More HIV news - screening in pregnancy?
In the run up to
World Aids Day tomorrow, you may be interested in the following snippets from the local Press:
Bernama quotes the Deputy Health Minister as saying there is
No Plan For Mandatory HIV Screening (in pregnancy)
Deputy Health Minister Datuk Dr Abdul Latiff Ahmad has dismissed suggestions for mandatory screening of pregnant mothers for HIV, saying the present tests at maternity clinics can adequately screen all diseases.
"These preliminary tests can detect whether a pregnant mother is infected with HIV, and we can then take the necessary steps including medication to reduce the risk of transmission to the baby," he told reporters.
A total of 1.8 million mothers nationwide have undergone these tests, he said. |
Then the Health Minister also claims there will be
Free AIDS drug therapy next yearThe drugs are already free for a limited number of HIV-infected people, among them mothers and babies, said Health Minister Datuk Dr Chua Soi Lek.
Currently, the three generic drugs cost from about RM290 to RM525 a month. Making the drugs here will reduce the cost to less than RM200 a month, he said.
Fully subsidising the drugs would cost the Government between RM15 million and RM26 million a year.
"We are currently waiting for the Domestic Trade and Consumer Affairs Ministry to approve the matter before we can proceed to produce the three drugs locally," Chua said.
It is a sign the Government was "serious in fighting this epidemic", he said. |
And more shocking statistics:
"There are 20 new cases of HIV cases reported daily of which three are confirmed cases of AIDS, while two people die of the disease on a daily basis," he said Malaysian AIDS Council president Datin Paduka Marina Mahathir said the move meant the country was "very much in the forefront" of the global battle against HIV/AIDS.
Some 58,000 Malaysians are infected with HIV. Of these, 6,545 have died of full-blown AIDS, Chua said today.
Some 1,500 HIV sufferers currently get the HAART free. Aside from mothers and babies, it extends to those infected through tainted blood or blood products, health workers infected through occupational exposure, and Government servants.
Chua estimated that next year, another 4,000 people will be infected with HIV.
In 2003 alone, 6,756 cases were detected. Three-quarters of these were aged between 13 and 39 years. Some 869 of these sufferers have died. Eighty per cent of them contract AIDS through intravenous drug use, and 13 per cent by heterosexual transmission.
Roughly 0.7 per cent were due to mother to child transmission. |
So no compulsory HIV testing for pregnant mothers unlike plans being mooted in Singapore. Some time ago a Southern State implemented compulsory HIV testing for Muslim newly weds - I wonder how the programme is doing? Anyone know?
Comments anyone?
Feedback: sulbutiamine
Yeeyang writes in about sulbutiamine.
Thanks for your email yeeyang. Sulbutiamine is marketed as Arcalion in Malaysia. It is a Vitamin B analogue and similar to vitamin B1 (thiamine).
According to MIMS, the indications for this drug are:
| Symptomatic treatment of all forms of functional asthenia, eg: Physical and intellectual overwork; memory disorders, difficulty in concentration; fatigue not overcome by rest; decreased intellectual efficiency and lucidity especially in the elderly. |
I have done a literature search and there are few randomized clinical trials with this drug and I am not particularly convinced of the effectiveness of this drug for
asthenia. To my mind bone pain is not an indication and I don't see how it would work in this circumstance.
As for safety and adverse effects, MIMS states " Mild agitation has sometimes been observed in elderly patients. Allergic skin reactions are rare, but have been reported"
Have you heard me today?
1 December is
World Aids Day and the theme is Women, Girls, HIV And AIDS.
The World AIDS Campaign 2004 seeks to address the way women's inequality helps fuel the transmission of HIV and increases the impact of AIDS.
The campaign's slogan 'Have you heard me today?' calls for action against the inequalities that not only put women and girls at risk but whole communities. |
Recent news items and links of interest:
Malay Mail
Health: The changing face of HIV/AIDSMalay Mail
MY HUSBAND GAVE ME AIDS ... and now I am jobless Malaysian Aids FoundationUNAIDS
Putting your kids at risk
I thought it was timely that the Star higlights the issue of
Putting precious lives at risk when it comes to road safety
Sadly, unrestrained children in cars are a common sight on Malaysian roads. One is also used to seeing children, and even babies, in the front seats of cars: on the lap of the passenger; standing, with her head inches away from the windscreen; seated behind the steering wheel, on the lap of the driver. Occasionally, children are even seen with their heads sticking out of car windows, or sunroofs, enjoying the breeze as their parents speed down the highway.
If the parents of any of these children were approached, they would deny being careless or foolhardy. Most, like the husband of Poon Mei Mei of Klang, Selangor, would consider it an insult to their driving abilities if it was suggested that their children were in danger every time they rode in a car without, at the very least, wearing a seat belt. |
I think driver education will fail in Malaysia. What we need is legislation and enforcement of the legislation. We need laws to force parents to put their children in car seats at the back, enforce rear seat belts, front air bags and what not. We need to ban people from performing crazy stunts like this from the
PanduCermat "hall of shame"Other news links:
Using seat beltsPercentage of accidents still too high
Losing your fingerprints
Highlighted in The NST website,
Poser over Perak woman’s vanishing fingerprints
M. Husairy Othman
TRONOH, Nov 26:
A 30-year-old businesswoman here is losing her fingerprints, and she’s not pleased about it.
