Mysterious Illness ?From the Star
Stool and food samples collected from villages
BY KULDEEP S. JESSY
CAMERON HIGHLANDS: Health Ministry officials collected samples of stool, tap water and food from 23 orang asli villages here for tests to determine the cause of death of five children recently.
Cameron Highlands MP S.K. Devamany said the samples were being analysed at the Institute of Medical Research in Kuala Lumpur.
“The Orang Asli Affairs Department and the Cameron Highlands Health Department are monitoring the situation everyday,” he said when visiting orang asli families, which had moved to a land behind a Buddhist temple in Tringkap, 6km from their original homes.
A check at Tanah Rata Hospital showed that 13 orang asli children, aged between four months and five years, were still warded.
Another nine children were under observation at a community hall near the hospital as they were out of danger.
|
Cameron Highlands has often been associated with fresh and clean air with sparkling clear water. This is also the place where you could find the freshest of vegetables and the beauty of exotic flowers. However, as with all highlands, the landscape is clearly changing at an enormous speed. This change has been loosely monitored, thus resulting in irresponsible and inappropriate development ,with an obvious lack in planning.
Orang aslis could be viewed as the barometers of environmental contamination. It could reflect the balance of our ecological system , giving clues to reveal a disruption. The symptoms mentioned highly suggest an inadvertant contamination at the surroundings of their settlement.
It would not be surprising if the results reveal the existence of a fatal contaminant. Pollution of our water and air is a growing problem that requires an urgent assessment. We need to put equal emphasis on maintaining environmental standards as we do on GDP figures. Providing quality water itself remains a challenge for this tiny country, where tap water has been known to contain silt and unknown contaminants. Even vehicles that spew high amounts of pollutants are ridiculously allowed to function.
The setting up of a new Environmental Ministry will not be effective if the people at these places do not react seriously to threats that are presented daily. This problem is real and should be dealt with accordingly. The Health Ministry only looks at the disease. It should be the responsibility of the Environmental Ministry to assist in such an investigation lest a stone be left unturned.
More on AgeingAren't we getting old or what? It wasn't long that there was a 2nd Malaysia Conference on Healthy Ageing held from April 9 to 11. It was mentioned in the
MMR back in March.
Now there will be a First Malaysian Conference on Anti-Ageing Medicine organised by the Society for Anti-Ageing Medicine Malaysia (SAAMM). I could not locate the latter's website so I presume there is none but
The Star (
MMM Permalink) has the story:
Meet to discuss ways to solve ageing problems
PETALING JAYA: If anti-ageing medicine is not implemented soon, the ageing population will be a burden to the Government, according to the Society for Anti-Ageing Medicine Malaysia (SAAMM).
Its president Datuk Dr S. Harnam said as the ageing population grew the demand for nursing homes would increase and this would involve greater government expenditure.
“Ageing is a disease none of us can escape. At the same time degenerative diseases such as cardiac diseases, strokes, arthritis and cancer increase rapidly after the age of 40,” he said in a statement.
He added that all these diseases led to a massive financial burden on the patient, family and nation, posing a serious socio-economic problem.
To deliberate on such issues and seek solutions to ageing problems, SAAMM will hold the First Malaysian Conference on Anti-Ageing Medicine.
At the conference, to be held at Nikko Hotel from May 1 to 3, it will give information on related medical breakthroughs.
Other topics to be discussed at the conference are internal and external degenerative changes and how to treat them with hormones, nutraceuticals, and aesthetic and cosmetic procedures.
The conference is endorsed by the Health Ministry, Malaysia Menopause Society and the National Sports Institute.
SAAMM is a non-profit medical society formed in 2002 by a group of medical specialists from various fields of medicine dedicated to the prevention and treatment of age-related diseases.
For details and registration, call Dr Aman Kaulsay at 012-215 3210. |
While I could not locate Society for Anti-Ageing Medicine Malaysia 's website, I managed to track down the
Malaysian Menopause Society's website and have duly added it to the MMR's
Public Society and Association links.
Feedback: Medical school in RussiaES sent int this email:
| Greeting, I am a student from Malaysia, currently i am applying a Medical course which is in Russia.It is a doubt that whether I.M.Sechenov Moscow Medical Academy fully reconize in Malaysia? Could you let me know it? |
Dear ES,
The
Malaysian Medical Council is the correct body to contact to see if the medical school in question is recognised in Malaysia or not. The MMC maintains a
List of Recognised Universities and a
List of Unscheduled Universities (one has to sit for a qualifying exam) but I don't know how updated these lists are (the Medical school you menitoned doesn't seem to be in either list) so you are best advised contacting the MMC directly. All this information is available as links fom the MMR's
Medical Schools section.
Childhood depressionThe NST ran an article on
Fighting depression in a child (
MMM Permalink) :
IF your child is withdrawn, refuses to participate in any activity and is always in a bad temper — and the symptoms persist for at least two weeks — these are signs that he or she is depressed.
Adults will find it difficult to believe that children can be depressed as we have in our mind an idealistic childhood — happy and carefree.
Yet, studies reveal that a child can face emotional problems and depression. Experts say clinical depression has been detected in toddlers, preschoolers and school-aged children.
Depression is one of the most common psychological disorders and is usually referred to as mood disorder. It affects a person's overall energy, emotions and behaviour.
Although the symptoms of a depressed child are different from those of an adult, the need to address the issue and seek treatment is just as serious. Depressed children can commit violent crimes, drop out of school and even commit suicide. |
I think schoolkids these days are enormously burdened with unending homework and tuition and whatnot on top of the pressure to perform during exams. Suicide amongst schoolkids is a preventable tragedy.
I'm glad this article highlights this issue as Childhood psychiatriac illnesses can be so easily missed or dismissed by parents/teachers.
The article highlights a talk by a Child Psychologist from the
Malaysian Psychology Centre. I managed to find the link to the MPC and it appears to be a commercial entity with various services related to Psychology and even Nutrition.
SARS revisitedRecently, new cases have been reported from China.
The
Straits Times reports:
The latest Sars outbreak in China has prompted Malaysia to reactivate thermal screening at airports and alert its hospitals and doctors to be on guard for symptoms of the disease.
'We are on full alert for passengers from China, more so from Beijing,' Malaysian Health Minister Chua Soi Lek told reporters.
Malaysia escaped relatively lightly when severe acute respiratory syndrome swept Asia last year. Out of 774 people killed globally from 8,000 infected, Malaysia had two deaths from five cases.
Mr Chua said passengers arriving from Beijing were required to undergo thermal scanning to check for fever.
Visitors from Guangzhou, Shanghai and Hong Kong were required to fill out health declaration forms.
About 2,000 people a day arrive in Malaysia from those places, the minister said.
The Health Ministry has reopened a Sars office and a hotline for public inquiries and reports.
Meanwhile, doctors have been reminded to be extra vigilant for signs of Sars when diagnosing illness among their patients. -- AP |
I was wondering what the SARS Hotline number is so I went to the
MOH website and was not suprised to see it NOT listed and there isn't even a link to SARS in the main page. The
Department of Public Health's website doesn't fare any better.
Pathetic. MOH and DPH webmasters need a kick in the you-know-what.
Anyway, for up-to-date news and information on SARS, we can always rely on our Doc Vadivale and his
Vadscorner.
Surgical Interventions for Parkinson's DiseaseIn an article in the NST, it mentioned 2 surgical procedures for the treatment of Parkinson's Disease ie Deep Brain Stimulation and Lesioning Procedure(Pallidotomy). They are to be performed by a neurosurgeon from Britain at UMMC. Here is a little more information about these procefures:-
What is Deep Brain Stimulation?
Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of disabling neurological symptoms—most commonly the debilitating symptoms of Parkinson’s disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems. The procedure is also used to treat essential tremor, a common neurological movement disorder. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications.
