In Malaysia, an estimated 50 children per annum suffering from a variety of haematological and inherited disorders would benefit from bone marrow or stem cell trans-plantation. By mendelian inheritance 25% of these children would be able to find a sibling who is a matched histocompatible donor. For the remaining 75% to have a chance at survival, search from another source would have to be made. This could mean a mismatched non-sibling related donor or a matched unrelated donor. We studied the chance of a Malaysian patient finding a matched sibling donor and a matched unrelated donor. Human Leucocyte Antigen (HLA) data from patients and their siblings were analysed. The HLA data were matched against the largest Asian bone marrow donor registry in Taiwan. 95% of the 138,744 donors in this registry come from Taiwanese Hokkien ancestry.
Percutaneous epiphysiodesis for arresting growth is a useful method for equalising moderate lower limb-length discrepancy. This paper reviews the result of this procedure performed at the Royal Hospital for Sick Children in Glasgowfrom 1989 to 1993. There were 8 children (5 girls and 3 boys) ranging in age (chronological) from 10 years 3 months to 13 years 3 months. Limb-length discrepancies (LLD) at the time of surgery were between 2.5 cm to 5.5 cm. The predicted LLD at maturity was obtained using the Moseleys graph. This ranged from 3.9 cm to 8.3 cm. The cause of discrepancy were hemihypertrophy (5), neurofibromatosis (1), AV malformation (1) and neonatal osteomyelitis (1). Bone age in 3 patients corresponded to their chronological age. In 2 patients their bone age were less than their chronological age by 1 year. In the remaining 3 patients their bone were less than their chronological age by 1 to 3 years. All patients had percutaneous epiphysiodesis of both the distal femur and proximal tibia. All patients except one had afinal LLD of 1 cm or less. There were 2 unsatisfactory results: one girl had a valgus knee due to asymmetric physeal closure. Another boy had a final LLD of 3.3 cm as the procedure was done near skeletal maturity. This technique is useful even with LLD greater than 5 cm in children whose predicted height is above average. The difference between chronological age and bone age ranged from I to 3 years.
Streptococcus pneumoniae is an important cause of community acquired infections, particularly pneumonia, acute otitis media, sinusitis and exacerbations of chronic bronchitis. Together with Haemophilus influenzae, it is an important cause of childhood meningitis. It is also a major cause of bacterial meningitis among adults. The emergence of Streptococcus pneumoniae resistant to penicillin and other antibiotics in recent years has complicated the management of pneumococcal infections world-wide'. In some areas, penicillin resistant strains have become the predominant pneumococcal isolates2. Multiply resistant strains and those resistant to second and third generation cephalosporins are also increasingly reported'. Treatment of meningitis and acute otitis media caused by such strains is particularly problematic. (Copied from article).
Chemiluminescence assay was used to assess the respiratory burst activities of polymorpho-nuclear leukocytes from paediatric patients reported to manifest with several episodes of recurrent bacterial infections. From this group of patients evaluated, only 10 cases of severe recurrent bacterial abscess exhibited more than 80% depression in the phagocytic chemilumi-nescence responses. The assay, being a sensitive method, was able to provide further useful laboratory investigation in diagnosing 4 patients with chronic granulomatous disease.
During a period of three years (February 1995 --January 1998), 30 biopsies were performed for patients within the paediatric age group in Hospital Universiti Sains Malaysia (HUSM). The majority of these patients (19 cases) had steroid-resistant Nephrotic Syndrome. Other indications were lupus erythematosus (5 cases), acute or chronic glomerulonephritis (5 cases) and infantile nephrotic syndrome (1 case). The biopsy of the 19 cases of steroid-resistant nephrotic syndrome gave the following findings: 10 showed minimal- change nephrotic syndrome, 4 focal segmental glomerulosclerosis, 3 mesangial proliferative glomerulonephritis and one diffuse sclerosing glomerulonephritis while there was insufficient glomeruli for a conclusive diagnosis in one case. The 5 patients with acute/chronic glomerulonephritis showed diffused sclerosing glomerulonephritis. The other 5 patients with lupus nephritis showed mesangial proliferative glomerulonephritis (2) and severe proliferative glomerulonephritis (3). The 5-month-old child with infantile nephrotic syndrome showed mesangial proliferative glomerulonephritis. There were no severe complications noted during or immediately after the procedure. There were 3 cases of gross haematuria, one lasting less than 24 hours and the other two less than
Thinking is something that we do all through our lives - an activity thcit possibly antedates our very birth itself Yet our children and we are not told about thinking or taught about the thinking process that dominates our lives, possibly, because of our own limited under-standing. Consequently, children are told to be logical and are discouraged from thinking differently, because it is the only type of think-ing we know and can understand. Methods of assessing their performance based on logical thinking underestimate their true potentials. The creative potentials of these children, 40% of who are right-brained need to be harnessed by approaches to learning that utilize methods of teaching and assessment, appropriate for their style of thinking. Another group of children, who need special attention, are those with learning disabilities that have been ignored, but can be corrected with appropriate programmes that provide a comprehensive approach to regular and special education.