Wishing to be identified only as "Au", her problem began when she was eight years old, when the dermal ridges on the middle fingertip of her left hand began to fade. cont... |
Astonishing story almost unbelievable. Perhaps this could be the answer.
Chronic Fatigue Syndrome
Chronic fatigue syndrome (CFS) is a disease characterized by symptoms of extreme, long lasting fatigue, loss of memory [Marcel], impaired sleep, sore throat, muscle and joint aches, headache, cough, photophobia, night sweats [Evengard], depression that has much lower ACTH and cortisol secretion than typical depression [Demitrack], lymph node pain, eye pain and fibromyalgia (muscle pain) [Bell DS], as well as white spots on MRI brain scans [Buchwald 1992] and single-photon emission computed tomography (SPECT) scans [Schwartz], loss of fingerprints in a third of the patients [Johnson p345], and a chronic low level activation of the immune system [Cannon] which may be accounting for many of the non-neurological symptoms, but all very variable, perhaps because different parts of the brain are attacked. ...cont.. |
From the
CFS Research website
| About 10% progressively lose their fingerprints. There's disruption. This generates interest with the FBI. People can't teach if they can't furnish fingerprints. The pathophysiology--lymphocytic ..itis that penetrates the vessels that engorge the areas around these vessels and may impair nutritional flow. Also they have punched-out lesions within the fibroblasts themselves. Fibroblasts make collagen, and it's necessary for the ground substance. |
Article from the Medical Journal of Australia.
Medical Faculty Capacity
Bernama
reports:
Efforts are underway to upgrade the capacity of medical faculties in local universities by increasing the number of lecturers, laboratories and apparatus in a move to tackle doctors' shortage in the country, the Dewan Rakyat was told Thursday.
This would enable every faculty to increase medical students' intake, Higher Education Ministry Parliamentary Secretary Datuk Dr Adham Baba said. |
I would imagine this Parliamentary talk is going to be in practice difficult to achieve given the current problem of Medical faculties even retaining their staff. How it is going to be done without a radical change in the salaries and work conditions I don't know. Perhaps some short term hiring of foreign medical staff? But given the uncompetitive salary structure here, you'll be seeing only staff from the Indian subcontinent and perhaps Myanmar.
In
June the MMR featured a newsreport whereby the "Council of Medical Deans chairman Professor Dr Zabidi Azhar Hussin said some [medical schools] had vastly exceeded their capacity, with a 1:8 medical lecturer-student ratio when 1:6 was the accepted ceiling". So in actual fact there is already a shortage - forget about increasing the capacity when there are medical schools which don't even meet the minimum accepted lecturer-student ratio. Address the shortcomings first then only talk about expansion!
Dengue: when to admit?
Dengue is unfortunately endemic in our country - this means we get dengue cases throughout the year, year in and year out. What we have is a surge in numbers from time to time and lately there seems to be more cases again from certain areas.
A relative of a patient of mind asked me today "what is the platelet count which decides when a patient with dengue should be admitted?".
Coincidentally, there is a thread going on in
Dobbs while discussing some medical issues, someone posted the link to an NST report that
Sick boy ‘sent’ home dies of dengue Over the five days, the boy could not eat or drink anything and was resting at home for most of the time.
Lee Wah said at 1am on Nov 2, Jefferson, who usually suffered in silence, complained of weakness and unbearable pain in his stomach. He took his son to the hospital again.
"The nurse on duty said it was a normal gastric reaction, gave my son more gastric medication and told me to come back at 8am because there was no doctor at that time.
"Because I had no choice, I reluctantly took him home but I took him to the hospital again at 3am because he was having difficulty breathing and his lips were turning pale.
"I told the same nurse on duty that my son was gasping for breath but she said it was due to the ‘gastric'.
"I insisted that the medical assistant on duty examine my son. Jefferson was given an okay but I was still worried. The assistant then told me to come back in the morning to see a doctor but then my son suddenly collapsed and could not walk.
"I told the nurse that he was too weak to even walk but she told me to put him in the car. It was then that my son fell unconscious and into a coma right before my eyes, but the hospital staff was still indifferent." Jefferson Junior died about seven hours later, and the cause of death was confirmed as dengue with cardiogenic shock. |
Sad to hear of death of young patients with dengue. Since we don't have all the facts of this case (or both sides of the story) it is not fair to make any judgements or comment on it.
One of the most important things ER and clinic doctors as well as patients should realise is that there is NO magical blood test or platelet count level which is required before one decides on admission. It is the
total clinical assessment which is important. So a patient with a platelet count of over 100x10^9/l and suspected dengue who is clinically ill looking, vomiting and unable to retain fluids will require admission.
You may be interested to view the current Guidelines for the Management of Dengue
Academy of Medicine Dengue Guidelines (PDF format)
Ministry of Health Dengue Guidelines (Word format)
Vit E: Twisting the facts
I have already highlighted the recent meta-analysis which shows that
Vitamin E supplements are useless in the prevention of coronary artery disease.
In the face of this, the vitamin industry now tries to
twist the facts and confuse the public.
