Biomedical subjects

M I Merican

Publications and source records attributed to M I Merican.

4 recordsLinked to original sources

PubMed2004

Developing the Malaysian health system to meet the challenges of the future.

The Malaysian health care system is a success story among countries of equivalent socio-economic status. However there are numerous challenges faced by the nation, which create the need for changes and reform. There is rising consumer demands and expectations for high technology and high cost medical care due to improved standards of living, changing disease patterns and demographic changes, inadequate integration of health services, maldistribution of resources and the threats as well as opportunities of globalisation and liberalisation. The changes in health policy, priorities and planning for the country are guided by the country's development policies, objectives and the challenges of Vision 2020, Vision for Health and the goals of the health system in ensuring universal access, improving equity and efficiency and the quality of life of the population. The essential services in the health system of the future are information and education of individuals to empower support for the wellness paradigm. There is also a need to restructure the national health care financing and the health care delivery system. The present roles and responsibilities of MOH also need to be reviewed.

Delivery of Health Care↗

PubMed1992

Hepatitis C: an update.

The identification of the Hepatitis C virus using molecular cloning techniques, besides making the term Non-A Non-B Hepatitis obsolete, enables the development of specific assays for the detection of antibodies in HCV-infected individuals, thus making it possible to obtain sero-epidemiological data of the disease. The carriage of Hepatitis C antibody varies worldwide. The disease is most prevalent in intravenous drug abusers or haemophiliacs. Parenteral transmission is the most important route of transmission. Sexual, intra-familial and perinatal transmissions are uncommon. About 40% could be community-acquired (sporadic). Diagnostic tests include enzyme-linked immunosorbant (ELISA) anti-HCV assay, recombinant immunoblot assay, HCV-RNA by polymerase chain reaction and HCV-Ag. More than 50% of acute cases becomes chronic and runs a benign and indolent course. About 20% progress to cirrhosis and some of these develop hepatocellular carcinoma. Several published trials have consistently shown that treatment with interferon in some patients is useful. There is however a relapse rate of 50%. Further trials with interferon and other anti-viral agents like ribavirin are awaited for more effective treatment.

Acute Disease↗

PubMed1992

Management of variceal haemorrhage.

Variceal bleeding is the most important complication of portal hypertension. Mortality due to the first variceal bleeding is very high (50%) and of those surviving a variceal bleeding episode, up to 80% may rebleed. Proper management of the acute variceal bleeding episode, the prevention of rebleeding and primary prophylaxis for variceal haemorrhage are therefore mandatory in order to improve the morbidity and mortality of cirrhotic patients with variceal bleeding. Injection sclerotherapy would be the treatment of choice for acute variceal bleeding. Drug treatment in the form of either a combined vasopressin-nitroglycerin regimen or somatostatin may be used as an alternative. Patients not responding to these treatments should be referred for surgery. For the prevention of variceal rebleeding, non-selective beta-blockers should be tried first, reserving long-term injection sclerotherapy for patients with contraindications or intolerance to beta-blockers or in whom beta-blocker therapy has failed. Surgical rescue in the form of either shunt surgery or lever transplantation should be considered if either treatment fails. A new technique, transjugular intrahepatic portosystemic stent-shunt (TIPSS) may replace shunt surgery in the future. Beta-blockers is the treatment of choice for primary prophylaxis of variceal haemorrhage and has a role in preventing acute and chronic bleeding from congestive gastropathy. However, the above sequential approach from the least invasive to the more invasive therapeutic options may not be appropriate for all cirrhotic patients with variceal bleeding.

Esophageal and Gastric Varices↗

PubMed1989

Management of heatstroke in Malaysian pilgrims in Saudi Arabia.

Heat stroke is hardly seen in Malaysia. However, it occurs commonly in Saudi Arabia during the Haj season. Many Malaysian pilgrims are affected every year and some die. Having faced this environmental hazard for eight years, the Malaysian Medical Mission, sent each year to look after our pilgrims, modified its treatment strategy in 1988 and successfully decreased the overall morbidity and mortality of affected patients without the use of sophisticated equipment. A brief account of the management of 17 cases seen in 1988 is given. Only one died following treatment. The rest recovered fully without any residual neurological deficit or other complications.

Female↗