004
Biogenerics
Spotted this interesting article in The Edge Daily.
Two years ago, the Malaysian government quietly invested RM75 million in a biotech venture to make "biogenerics" or off-patent biotech drugs. The company, a wholly owned subsidiary of the Ministry of Finance, is Inno Biologics Sdn Bhd. However, up until now, the government has still not made a formal announcement on the investment.
75 million ringgit of tax payers' money. Still no formal announcement?
Ahmad Zaharudin explains that the main reason for the low-key nature of Inno Biologics' formation is purely strategic. "We didn't want our neighbouring countries to know early on what we were planning as many are getting into the biotech space as well."
Really? And do you think it will be easy to keep a 75 million ringgit plant a secret? Lame excuse.
Or is it no one thinks the tax paying public (hey and incidentally a voting public in case anyone's forgotten) deserves a reason for the 75 million ringgit expenditure? Anyway the cat's out of the bag.
Yet others question the appropriateness of the deal - how did the Science Adviser (Tan Sri Datuk Dr Ahmad Zaharudin Idrus) to the Prime Minister end up as Inno Biologics' chairman?
Hmmm.
Ahmad Zaharudin says there is no conflict of interest in his position as both Science Adviser and chairman of Inno Biologics. Apart from being a government representative to oversee the development of the company, he says there is so much to be done in science and technology that conflict of interest is not relevant in this case.
Double hmmmm.
He adds that he does not earn any money from Inno Biologics or ask for special favours from the government to help the company. "We could have asked the Ministry of Health for an exclusive contract to buy insulin from us but we did not," he stresses.
Maybe because the plant hasn't made any money yet and more importantly hasn't produced anything yet?
Will Inno Biologics survive?
Large government-funded projects like Inno Biologics typically face criticism that they are not viable. Otherwise, why wouldn't private investors fund the project?
Good point. Hopefully this project won't be another white elephant.
But they already will face competition from the Private sector:
Even at home, Inno Biologics will possibly face competition from an insulin plant being built in Penang. In June last year, it was announced that a US$34-million (RM129.2 million) human insulin plant will come onstream by mid-2005 in that state. The project is a joint venture between the Penang Development Corporation and London-based GeneMedix plc. The latter was founded by well-known Malaysian biotechnologist Dr Kim Tan. GeneMedix will license its insulin-making technology to the Penang plant, which will then manufacture and commercialise human insulin.
Spotted this interesting article in The Edge Daily.
Two years ago, the Malaysian government quietly invested RM75 million in a biotech venture to make "biogenerics" or off-patent biotech drugs. The company, a wholly owned subsidiary of the Ministry of Finance, is Inno Biologics Sdn Bhd. However, up until now, the government has still not made a formal announcement on the investment.
75 million ringgit of tax payers' money. Still no formal announcement?
Ahmad Zaharudin explains that the main reason for the low-key nature of Inno Biologics' formation is purely strategic. "We didn't want our neighbouring countries to know early on what we were planning as many are getting into the biotech space as well."
Really? And do you think it will be easy to keep a 75 million ringgit plant a secret? Lame excuse.
Or is it no one thinks the tax paying public (hey and incidentally a voting public in case anyone's forgotten) deserves a reason for the 75 million ringgit expenditure? Anyway the cat's out of the bag.
Yet others question the appropriateness of the deal - how did the Science Adviser (Tan Sri Datuk Dr Ahmad Zaharudin Idrus) to the Prime Minister end up as Inno Biologics' chairman?
Hmmm.
Ahmad Zaharudin says there is no conflict of interest in his position as both Science Adviser and chairman of Inno Biologics. Apart from being a government representative to oversee the development of the company, he says there is so much to be done in science and technology that conflict of interest is not relevant in this case.
Double hmmmm.
He adds that he does not earn any money from Inno Biologics or ask for special favours from the government to help the company. "We could have asked the Ministry of Health for an exclusive contract to buy insulin from us but we did not," he stresses.
Maybe because the plant hasn't made any money yet and more importantly hasn't produced anything yet?
Will Inno Biologics survive?
Large government-funded projects like Inno Biologics typically face criticism that they are not viable. Otherwise, why wouldn't private investors fund the project?
Good point. Hopefully this project won't be another white elephant.