Carotech, which produces 18,000 kilos of its Tocomin 50 per cent a year, is now hoping to promote this approach in Europe too. The firm, which started producing tocotrienol from palm oil in 1995, remains the largest producer, although competition from products like rice oil is increasing.
“Even though I don’t produce tocopherols I am advocating the use of all seven forms found in nature,” said Leong.
The emerging science on vitamin E has been causing peaks and troughs in demand for a number of years. Manufacturers of the vitamin at last week’s Health Ingredients Europe show confirmed that the John Hopkins trial released earlier this month had already made an impact on sales.
“According to feedback from some customers, there is a short term drop in vitamin E business in the week since the story ran,” noted Thomas Breisach, spokesman for DSM Nutritional Products, one of the largest manufacturers of the synthetic vitamin.
Leong also fielded several enquiries about the study.
“Four people have stopped by my stand to ask about this study. The last thing we want is for the consumer to stop taking vitamin E,” he added. |
I have to take Leong to task for being quoted in the article as saying "meta-analyses are often highly speculative because of the different variables in each study". Meta-analyses if carefuly done represent one of the most powerful tools of Evidence Based Medicine. In fact it would be considered
Level 1 in the various tiers of EBM. To sally a Level 1 EBM method as "speculative" is in my view irresponsible. I would also take him to task for "advocating the use of all seven forms found in nature" without any Evidence to back this advice. Of course the last thing manufacturers want for consumers to do is to stop taking vitamin E since this would affect their sales. But until there is strong evidence to support doing so, one cannot advocate it for prevention of CAD.
This writer does not take any vitamin E supplements!
All choked up
Well I am. Truly sad to read that
Girl chokes to death on sweetAn evening bicycle ride routine for a three-year-old girl turned tragic when she choked on a sweet and fell from her bicycle in Sri Petaling here on Sunday.
Three-year-old Wong Poh Yan died when she choked on a sweet while riding a bicycle near her home in Sri Petaling on Sunday. Her maid tried to remove the sweet but failed. She was rushed to a nearby clinic but was pronounced dead on arrival.
Wong Poh Yan's father rushed her to a nearby clinic minutes later but she was pronounced dead upon arrival.
A post-mortem at the Universiti Malaya Medical Centre yesterday revealed that she had choked to death. |
What is sad is that appropriate First Aid might have saved this young child. How many of you know how to apply the Heimlich Manuever properly? The procedure for adults and children is different. It also needs to be modified for unconscious patients. Who was Dr. Heimlich? The
Heimlich Institute has the background and it tells of
Dr Henry Heimlich who has devoted his life to many innovative life saving techniques and devices - not just the maneuver which he is famous for.
So in case you don't know anything about the
Heimlich Manuever, do yourself a favour and take the link and arm yourself with knowledge on
how to save a Choking victim. It could well save a life.
Update: Catholic Doctors' Association
The
Catholic Doctors' Association of Malaysia has been revamped and the
MMR's Professional Societies and Associations page of links has been accordingly updated.
The new site looks great and runs on
Blogger's publishing engine. You might be interested to read articles like
Assisted Reproductive Technology from the Catholic Doctors' viewpoint.
Feedback: NKF
Ferida writes
The National Kidney Foundation of Malaysia has redesigned its website at www.nkf.org.my but your link does not take one there.
The NKF website is informative and very helpful to kidney patients and I am told it is now being managed, updated and information written by a very senior journalist who now works as the Communications / Public education manager.
As i know many people who are kidney failure, please highlight their link where possible. Thank you. |
Thank you for writing in Ferida. I checked the
MMR's Societies page and indeed the
National Kidney Foundation is listed with the correct link. In fact searching with the above Google link for "National Kidney Foundation" takes one to the correct page and link.
That said, I think too the NFK's current site is well designed and kudos to the webmaster for keeping it up-to-date.
Expired Chinese medicines
It is commonplace to find expiry dates on "Western" medicine packaging or bottles. But have you given a thought to the fact that Chinese medicine too has a limited shelflife? Now the Federation of Chinese Physicians of Malaysia and Medicine dealers association of Malaysia admit that the majority of Chinese medicine Halls in the country, do not keep an inventory of their medicines.
RedNova reports:
Negligence and the failure of retailers to keep an inventory of their stocks have led to expired traditional medicines being sold in Chinese medical halls.
Most of the medicines are imported from China.
According to the Federation of Chinese Physicians and Medicine Dealers' Associations of Malaysia, most of the over 5,000 Chinese medical halls in the country do not keep an inventory of their traditional medicines.
Its secretary, Thong Choong Khat, said such medicines had a shelf life ranging from two to three years like the Western medicines registered with the Health Ministry.
"However, most of the retailers do not keep an inventory of their stocks with regards to the manufacturing, purchase and expiry dates like what their counterparts in pharmacies are doing.
"As a result, it is common for them to accumulate stocks of traditional medicines after some time and unknowingly sell them to their customers even after the expiry date. |
Consumers beware.
Poor State of the Health System
In The Star,
Boy with tumour still short of RM56,000
 IPOH: More than RM23,000 in donations poured in for four-year-old Teo Kheng Leong, who is suffering from a lymphatic tumour on the right side of his chest, after his plight was highlighted 10 days ago.
