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Posted: 03 Sep 2011 08:44 PM PDT

He might be a medical man, but his work outside his field of specialty also defines him. Datuk Dr J. S. Sambhi stands tall as a Malaysian who has made significant contributions in medical and health-related work in the country.

HIS eyes burn with a determination and passion that has seen him through his long career as an obsterician & gynaecologist, as well as the voluntary work that is his passion.

He was recently conferred the Malaysian Medical Association (MMA) Outstanding Public and Healthcare Service Reward in recognition of his significant contributions in medical healthcare and related services in Malaysia.

Dr Sambhi received the award from Sultan Azlan Shah, the Sultan of Perak, at a ceremony held at the Ipoh Royal Club.

The award recognises a person (Malaysian or foreigner) who has made significant contributions to medical healthcare and related services for the country or internationally, and/or has been associated with activities of the MMA in the interest of the association and the profession.

Penang boy

Dr Sambhi was born in Penang, in 1931, and had his primary and secondary schooling in Batu Road School, and at the Victoria Institution in Kuala Lumpur.

He went on to graduate from University of Malaya (Singapore) with a degree in medicine, and then completed his postgraduate studies at Oxford, England, majoring in obstetrics and gynaecology.

In 1966, he obtained membership to the Royal College of Obstetricians and Gynaecologists (M.R.C.O.G), and the Fellowship (F.R.C.O.G) in 1982.

He met his wife, Margaret, in the labour rooms at Oxford, and they were married in 1967 in Penang. They are blessed with two boys and a girl, and four grandchildren.

Together with his wife, he started his own private practice in 1972; and in 2008, he was appointed as Fellow of the Academy of Medicine Malaysia.

He awarded with the Federal Datukship (P.J.N) in 2000.

Have a heart

In 1982, when Dr Sambhi was president of the Kuala Lumpur Rotary Club, he proposed the idea of forming a Heart Foundation of Malaysia or Yayasan Jantung Malaysia.

His fellow members of the Rotary Club agreed, and with the encouragement of the Health Ministry, Yayasan Jantung Malaysia (YJM) was officially conceived in 1982. It was then registered as a society in 1984.

Since then, the society has been in the forefront of campaigning for good heart health.

"Back in the 1960s, some of the biggest killers were mostly communicable diseases such as tuberculosis, malaria, typhoid and cholera. As the country progressed, the rate of such communicable diseases reduced, and in recent times, these diseases have almost been eradicated.

"Unfortunately, the number of non-communicable diseases such as heart disease were rising, and this was blamed on the stress and strains of modern living, as well as lifestyle changes due to urbanisation," noted Dr Sambhi.

"Twenty years down the road, heart disease remained the number one killer in Malaysia. The severity of the situation was shocking, and I realised that we needed to do something about it. Hence the idea to form YJM," he explained.

Rising to the challenge

As founder and chairman of the YJM, Dr Sambhi faced a host of challenges.

"I believe that the main challenge for many of us non-governmental organisations (NGOs) lies in obtaining sufficient funds for our programmes and events or activities. In the early years of YJM, our initial goal was to help fund treatment for heart patients overseas, as very few heart surgeries were done in Malaysia at the time," he said.

"As the number of patients increased however, so did the costs involved. Unfortunately, assistance from the public and the Government were not forthcoming, and we were thus unable to meet the demands.

"We realised that we were slightly off-track, and decided to revamp the main goal of YJM, with our main priority and emphasis on the education of preventing cardiovascular diseases. With that in mind, we started off nationwide (including Sabah and Sarawak) heart education and preventive programmes," he explained.

Despite his busy schedule, Dr Sambhi remains actively involved as the chairman of YJM. He explained: "We know that cardiovascular disease is the number one killer, not only in Malaysia, but worldwide. We also know that almost half of the deaths due to them are actually preventable! It is my belief, that education is the main key, and there is no other substitution for it in the prevention of cardiovascular disease. Education is also very important in inculcating the need for better life quality."

He added that a better quality of life can start with just a little effort in changing your lifestyle, and YJM stresses on some simple, but important points, including:

*Diet – low in salt, fat and sugar

*Exercise

*No smoking

*Prevention and control of blood pressure, diabetes, and cholesterol

*Reduce stress

*An annual medical checkup

"The fact that cardiovascular diseases are actually preventable with these simple changes in diet and lifestyle motivates me even more, to be actively involved in Yayasan Jantung Malaysia, even though I specialise in obstetrics and gynaecology," Dr Sambhi explained.