But they already will face competition from the Private sector:
Even at home, Inno Biologics will possibly face competition from an insulin plant being built in Penang. In June last year, it was announced that a US$34-million (RM129.2 million) human insulin plant will come onstream by mid-2005 in that state. The project is a joint venture between the Penang Development Corporation and London-based GeneMedix plc. The latter was founded by well-known Malaysian biotechnologist Dr Kim Tan. GeneMedix will license its insulin-making technology to the Penang plant, which will then manufacture and commercialise human insulin.
Friday, March 12, 2004
eHealth Asia 2004
Just a reminder. 25 days to go to eHealth Asia 2004.
The theme is "Improving Health Outcomes through Information Technology" and the meeting will be held from April 6th to 8th at the Grand Plaza Park Royal, Kuala Lumpur (conveniently held at the Golden Triangle where you can shop till you drop )
This 3-day event is organised by MHIA in collaboration with the International Medical Informatics Association (IMIA) and Asia Pacific Association for Medical Informatics (APAMI). It is endorsed and supported by Ministry of Health Malaysia and other affliated healthcare organisations.
If you are IT savvy (well, surfing to this site, being able to use a mouse and keyboard makes you IT savvy ;) ) and interested in Health Informatics in particular, I think you should attend this meeting.
Just a reminder. 25 days to go to eHealth Asia 2004.
The theme is "Improving Health Outcomes through Information Technology" and the meeting will be held from April 6th to 8th at the Grand Plaza Park Royal, Kuala Lumpur (conveniently held at the Golden Triangle where you can shop till you drop )
This 3-day event is organised by MHIA in collaboration with the International Medical Informatics Association (IMIA) and Asia Pacific Association for Medical Informatics (APAMI). It is endorsed and supported by Ministry of Health Malaysia and other affliated healthcare organisations.
If you are IT savvy (well, surfing to this site, being able to use a mouse and keyboard makes you IT savvy ;) ) and interested in Health Informatics in particular, I think you should attend this meeting.
Locum Jobs Available
Jobs available in Bangsar. Check out the latest Jobs available posting in the MMR's Locum Agency - Jobs Available listing.
Another new request for a locum job comes from Dr. Seenivasan who is looking for permanent locum in the evenings (5.30 to 9.00pm) on weekdays, in KL. More in the Locum Agency - Jobs Wanted listing.
Jobs available in Bangsar. Check out the latest Jobs available posting in the MMR's Locum Agency - Jobs Available listing.
Another new request for a locum job comes from Dr. Seenivasan who is looking for permanent locum in the evenings (5.30 to 9.00pm) on weekdays, in KL. More in the Locum Agency - Jobs Wanted listing.
Thursday, March 11, 2004
Site update
Added the Association of Specialists in Private Medical Practice to the Professional Societies and Associations listing of the MMR.
The ASPMP was formed in 1999 to help address problems facing private medical specialists relating to :
- professional rights,
- the incursion into ethical practice by extraneous profit-oriented forces, and
- the compromise of patient care thereof.
The MMR search page by the way, also links to the Academy of Medicine's Specialist Register and you can actually search for Specialists in the AM.
Added the Association of Specialists in Private Medical Practice to the Professional Societies and Associations listing of the MMR.
The ASPMP was formed in 1999 to help address problems facing private medical specialists relating to :
- professional rights,
- the incursion into ethical practice by extraneous profit-oriented forces, and
- the compromise of patient care thereof.
The MMR search page by the way, also links to the Academy of Medicine's Specialist Register and you can actually search for Specialists in the AM.
Wednesday, March 10, 2004
Show me the money
A little about funding this time.
The NST has this report about the Japanese Chamber of Trade and Industry, Malaysia (Jactim) Foundation donating RM120,000 for the purchase of 44 Hemoglobin meters.
"Anaemia, one of the leading causes of morbidity among antenatal mothers, can be easily treated if detected early. To date only 686 clinics out of the 858 health clinics in Malaysia are equipped with the meter."
Sad that the MOH lacks RM120,000 to purchase basic equipment and yet the YB Health Minister can boast in this report from The Star that the National Health Welfare Fund will get an additional RM20million. Is it because the latter is a more "high profile" project?
Interesting too to see the latest development of this Fund :
Health Minister Datuk Chua Jui Meng said the centre would help to speed up the application process and reduce red tape, as applicants no longer required approvals from various departments. It would be located at the ground floor of the ministry’s Block C in Jalan Cenderasari, Kuala Lumpur.