The money, however, is still not enough for the two operations to remove the tumour and follow-up treatment at the KK Women’s and Children’s Hospital in Singapore.
Kheng Leong needs RM80,000 and is still short of RM56,654.
Perak MCA Public Services and Complaints Bureau chief Datuk Lee Kon Yin said the boy would be undergoing his first operation on Dec 7 with the initial sum collected.
Perak MCA Public Services and Complaints Bureau chief Datuk Lee Kon Yin (left) presenting the cheque for RM23,346.80 to Teo Cheng Song and his son Kheng Leong.
Thanking donors for the present sum, Lee appealed for more donations to allow the boy to lead a normal life.
On Nov 9, The Star reported that Kheng Leong’s father Cheong Song, 30, a plumber, could not afford the operation with his meagre income and that he had to mortgage his house and exhausted all the money and savings on Kheng Leong’s check-ups at private hospitals in Ipoh and Penang over the last two months.
Treatment in Singapore was sought because local specialists said they could not carry out the surgery. |
Such pleas for donations are becoming more rampant ever since this role was designated to the media by the Minister of Health. Such sympathetic plights usually get a good response from the general public and on many occasions will surpass the amount required. Unfortunately in some cases, the life is lost even before the amount of money could be raised.
The authenticity of each case is at the discretion of the media. Even the amount collected would be under the control of such media organisations. There are hardly any guidelines as to the nature of cases to be highlighted. There is also currently little transparency and accountability as to the unused amount.
There is little doubt that we have good cardiothoracic surgeons in Malaysia who are capable for such a complicated and risky procedure. Perhaps the parents have not exhausted their search for expertise in Malaysia before turning overseas. Mind you, the patient's follow up was also at private hospitals in Malaysia which are notoriously expensive. They obviously had no trust in the public hospitals in Malaysia and would rather beg than subject their son to the infamous environments attributed to public hospitals.
The issue is should the parents be allowed to seek sympathy from the Malaysian public when the procedure involved could be done at a much cheaper rate in Malaysia.
Was it also ethically unsound for these private hospitals to exhaust the family's finances knowing very well that they lacked the expertise to treat the child?
Are there no foundations/organisations in Malaysia that acts to provide funds to needy patients?
News of such plights only reflects the ill state of our health system. We do not have the support services to cater to patients that may need financial assistance. There is little communication or sharing of resources between the public and private sectors in Malaysia. If we are to be a developed nation by 2020, we need to rectify this situation. We need to combine and fully utilise resources at our disposal. We need a health system that caters to all Malaysians, not only the priviledged few. Perhaps revisiting the idea of a National Health Insurance Scheme is wise. An overhaul of our health system, that at the moment appears fragmented and totally disorganised, is needed.
All out of drugs
Well not quite - just Zocor, CoAprovel and Lipanthyl.
The Star reports:
Patients who need medicine from the University Malaya Medical Centre’s (UMMC) pharmacy will be ensured of supplies from Tuesday after the hospital rectifies its current drug shortage.
UMMC acting director Prof Chua Chin Teong said the shortage was a result of increased demand from patients and miscommunication within the centre’s administration.
He said after a discussion yesterday, the administration found that the pharmacy had run out of drugs such as Simvastatin, CoAprovel and Fenofibrate since Thursday.
“We look at this seriously and have taken measures to ensure this problem will not occur again,” he said in a statement yesterday, adding that the shortage was only temporary.
Prof Chua was responding to a news report on a shortage of drugs in the UMMC’s pharmacy. The medication included cholesterol-controlling drugs such as Zocor, CoAprovel and Lipanthyl.
The shortage was pointed out by several patients and a pharmacist has said there was no budget to purchase the drugs by the end of the year. |
A shortfall in drug supply can occur for several reasons - sometimes it's because of manufacturing problems or problems with suppliers not fulfilling their contractual obligations. But a shortfall because of "lack of budget"? It's a pity managerial and administrative deficiencies result in patients suffering. The latter often suffer in silence since they know their drug costs are heavily subsidised. Let's not see this happen too often but at least UMMC is being honest and transparent about it.
Child injury
The Health Minister is reported to say
"Injury Main Cause Of Child Deaths, Disability"Child injury is now a leading cause of child deaths and disability in the country, says Health Minister Datuk Dr Chua Soi Lek.
He said according to the Malaysian Vital Statistics Bulletin, road accidents alone killed 1,232 children in 2001.
"This means three children dying each day," he said in his speech at the launching of the Progress for Children Global Report by United Nations Children's Fund (Unicef), here Thursday. |
What a shame. You can't blame the kids - they don't know any better. But I blame the parents who allow the kids to jump around the car and not insisting on them wearing safety belts or not using kiddy car seats. Worse still are the parent who allow the child to stand on the front passenger seat. They are simply inviting trouble.
Know any such parents personally?
World Toilet Day
I guess this post can be remotely medical in the guise of "Public Health" ;)
I kid you not. November 19 is
World Toilet Day19 November was declared 'World Toilet Day' in 2001 by 17 toilet associations around the world. Since then there has been established an annual World Toilet Summit and many other regional conferences. Each toilet association has also engaged in many activities promoting clean toilets in their own respective country.
