Usage of Traditional and Complementary Medicine (T & CM): Prevalence, Practice and Perception among Post Stroke Patients Attending Conventional Stroke Rehabilitation in A Teaching Hospital in Malaysia.

INTRODUCTION: The lack of evidence that proves the benefit of traditional and complementary medicines (T & CM) in treating chronic medical conditions does not deter its usage among patients worldwide. Prevalence of usage among post-stroke patients in Malaysia especially is unknown. This study aims to determine the prevalence, practice and perception of T & CM use among stroke survivors attending an outpatient rehabilitation program in a teaching hospital. METHODS: A cross-sectional study was conducted among 104 post stroke patients attending an outpatient rehabilitation program. A structured self-administered questionnaire was used to collect data on sociodemographic and clinical profile of patients, as well as types of therapy used and perception on T & CM usage. Descriptive analysis was done, and bivariate analysis was used to determine associations between categorical data. RESULTS: Mean age of patients was 62 years (SD 12.2), 54% were Chinese and 75% of the patients had ischaemic stroke. Mean age of T & CM users was younger compared to non- T & CM users (61 years vs. 66 years, p=0.04). Two-thirds (66%) of patients admitted to concurrent T & CM usage while attending conventional post stroke rehabilitation. Acupuncture (40.4%), massage (40.4%) and traditional Chinese medicine (11.5%) were the most common T & CM used. Positive perception was recorded in terms of ability of T & CM usage to relieve post stroke symptoms (68%), and it was safe to use because it was made from 'natural sources'. Negative perception recorded: T & CM caused significant adverse effects (57.6%) and was not safe to be used in combination with other conventional medicines (62.5%). CONCLUSIONS: Concurrent T & CM usage among post-stroke patients attending structured outpatient rehabilitation program is widely practised especially acupuncture, massage and traditional Chinese medicines. Overall the perception towards its use is favourable.

Etiological factors of constipation in the elderly, with emphasis on functional causes.

Constipation is a particularly troublesome complaint in the elderly yet it is usually considered to be a simple management issue. Therefore physicians' lack of interest in and inadequate training about the etiology of constipation may contribute to their inability to manage the problem of constipation effectively. Constipation can become a chronic problem, refractory to management, and most likely the result of lifelong patterns of bowel and dietary habits and laxative use, along with the interaction of pathophysiological and perhaps senescent changes of gut motility. This article reviews the types and causes of constipation and the management of the problem in the elderly.

Invasive fungal infections in living unrelated renal transplantation.

In many developing countries, renal transplantation from paid, unrelated donors constitutes the main type of renal transplantation. Several medical and social problems are likely to occur in association with this practice. Among the many medical complications, invasive fungal infections are the most feared. In this report, we describe our experience with 3 patients who underwent living unrelated renal transplantation (LURTX) and developed this complication. One patient developed disseminated mucormycosis, 1 developed invasive aspergillosis (IA), and the third developed central nervous system (CNS) infection with Ramichloridium mackenziei. Two died within a few months after the diagnosis, whereas the third developed hemiplegia and is debilitated.

Physician's perceptions of fever in children. Facts and myths.

OBJECTIVE: To ascertain the knowledge and attitude of physicians, regarding fever in children. METHODS: A self-administered questionnaire was mailed to 600 randomly selected pediatricians, family practice physicians, emergency medicine physicians and general practitioners, who practice in Saudi Arabia. Appropriateness of responses to questions was determined on the basis of current medical literature. A rectal temperature of 38.0 degrees C is generally accepted as indicative of fever in children. RESULTS: Of the 600 physicians surveyed, 419 (70%) completed and returned the questionnaire; 17% of the physicians were consultants, 28% specialists and 55% general practitioners. Fifty-eight percent of the physicians had 10 years or more of experience. A rectal temperature of less than 38.0 degrees C was considered to indicate fever by 38% of physicians. Nearly 84% of physicians would initiate antipyretic therapy at a temperature of 38.5 degrees C or less and 56% cited a temperature of 40.0 degrees C or less to be dangerous. Only 5% believed that fever was not dangerous, while the remaining cited the principal danger of fever to be convulsions (69%), brain damage (35%), or death (8%). The responses to the main purpose of antipyretic treatment were to prevent convulsions (70%), to make the child comfortable (55%) and to prevent brain damage (29%). Approximately 53% of physicians reported that the most serious consequences of febrile convulsions were brain damage, learning disability, epilepsy, or death. Only 26% of physicians agreed that a sleeping child with fever should be left undisturbed. Approximately 25% advised inappropriate dosage or administration intervals of paracetamol. Almost all physicians recommended sponging or bathing to reduce fever. All respondents try to educate parents regarding fever and its management. CONCLUSION: A significant number of the surveyed physicians have demonstrated a serious lack of knowledge of the nature, dangers and management of an extremely common health problem. Physicians differ substantially in their knowledge of, and attitude toward fever in children, which is perhaps attributed to their different background in medical education and clinical training.