Strange there is no publication of Contact phone number, Fax, Email address , or details on How To Apply or does the YB Health Minister expect needy patients from out of town to trudge all the way to Block C?
A little about funding this time.
The NST has this report about the Japanese Chamber of Trade and Industry, Malaysia (Jactim) Foundation donating RM120,000 for the purchase of 44 Hemoglobin meters.
"Anaemia, one of the leading causes of morbidity among antenatal mothers, can be easily treated if detected early. To date only 686 clinics out of the 858 health clinics in Malaysia are equipped with the meter."
Sad that the MOH lacks RM120,000 to purchase basic equipment and yet the YB Health Minister can boast in this report from The Star that the National Health Welfare Fund will get an additional RM20million. Is it because the latter is a more "high profile" project?
Interesting too to see the latest development of this Fund :
Health Minister Datuk Chua Jui Meng said the centre would help to speed up the application process and reduce red tape, as applicants no longer required approvals from various departments. It would be located at the ground floor of the ministry’s Block C in Jalan Cenderasari, Kuala Lumpur.
Strange there is no publication of Contact phone number, Fax, Email address , or details on How To Apply or does the YB Health Minister expect needy patients from out of town to trudge all the way to Block C?
Show me the nipple
The Star recently had an excellent article on Balancing careers and breastfeeding.
According to the World Alliance for Breastfeeding Action, when women also work for a cash income, their work seldom accommodates reproductive work, such as pregnancy, breastfeeding and childcare. Most working women who want to breastfeed give up the idea of optimal breastfeeding, and resort to partial, mixed or token breastfeeding.
That's a pity and I think employers should sit up and take note. Is your workplace breastfeeding friendly?
If you want to know more about Breastfeeding and lactation, Nutriweb has more information on this topic.
Doc Liew also had a hilarious incident recently, and the problem arose in a woman who was not breastfeeding.
Dr. Liew : "Show me the nipple."
Mother : "Okay." *lift up shirt*
Dr. Liew : "No no no! Not your nipple. I mean the rubber nipple of his feeding bottle."
Mother : "Owh..." *show feeding bottle*
Hilarious :)
The Star recently had an excellent article on Balancing careers and breastfeeding.
According to the World Alliance for Breastfeeding Action, when women also work for a cash income, their work seldom accommodates reproductive work, such as pregnancy, breastfeeding and childcare. Most working women who want to breastfeed give up the idea of optimal breastfeeding, and resort to partial, mixed or token breastfeeding.
That's a pity and I think employers should sit up and take note. Is your workplace breastfeeding friendly?
If you want to know more about Breastfeeding and lactation, Nutriweb has more information on this topic.
Doc Liew also had a hilarious incident recently, and the problem arose in a woman who was not breastfeeding.
Dr. Liew : "Show me the nipple."
Mother : "Okay." *lift up shirt*
Dr. Liew : "No no no! Not your nipple. I mean the rubber nipple of his feeding bottle."
Mother : "Owh..." *show feeding bottle*
Hilarious :)
Site update
Added the International Medical University Alumni's website. This looks like a well designed place for graduates of the IMU to interact and network. It's nice to know where your mates from med school are now and what they are up to. Some of them might not even be practicing medicine and may be in the IT line for all you know ;) Thanks to Dr. HM Goh for the info.
There are a couple of other Alumni sites listed in the MMR. One is Padu, the Persatuan Alumni Doktor USM's society for all graduates of USM MD,MMED(USM) from 1986 onwards. Another is the Manipal Alumni Association Malaysia, the Home page for graduates of Kasturba Medical College.
If you know of any other Alumni web pages, please let me know.
Added the International Medical University Alumni's website. This looks like a well designed place for graduates of the IMU to interact and network. It's nice to know where your mates from med school are now and what they are up to. Some of them might not even be practicing medicine and may be in the IT line for all you know ;) Thanks to Dr. HM Goh for the info.
There are a couple of other Alumni sites listed in the MMR. One is Padu, the Persatuan Alumni Doktor USM's society for all graduates of USM MD,MMED(USM) from 1986 onwards. Another is the Manipal Alumni Association Malaysia, the Home page for graduates of Kasturba Medical College.
If you know of any other Alumni web pages, please let me know.
Tuesday, March 09, 2004
What's your Cholesterol IQ?
It was recently revealed that a survey conducted amongst Malaysians shows knowledge about cholesterol to be lacking.