DBS uses a surgically implanted, battery-operated medical device called a neurostimulator—similar to a heart pacemaker and approximately the size of a stopwatch—to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms.
Before the procedure, a neurosurgeon uses magnetic resonance imaging (MRI) or computed tomography (CT) scanning to identify and locate the exact target within the brain where electrical nerve signals generate the PD symptoms. Some surgeons may use microelectrode recording—which involves a small wire that monitors the activity of nerve cells in the target area—to more specifically identify the precise brain target that will be stimulated. Generally, these targets are the thalamus, subthalamic nucleus, and globus pallidus. The DBS system consists of three components: the lead, the extension, and the neurostimulator. The lead (also called an electrode)—a thin, insulated wire—is inserted through a small opening in the skull and implanted in the brain. The tip of the electrode is positioned within the targeted brain area.
The extension is an insulated wire that is passed under the skin of the head, neck, and shoulder, connecting the lead to the neurostimulator. The neurostimulator (the “battery pack”) is the third component and is usually implanted under the skin near the collarbone. In some cases it may be implanted lower in the chest or under the skin over the abdomen.
Once the system is in place, electrical impulses are sent from the neurostimulator up along the extension wire and the lead and into the brain. These impulses interfere with and block the electrical signals that cause PD symptoms.
What are the advantages?
Unlike previous surgeries for PD, DBS does not damage healthy brain tissue by destroying nerve cells. Instead the procedure blocks electrical signals from targeted areas in the brain. Thus, if newer, more promising treatments develop in the future, the DBS procedure can be reversed. Also, stimulation from the neurostimulator is easily adjustable—without further surgery—if the patient’s condition changes.
What is the prognosis?
Although most patients still need to take medication after undergoing DBS, many patients experience considerable reduction of their PD symptoms and are able to greatly reduce their medications. The amount of reduction varies from patient to patient but can be considerably reduced in most patients. The reduction in dose of medication leads to a significant improvement in side effects such as dyskinesias (involuntary movements caused by long-term use of levodopa). In some cases, the stimulation itself can suppress dyskinesias without a reduction in medication.
Adapted from National Institute of Neurological Disorders and Stroke, US
|
Stereotactic pallidotomy is not without certain risks although major morbidity and mortality is less than 1%. One side effect of pallidotomy has been a contra-lateral visual field defect seen in approximately 7-10% of patients. This visual field defect or scotoma creates a blind spot in the lower visual field and if this occurs on the left side it is generally well tolerated, but on the right side it may disturb reading. The incidence of this side effect and other potential side effects are minimized by intraoperative physiologic testing during the procedure.
Stereotactic pallidotomy or thalamotomy is only mildly painful. The surgical target within the pallidum is defined by a CT and/or MRI scan carried out with a special stereotactic frame attached to the head. Once the appropriate target coordinates have been selected on a computer work station, the patient is taken back to the operating room for the surgical procedure itself. A small patch of hair is shaved in the frontal region and the surgery is then carried out under intravenous sedation. A 3 cm skin incision is made in the scalp after infiltration with local anesthesia and a burr hole is drilled through the skull. A 1.8 mm insulated stimulating electrode is then introduced under impedance monitoring into the postero-ventro-lateral globus pallidus. The target area is stimulated with very small electrical impulses which may give rise to a variety of different reactions. The purpose of the stimulation is to make sure that the probe lies in the correct area of the pallidum. With electrical stimulation, tremor and rigidity can be reduced almost immediately in the operating room and this confirms accurate placement of the electrode tip. Electrical stimulation may also give rise to visual, motor, sensory or other untoward symptoms and this would indicate that the probe may need repositioning. If symptoms occur even after repositioning, there is a risk that the surgery cannot be performed safely and the probe would be removed without actual creation of the lesion.
When the intraoperative stimulation indicates that the tip of the electrode lies in the optimal location, a temporary (nonpermanent) lesion is first made. This allows for detailed testing of the patient intraoperatively to insure that no neurologic deficit will be incurred with creation of a permanent lesion. It also will allow for assessment of beneficial effect on tremor, rigidity and bradykinesia. If all of these conditions are met, then a permanent lesion is created at the target site. During the lesioning, the patient will be given a variety of motor, visual and psychological tests to check that no adverse effects develop. If unexpected reactions are observed, further lesioning is stopped immediately. It should be noted that none of the stimulation or lesioning is at all painful.
Extracted from Massachucetts GH Functional Neurological Services |
Other links
Asia Pacific Parkinson's Disease Association
Marina in the newsMarina Mahathir is speaking on AIDS yet again, this time at the World Conference on Health Promotion and Health Education that opens in Melbourne today.
From
The Age:
 "We've done a lot to promote women's rights and options and talk about health because it had been really hard for them to get realistic information," she said.
"For a long time a lot of women had no idea that they were at all vulnerable. We tried to open their eyes to the fact that women are very vulnerable because you really depend on men using condoms so that you don't get infected."
Safe sex was a difficult issue for women to negotiate with their male partners, she said. Although condoms were widely available in Malaysia, there was great reluctance to use them.
"Some people think it is not allowed in our (Muslim) religion or that it doesn't make it pleasurable," she said.
It was a myth that condom use was forbidden for religious reasons, "so we are trying to get the people to understand that there is nothing wrong with it".
One approach was to run training workshops on safe sex for religious leaders, she said. |
There's still lots of ignorance and misinformation in the community about safe sex and AIDS.
What more reason to reinforce the importance of utilising all possible means of disseminating the information to the public.
So Marina, on your return to Malaysia could you please tell the people in charge of the Malaysian Aids Council and the Malaysian Aids Foundation that their
Website has been down for yonks. If anyone knows of any Malaysian website dedicated to AIDS information, please let me know. I shall be happy to put it up on the MMR. In the meantime, AIDS in e-Malaysia is suffering from AIDS (Acquired Information Deficiency Syndrome)
Night Eating Syndrome(NES)How many types of circadian rhythms have you heard of? Sleep circadian rhythms are famous leading to the phenomenon of jet lag. However, NES now describes another circadian rhythm , that is of food intake. It is said that people with NES have a circadian rhythm of food intake that is delayed by 4-5 hours. Therefore they are more likely to munch after dinner and may also awaken several times in the night to have a snack.
NES is said to be related to stress rather than hunger. It also occurs more commonly in obese persons, in as much as 25%. It is also said to affect 1-2% of the general population. Among the characteristics of NES include :-
1. lack of or decreased appetite during the day
2. insomnia
3. increased appetite at night
4. evening hyperphagia (increased eating) and nocturnal eating (arising to eat after having gone to bed)
5. feeling tense, anxious, worried, or guilty while eating
6. the tendency to eat carbohydrate-rich foods such as sugars and starchy foods.
It may also be related to depression and certain studies have found good responses to antidepressants. Research into this area is continuing and among them the effects of certain hormones on the circadian rhythm of food intake.
NES and stressWebMD
Locum UpdateNew
Locum jobs available:
- Locum wanted for polyclinic in Kuantan
- Doctors with interests in aesthetic and wellness clinic wanted
- Doctors required for emergency medical transfer by road/air
Healthcare in the Estates'It's a Form of Slavery'
The suffering classes -- plantation workersAsiaweek ran this story on Malaysia's plantation workers sometime back.
| Malaysia's plantation workers -- over half of whom are ethnic Indian -- are its most abject citizens. Their wages are pitiful, their housing wretched, their children's education lacking and their health care negligible. Recently, the Malaysian Medical As-sociation (MMA) said that it is "deeply concerned at the deplorable state of health care in plantations," where most workers live with their families. The MMA has urged a campaign for change so that "the plantation population of more than 1 million people will be integrated into the mainstream of national development and health care." Presently, they are firmly outside it. |
That was back in 1997. Have things changed? Do the powers-that-be really care?