A study on 30 asthmatic children was conducted in Kuala Lumpur. The objective of this study was to study the relationship between respirable particulate (PM10), sulphur dioxide, ozone and various meteorological factors such as humidity, level ofrainfall and temperature with asthma attacks. This study was conducted from 1st September to 31 December 1994. Patients were selected from the Paediatric Unit, Kuala Lumpur Hospital. Questionnaires were used to obtain information from their parents on the history and severity ofasthmatic attacks ofthese patients. Questionnaires were also used to determine if the indoor sources contributed to the attack. Diary cards were used to collect information on the frequency of asthmatic attacks. Each patient's progress was followed through every week during the study period and the attacks were recorded. The data on air quality on the PM10, sulphur dioxide, nitrogen dioxide, carbon monoxide and ozone were collected hourly using the microcomputer system of air monitoring unit from the Universiti Pertanian Malaysia air quality monitoring station located at the City Hall, Kuala Lumpur. The meteorological parameters such as temperature, relative humidity and rain-fall levels were also monitored daily. The asthmatic attack percentage was obtained by dividing the number of attacks in a day with the total number of sample and multiplying by a hundred. Statistical tests indicated that there was a significant correlation between asthmatic attacks and the PM10 concentrations (r=0.73), nitrogen dioxide (r=0.57) and.carbon monoxide (r=0.53) throughout the study period. During the haze episode, more significant correlations between asthmatic attacks, PM10 concentra-tions (0.86), carbon monoxide (0.79) and nitrogen oxide (0.53) were found. Multiple regression statistical test showed that PM10 had the greatest influence on the asthmatic attack rate. The minute respirable particulate which entered the respiratory system of the asthmatics triggered attacks on these patients.
Serious protein-energy malnutrition and severe nutrient deficiencies affected children in poor rural communities and estates during the first half of the century until the 1960s or so. Since then, the nutritional status of children in Malaysia in general has imporved amidst active socioeconomic development and various intervention programmes that have been implemented. Nevertheless, results from studies undertaken in the 1990s indicate that certain old nutrition problems in children still persist. These include protein-energy malnutrition in the forms of underweight, stunting and wasting, as well as iron deficiency anaemia, worm infestation and iodine deficiency disorders. Meanwhile, there is an increase in the prevalence of overweight among urban children. This review discusses the prevalence of these issues in rural communities, estates, Orang Asli, and communities in Sarawak and Sabah.
Malaysia is a rapidly developing country with a very young population, about 36% of which are below the age of 15 years. The standard of child health has improved greatly. However, there are great changes in the morbidity and mortality patterns of childhood diseases relating mainly to an improved standard of living; availability of safe water supply and adequate sanitary latrines; a higher literacy rate; rapid industrialisation and urban migration. The infant mortality rate has droppedfrom 50.1 per 1,000 livebirths in 1986 to 10.4 in 1995, and similar trends apply also to neonatal, perinatal and toddler mortality rates. Nevertheless, current major child health problems are those relating to events in the perinatal period and to infections. Despite improvements in the standard of neonatal care with the use ofhigh technology, the commonest cause of certified deaths still occur in the neonatal period. A rapid and inexpensive screening test for G6PD deficiency, a disease present in 2-3% of the population, is now widely available and, together with the use of phototherapy is largely responsible for the declining incidence of kernicterus in the country. Infections remain an important cause of morbidity and mortality although their patterns have changed. The very high (>95%) WHO-EPI-vaccines coverage rate is linked to the great reduction in the incidence of diphtheria, pertussis, tetanus, poliomyelitis and measles. Childhood tuberculosis is less common now, with about 250 - 300 reported cases per year and TB meningitis is rare with about 30-40 reported cases/year. The hepatitis B carrier rate is high (5%) and the introduction of routine newborn hepatitis B vaccination in 1989 is expected to have a positive impact as is the immunisation of young girls against rubella introduced in 1985 in reducing the incidence of congenital rubella syndrome. The incidence of malaria has declined but remains prevalent in the interiors of PeninsularMalaysia and in Sabah and Sarawak. Filariasis is largely under control. Unfortunately, despite great efforts at mosquito control, dengue virus infection remains a major problem with thousands of cases reported every year. Children are most susceptible to dengue haemorrhagic fever with many dying from the shock syndrome. The incidence of acute gastroenteritis has also dropped with most cases being due to a viral aetiology. Acute respiratory infections, mostly viral in origin, account for most attendances at paediatric outpatient services. Although staphylococcal and streptococcal impetigo and pneumonia are common, the incidence of streptococcal related diseases like rheumatic fever and acute glomendonephritis is rapidly declining. The nutritional status of children has improved in tandem with the rise in the standard of living, but subclinical malnutrition is prevalent, particularly among urban squatters and the rural poor. There is a disturbing decline in breastfeeding among urban working mothers. Poor weaning practices and food habits are responsible for the common occurrence of nutritional anaemia (5%) among infants and young children. Greater prosperity, rapid industrialisation and urbanisation have resulted