"The survey, involving 336 adults aged between 25 and 60 years, revealed several misconceptions regarding cholesterol. For example, 95% of the respondents thought that cholesterol in the body came from diet alone when in fact our liver produces two thirds of cholesterol. "
and...
"..while a large number of respondents were aware of the consequences of high cholesterol on heart health, only one third of the adults knew what was the desirable level of cholesterol"
So how much do you know about cholesterol and other issues "close to your heart"?
You can surf over to the Heart Foundation of Malaysia for more information.
If you are a Palm PDA afficionado like Doc Liew and myself there's an excellent free utility called Stat Cholesterol which guides clinicians through the new ATP III cholesterol guidelines. It calculates absolute risk of MI using the point method outlined in the ATP III Executive Summary. It also includes calculation of risk for any symptomatic coronary heart disease using the 1998 Framingham method. Absolutely free.
It was recently revealed that a survey conducted amongst Malaysians shows knowledge about cholesterol to be lacking.
"The survey, involving 336 adults aged between 25 and 60 years, revealed several misconceptions regarding cholesterol. For example, 95% of the respondents thought that cholesterol in the body came from diet alone when in fact our liver produces two thirds of cholesterol. "
and...
"..while a large number of respondents were aware of the consequences of high cholesterol on heart health, only one third of the adults knew what was the desirable level of cholesterol"
So how much do you know about cholesterol and other issues "close to your heart"?
You can surf over to the Heart Foundation of Malaysia for more information.
If you are a Palm PDA afficionado like Doc Liew and myself there's an excellent free utility called Stat Cholesterol which guides clinicians through the new ATP III cholesterol guidelines. It calculates absolute risk of MI using the point method outlined in the ATP III Executive Summary. It also includes calculation of risk for any symptomatic coronary heart disease using the 1998 Framingham method. Absolutely free.
Feedback
Ho Hee Kheen sent in this:
Just want to inform that there's a medical school in Sabah, in Universiti Malaysia Sabah. It is only about a year's old. No website yet.. Cool site you have here.. Keep it going!
Thanks for the headsup Hee Kheen. I was not aware there's a Medical School in UMS. Checking the UMS website indeed does not show any info about there being a school of medicine. I'd appreciate it if anyone who knows more about the programme there can provide more details like staffing, enrolment etc. I'll put a link in the MMR if and when there is a website with information on this medical school.
Ho Hee Kheen sent in this:
Just want to inform that there's a medical school in Sabah, in Universiti Malaysia Sabah. It is only about a year's old. No website yet.. Cool site you have here.. Keep it going!
Thanks for the headsup Hee Kheen. I was not aware there's a Medical School in UMS. Checking the UMS website indeed does not show any info about there being a school of medicine. I'd appreciate it if anyone who knows more about the programme there can provide more details like staffing, enrolment etc. I'll put a link in the MMR if and when there is a website with information on this medical school.
Monday, March 08, 2004
Another Medical School coming?
The Star has this report on Nottingham University setting up shop in Malaysia.
Nottingham's new RM100mil campus in Semenyih, Selangor, is scheduled to be completed by September next year. “It is going to be a more conducive learning environment with all the facilities we will provide our students with, and definitely quieter as it will be away from the bustling city of Kuala Lumpur where the campus is located now,” says Dr Atkin.
At present, programmes offered at the Malaysia campus come under the Nottingham University Business School, Division of Computer Science and Information Technology, Division of Foundation Studies, and Division of Engineering.
In line with its expansion plans, the university hopes to widen its portfolio of courses in Malaysia to include undergraduate and postgraduate education programmes and several health science-related courses, such as pharmacy, nursing, medicine and biotechnology.
From the report, I understand this will not be a "twinning" job but a full fledged campus instead.
When that happens, I'll have to add this to the ever growing list of Medical Schools in Malaysia in the MMR. Has anyone encountered doctors from the pioneering class of the Penang Medical College? They were supposed to have graduated in 2001.
The Star has this report on Nottingham University setting up shop in Malaysia.
Nottingham's new RM100mil campus in Semenyih, Selangor, is scheduled to be completed by September next year. “It is going to be a more conducive learning environment with all the facilities we will provide our students with, and definitely quieter as it will be away from the bustling city of Kuala Lumpur where the campus is located now,” says Dr Atkin.
At present, programmes offered at the Malaysia campus come under the Nottingham University Business School, Division of Computer Science and Information Technology, Division of Foundation Studies, and Division of Engineering.