Now we hear this complaint from the MTUC in
Utusan Malaysia:
MTUC: stop engaging unqualified medical personnel for plantations
KUALA LUMPUR April 21 - The Malaysian Trades Union Congress (MTUC) has called on the Health and Human Resources Ministries to reprimand employers who engage unqualified medical personnel to work in plantations.
Its President, Senator Zainal Rampak, said employing unqualified medical personnel violated Section 2 of the Estate Hospital Assistants (Registration) Act 1965.
In a statement Wednesday, he said the MTUC had received a complaint from an affiliate, the All Malayan Estates Staff Union (AMESU), that certain plantation companies were employing unqualified medical personnel as hospital assistants at low wages to cut costs.
Zainal said these unqualified medical personnel were mainly ex-servicemen who had undergone short courses of between six and seven months in para-medical subjects such as First Aid but did not have the extensive internship experience in hospitals.
"Their training programmes, which do not include a final examination, are supervised and certified by the Defence Ministry and are meant to serve military needs.
"Upon retiring from the army, they apply for jobs as estate hospital assistants and plantation companies are happy to employ them because they are prepared to accept lower wages," he said.
He said the competency certificates issued by the Defence Ministry's Medical and Dental Corps were not recognised by the Health Ministry as equivalent to the hospital assistants' or nurses' diploma.
Zainal said the MTUC was concerned that some of these unqualified medical personnel were taking over the role of qualified doctors and pharmacists by diagnosing, treating, prescribing and preparing medicine for estate workers and their families.
If this practice was allowed to continue unchecked, it would pose a serious threat to the well-being of estate workers and their families, he said.
He urged the Human Resources Ministry to investigate the matter and stop the unethical and illegal practice.
MTUC would also be writing to the respective Ministers to request them to intervene and address the problem before any tragedy takes place, he added. |
Same old story. Employers try to cut costs. Employers continue to exploit their workers. Sigh.....
More comments about Measles booster vaccineThe following are comments from a Professor of Primary Care & Public Health from the UK:
Giving a booster dose of measles vaccine is now common practice. It started in the UK a few years ago and also goes on in other countries. The rationale is that around 5-10% of children do not seroconvert with only one injection, compared to about 1% after two injections. See the link below for details:
http://www.mmrthefacts.nhs.uk/basics/twodoses.php
In the UK, the first dose is given around 12-15 months and the booster around 3-5 years. As it is quite difficult to get single measles vaccines in the UK, the combined MMR vaccine is used for the booster injection.
Complication rates seem low and the benefits probably outweigh the risks. |
What about the rationale for giving the vaccines to older children i.e. 7yrs to 15 years old?
1. There is no rationale for giving the booster at a later age, unless it is part of a catch up exercise. When the booster was introduced in the UK, older children were also given the booster to cover them. Once this had been done, the booster was then only given to 3-5 year olds. The earlier the booster is given, the earlier children are protected.
2. Most developed countries give only one or two injections - even with just one injection, if uptake rates are high (> 95%), measles almost disappears.
The key issue is ensuring that there is a high uptake of the primary injection. If this is done, rates of measles are very low even though some children will not have sero-converted.
3. This depends on how thorough the public health system wants to be!
However, if there is a high uptake of measles vaccine in children, then the number of cases of measles is very low. In the UK, the booster was only given to children when it was introduced. It was not offered to adults.
There has been an increase in the number of cases of measles in the UK recently but this is because there have been a lot of scare stories about the MMR vaccine which has resulted in a decline in immunisation rates (from 95% to about 85%).
The lesson from the UK is that if enough children (i.e. close to 100%) receive one measles immunisation, this is sufficient to control measles. The second injection further raises seroconversion rates and cuts the number of cases even further, There is probably no need for a third injection. |
HealthWorlds Asia CongressCyril Jonas sent in this email:
We The JanKossen Group of Switzerland is organizing a health congress from the 2-5 September 04.
Information about this congress is available at http://www.healthworldsasia.comThanks for the update Cyril. The website is informative but FYI, the dropdown menus do not work for
Firefox which is my preferred browser now instead of Internet Explorer since it loads faster and is more stable than IE. Lets see more webmasters design their sites carefuly and avoid being too IE-centric.
eHealth Asia 2004 - the aftermathOne can view the
Synopses and Presentations online.
These are the complete slides of all the presentations in PDF format.
Site updateAdded the
Malaysian Down Syndrome Society's webpage to the MMR's listing of
Public Societies and Associations.
Thanks to Dr Cheah for pointing it out.
Down Syndrome SupportHistory
In 1866, an English doctor named John Langdon Haydon Down wrote a description of people with a certain type of developmental delay. Because he was the first to write about it, the condition became known as Down syndrome. But Dr. Down didn't know exactly what caused it.
Nearly 100 years later, a French geneticist (say: juh-neh-tuh-sist) named Dr. Jerome Lejeune discovered that Down syndrome is caused by a problem with the number of chromosomes (say: kro-meh-sohms) a person has. Chromosomes are thread-like structures in the middle of a cell that carry the genes. Keep reading to learn about what Down syndrome is, what causes it, and more.
What Is Down Syndrome?Down syndrome (say: sin-drum), or DS, is one of the most common genetic causes of mental retardation or developmental delay. That means it is caused by a problem with a person's chromosomes, on which the genes that make each person unique are located.
People with DS are usually mildly to moderately mentally retarded. Some are developmentally delayed and some are severely retarded. Each person with DS is different.
Dr. Down worked in a hospital that had many patients who were mentally challenged. When Dr. Down wrote about the condition, he tried to give a description of what the people looked like. He described people with DS as being born with certain physical traits. However, his description was not completely correct because not every person with DS looks the same.
Babies with DS tend to develop more slowly than other babies do. They may start walking later than other babies. When they are grown, they tend to be smaller than the other members of their family and they may be a little stocky or heavy.
Many people with DS have eyelids that may be slanted upward. They may have small folds of skin at the inside corners of their eyes. Their noses may be somewhat flat and their ears may be small and shaped abnormally. They may have a large space between the big toe and the second toe.
Children who are born with DS are also more likely to have certain health problems. They are more likely to get infections, such as respiratory illnesses (problems with lungs and breathing). When they do get infections, they often last longer. They may have eye or ear problems or digestion problems like constipation. Some babies with DS may have problems in their stomachs or intestinal blockage that prevent them from digesting food properly.
About half are born with heart defects, which means there is something different with the way their heart developed. Some develop leukemia, a type of cancer. But each person with DS is different and may have one, several, or all of these problems.
Adapted from the website of Persatuan Sindrom Down Malaysia |
Persatuan Sindrom Down Malaysia was set by some concerned parents of Down Syndrome children. Here is the brief background of PDSM.
Background and History of PSDM
 Down Syndrome (DS) is believed to occur in 1 in 800 births thus making it the largest single group within the broad classification of persons with disabilities.
Prior to the registration of PSDM, there were no national organizations looking into the affairs of DS children, their parents and immediate relatives. There were scattered parent support groups, mostly unregistered, at the district or local levels only. In general, the Down Syndrome Community, especially in the rural areas are left to care for themselves with the parents being their main source for help and support.
On the 24th, September 2000, at the Selayang Hospital, a group of concerned parents, some medical professionals and some individuals, numbering about 76 people, with representations from 7 states met, leading to the formation of a Pro tern Committee of the Association. An immediate objective of the Pro tern Committee was to get the Association officially registered and this was successfully accomplished on the 11th , May 2001.
PSDM is a non profit organization looking into the welfare of persons with DS, their parents, guardians and their immediate families
|
Persatuan Sindrom Down Malaysia
Online assistance to quit smoking While driving along the North-South Highway I spotted one billboard showing a teenager covering her mouth and the large words "Tak Nak" next to her. Looks like the Tak Nak anti-smoking campaign is still in full swing.