Since 2001, World Toilet Day has become a global platform for academics, sanitation experts, toilet designers, environmentalists etc. to share the latest on rural and urban toilets.
The World Toilet Organisation asks each individual, in their respective country, to request better equality (more facilities for women); more accessibility & special provisions (for the disabled & mothers with babies); clean toilets (for everyone); and more toilets (for the less fortunate). |
And would you believe it, there is actually a
World Toilet Organization. If they have International rankings, I'll bet we score as low as our
e-Government rankings!
Feedback: GVHD
Chet writes to ask about GVHD.
Thanks for writing in Chet. GVHD stands for Graft-versus-host-disease which is a complication of allogeneic bone marrow or stem cell transplantation. The 100 day mark is an arbitrary one which is used to separate Acute GVHD (before 100 days) from Chronic GVHD (occuring after 100 days) though the clinical features of the two are also different. The demarcation is not absolute and with some of the newer transplants like mini-transplants, Acute GVHD can occur later than 100 days. Chornic GVHD has also been known to occur earlier than 100 days, e.g. in unrelated transplants. GVHD is not all that bad since some GVHD is important to exert an anti-leukaemia effect.
I believe your niece did have skin GVHD which responded to treatment.
The incidence of GVHD in Asians btw, is lower than in Caucasions.
Further reading:
Graft-versus-host-disease
Free Salsa Dance Lesson
Rather than resort to slimming pills which could do you serious damage, here's a better alternative. The
Heart Foundation of Malaysia is organising a free salsa lesson and performance in conjunction with the Heart Health Event.
The event will be this Thursday at the Giant Supermarket in Amcorp Mall, Petaling Jaya, from 5pm.
What a great way to keep fit! So thought of taking up dancing lessons?
Source:
Bernama
Dangerous slimming scams
Will they never learn? It was only in September, two months back when there was the shocking
Herbal slimming pills and sudden death episode which tragically resulted in the loss of life of a Ministry of Health employee. It seems people are still consuming "slimming pills" from dubious sources.
Although she is
RM7,000 lighter after taking slimming pills she was lucky not to have suffered more adverse effects or even died.
A 37-year-old hair stylist was told that who took slimming pills for two weeks ended up with severe side-effects that required medical treatment costing RM7,000.
To make matters worse, she did not lose any weight after taking the pills which she had bought from one of her customers.
Although she filed a police report on Oct 28 on the matter, she said that all she wants is a refund of the RM325 she paid for the box of capsules, and to warn others about the dangers of such weight-reducing drugs.
Lai Yet Sar, 37, a mother of four from Jinjang, said she was introduced to the product by a customer who, in August and September this year, came thrice to the salon she worked for.
She was told to consume a packet of eight capsules a day — two in the morning with a special tea that came with the slimming product, two with water in the afternoon, and four at night with water.
"Two weeks after taking the capsules regularly from Sept 5, I developed severe chest and stomach pains and began vomiting. I also suffered giddy spells and was unable to eat," said Lai at a Press conference yesterday. She then sought treatment at Selayang Hospital and Hospital Kuala Lumpur before visiting a gastro-enterology centre in the city several times. |
She claims that all she wants
is a refund of the RM325! My goodness. I think we should demand more than that. I think the full force of the law must come down hard on people who peddle illegal and potentially dangerous drugs. It seems to me the enforcement arm of the MOH is suffering from muscle atrophy.
Do we need to see more deaths from ingestion of illegal slimming pills before serious action is taken?
Lost in cyberspace
I have notice the past few days, email from the
Feedback form is not working all the time - only very intermittently. The form works fine but I am not consistently receiving the messages in my email inbox. There's no response from my hosting company's support and I can't call them as they are still on holiday :(
So if any of you have tried sending feedback, please be patient. Post a comment here if you sent feedback the past week but did not hear from me.
This also affects the
Locum submissions.
Thank you for your patience.
IMU: Bachelor of Nursing
The
International Medical University will be starting a
Bachelor Of Nursing course in February 2005.
Thanks to
YP for the heads up.
Quoting the Dean, Prof Victor Lim:
He said that this is a four-year or 8 semesters full-time programme leading to the award of an IMU Bachelor of Nursing (Hons) degree. In line with the university mission, the nursing programme aims to prepare graduates with the scientific knowledge, skills and right attitudes to enable them to provide the best quality care to patients.
“Nursing is a noble and increasingly attractive profession which focuses on aspects such as caring, nurturing, educating and being researchers in the health care system. Caring remains the essence of nursing. It is the caring behaviour and practices that distinguish nursing from other professions.”
“With better education opportunities, nurses are now eligible to take up senior positions in health care organizations. Apart from becoming nurse managers and nurse administrators, they can now become university professors, researchers, nurse specialists, consultants and senior executive officers.” |
My worry is where they'll get the teaching staff from. More pinching from the Government and Universities?
World Diabetes Day
November 14th has been designated World Diabetes Day. Interestingly, the date was chosen as it is the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in October 1921.
This year's theme is
Fight Obesity Prevent Diabetes. The problem of obesity has been highlighted in
MMR in July this year.
There is no short-cut to tackling obesity other than to maintain a sensible diet and to excercise regularly.