In line with its expansion plans, the university hopes to widen its portfolio of courses in Malaysia to include undergraduate and postgraduate education programmes and several health science-related courses, such as pharmacy, nursing, medicine and biotechnology.
From the report, I understand this will not be a "twinning" job but a full fledged campus instead.
When that happens, I'll have to add this to the ever growing list of Medical Schools in Malaysia in the MMR. Has anyone encountered doctors from the pioneering class of the Penang Medical College? They were supposed to have graduated in 2001.
Sunday, March 07, 2004
Political doctors
So why do doctors go into politics? Have you wondered?
In the run up to the elections, we are going to see a publicity blitz from the media on the candidates, such as this write up in The Star on Dr. Ng Yen Yen.
When she was posted to Mentakab, Pahang as medical officer, she realised many rural women were ignorant about children’s health.
“They didn’t know the importance of innoculation or immunisation against tetanus or diphteria. Young children were suffering unnecessarily. I saw how high the mortality rate was and decided I had to educate these mothers. They needed to know how to look after their family’s health as the young generation will inherit our country.’’
On her own initiative, she organised local health seminars, embarked on immunisation campaigns and gave talks on preventive care.
Soon she realised she needed a platform to further her reach.
So what is she reaching for? From the article, I am not clear what the reason was she left medicine for politics. In fact I am amazed at the number of Malaysian doctors going into politics. Datuk Seri Dr. Mahathir is the most prominent but there are plenty other examples both in the BN and Opposition. Some I know are indeed inspired by a burning desire for justice for the community.
We've got to muddy our feet is an interesting interview by Aliran with doctor-turned-activist Dr Jeyakumar Devaraj.
AM: Why did you leave your full-time medical practice to work with marginalized people?
Kumar: I was already working with the marginalized people when I was working as a doctor. The reason I resigned was that it appeared my time in government was over. I was facing a lot of pressure to take up a posting outside Perak. In the course of a year, I had been transferred three times: to Pahang, to Kedah and to Sarawak. And I perceived this as an attempt to remove me from the work we were doing in Ipoh and the Kinta area for marginalized groups - in squatter areas, in estates. We perceived this as an attempt to weaken the group and to ultimately stop our work. And for that reason I refused to go.
I admire your principles JD. If you are standing once again against impossible odds, I wish you all the best!
Kumar: I think even standing against Samy Vellu was a hopeless cause! (Laughs) Sometimes you have to stand up for a principle even if you don’t think you can win in the near term – because when you raise the issues, people start thinking about them. Then these issues become more popular, more widely debated. And certain things like electoral irregularities - when you highlight these, even if you don’t eradicate them altogether, there is more fear on the parties who are actually misusing the process.
So why do doctors go into politics? Have you wondered?
In the run up to the elections, we are going to see a publicity blitz from the media on the candidates, such as this write up in The Star on Dr. Ng Yen Yen. When she was posted to Mentakab, Pahang as medical officer, she realised many rural women were ignorant about children’s health.
“They didn’t know the importance of innoculation or immunisation against tetanus or diphteria. Young children were suffering unnecessarily. I saw how high the mortality rate was and decided I had to educate these mothers. They needed to know how to look after their family’s health as the young generation will inherit our country.’’
On her own initiative, she organised local health seminars, embarked on immunisation campaigns and gave talks on preventive care.
Soon she realised she needed a platform to further her reach.
So what is she reaching for? From the article, I am not clear what the reason was she left medicine for politics. In fact I am amazed at the number of Malaysian doctors going into politics. Datuk Seri Dr. Mahathir is the most prominent but there are plenty other examples both in the BN and Opposition. Some I know are indeed inspired by a burning desire for justice for the community.
We've got to muddy our feet is an interesting interview by Aliran with doctor-turned-activist Dr Jeyakumar Devaraj. AM: Why did you leave your full-time medical practice to work with marginalized people?
Kumar: I was already working with the marginalized people when I was working as a doctor. The reason I resigned was that it appeared my time in government was over. I was facing a lot of pressure to take up a posting outside Perak. In the course of a year, I had been transferred three times: to Pahang, to Kedah and to Sarawak. And I perceived this as an attempt to remove me from the work we were doing in Ipoh and the Kinta area for marginalized groups - in squatter areas, in estates. We perceived this as an attempt to weaken the group and to ultimately stop our work. And for that reason I refused to go.
I admire your principles JD. If you are standing once again against impossible odds, I wish you all the best!