For those already smoking, it can be pretty hard to quit. You can get help from the local Quit Clinics. See more in the MMR posts:
Holy Smoke,
Holy Smoke II and
Feedback: Quit clinic at other hospitals?ASH (Action on Smoking of Health Commitee) of the MMA is organizing a "Train the Trainers" course in smoking cessation - this is geared towards any doctor that intends to equip him/herself with the latest methods and approaches against smoking. They will be able to set up their own "Smoking Cessation Clinics" as such.
Details of the course:
Date: 24th April 2004
Time: 9am to 5pm
Venue: MMA House, Jalan Pahang, Kuala Lumpur
Course fee: RM 30.
Contact MMA: Tel 03-40411375 email [email protected]For those wishing to lookup online help on quitting smoking, the
Medical Tribune has a useful article with links which I reproduce here:
www.4woman.gov/QuitSmoking/howtoquit.cfm, a section of the U.S. National Women's Health Information Center, provides interesting fast facts on smoking and five key steps on how to quit. Did you know that more women join support groups to stop smoking than men? But on the downside, women are less successful than men in quitting.
www.lungusa.org/ffs is the American Lung Association's free online smoking cessation program. The program requires registration and is rather structured with seven modules, each taking about a week to complete. These cover determining readiness, confidence building, understanding your habit, physical and psychological recovery, long-term strategies, fitness, and more. The final module covers how long the recovery process will take and includes a section on evaluating the program. Interaction is encouraged on the message boards, which are commendably active.
www.surgeongeneral.gov/tobacco has consumer and clinician materials on tobacco cessation. The Clinician’s Packet is a how-to guide for implementing the U.S. Public Health Service’s clinical practice guideline Treating Tobacco Use and Dependence. It summarizes treatment strategies, including the use of pharmacotherapy, for the three different categories of patients.
www.quitnet.com claims to be the largest quit smoking program in the world. The basic quit program offers free advice but its premium membership, which offers one-to-one counseling and rewards for hitting quitting milestones, charges. QuitNet.com Inc. is a private company operating with the Boston University School of Public Health.
|
And lastly, for those "kay-po" people, here's an online journal of a real Malaysian trying hard to quit smoking - a
"Journal of a Cold Turkey".
Virtual Second Opinion The Association of Telehealth Service Providers reports that approximately 5,000 patients sought a VSO in 2002 (www.atsp.org). In general, patients who seek this form of treatment are those with a narrow range of serious conditions. According to Joseph C. Kvedar, MD, Director of the VSO provider Partners Telemedicine, “If they were sick with an acute illness, then they wouldn’t be surfing the Web.” Jonathan Schaffer, MD, Managing Director of the e-Cleveland Clinic, agrees: “These are life-threatening and life-altering diagnoses; these are things that shake people up—they have to drop what they’re doing and attend to [their condition].” In all, says Executive Director C. Martin Harris, MD, the Cleveland Clinic’s VSO service covers only about 300 of a possible 6,000 diagnoses.
As with other types of second opinions, patients turning to VSOs in the hopes of receiving a different diagnosis are likely to be disappointed. The Harvard University physicians employed by Partners disagree with the primary physician’s diagnosis in only 5% of the VSO cases handled by the company. However, the VSO can lead to inventive or unexpected treatment approaches; Partners’ specialists suggested amendments to the primary physician’s therapeutic advice in a startling 90% of cases.
Source: Oncology Netguide
|
We are in the age of Telemedicine. Are Malaysians ready for this? Would health consumers pay for 2nd Expert Opinions as a "virtual consultation"? I believe Pantai Medical Centre has already initiated this but I do not know how successful the program is. I personally think there is yet another unexplored area of tele-consultation which is a virtual doctor-doctor consultation. This is already taking place in a modest manner in the interaction between Malaysian doctors in the busy forum
Dobbs.
What I am interested to know is if there are MMR readers out there interested in a public Forum for the public to interact with real Malaysian doctors?
9th Southeast Asian Healthcare ShowFrom
The Edge Daily
Malaysia will play host to the biggest healthcare trade show in Southeast Asia from April 21 to 23.
The exhibition will be held at the Mid Valley Exhibition Centre in Kuala Lumpur. The exhibition will have 130 exhibitors and the organisers expect about 5,000 visitors.
|
I can't locate any other website on more details like the participants but I guess the usual Industry players will be there....
Update 19 April 2004Kenny Gan has kindly provided the URL of the exhibition:
http://www.abcex.com/
Atypical Measles : Does it exist?Recently the Health Minister shot back at the Consumer's Association of Penang for its description of atypical measles, which he says does not exist. Lack of proper planning of the mass immunisation of measles has led to confusion after confusion. I though it would be proper to determine if indeed there is such a thing as atypical measles.
Am J Med Sci. 1981 Jan-Feb;281(1):51-5. Related Articles, Links
Atypical measles syndrome: unusual hepatic, pulmonary, and immunologic aspects.Frey HM, Krugman S.
The atypical measles syndrome is a relatively new disease that was first recognized 15 years ago. Initially, it occurred in children who were exposed to wild measles virus several years after they were immunized with killed measles vaccine. It was characterized by a two- to three-day prodrome of high fever, cough, headache, and myalgia followed by a rash that resembled Rocky Mountain spotted fever, scarlet fever, or varicella and associated with roentgenographic evidence of pneumonia with or without pleural effusion. This report highlights three unusual manifestations of this syndrome: 1) transient hepatitis, 2) persistence of pulmonary lesions for several years, and 3) occurrence of excessively high measles hemagglutination-inhibition antibody titers. Today, this syndrome occurs predominantly in adolescents and young adults.
Atypical measles syndrome (AMS)
Atypical measles syndrome (AMS): An altered expression of measles, AMS begins suddenly with high fever, headache, cough, and abdominal pain. The rash may appear 1 to 2 days later, often beginning on the limbs. Swelling (edema) of the hands and feet may occur. Pneumonia is common and may persist for 3 months or more.
AMS occurs in persons who were incompletely immunized against measle. This may happen if a person were given the old killed-virus measles vaccine (which does not provide complete immunity and is no longer available); or the person were given attenuated (weakened) live measles vaccine that was, by accident, inactivated during improper storage. Immunization with inactivated measles virus does not prevent measles virus infection. It can, however, sensitize a person so that the expression of the disease is altered, resulting in AMS.
Being atypical, AMS can be confused with other entities including Rocky Mountain spotted fever, meningococcal infection, various types of pneumonia, appendicitis, juvenile rheumatoid arthritis, etc.
Adapted from University of Miami, School of Medicine |
So yes, there is such a thing as atypical measles. But would atypical measles be more prevalent in individuals who were vaccinated twice?
Vaccine. 2000 Dec 8;19(9-10):1093-6
Atypical measles in a patient twice vaccinated against measles: transmission from an unvaccinated household contact.
Artimos de Oliveira S, Jin L, Siqueira MM, Cohen BJ.
Department of Infectious Diseases, Hospital Universitario Antonio Pedro, Rua Marques do Parana, 303, 2o. andar, RJ 24030-210, Niteroi, Brazil. [email protected]
Described are two cases within the same household that were involved in an outbreak of measles in Niteroi, RJ. Measles diagnosis was confirmed serologically by specific IgM detection in Case 1 (classic measles) who was unvaccinated, and rising measles specific IgG in the absence of IgM in Case 2 (mild modified measles) who had a history of two vaccinations with measles-containing vaccines. Measles virus was detected by reverse transcriptase polymerase chain reaction (RT-PCR) in saliva samples from both cases. The nucleic acid amplified by RT-PCR was sequenced and showed identical measles sequence in the two cases. This study highlights the difficulty of diagnosing nonclassical measles infection on clinical and serological grounds, and the usefulness of PCR for viral RNA sequencing from noninvasive specimens for confirming epidemiologic links. |
So yes atypical measles can occur especially in vaccinated individuals exposed to the virus. The diagnosis as mentioned can be difficult and often overlooked.