Helping families

Besides Yayasan Jantung Malaysia, Dr Sambhi also has a halfway house for families of heart patients who come to Kuala Lumpur for treatment.

"The first halfway house was started in June 1998, and was set up as a means of accommodation for patients and their families (of low income groups), who have been referred to hospitals in Kuala Lumpur.

"In Kuala Lumpur, many of the hotels are expensive, and low-income families are unable to afford a room in these hotels. For a very minimal fee daily, the halfway house provides comfortable, cheap, and subsidised accommodation for these families, which even includes transportation to and from the hospital.

"The response has been quite good; many of the families stay for about three to five days, while there have been some who have stayed two weeks, depending on the length of treatment. It is very satisfying to see families together, especially during their time of need, and I am very happy that YJM has been able to provide this service to the public," he explained.

"Since I've started practising medicine 50 years ago, the healthcare services in Malaysia have improved by leaps and bounds. Healthcare is now readily available and acceptable by the public; unfortunately, the cost has also accelerated tremendously and we have to be cautious that average, as well as lower and middle class citizens, are not left out from the receiving end of adequate and up-to-date medical care. It is essential that we insist on quality, and not quantity when it comes to receiving the best medical care," he added.

Down time

For a man his age, Dr Sambhi is still going great guns despite his busy schedule. His secret?

"Even with my busy schedule, I still do find the time for some relaxation. It is important not to overtax your body, and of course, in order to help others, I would have to ensure that my own health is in the best possible state first!

"No matter how busy you are, you should always set aside some time for some physical activity. In fact, just 30 minutes a day, three to four times a week, can do wonders to your health. You can also include your family, and use this opportunity to go to the park, for some exercise or a brisk walk, to bond with them and spend some quality time together. That's just what I do every day for 30 minutes – go for a walk in the park with my wife," he shared.

"Everyone faces challenges in their life every once in a while, and no one is free from the stresses of daily life or routines. It is important that we try to overcome our hurdles and problems, facing each one with a positive and optimistic attitude. Of course, at times, certain problems or challenges may be too big for us to face alone, which is why we need our friends, family and loved ones.

"We can share our emotions and feelings with them, while seeking advice or opinions from them at the same time. This helps release our stress, therefore also helping in finding the solutions to our problems. Different individuals may have different methods and ways of facing their own challenges, which may also include exercise, playing a sport, or even meditation," he added.

This octogenarian who has devoted his life to healthcare has one bit of advice for all Malaysians: "God has given us a heart, so that we may live a full and fruitful life in this world. Let us cherish our only heart so that it continues to function without abuse; for, to live is meaningful, but to exist is meaningless."

A safe feed

Posted: 03 Sep 2011 08:40 PM PDT

Food-borne illnesses can place a heavy burden on any healthcare delivery system.

EVERYONE needs to eat to live. Yet the food consumed can be a source of illness, which is self-limiting on most occasions. However, there are instances when people have died from the food they ate.

Everyone is at risk of foodborne illness, irrespective of where they live. There are about 200 food-borne diseases. Media reports on the E. coli outbreak in Germany, melamine contaminated milk in China and the high percentage of bacterial contamination of food sold during Ramadhan are reminders of everyone's vulnerability.

Soon et al in a "Review of food borne diseases in Malaysia" stated that "Half of the food borne related diseases from the early 1990s until today were associated with outbreaks in institutions and schools, mostly due to unhygienic food handling procedures ... the main contributing factor to food-borne diseases was identified as insanitary food handling procedures which accounted for more than 50% of the poisoning episodes." (Food Control June 2011: 22; 6: 823-830)

Food-borne diseases affect the young, elderly and the sick more than others and can lead to a vicious cycle of diarrhoea, malnutrition and even death. It has a negative impact on the healthcare delivery system and economic productivity.

There have been changes in the patterns of foodborne illness. The traditional patterns of localised illness, easy isolation of the causative agent, low mortality and easy treatment with antibiotics are not infrequently replaced with widespread illness, difficulties in isolating the causative agent, high mortality and antibiotic resistance.

The majority of food-borne diseases are preventable with proper food handling, preparation and storage. The authorities are doing their part. However, this article is about what we as individuals can do to ensure that the food we eat is safe.