Trouble with alot of nutrition resources out there is that there is scant data for Asian food. Well, if you own a Palm PDA, you can carry the database with you and work out how many calories, mg of cholesterol, sodium etc for various types of Asian food. The database is available for free download from the
KVPUG Yahoo group in the files section. You have to register (for free) with Yahoo and then join the group before you can download the file. The database is available in HanDbase, MobileDB and PilotDB formats for PalmOS. If you are interested in other formats, please read the included readme.txt file.
The other question you should ask is are you Obese?
Again if you use a Palm PDA you can keep track of your measurements using a special calculator called
Fatcalc which you can download from Palmgear.
 Estimates your Body Fat according to BMI, Ideal Body weight and Fat content. Also calculates your BMR, Daily Calorie requirements and has a guide to how many Calories you'll burn according to type of physical activity/exercise.
You can Load/Save your data so that you don't have to re-enter measurements. This will also allow you to keep track of your weight and other measurements by Date.
|
Here's wishing all Muslims a Selamat Hari Raya! Hopefully if you are a Muslim diabetic, you followed the
Ramadan Guidelines for diabetics...
Links:
International Diabetes FederationWHO Diabetes ProgrammePersatuan Diabetis Malaysia (the webmaster here hasn't updated the site for sometime and certainly no mention of World Diabetes Day 2004 but only the 2002 one!)
Forensic pathologists - critical shortage?
The issue was highlighted in the Malay Mail:
For want of a pathologist, a case was lost? On Dec 30, last year, the body of a five-year-old murder victim was kept in "cold storage" at the Ipoh Hospital as no pathologist was available to conduct a post-mortem.
As such, the probable time of death for Winnie Chew Yin Wai, who died of strangulation, was not disclosed.
This missing link proved crucial in the murder case against the girl's mother, 42-year-old Kong Yik Lin.
Yesterday the High Court acquitted Kong without calling for her defence, after citing a failure in the prosecution to establish a prima facie case.
Judge Datuk V. T. Singham said there was a lack of medical evidence on the death as the post-mortem was only conducted a day after the victim's death.
Singham dropped another bombshell when he said it was the third such case where no pathologist was avaliable to conduct post-mortems.
He said in one of the said cases, it was a medical officer (MO) who conducted a post-mortem while receiving instructions through the telephone! |
Shocking state of affairs as far as the country's forensic pathology services goes? Hardly CSI stuff.
The Deputy Health Minister then appears to be in "denial mode" when he is quoted in the NST as saying there are "
Enough forensic pathologists in the country"
There are enough forensic pathologists in the country, Deputy Health Minister Datuk Dr Abdul Latiff Ahmad said today.
He said there was one chief pathologist in every State, supported by other pathologists specialising in different medical disciplines.
"We are not suffering from any major shortage. In fact, we have enough pathologists nationwide," he said during a visit to the Balik Pulau Hospital here.
"The ministry is also training new pathologists to meet future demands."
Dr Abdul Latiff, however, could not provide the exact number of pathologists in the country. |
Really, Dr Abdul Latiff? Readers of the NST must have been perplexed when the next day, the NST carried the story "
Critical shortage of forensic pathologists"
Malaysia needs at least 50 forensic pathologists but has only 19. Five States have none, said a health official.
When a forensic pathologist is required, one of the four on the Kuala Lumpur Hospital's staff is flown out, the official told the New Straits Times. The shortage has reached a critical stage, due to growing workloads and the need for more detailed examinations of bodies, said the official, who declined to be named. |
So perhaps this nameless health official, who is apparently contradicting what the Deputy Health Minister is saying, tells of the true picture? Why hide the facts?
The lack of forensic pathologists is not unique to Malaysia. Even in Australia,
a lack of pathologists is causing long delays in burying or cremating the deceasedPerhaps forensic pathology is not glamorous enough a specialty to attract young doctors? Shows like
Quincy ME aren't enough to attract more to this field. We need first of all to acknowledge that we are short staffed in this area. No point denying there is a problem. Address it by recruiting more trainers and have a better career and salary structure to retain your staff. Let's face it, forensic pathologists are going to be government employees and unless the government wants to see more unsolved murders or botched post-mortems and waste of courtroom time, then something has to be done urgently.
Links:
Malaysian College of Pathologists( I think the MCOP could do with a new website with a proper domain rather than this Geocities one which hasn't been updated in a while. If there is a new link please let me know )
High dose vitamin E useless for heart disease
Are you one of those still taking high dose Vitamin E supplements in the belief that they are beneficial for the prevention of coronary artery disease?
Well, it has recently been reported in the Annals of Internal Medicine that high doses of Vitamin E may actually be detrimental. The
American Heart Association has the news:
To determine if there is a “dose response,” researchers examined different doses of vitamin E supplements and risk of death from any cause. They studied death rates in published clinical trials comparing vitamin E supplementation to placebo and included findings from 14 studies, from 1993 to 2004. Doses ranged from 15 to 2000 IU/day, and average intake was about 400 IU a day.
“Increasing doses of vitamin E were linked to an increase in death,” said lead author Edgar R. Miller, M.D., Ph.D., associate professor of medicine at Johns Hopkins University in Baltimore, Md.