So the CAP did do their homework after all! This should keep our Health Minister on his toes!!
Measles fiasco - Did MOH fail its duties of informing the public?In a letter to the
NST ,
Clear air on measles jabs
I AM more confused after reading the explanation by the Health Ministry’s Family Health Development Divi-sion deputy director Dr Mymoon Alias’ in “Safe to give children second booster shot” (NST, April 6) on the ongoing national measles immuni-sation campaign.
She said based on the ministry's epidemiological model, it was predicted that a major outbreak of measles would occur next year or in 2006. This was not mentioned in the ministry circular that I received through my son.
It merely stated the target group, where and when the children will be immunised and why immunisation is so important. The circular ended with the statement that these children would be immunised regardless of whether they have been immunised or have had measles before.
However, the circular did not give an option to refuse the second booster dose. Parents are asked to get a certi-ficate from a doctor only if their child has any medical conditions that prevent their immunisation.
The deputy director also did not explain why F.P. Ng's daughter (NST, April 5) need to have a third (booster) dose.
I understand that measles vaccination is not perfectly safe as mentioned by her as it also carries a risk (though rare) of hypersensitivity reaction, high fever, seizures, encephalitis and encephalopathy as well as local reactions such as swelling and redness.
Again, this was not stated in the circular. Parents have the right to be informed of these risks before they can make an informed decision on whether to allow their child to be immunised.
Z.B.A.
Kubang Kerian
|
Confusion has recently arisen about the mass measles immunisation programme currently in progress. Views from parents similar to that above is becoming familiar. Many claimed that parents have been poorly informed about the details in this immunisation campaign. Heck , even the healthcare personnel , who are not directly involved, appear clueless. Was there a failure in the dissemination of information to the general public?
The Ministry of Health believes that there is an urgency to implement this programme as a result of their projection of a major measles outbreak. It was deemed so urgent that this programme appears rushed with little information being presented to the public. Parents only got to know about this through a small piece of paper with a few words written on it. Healthcare personnel were also given a short notice to amass a team for performing these immunisations. Little information was available about possible side effects and teams of nurses are ill prepared for unforseen emergencies like anaphylatic reactions. With such a huge immunisation campaign, the risk for such emergencies can become greatly increased. Are the nurses trained? Are the teachers well informed? Are the parents aware of all the possible side effects?
It is quite obvious that this immunisation programme was shoved down the throats of Malaysians. There was little planning and even less regard for the opinions of the general public. The MOH has failed miserably in its organisation of such campaigns. Many are begining to query the urgency of such a costly and mammoth programme. Could there be an alternative public health measure to curb the purported risk of a measles outbreak? Or at least could the programme have been delayed to allow for better planning?
The MOH should shed its authoritarian mentality with regards to health issues. It should always seek to understand the general public and be sensitive to their needs. It should never cease to explain and to educate the public. Health officials should continue their work in preserving the health of the nation but should never lose touch with the humanitarian aspect of providing healthcare.
Obesity in ChildrenIn Medscape,
Fatty Meals, Advertising Linked to Youth Obesity
Kids' Menus at Restaurant Chains Loaded With Fat, Calories
Donya C. Arias
Food advertising and marketing aimed at children as well as fat-laden restaurant meals are two recent targets of public health advocates seeking to stem skyrocketing childhood obesity rates.
The Center for Science in the Public Interest studied 20 of America's biggest table-service chain restaurants that offer kids' menus. The results: most kids' meals pack way too much saturated fat, calories and sodium to fit into a healthy diet.
"These chains should be encouraging kids to eat some of the healthy dishes they offer adults, but instead their kids' menus primarily feature oversized portions of burgers, fries and fried chicken fingers," said Center for Science in the Public Interest senior nutritionist Jane G. Hurley. "Now, kids come to expect that kind of junk food at school and at home."
................. |
Obesity is on the rise. Unfortunately, children are equally affected by this trend. We may not know the true figures until perhaps the next National Health and Morbidity Survey in 2006. The last survey was done in 1996.
They found that 4.4% and 16.6% of the population were obese and overweight respectively. Based on the adult population (males and females) aged between 20-59 years old of 10.4 millions (1996 Population Consensus, Statistics Department), it is estimated to be about 450,000 obese and 1.72 million overweight adult Malaysians respectively.
That was 10 years ago. I suspect figures are going to be much higher in the next survey. However, children are rarely focused upon. Obesity in children appears more acceptable. Many parents also falsely believe that having a fat child equates to a healthy one. We now know that it is not true.
Obesity in children can increase his/her risk for future medical problems, for example, diabetes and cardiovascular diseases. We need to inculcate the habit of proper diet and exercise in our children to decrease the incidence of obesity in this age group. By doing so, we may be able to lower the prevalence of major diseases like diabetes, which incidentally is also on the rise, in the near future.
Parents play a pivotal role in educating their children and not succumbing to their demands. Choosing the right food outlets and the right food is their responsibility. Not all Western food is unhealthy and likewise not all local food is healthy. Parents need to educate themselves on proper diet management for their children as well as for themselves. Here consultations with a dietitian may help. However, reading from newspapers , magazines and the internet, may provide them with the answers. There are several local websites that are helpful in detailing the calories of local food in particular.
Large food chains should also play their role in protecting children from obesity. Aggressive advertising should be channeled to convey healthy habits and not solely for profit-orientated purposes. They have to shoulder part of the blame for the current rise in childhood obesity. Their children's packages should be balanced and thus provide the correct proportions of nutrients.
Malaysia is certainly not immune to the problem especially in urban areas. We need to look at it seriously as an attempt to improve the health status of Malaysians in the future.
Take a look at this website
Nutriweb - a Malaysian site
Illegal Sex StimulantsFrom the
Daily ExpressPETALING JAYA: More Malaysian men are turning to illegal sex stimulants, thus fuelling the burgeoning drug industry in the country.
Health Ministry’s Pharmaceutical Services Division Director, Datuk Mohd Zin Che Awang, said Saturday that of the RM14.98 million worth of unregistered drugs seized by the division between January and February (see report on Page 6), some RM9 million worth were sex stimulants.
“There is an increasing demand from Malaysian men to boost their sex drive. The main reason could be due to a surge in male population and the illegal industry takes this opportunity to manufacture these drugs to fulfil the demand,” he said at a news conference at his office, after giving a briefing on the growing threat of unregistered drugs in the country.
He said most of the drugs seized lately contained Tadalafil and Sildenafil, both chemicals widely used to treat erectile dysfunction or impotence in men.
The illegal sex stimulant drugs industry was not only thriving on local demand but also from overseas, he said.
“We have received complaints from as far as Bahrain a Tongkat Ali Plus exported from Malaysia,” he said.
The product was believed to have tested positive for Sildenafil, which is classified as a schedule poison.
“The Drug Control Authority would like to advise the public against buying and using Shitek Tongkat Ali 400mg and Longeria Capsules.
These two products were tested and found to contain an ingredient which is not allowed to be used in traditional medicines and could be deleterious to the health of the user,” said Mohd Zin.
He advised the public not to purchase or consume these drugs as they could lead to severe side effect, especially among heart and diabetic patients, and those suffering from high blood pressure.
“Sildenafil and Tadalafil are medicines, which can only be prescribed by doctors for men diagnosed with the condition of erectile dysfunction.
These drugs could interact with other medicines resulting in serious adverse effects such as lowering of blood pressure if used together with the antihypertensive drugs,” said Mohd Zin. - Bernama Are Malaysian men that pathetic? Do they really need pharmacological help or is it for kicks? Many are not aware of the dangers - that is until some high profile death from improper use of drugs as a "sex stimulant" occurs and is reported in the news.