Foodborne illnesses

Foodborne illnesses are defined as diseases, usually either infectious or toxic in nature, caused by agents that enter the body through the ingestion of food. There are about 200 illnesses that are foodborne.

There are several infectious diseases that are foodborne. The major bacterial infections are salmonella, E. coli, campylobacter and cholera. The Health Ministry's 2009 data reveal that the incidence per 100,000 people for cholera, dysentery, food poisoning, typhoid and hepatitis A were 0.98, 0.54, 30.17, 1.07 and 0.14 respectively, with mortalities reported for cholera and food poisoning.

Salmonella bacteria cause typhoid, paratyphoid and enteritis. The common foods involved include poultry and other meats, milk, eggs and chocolate.

E. coli is a common cause of food borne illness. The bacteria causes gastroenteritis, urinary tract infections and meningitis in the newborn. The emergence of strains that cause intestinal bleeding (enterohaemorrhagic) in recent years have led to severe and occasional fatal consequences, especially in the young and elderly. Although not common, these strains are one of the most serious food-borne illnesses.

Campylobacteria is a common cause of enteritis. The common foods involved include milk, raw or undercooked poultry, and drinking water. It may lead to chronic health problems, eg arthritis, and neurological disorders in 2% to 10% of those infected. Gastrointestinal perforation is a rare complication of infection of the ileum, which is at the end of the small intestine.

Cholera, which is caused by the bacterium, Vibrio cholerae, is a major public health problem in many developing countries. It is a water and foodborne disease. The common foods involved include rice, vegetables and various seafoods. If untreated, cholera leads to severe hydration and even death.

Poisonous toxic material can also get into our food and cause illness. They include natural occurring toxins, metals, environmental pollutants, pesticides, chemicals used for feeding or treating animals or cleaning and illegal food additives.

Naturally occurring toxins, eg mycotoxins, cyanogenic glycosides and toxins in poisonous mushrooms sometimes cause severe illnesses.

Metals, eg lead and mercury, which contaminate food through air, water and soil pollution, damage the nervous system and kidneys in the children and the elderly.

Organic pollutants which are unwanted industrial byproducts and waste incineration e.g. dioxins and polychlorinated biphenyls can accumulate in the environment. These pollutants may lead to various adverse effects in people exposed to it.

Changes in animal husbandry practices have led to disease in humans. For example, bovine spongiform encephalopathy (BSE or "mad cow disease") have been attributed to the increased use of bone and meat as food supplements for cattle. Furthermore, the addition of antibiotics to animal feed has led to concerns about the transfer of antibiotic resistance to bacteria that infect people.

Illegal food manufacturing practices like the addition of melamine to increase the protein content of milk have led to acute kidney damage in children.

Clinical features

The symptoms depend on the causative agent and are usually experienced between one to three days after consumption of the food. However, there may be a longer incubation period in some food-borne illnesses. The common symptoms are diarrhoea, vomiting and abdominal pain. The majority of infections resolve by itself and all that is needed is drinking large amounts of fluids to avoid dehydration.

However, about 3% of food borne illnesses result in long term health problems like kidney damage, arthritis, neurological disorders and even death.

It is vital to seek medical attention if the bowel movements are very frequent, very watery, bloody or lasts more than three days.

Keeping clean

Although food may appear clean, it does not mean that it is safe. It has been estimated that about 2.5 million bacteria are needed to make 250 ml of water appear cloudy while it takes about 15 to 20 bacteria to cause illness.

Cleanliness involves washing hands before handling food and often during its preparation, washing and sanitising all utensils and surfaces used for food preparation, protecting the food and kitchen from pests or animals, and always washing the hands after going to the toilet.

Food should be cleaned during its preparation together with the utensils and surfaces used, particularly when there has been contact with raw meat or seafood. After the meal, the excess food should be put into bin with a cover. The dishes and utensils used should be cleaned with detergent and running water and wiped with a clean dry cloth or left to air-dry.

Food should be kept from pests or animals by covering them, putting them in closed containers, removing rubbish regularly, using insecticides or baits (while making sure they do not contaminate the food) and keeping domestic pets away from food preparation areas.

Washing hands after going to the toilet prevents the contamination of food by faecal material.

