Perception Towards Health Promotion Activities: Findings From A Community Survey In The State Of Penang, Malaysia

The study aimed to explore the perceptions towards health promotion activities among population of Penang Island, Malaysia. The study was designed as a questionnaire based cross sectional analysis. General public from the district of Jelutong, located in the state of Penang, Malaysia was conveniently approached for the study. Descriptive statistics were used to ascertain demographic characteristics where as inferential statistics were employed to measure the extent of association among study variables. Out of 480 respondents, a response rate of 82.7% was achieved. The study cohort was dominated by females (63.0%) and majority of the participants belonged to Malay ethnicity (88.1%). One hundred and seventy two (43.3%) never attended a health promotional campaign and mentioned lack of time and transport as potential barriers. Among those who attended such activities, one third was satisfied with the benefits of health campaigns. Approximately 90% of the participants demanded accessible locations, common language as mode of communication and complete medical checkups with professional advice at health promotional campaigns. General public can encouraged to participate in the health promotion activities by considering their priorities before designing a health promotion program. This will help in targeting and achieving the goal “health for all”.

Clinical Significance Of Serum HbeAg Among HbsAg Positive Patients.

Hepatitis B Virus (HBV) infection is a menace worldwide as a major cause of morbidity & mortality through its consequences viz. acute hepatitis, chronic active, or persistent hepatitis, cirrhosis of liver and primary hepatocellular carcinoma. A total of 127 'HBsAg positive' patients were studied for 'HBeAg' by serum ELISA. Patient's aged between 11 to 60 years with a mean age 27.11. Out of 127 'HBsAg positive' cases 19 (14.96%) were 'HBeAg positive', of which maximum (21.43%) were among <20 years age group. Among 106 male patients 15 (14.155) & among 21 female patients 4 (19.055) were 'HBeAg positive'. Often the initiation of therapeutic approach remains a dilemma in absence of laboratory assessment of viraemic load or presence of HBV DNA through PCR or other DNA hybridization techniques. In such situations, alternatively, a significantly serum 'HBeAg' among 'HBsAg positive' patients may be taken as a surrogate marker for acute viral replication, and, thus apply justifying the initiation of antiviral chemotherapy without delay.

Effect of Tranexamic Acid after Cardiac Surgery in Children.

Background: The antifibrinolytic drug tranexamic acid (TA) decreases blood loss in Pediatric patients under going cardiac Surgery. However its efficacy has not been extensively studied in children. Method: We examined 750 children under going cardiac surgery form 2004 to 2007 in National Institute of Cardiovascular Diseases (NICVD), 379 children in the Tranexamic Acid group (TA) and 371 included in placebo (P) group. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (10mg/kg followed by 1mg/kg/hr) and saline placebo. After admission to intensive care unit total blood loss and transfusion requirements during the first12 hours were recorded. Result: Children who were treated with tranexamic acid had 24% less total blood loss (26±7 vs 34±17 ml/kg) compared with children who received placebo (p<0.05). Additionally, the total transfusion requirements, total donor unit exposure and financial cost of blood components were less in the tranexamic acid group. Conclusion: Tranexamic acid can reduce perioperative blood loss in children undergoing cardiac surgery.

Ebstein’s Anomaly Corrected by Tissue Valve: Case Report.

Ebstein’s anomaly is a rare form of congenital heart disease with incidence of 1% of all congenital heart diseases. There are two modes of surgical correction of Ebstein’s anomaly: either biventricular repair with or without tricuspid valve replacement, or palliative univentricular repair consisting of bidirectional Glenn shunt or Fontan procedure. We treated a case of severe form of Ebstein’s anomaly with ASD secundum with WPW syndrome. Radiofrequency ablation was done to treat WPW syndrome preoperatively. Celermajer’s index is a prognostic indicator for tricuspid valve repair or replacement. On 04.03.08 tricuspid valve was replaced with 31 mm Carpentier-Edwards bovine pericardial valve under cardiopulmonary bypass. Postoperative period was uneventful. Follow up echo done on 01.06.08 which revealed normally functioning tissue valve found in tricuspid position TR Grade I. So, in conclusion, preoperative evaluation and workout of Celermajer’s index is essential before surgical intervention for decision of tricuspid valve repair or replacement. Last but not the least, any event of arrhythmia should be properly evaluated.