Kumar: I think even standing against Samy Vellu was a hopeless cause! (Laughs) Sometimes you have to stand up for a principle even if you don’t think you can win in the near term – because when you raise the issues, people start thinking about them. Then these issues become more popular, more widely debated. And certain things like electoral irregularities - when you highlight these, even if you don’t eradicate them altogether, there is more fear on the parties who are actually misusing the process.
Site update
Added Hospital Kuantan (Hospital Tengku Ampuan Afzan) 's webpage to the MMR listing of Public Hospitals. The site is in Bahasa Malaysia only. The site is missing the "big picture" i.e. the image in the main front page is missing therefore I am linking it to the "About/Kenal" page. The links on the left are created in a font too tiny to read. There is some useful information on the hospital though on the whole, the website could do with a more professional touch.
Added Hospital Kuantan (Hospital Tengku Ampuan Afzan) 's webpage to the MMR listing of Public Hospitals. The site is in Bahasa Malaysia only. The site is missing the "big picture" i.e. the image in the main front page is missing therefore I am linking it to the "About/Kenal" page. The links on the left are created in a font too tiny to read. There is some useful information on the hospital though on the whole, the website could do with a more professional touch.
Friday, March 05, 2004
Discussing Doctors
How many webforums have you come across where patients discuss their doctors openly?
I stumbled on some folks in the USJ Forum comparing Sunway Medical Centre and Subang Jaya Medical Centre!
The 'net is a strange place indeed.
How many webforums have you come across where patients discuss their doctors openly?
I stumbled on some folks in the USJ Forum comparing Sunway Medical Centre and Subang Jaya Medical Centre!
The 'net is a strange place indeed.
Hemodialysis and privileges
Well, a medical student blog with a conscience. YP talks about medical privileges from this NST article.
Haemodialysis can help a kidney patient lead a normal life, but it requires regular weekly treatments on a dialysis machine. Ideally, all those suffering from end-stage renal failure should be able to receive dialysis in government hospitals. But they are already stretched to the limit and treatment in private clinics is expensive.
The article goes on to say how the Health Ministry provides aid to the NGOs who in turn are helping out patients in need of haemodialysis. All well and good. But again I think the long term solution is a Comprehensive National Health Insurance plan.
Searching the MMR, I found the National Kidney Foundation website in the Public Societies and Association listing. I wascurious to see if there was a list of Dialysis centres in the country and Google comes to the rescue again. The CRC has a PDF publication of Haemodialysis Centres in Malaysia for 2003.
Well, a medical student blog with a conscience. YP talks about medical privileges from this NST article.
Haemodialysis can help a kidney patient lead a normal life, but it requires regular weekly treatments on a dialysis machine. Ideally, all those suffering from end-stage renal failure should be able to receive dialysis in government hospitals. But they are already stretched to the limit and treatment in private clinics is expensive.
The article goes on to say how the Health Ministry provides aid to the NGOs who in turn are helping out patients in need of haemodialysis. All well and good. But again I think the long term solution is a Comprehensive National Health Insurance plan.
Searching the MMR, I found the National Kidney Foundation website in the Public Societies and Association listing. I wascurious to see if there was a list of Dialysis centres in the country and Google comes to the rescue again. The CRC has a PDF publication of Haemodialysis Centres in Malaysia for 2003.
Thursday, March 04, 2004
Locum jobs wanted update
There are several new listings of Doctors seeking locum posts in the MMR's Virtual Locum Agency
Dr. Koh is seeking a locum postion around Puchong area and KL in general. There are several Doctors from India looking for jobs in Malaysia too. Even the previous MMR's locum agency had many requests for jobs from Indian doctors. I guess there must be something which makes Malaysia an attractive place to work. A siginificant Indian minority population must be one. Salary? I don't know, but I guess if you think Malaysian doctors' salary is poor, our Indian counterparts must be even worse off.
There are several new listings of Doctors seeking locum posts in the MMR's Virtual Locum Agency
Dr. Koh is seeking a locum postion around Puchong area and KL in general. There are several Doctors from India looking for jobs in Malaysia too. Even the previous MMR's locum agency had many requests for jobs from Indian doctors. I guess there must be something which makes Malaysia an attractive place to work. A siginificant Indian minority population must be one. Salary? I don't know, but I guess if you think Malaysian doctors' salary is poor, our Indian counterparts must be even worse off.