Proper cooking

Proper cooking will result in the death of most dangerous micro-organisms. It is known that food cooked to a temperature of 70 degrees Celsius is safe for human consumption as large concentrations of micro-organisms are killed at this temperature within 30 seconds. Particular attention should be given to meat, poultry, sea foods and eggs.

Care must be taken if a microwave oven is used as the temperature in the food may be unevenly distributed. It is noteworthy that certain plastic containers cannot be used because they release dangerous chemicals in the microwave oven.

If a thermometer is unavailable, poultry should be cooked until the insides are no longer pink, eggs and seafood until they are piping hot, and boiling liquids for an additional minute after they have come to a boil.

Cooked food consumed some time after it has been cooked should be reheated before eating.

Safe water and raw food

Safe water and raw food are vital in ensuring food safety. The treatment of water with specified amounts of chemicals and its filtration by the authorities helps in the inactivation of micro-organisms but it is the boiling of water that kills most dangerous micro-organisms. One should not drink or use untreated water from rivers or canals as they contain micro-organisms and parasites.

Raw food should be selected carefully. Fruits and vegetables have to be fresh. Meats and poultry should be slaughtered in hygienic facilities maintained by the authorities. If fruits and vegetables are eaten raw, they must be washed carefully before eating, after throwing away the parts that appear rotten or mouldy. Food that appear damaged or rotten, are mouldy or past its expiry date should not be eaten.

Separate raw and cooked food

Raw and cooked food should be kept separated to prevent the transfer of micro-organisms from the raw to the cooked food. This can be done by using separate dishes and utensils and storing them separately in containers with lids. This should be done at the time of purchase of the food and during its preparation.

Keep food at safe temperatures

Cooked food should be served piping hot and not kept a room temperature for more than two hours. If not consumed immediately, all cooked food as well as perishable foods should be kept refrigerated, preferably below 5 degrees Celsius. This is because micro-organisms multiply rapidly at room temperatures with slower or cessation of growth at temperatures above 60 or below 5 degrees Celsius.

Food should not be stored in the refrigerator for too long. If refrigeration is unavailable, fresh foods should be cooked and consumed immediately.

Thawed food should be cooked without delay.

Food safety involves everyone, i.e. the authorities, companies and people who produce, process, transport, or sell food, and consumers. All have responsibilities for taking the necessary measures to identify and control the hazards that may make the food unsafe. Although proper precautions are taken in most instances, it only takes one slip to cause an outbreak which may lead to fatalities.

Everyone, as consumers, have a responsibility to themselves and their families to ensure food safety by proper handling, preparation and storage. The measures that can be taken are simple and inexpensive.

Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.

Testing for HPV

Posted: 03 Sep 2011 08:36 PM PDT

New HPV test identifies women at greater risk of cervical cancer.

A NEW test from Roche Diagnostics is now available in Malaysia to help identify women at greater risk of developing cervical cancer.

The cobas® 4800 HPV test works by detecting the presence of the Human Papillomavirus (HPV), which is responsible for more than 99% of all cervical cancer cases.

More specifically, the test identifies the two highest risk strains of HPV – 16 and 18 – which together account for 70% of cases.

HPV is contracted via sexual contact, and a woman can become infected even if she has only had one sexual partner, or even if it's been many years since she had sex.

Cervical cancer is the second most common cancer among Malaysian women. Each year it claims the lives of more than 600 women across the country – a rate that is two times higher than that in countries such as the United Kingdom and The Netherlands.

There are more than 100 types of HPV, of which 14 are considered high-risk with respect to developing cervical cancer. Of these 14, two are most likely to lead to cervical cancer – HPV 16 and 18.

Women with HPV 16 or 18 are 35 times more likely to develop cervical cancer than those without HPV. The FDA-approved test identifies HPV 16 and 18 individually, while simultaneously detecting 12 high-risk HPV types as a "pooled" result.

"HPV is a very common infection, with up to 75% of women being infected at some point in their life. With the launch of the test, we are now able to identify women with the highest risk HPV types for cervical cancer, HPV 16 and 18. This is particularly valuable as it allows doctors to better manage their patients accordingly," said Jeffrey Chin, general manager, Roche Diagnostics Malaysia.

Globally, almost 500,000 women are diagnosed with cervical cancer each year, and half of them die from the disease. The majority of these deaths occur in Asia, which accounts for 52% of the world burden of cervical cancer.