According to the analysis, there is no increased risk of death with a dose of 200 IU per day or less, and there may even be some benefit. However, an increased risk was found at amounts above 200 IU per day and significant risk of death was found starting at 400 IU a day. Those who take greater than 400 IU of vitamin E a day are about 10 percent more likely to die than those who do not, researchers said.
“Many people who take vitamin E supplements take between 400 and 800 IU in a single capsule,” said Miller. |
This goes to show the importance of
meta-analyses which pools the data from many smaller studies which alone may not be as informative or even as accurate.
Advance Directives
Recently in The Star,
A patient’s final decision
When a terminally ill woman returns home to Europe for euthanasia, a doctor wrestles with his ambivalence. .....Cont.. |
Euthanasia remains a controversial issue even in advanced countries like the United States. In Malaysia, this issue is non-debatable. It contravenes all religious principles and the Hippocratic oath. In terminally ill patients, however, grappling with the idea of euthanasia becomes more tangible and perhaps understandable. Nevertheless, the reasons for writing this is not about euthansia but rather the idea of advance directives. It involves patients that can no longer make important decisions due to mental incapacity at the time these decisions are warranted. The burden is then passed on to the next of kin which on some occasions may not have the patient's best interest in mind.
Here is a scenario. A 70 year old man with a previous stroke and a background history of diabetes presents with a gangrenous foot. His stroke has caused all reasonable cognition to be lost and has been bedbound since. The medical decision is that this foot has to be amputated. Unfortunately, the children whom sadly are not involved in his care, have decided against the much needed operation which if not performed, would certainly spell death. This man was seen as a "burden" and thus anything that would facilitate death may be seen as invigorating. The question is would the patient in a better frame of mind be making the same decision? Do the decision makers have the patient's best interest at heart?
Advanced directives are meant to relate the wishes of the patient during times where he/she is still mentally capable of rational decision making before disease corrupts the body and mind alike. For example the idea of active resuscitation. It can also be written by healthy individuals for times when disease may appear too swiftly. Perhaps
this site explains the idea of advance directives more clearly. Malaysians should explore this idea further as we grapple with more ethical issues in future. It is a living will that appears as an insurance incorporating the patients choices in events of ill health and mental incapacity.
What are your opinions on this?
The heart of a Volunteer
The world today is filled with chaotic scenes. From battle zones in the Middle East to the poverty and starvation in Darfur, many fellow humans are stranded, lost between warring factions. Helpless and disorientated, many have resorted to thriving in living conditions that only rodents would be proud of. The outside world it seems, is oblivious or perhaps have turned a deaf ear to their silent plights.
Just when all hopes are lost, the emergence of individuals showing the bravery of a tiger and the compassion of a saint called volunteers, provides light at the end of the tunnel. It is a mystery what drives these souls to voluntarily uproot themselves from the luxury of a metropolitan city and settle in conditions that are often described as uninhabitable. Their presence provides a precious sense of hope. Battle scared on most occasions, refugees welcome the sight of a non-hostile human, bearing not weapons but much needed food and medicines.
The ghastly cold blooded killings are incomprehensible. War torn countries destroy centuries of treasures in a fit of rage and for reasons that sometimes seem utterly childish. They leave behind a trail of destruction. Scores are eradicated from their homes and driven to foreign and unfamiliar territories. Seeking refuge in areas that will only display further hostility, with basic amenities that many of us take for granted, scarce.
Only one hope remains. The heart of a volunteer.
Mercy Malaysia
Feedback: Gassy question
W writes:
| what makes gas in my stomach for about 1 month now? i did a scope on my stomach and ultrasound seems ok |
Excessive "gas" is a common complaint. It may manifest as belching, bloatedness or flatulence. Like all other symptoms, the underlying cause or diagnosis requires first and foremost a thorough history taking, a thorough physical examination and then only appropriate tests. You may be interested to read this very good article on
Gas in the Digestive tract and armed with information, do go back to your doctor with the same question.
Feedback: Complaint about a clinic
Ivy writes in to say she has a complaint about a clinic.
Well Ivy, you didn't say what the nature of the complaint is. If it is alleged unprofessional conduct of the doctor concerned, then the proper channel is to lodge a report with the
Malaysian Medical Council. For other complaints it really depends on the details and you may have to go to various bodies like the local council or even seek legal redress (consult your lawyers) for contractual matters and what-not.
Whither the NHFS?
Personal Money has an excellent issue out this month with articles on Affordable Healthcare for All as the theme.
One thing caught my eye which I think is a problem with many of the current health coverage policies offered by private insurance companies in Malaysia:
| The weakness in a number of medical insurance policies, including Sihat Malaysia, is that they are annual policies, and insurance companies have the right not to renew policies |
I have had quite a few patients where after falling sick, they get hospitalised, they get their insurance claims and what follows? The insurance companies then refuse to renew the policies the following year. To my mind that means the insurance companies only intend to insure healthy people.
What's the point?The article also mentions that some companies now offer "guaranteed renewable medical insurance". Well and good. I think you could go for this sort of policy. Read the fine print. Question your agent. Is the insurance renewable? If it is, what are the exclusion clauses? If your insurance is not "guaranteed renewable" I would suggest strongly that you switch.