Channel 4 News has an article on
Sex and Drugs
FeedbackCGL wrote:
I would like to donate my baby cord blood to the public cord blood bank in Malaysia, please help to provide some info and contact for me to contact the hospital.Thanks for your email. Unfortunately, Malaysia has not yet launched a Public Cord Blood Bank - this is sorely needed as Unrelated Cord Blood Stem Cells are vitally important for a source of stem cells for patients who need a Stem Cell Transplant but do not have a sibling who is a HLA match. Public Cord Blood Banks store Cord blood and stem cells are open to anyone who requires them. This is in contrast to Private Cord Blood banks which store blood only for individuals (see my earlier blogs on
Cord Blood Bank and
Cord Blood Bank II)
The Ministry of Health has plans to setup a Public Cord Blood Bank based in Hospital Kuala Lumpur. In fact personnel have been sent abroad for training. The Bank has not yet commenced operation.
The spirit of givingCancer remains a frightening word. Indeed it should be, as cancer is now the second biggest killer in Malaysia. Sadly, it also afflicts children and this deprives them of their childhood and in most instances their lives as well. Parents suffer the emotional stress of seeing their innocent bundle of joy, wasting away. It is like a dagger in their hearts. It hurts so much that they are willing to sacrifise themselves, to save their beloved child. Fortunately, the spirit of humanity is at its strongest in the bleakest of moments. It gives that extra push to go forward. It gives rise to hope. Hope that one day, all will be well again.
Support for cancer patients is essential. We see charities after charities for cancer patients. It never ends and it probably never will. Financial contraints is evident in most families with an afflicted member. Indeed treatment is expensive.
Doing charity is a noble deed. The spirit of giving and not expecting anything in return. It is about giving a chance for another to live. It is about realising another's dream and forgoing your own so that others may have that chance! That is the spirit of giving!
Want that chance to help out. Visit
Makna's website
eHealth Asia 2004Well
eHealth Asia 2004 was a resounding success IMO. I was pleasantly suprised to see such a large turn out. There were participants - speakers as well as attendees from abroad as well as all round Malaysia. Charles Moreira has
the story in The Star.
Yours truly
spoke about PDAs in Medicine. I thought the audience was quite lively and there were quite a few questions and comments from the floor.
Health Informatics is in its infancy in Malaysia. I think meetings like that auger well for the future.
Cord Blood Banking IIFurther to my earlier
blog on Cord Blood Banking.
Yahoo has this
Story . Some highlights:
The marketing has proved to be effective. The private blood banking industry is expanding although many medical experts criticize the companies for exploiting parents' paranoia. Many doctors advise healthy families not to succumb to promotions because the likelihood of ever using the blood is rare, future medical uses for it are uncertain and storage standards can be lacking. It's marketing, marketing, marketing. Sound familiar?
What the storage firms' promotions don't say is that the vast majority — about 3,500_ of cord blood stem cell transplants have been done using cells from unrelated donors from public banks. About 300 transplants have involved sibling donors while 14 have been done using a child's own cells, said Dr. John Wagner, Scientific Director of Clinical Research of the Blood and Marrow Transplant Program and Stem Cell Institute at the University of Minnesota. Yup. The Public cord blood banks (those which store cord blood open for use by any matching recipient) do the real work. The Private banks get the money.
Some Web sites list the various conditions that have been treated with cord blood stem cell transplants, including genetic diseases and leukemia. But if a child has a genetic disease, his or her own cord blood would be useless in treating it because the cells are also infected. And doctors said that if a child gets leukemia at a young age, a cord blood transplant wouldn't be done for fear the blood might also have the conditionSpot on. Exactly what the comments were about in the first blog.
Doctors say that if parents donate their children's cord blood to a public bank, there is a high probability it will be used. There are only about 20 public banks in the country but they can only work with a limited number of hospitals because receiving and processing the donations is expensive. A bill introduced in the Senate last October would expand public cord blood banking. At least someone has his priorities right.
Dr. Joanne Kurtzberg, director of the pediatric bone marrow and stem cell transplant program at Duke University Medical Center, questions whether it is appropriate for private blood banks to bring up potential future uses such as diabetes or arthritis in marketing materials, as many do. She said evolving technology may mean that other types of cells might be as good as cord blood stem cells for transplants.
"None of these companies are saying that if you don't save your child's cord blood, there are other alternatives if a child gets sick," said Kurtzberg.
Absolutely correct. Harvesting stem cells from adult marrow might just be good enough.
He doesn't want parents who don't store cord blood to feel guilt. Unfortunately that's what their marketing is all about. Play on the "guilt".
Grants agrees it is difficult for parents to distinguish between banks. "It really is caveat emptor."
He suggests parents ask about companies' track records and profitability. CorCell Inc. president and chief executive Marcia Laleman recommends asking about accreditation, storage facilities and transportation procedures. The other issue is how long the said private company will last before it goes bust? What happens to all the cord bloiod then?
False weight loss claimsFurther to the
earlier post by Dr. Cheah,
FDA warns 16 companies to stop false weight-loss claims:
The FDA has ordered 16 companies to stop making false and misleading claims for weight-loss products promoted online. Many of these products are falsely claimed to block starch, carbohydrates and fat calories while allowing consumers to lose weight without any lifestyle changes. The products included: Block It, Carb Intercept, Carb Zapper, Chito Block 2000 Plus C, Chitosan 500mg, Dream Shape, Dreamshape, Extreme Carb Blocker, F Block Chitosan, InShape, Lean
Image Carb Blocker, Liposin, Metabo Fat Blocker, Metabo FatBlocker, Starch Blocker 1000, Super Chitosan, Super Starch Blocker 1000, TrimSpa Carb Blocker, TrimSpa Fat Blocker, Ultra Block 2000 plus C, Ultra Carb Blocker, Ultra Carbo Blocker
2000, Ultra Carbo Blocker 3000, Ultra Carbohydrate Blocker 2000, and Zone Fat Blocker. How many of these products are on Malaysian drugstore shelves?
The business of organ transplantsYup. There's
money in the business of body partsA recent scandal at the University of California-Los Angeles, in which two men, including the director of UCLA's Willed Body Program, were arrested for selling stolen body parts for their own profit, has turned a national spotlight on an industry that operates in the dark: the largely unregulated acquisition and dissemination of body parts for medical and scientific research.Yes, this is happening in a developed country like the USA. These are just body parts. The bigger problem lies in poorer countries where people are tempted to sell organs for money. In
Kidney for Sale: The Dilemma there's the sad tale of a 16 year old African boy who is offering his kidney for sale so that he has enough money to go to school. This may sound familiar in the poorer Asian countries too where desperate people are driven to desperate acts like selling their organs for cash.
Do we want to see a situation like this in Malaysia?
There has been recent moves to
review our Organ Transplant Laws. This article highlights our ex-Health Minister speaking as what he really is qualified to speak as - a lawyer!
There is presently no legislation in the country governing the removal of organs from live donors, Chua also pointed out.
In the absence of any clear legal authority, it is presumed that live donations are legally permissible by way of valid consent obtained from the donor. While awaiting the formulation of an appropriate law on this, the Ministry of Health is in the process of developing guidelines on organ donation and transplantation from living donors.About time too. Otherwise it'll be another way for the rich to take advantage of the poor.
Some links:
Bioethics: Selling OrgansOrgan donation FAQ
Update: Locum jobs AvailableThe MMR's Online Locum Service has a new listing for a
Locum Job Available in the Kajang area.
World Health DayToday is
Word Health Day. The theme is Road Safety. Drive carefully folks!
I was scouting around for Malaysian road accident statistics and I managed to find some from
Polis DiRaja Malaysia and
hereAnd
TV Smith of course (Malaysia Boleh Records):
Highest Number Of Road Accidents In The World - 26,662 died in road accidents between the years 1997 to 2002.