About cervical cancer

Cervical cancer is a cancer that starts in the cervix, which is the lower part of the uterus. The cervix is made up of millions of cells, and sometimes, changes can occur in the cells that, if left untreated, can develop into cervical cancer.

With proper testing and treatment, most cases of cervical cancer can be prevented.

There are two main types of cervical cancer:

Adenocarcinoma (ADC), which is the most aggressive form of the disease. It occurs in glandular cells and comprises 24% of cases.

Squamous cell carcinoma (SCC) is the more common form of the disease, and comprises about 76% of cases.

Cervical cancer is a silent disease, with no symptoms until the disease becomes invasive. Once the disease extends beyond the cervix, symptoms may include vaginal bleeding; menstrual bleeding that is longer and heavier than usual; bleeding after menopause or increased vaginal discharge; bleeding following intercourse or pelvic exam; and pain during intercourse.

According to the International Federation of Gynecology and Obstetrics (FIGO), there are five main stages of cervical cancer:

Stage 0: Carcinoma in situ (the earliest form of cancer defined by the absence of invasion of surrounding tissues).

Stage 1: Invaded cervix, but has not spread.

Stage 2: Has spread to nearby areas, but not outside pelvic area.

Stage 3: Has spread to the lower part of the vagina.

Stage 4: Has spread to nearby organs, metastasis.

Testing matters

Early identification of cervical cancer is critical as the cure rate for pre-cancer is 98%; however, once it has developed into cancer and spread to other organs, less than 20% of women survive past five years.

Currently, the most common test for cervical cancer is a Pap smear, which looks at changes in the cells within the cervix. A HPV test is different from a Pap smear in that it looks for the DNA of the virus and detects the presence of HPV before changes have occurred in the cells within the cervix.

In a recent, large scale clinical trial – the ATHENA study – one in 10 women who tested positive for either HPV 16 or 18 had cervical pre-cancer, even though their Pap test was normal, so it's important for women to request a test for HPV 16 and 18 as part of routine screening.

Patients can receive a test for HPV 16 and 18 from their general practitioner or a specialist healthcare professional such as a gynaecologist. The test for HPV 16 and 18 is done in the same way as a Pap smear and can be done at the same time as a Pap smear.

According to the American Society for Colposcopy and Cervical Pathology (ASCCP), if a woman returns a "normal" result for a Pap smear but a positive test result for HPV 16 or 18, she should be sent for a colposcopy to determine if further action is required.

A colposcopy is a procedure where the lining of the cervix is closely examined using a magnifying instrument called a colposcope to check the cells that line the cervix for abnormalities.

If the colposcopy detects abnormalities, a biopsy may be carried out whereby a small sample of tissue is removed for further testing or LEEP (loop electrosurgical excision procedure) will be performed. LEEP is a technique that uses electric current passed through a thin wire loop to remove abnormal tissue.

"While the traditional way of screening for cervical cancer – the Pap smear – looks at changes in the cell, it does not always provide accurate information. The new Roche HPV test detects the DNA of the virus, and more importantly, can specifically detect HPV 16 and 18, which Pap is unable to do.

"It is critical that we identify early and accurately which individuals are at greater risk of developing cervical cancer and ensure they are appropriately managed," said Colonel Dr Kunaseegaran Ragavanaidu, head and consultant pathologist, department of pathology, Hospital Angkatan Tentera Tuanku Mizan.

"The Roche HPV Test represents a new era for cervical cancer detection and prevention. It can provide healthcare professionals with valuable insights to assess the risk of a patient developing cervical cancer. They can then make an early, informed decision about how best to treat the patient which helps ensure the best possible outcome," Dr Kuna said.

"Given cervical cancer is a preventable disease, it should not be claiming so many lives here each year. At the Military Hospital, we have decided to use the test for primary screening and I urge others to adopt this approach and technology so that cervical cancer can not only be managed better, but in fact, prevented," concluded Lieutenant General Datuk Dr Abdul Razak, director general of health services, Malaysian Armed Forces, Ministry of Defense Malaysia.

The new Roche HPV test is currently performed by the Military Hospital and is available through a number of laboratory chains in Malaysia, including Clinipath, Lablink, Biolife Lab and Prince Court Medical Centre.

Kredit: www.thestar.com.my

Ahad, 4 September 2011

The Star Online: Lifestyle: Health

The Star Online: Lifestyle: Health

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