In the meantime, there is also an excellent article on "Social Insurance For All" in the same issue of Personal Money. At least our neighbnour down south has a system in place. What about Malaysia? There was talk about a "National Health Financing System". This is preferable to a hodge-podge collection of private health care insurance with differing policies. Why is the Malaysian Government dragging it's feet in this important issue? The
MMA's stand is that the NHFS should not be privatised or profit-orientated. The MMA president said "..the NHFS should protect everyone regardless of their age, income level and station in life, it should provide comprehensive basic healthcare service to the sick". The MMA also issued a
Press Statement on this matter back in 2002.
We keep hearing officials praising the "affordable public healthcare" in this country. True, visits and drugs are heavily subsidised but what are the problems? In
Complaints against the Health Ministry (
MMM permalink), the Health Secretary-General was quoted as saying “Some of the complaints involved the ineffectiveness and arrogance of certain medical staff and nurses, harsh treatment and the unfriendly attitude towards patients, long waiting time and delay in arrival of doctors who are “on-call” in rural clinics”. Yes it is the long waiting list which is a problem which still deters the public seeking care in the public health sector. This is not to mention the
Overcrowded wards.
I think we urgently need the NHFS. This would take off some of the burden from the public healthcare services. Every concerned individual should lobby his or her MP. Perhaps there should be a concerted effort for a fresh joint petition?
Locums - should this be compulsory?
Wel, there's the not suprising news that the
plan to build private wings in public hospitals has been scrapped - we did not think it would be a very good idea in the first place.
In the same news story:
Meanwhile, doctors would be allowed to take 20 hours of locum, or substitute, work a month, standing in for doctors who were off or on leave.
Locum work, currently allowed for emergency units, will also be allowed at outpatient departments. The current rate is RM30 an hour, the same as in private practice. |
Now that the MOH will extend the locum system within the Government hospitals I hope someone will implement a
minimum staffing requirement - meaning that if a particular unit falls short, then employing locums would be compulsory. You can't expect a short-staffed department to function properly, certainly not in a key area like health care.
What say you?
Late diagnosis of cancer
The Health Minister hit the nail on the head when he commented on the problem of late diagnosis of cancer in this country. As reported in
The StarEighty per cent of cancer cases in Malaysia were diagnosed only at the advanced stage due to lack of awareness, Health Minister Datuk Dr Chua Soi Lek said.
He said the patients had sought treatment from unprofessional medical practitioners such as bomoh and sinseh (traditional Chinese medical practitioners) during the initial stages of cancer.
“Forty thousand cancer cases were reported last year, which is a serious issue, and about 80% of them were diagnosed at a late stage.
“Most of the patients also feel too embarrassed to go to the hospital and would rather seek traditional treatment,” he said. |
Curing cancer requires screening, early detection and appropriate treatment. Unfortunately this country has a lot of quack medicine and in my opinion traditional healers should be barred from treating cancer patients. I have seen far too many cancer patients having proper treatment delayed because they sought treatment from bomohs, sinsehs and what-not first. In my opinion these traditional medical practitioners have jeopardised the patients' chances of cure. The best shot at cure is always the first shot. Now that the Health Minister has stated the problem, what action will they take?
Free checkups by Socso
It's
reported in the Star today that
Socso intends to provide "free medical checks" for contributors at the age of 40.
Socso contributors who turn 40 will be given free health screening to detect early symptoms of medical problems among the country’s five million contributors.
The screening will include a physical examination and blood tests to detect health problems, including cancer.
If initial test results indicate that a person is at risk of developing diabetes or other ailments, he will be asked to go for a second and more thorough examination.
Should the second screening provide clearer evidence of a high sugar or cholesterol level in the person's blood, he will be put on a special programme to reduce the risk of him becoming a diabetic or a heart patient.
Those found to be suffering from more serious medical problems will be sent to government hospitals for treatment.
The number of contributors who will benefit from the move is still being worked out, but the figure is said to be “substantial.”
Human Resources Minister Datuk Dr Fong Chan Onn said the plan, aimed at providing quality service to contributors, would be implemented soon under a pilot project. |
I have some comments to make. Firstly I think to use the word "free" is stretching the truth somewhat if the funds come from Socso and ultimately this comes from Socso contributors themselves.
While I am sure intentions are good, one must also question the ultimate usefulness of a one-time medical checkup. The analogy is sending your car for only one check when it is 4 years old. For preventive healthcare, you need to see your primary care doctor on a regular basis and not only once when you are 40 years old.
The screening is supposed to include cancer detection. I hope for goodness' sake they do not incorporate blood tumour marker tests. I have already
mentioned that blood tests for tumour markers as a screening procedure for cancer are
not useful and may be misleading in that the test may be falsely negative or falsely positive giving rise to unnecessary further investigations and anxiety. This was highlighted in the NST back in August in the report "
Indiscriminate testing raises doctors’ concern". What then are the proper screening tests for cancer? I posted
Cancer Screening Guidelines earlier according to American Cancer Society. The only blood test mentioned as a screening procedure is the PSA and even this
may not be as useful as we think.
Well I await further details on this development, in particular what the actual screening process comprises.