Highest Concentration Of Colour-Blind People In One City - Kuala Lumpur. Over 3 million motorcyclists who suffer from this rapidly spreading medical condition are riding through red lights at traffic junctions daily.You can only conclude the numbers are horrendous and something needs to be done.
Another Traditional Medicine CautionSingapore Health authorities recently issued this
warning:
A TRADITIONAL Malay medicine used to treat rheumatism has been found to be adulterated with two 'Western' ingredients which can lead to health problems like gastric bleeding.
The Health Sciences Authority (HSA) yesterday warned the public to avoid Pil Ajaib Cap Emas, Penguat Urat Saraf or Gold Brand Magic Pill, Nerve Strengthener, because it contains dexamethasone and indomethacin.
Indomethacin is an anti-inflammatory agent used for the treatment of joint pains and arthritis, and can cause gastric bleeding and blood disorders.
Dexamethasone is a steroid used in the treatment of allergic disorders and inflammatory conditions.
Prolonged consumption can cause problems including hypertension, osteoporosis and Cushing's syndrome, a hormonal disorder caused by prolonged exposure of the body's tissues to a high level of steroids.
The HSA started investigations after two patients contracted Cushing's syndrome, which doctors suspected was connected to their use of the herbal medicine.
It said the product is not sold here and that patients had obtained it outside Singapore.
While the product has a Malaysian registration number, it is not approved in Malaysia.Therein lies another danger with "traditional medicines". These may be laced with steroids and other powerful drugs in uncontrolled amounts. They provide immediate relief for symptoms like joint pains but when used inappropriately and without medical supervision, leads to disastrous results. I recall seeing one unfortunate man who was so Cushingoid and osteoporotic after taking Chinese "rheumatism" medicine for years. The actual diagnosis? Gout! The poor man could have been simply treated with diet and allopurinol.
Steroids are not the only problem. Substances in Chinese herbs like
Aristolochic acid, have been shown to
cause cancer. I have noticed too a high incidence of Myelodysplasia (a pre-leukaemic blood disorder) in older Chinese patients who often in the history, have taken alot of Chinese supplements or traditional treatment. With the establishment of the
National Cancer Registry, we now have better statistics. Cancer is
more prevalent in Malaysian Chinese than the other ethnic groups. I suspect it is environmental and the clue may lie in the various "supplements" and "herbs" the health-conscious Chinese population like to ingest. Again, please be
warned, things "Natural" does not automatically mean "Safe".
Health Supplement Warning
There has been a recent report on
consumerreports.org, a nonprofit organisation and republished in Medscape, about a list of dangerous natural supplements that may have detrimental side effects.
Below is the list:-
Definitely Hazardousaristolochic acid (Aristolochia, birthwort, snakeroot, snakeweed, sangree root, sangrel, serpentary, wild ginger)
Very Likely Hazardouscomfrey (Symphytum officinale, ass ear, black root, blackwort, bruisewort, consolidae radix, consound, gum plant, healing herb, knitback, knitbone, salsify, slippery root, symphytum radix, wallwort)
androstenedione (4-androstene-3, 17-dione, andro, androstene)
chaparral (Larrea divaricata, creosote bush, greasewood, hediondilla, jarilla, larreastat)
germander (Teucrium chamaedrys, wall germander, wild germander)
kava (Piper methysticum, ava, awa, gea, gi, intoxicating pepper, kao, kavain, kawa-pfeffer, kew, long pepper, malohu, maluk, meruk, milik, rauschpfeffer, sakau, tonga, wurzelstock, yagona, yangona)
Likely HazardousBitter orange (Citrus aurantium, green orange, kijitsu, neroli oil, Seville orange, shangzhou zhiqiao, sour orange, zhi oiao, zhi xhi)
Organ/glandular extracts (brain/adrenal/pituitary/placenta/other gland "substance" or "concentrate")
Lobelia (Lobelia inflata, asthma weed, bladderpod, emetic herb, gagroot, lobelie, indian tobacco, pukeweed, vomit wort, wild tobacco)
Pennyroyal oil (Hedeoma pulegioides, lurk-in-the-ditch, mosquito plant, piliolerial, pudding grass, pulegium, run-by-the-ground, squaw balm, squawmint, stinking balm, tickweed)
Scullcap (Scutellaria lateriflora, blue pimpernel, helmet flower, hoodwort, mad weed, mad-dog herb, mad-dog weed, quaker bonnet, scutelluria, skullcap)
Yohimbe (Pausinystalia yohimbe, johimbi, yohimbehe, yohimbine)
The side effects include kidney failure, liver function abnormalities, increased cancer risk and even death. It may also interfere with other medications making them less effective , for example , oral contraceptive pills.
It is important to read the contents of health supplements that you are purchasing from the pharmacy. If unsure, discuss it with your doctor.
False weight loss claimsThe below article was published in
Medscape and I thought it would be better to put the article in its entirety.
FDA Warns Web Sites Over Weight Loss Claims
WASHINGTON (Reuters) Apr 02 - "Eat all you want!" "Watch the fat disappear!" "Block the starch and lose weight!"
These and other similar weight loss claims for some dietary supplements can cause "unfounded hope" and must be removed from Web sites that use them, the U.S. Food and Drug Administration warned on Thursday.
The agency said it sent warning letters to 16 Web sites that promoted certain products as blocking carbohydrates, starch and calories from fat without noting the need to make lifestyle changes, like exercising or eating a healthy diet.
"These products give unfounded hope to people who are attempting to lose weight," Acting FDA Commissioner Lester Crawford said in a statement.
"False and misleading claims have significant health consequences to individuals that may be overweight because these products do not produce the desired results," he said.
The letters are part of ongoing FDA efforts to fight obesity as well as prevent companies from making untrue claims about dietary supplements, the agency said.
The Web sites have 15 days to respond to the agency and outline their plans to remove the claims. If they do not, the FDA can seize the firms' supplies, impose fines and take other enforcement actions.
eVitamins.com, weightlossguide.com and VitaMaker.com are among the sites cited by the FDA. Several sites could not immediately be reached for comment.
|
This article is very relevant in Malaysia where we see claim after claim in advertisements in the press on miraculous weight loss. The Government has yet to be strict as these are scams! Imagine claims that chilli wraps can make you lose weight! Even pharmaceutical manufacturers should not be spared from action if proven to perpertuate false claims.
I hope that the Malaysian Government will follow in the footsteps of the FDA. The internet needs monitoring especially Malaysian hosted sites. I have come across many ludicrous claims being spread on the internet by Malaysians regarding miraculous cures. Such unscrupulous advertising should be stopped and the masterminds held accountable for their actions.
There is no shortcut to weight loss. A proper diet regimen and regular exercise remains the mainstay of weight loss programmes. Getting advice from a dietitian and physical instructor will be advantageous. Medications would just help this process. Medications like Orlistat, will help and requires a doctor's prescription! Nevertheless, diet and exercise remains essential despite being on medications!
Rather than visit shady joints, I would advise my patients to join an exercise programme and be on a good diet regimen. The choice is yours.
Visit this Malaysian site on weight management:
Weight Management Information Centre
Road Safety
The theme of
World Health Day,which is on 7th April, is Road Safety.
Road traffic injuries are a deadly scourge, taking the lives of 1.2 million men, women and children around the world each year. Hundreds of thousands more are injured on our roads, some of whom become permanently disabled. The vast majority of these occur in developing countries, among pedestrians, cyclists, motorcyclists and users of public transport, many of whom would never be able to afford a private motor vehicle.For starters, how safe are our cars? Recently Proton ran an ad in the papers which proudly declared the fact that 80% of the one of it's cars shell remained intact in a crash test (no references were given to who did the test and no other data was made available). More important actually is what happens to the occupants inside the car who may be bounced around like rag dolls. Crash test dummies may help provide some data on this. No point if the shell is intact and the driver succumbs to massive chest and head injuries!