Aspects of Infection in Intensive Care Unit - Prevention and Control.

Intensive Care Unit (ICU) is the most vulnerable area in the hospital premises. Hospital acquired infections in critically ill patients as well as of transmission of infections from a patient to another patient or to the health care workers or vice versa can occur in ICU. ICUs combine physicians, nurses and allied health professionals to manage patients with life threatening single or multiple organ system failure, including stabilization after surgical interventions. It is a continuous management including monitoring, diagnosis, and support of failing vital functions as well as the treatment of the underlying disease. Here we have to discuss the source of infection and their effective control measurement in intensive care unit. Ventilator associated pneumonia (VAP) as well with other sources is most common nosocomial infection having 33% mortality in ICU.

Evaluation of hospitalized infants and young children with bronchiolitis - a multi centre study.

Four hundred and twenty nine young children with bronchiolitis admitted consecutively in different hospitals of Bangladesh were evaluated. Three hundred and forty eight children studied for their putative risk factors, clinical profile, management and the outcome. Both cases and controls were examined for respiratory syncytial virus (RSV) antibody status. The diagnosis of bronchiolitis was made on the basis of first attack of wheeze in previously healthy children below two years of age. Detailed history including the possible risk factors, the management and daily follow-up on the ward and the outcome at discharge were documented through a structured questionnaire. Chest x-ray was done in each case to find out the radiological changes. Blood of 266 patients and 30 controls were studied for RSV IgM and IgG antibody by ELISA. There were 66% male and 34% female children. The median age of the children was 3.0 months and 82.7% were below 6 months of age. Most of the babies were born term (88%), with ABW (73%), by normal vaginal delivery (88%). Exclusive or predominant breast-feeding were given in 72% cases. The location of the patient was rural in 55% cases. Around half of the parents were illiterate or slightly educated (up to 5 years schooling) fathers 46.5% and mothers 56% and majority of the parents were poor (74%). In 52% cases the number of family members in one room were four or more. Half of the parents (52%) were smokes and there was atopy in 26.5% families. The clinical features of bronchiolitis were mostly cough (99%), respiratory distress (97%), feeding difficulty (93%) and fast breathing (96%) (median RR 68/min). Fever (1000F or more) was in only 33% cases, though parents complained in 90% cases. All children (100%) had wheeze and crackles in lungs in 96% cases. Liver could be palpable in 83% and spleen in 42% cases. Important radiological features were increased translucency (96%), increased interstitial markings (87%), hyperinflation (75%) and streaky densities (61%). In 69.6% cases TLC was 12,000 or less and only 15% with a neutrophil fraction greater than 60%. Children were positive for IgM antibody in 43.6% cases and both IgM and IgG in 5.3% cases. The main modalities of treatment were antibiotics (99%) (Ampicillin, 76%), oxygen therapy (83%), nebulised salbutamol (76%) and intravenous fluid (51%). The median duration of hospital stay was 4 days. Most of the children were discharged with improvement (96%) with 2% mortality. Not a single case was diagnosed as bronchiolitis in hospitals outside Dhaka. Cefrtiaxone (72.5%) and parenteral steroids (70.5%) were the mainstay of therapy there.

Antiviral therapy: respiratory infections, chronic hepatitis.

This review focuses on the activity, clinical pharmacology, and clinical indications of antiviral agents used in the management of influenza, respiratory syncytial virus infections, and chronic hepatitis B and C. Two neuraminidase inhibitors, a new class of antiviral agents, were recently approved for the treatment of influenza A and B in children.

Anti-herpes viruses agents.

Antiviral agents with demonstrated efficacy are currently available for the management of infections in children caused by the herpes viruses including herpes simples type 1 (HSV1) and type 2 (HSV2), varicella-zoster virus (VZV), and cytomegalovirus (CMV). Recently, progress has been made in the development of newer agents with enhanced activity against these viruses including resistant strains. This review focuses on the activity, clinical pharmacology, and clinical indications of antiviral agents used in the treatment of infections caused by the different herpes viruses in children.