I think Air bags should be made compulsory on all cars in Malaysia. These are conspicuously absent in Proton cars sold locally whereas they are present in export models according to the laws overseas. Why the double standards? Is the $$$ bottomline more important than saving lives? There also should be laws on the compulsory use of seat belts for rear passengers. Its sad to read of young lives needlessly lost due, even innocent passengers who might have been saved if they used their rear seat belts.
What about our commercial vehicle drivers?
Recently there was a story in the Malay Mail on an accident in which a lorry crashed into a house killing several people.
"A 41-year-old lorry driver who rammed his trailer into a house in Kampung Pangkalan Batu on Monday was high on drugs at that time.
Police yesterday said the urine test conducted on the driver after the fatal accident was positive for ganja." I am wondering how stringent are the Medical Examination requirements for drivers of heavy vehicles? Can any private practictioner still certify fitness or is it time for another Fomema-like action here?
KICK (Kempen Immunisasi Campak Kebangsaan)This programme is scheduled to start in April and end in September although many states are aiming at completing this programme by May or June. It is basically a mass immunisation programme for children between 7-15 years of age. This is in line with WHO's target of Measles Eradication by 2005.
The Mumps, Measles and Rubella vaccine was only recently implemented few years ago as a compulsory component of a child's immunisation schedule done at 9 months of age. This does not offer much protection to the majority of the population of Malaysia and we continue to see cases of measles. The target for this campaign is 100% coverage or at least close to it.
Schools have been briefed at this point and it has been agreed that consent need not be taken as it is a compulsory exercise although parents are informed through pamphlets circulated through their children.
There are several exceptions where a child can opt out:-
1. High fever > 38.5 C
2. Hypersensitivity to neomycin
3. On immunosuppressive therapy
4. Immunodeficiency syndromes
5. History of anaphylaxis reactions to previously injected measles or MMR vaccines
This requires a doctor's certification first.
Even if a child has claimed to have been immunised, he would not be spared from this exercise.
The measles vaccine used is monovalent and requires a subcutaneous injection route as per manufacturer's recommendation. Adverse reactions from measles vaccine is rare with the common ones being fever (5-15%) and rash (5%). Hypersensitivity reactions has a reported incidence of <1:100,000. Encephalitis has an even rarer incidence of <1:1,000,000. So the vaccination is safe.
Previous reports of a link between measles immunisation and autism has been disputed and proven untrue.
To Doc, I hope this information is useful and could help you counsel the anxious parents.
Caesarean Section : The Psychological EffectsThe Star had an article today titled "Caesarean Guilt". It describes the mental anguish that Kate Winslet (remember Titanic?) had to undergo after her Caesarean section to deliver her first child. This article pointed out how a Caesarean section affects a woman and the perceptions that probably many have regarding a Caesarean section.
One description is that of failure. A perception of failure by the mother, in performing her duties of naturally delivering her baby. Many Caesarean's are unplanned and this can leave the mother unprepared and thus regard herself as a failure. Even medical terms like "failure to progress" commonly used by obstetricians, actually compounds the problem.
The article also pointed out correctly that most Caesarean's are actually unnecessary. Caesarean rates are climbing and this pattern is similar in Malaysia as well. This results from a lower threshold for Caesarean section, probably due to knowledge of its availability.
After Caesarean, serious mental health conditions can occur, for example, depression and post traumatic stress disorder. This is so true and under-recognised by doctors. We do not provide enough support to our patients post natally. The "deal" is closed after the baby is born and mother is discharged from the ward. Our antenatal health education too, do not mention much about Caesarean section with the false notion that it will not happen to you! Perhaps we should look into it further!
I will never fully appreciate the emotions of childbirth and can only attempt to comprehend its complexities! :)
Below are some excellent sites
Caesarean.Lifetips.comCaesareanBirth.com
FeedbacK: ENT Specialist Hospital?RICHARD C. sent in this query:
I am looking for a hospital which specialises in ear,nose & throat ailments. For example, we have Tun Hussein Onn hospital for eye treatment. Is there any such hospital for ENT?Thanks for your query. Firstly do write in lower case rather than all in upper case! Anyway I have converted your message to lowercase with the help of this
Case toggle tip from TechTV.
Anyway I digress. The short answer to your question is No. I am not aware of any solely ENT hospital. The
Tun Hussein Eye Hospital is one of the few exceptions being a "sub-specialty" hospital. The others I can think of are the National Heart Institute and the Institue of Respiratory Medicine (formerly the Tb hospital). I don't think it is a great idea to have too many "sub-specialty" hospitals simply because of the "No Man Is an Island" principal. Doctors in a "sub-specialty" hospital may have problems getting help from colleagues in other disciplines when the need arises. For example, a diabetic patient with heart disease who requires an eye operation trundles off to an Eye Hospital. But there may be no Physicians, Diabetologists or Cardiologists in attendance in case there is a need to refer to one e.g. should there be a issue like management of diabetes during and after surgery or should the patient develop angina pectoris or something.
Cord Blood BankingBlood stem cells from the umbilical cord may be frozen and used later to restore bone marrow in the treatment of several types of diseases. However to date, the vast majority of Cord Blood Transplants have been performed using Cord blood from sources other than the patient's own and these are taken from
Public Cord Blood Banks (currently only available overseas) where searching for suitable matching Cord Blood is openly available to those requesting.
This is in contrast to a
Private Cord Blood Bank which provides processing and storage of cord blood for "potential" future use by the child or family members only.
What are the current recommendations?
The
American Academy of Pediatrics has this to say:
The AAP panel express concern that "families may be vulnerable to emotional marketing (from private blood banks) at the time of birth of a child and may look to their physicians for advice.'' They point out that the vast majority of children will never require the use of stored cord blood. Current estimates place the chances of a child needing to use his or her own cord blood sample at somewhere between 1 in 1,000 and 1 in 200,000.
The AAP experts conclude that because the potential uses of cord blood remain extremely "limited,'' cord blood banking should only be considered "if there is a family member with a current or potential need to undergo a stem cell transplantation.''
On the other hand, they encourage parents to donate cord blood "at no cost'' to national (Public) stem cell banks, in much the same that organs are donated to help strangers in need. Parents should give informed consent before donating cord blood, and contact between the donor family and blood bank should be maintained in case "a genetic disease or (leukemia) develops'' within the donor family.
SOURCE: Pediatrics 1999;104:116-118The Royal College of Obstetricians & Gynaecologists UK's standpoint:
Routine directed commercial cord blood collection and stem-cell storage cannot be recommended at the present time, because of the insufficient scientific base to support such practice and the attendant logistic problems of collection for NHS providers.
Each trust needs to develop its own policy on how to respond to prenatal requests for cord blood storage through commercial providers.
Collection of altruistic donations and directed donations for at risk families remain acceptable procedures through established public sector cord blood banks.Recently, the highly respected Medical Letter on Drugs and Therapeutics has also concluded that routine use of private storage is "unlikely to be worthwhile." [Private cord blood banks. The Medical Letter 46:21-22, 2004]. See also the Cord Blood Bank section in
QuackwatchSo it looks like the medical profession currently encourages Public Cord Blood Banking but does not encourage Private Cord Blood Banking.
What is happening in Malaysia? There still is no viable Public Cord Blood Bank though there are plans afoot by the MOH but it's not happened yet. On the other hand Private Cord Blood Bank
companies are already going round recruiting parents as potential customers.
Unfortunately it is all "hard sell". You tell parents its for "insurance" but really its very unlikely the child will need his cord blood in the future unless as the child belongs to a family where there is a known genetic disease amenable to Stem Cell transplantation (as per RCOG recommendation). Moreover, the Private cord blood bank sells the notion of the potential of curing leukaemia
if the child gets it in the future as one of the reasons for storing cord blood for the child. The point is if the child gets leukaemia in the future, he or she actually needs cord blood or stem cells from
other individuals and not his or her own if it comes to a transplant.