in changes in the childhood disease pattern where non-communicable diseases assume greater importance as the problems of malnutrition and infection are gradually overcome. Road traffic accidents are a major killer and home accidents, largely preventable, are an important cause of morbidity and mortality. Childhood cancer, with about 550 new cases a year, is an important cause of death beyond infancy. Major congenital malformations, with a 1% prevalence rate, cause much ill-health. Thalassaemia is a particularly common genetic disease with fl thalassaemia gene frequency of about 5%. The prevalence of asthma is increasing, with a rate of 13.9% in the Kiang Valley but the prevalence of asthma-related symptoms is much higher. Physical, sexual child abuse and neglect, abandoned babies, substance abuse are but signs of stress of modern city living and peoples inability to cope with it. Although the general standard of child health has greatly improved, there are several states where it is still not satisfactory. In Sabah where there is a large illegal immigrant population, the infant mortality and infection rates are relatively high. In Kelantan and Trengganu, it is common for parents to refuse permission for a lumbar puncture required to treat meningitis. Other still deeply entrenched, culturally-related adverse health practices include : a fatalistic attitude to illness; a preference for traditional practitioners of medicine resulting in late treatment; and 'doctor-hopping' with unrealistic expectations of 'instant cure'. Childhood illnesses that are uncommon in Malaysia include: cystic fibrosis, coeliac disease, ulcerative colitis, Crohns disease, Sudden Infant Death Syndrome, Encopresis, enuresis and epiglottitis due to Haemophilus Influen:ae.
Surgery done around gingival margin may eventually result in loss of attachment and recession of the gingiva. Root hypersensitivity is another possible complication when coupled with overzealous tooth brushing by the patients. This paper presents an alternative method to remove a lesion located at the lateral cervical third of a root. Its advantage is that the gingival margin is kept intact.
The palatal root of the first permanent molar is the most commonly deflected root into the maxillary sinus during extraction. A rational approach to the surgical removal of a root from the antrum is important. Some surgeons prefer the alveolar approach while others prefer the Caldwell-Luc operation. A case is presented where the palatal root tip of the left upper first molar was removed from the maxillary sinus by the Caldwell-Luc approach with simultaneous closure of the oro-antral fistula resulting from dental extraction. A fibreoptic light probe was used. The advantages and disadvantages as well as how to avoid the common complications of this surgical technique are discussed. A good result was achieved with successful removal of the root and no loss of sensibility of the teeth and/or gum for this case.
The calcifying epithelial odontogenic tumour (CEOT) is a rare benign odontogenic neoplasm which was first described by Pindborg in 1955. It accounts for less than 1% of all odontogenic lesions. A case of CEOT which presented together with cardiac abnomlalities is presented here and the literature of CEOT is reviewed.
Endoseous Implant insertion for the replacement of missing teeth is the state of the art at present times. An understanding of the biology of the perimplant tissues is imperative for the overall success in the dental rehabilitation of a patient with fixture supported prosthesis. The dental implant tissue interface comprises bone, both cortical and cancellous bone; supracrestal connective tissue and the epithelial attachment. A comprehensive review of the response of bone during the postoperative or healing phase, the loading or remodelling phase and during the steady phase is described.
MeSH terms: Anodontia; Bone and Bones; Connective Tissue; Epithelial Attachment; Humans; Dental Implants; Tooth Loss
Microleakage testing has been used to determine the possible clinical performance of a restorative material. Many microleakage testing materials have been developed and performed through the years. There has been no agreement as to which testing methodology would give the most accurate results. Attempts have been made to simulate the oral conditions and to give a more quantitative representation of micro leakage. The different micro leakage testing methodologies are presented in this paper.
The construction of an electrical pain stimulator was described.
The parameters of pulse width and frequency on the quality of
pain stimulation was determined. The best design and construction
of the electrode for the stimulator was produced.
MeSH terms: Cardiovascular Physiological Phenomena; Electrodes; Electric Stimulation Therapy; Pain
A pilot study was conducted on 135 sixteen-year-old students from three rural schools in Kelantan to establish the prevalence of orofacial pain and discomfort. About 44% reported to have experienced some oro-facial pain in the preceding four weeks. About 27% of those with pain, still experienced the pain at the time of clinical examination but only 8% have consulted professional help. Most of the pain encountered were only mild or moderate in nature. Only 7% and 10% respectively, reported that the pain affected their sleep and concentration to study. The main cause was toothache and sensitivity. The prevalence of discomfort was 22%, the most common causes being recurrent oral ulcers and bleeding gums. The impacts of orofacial pain was mainly manifested at the personal level, and very few affecting social functioning. However, untreated decay and missing teeth were very low (mean DT 0.47, mean MT 0.27), while filled teeth (mean Ff 2.9) was the main component of the DMFf (mean 3.66, sd ± 2.6). Severe periodontal disease and the prevalence of traumatised teeth was not a major public health problem. The high prevalence of pain merit further research. Therefore a larger study involving other age-groups in other states is planned.
MeSH terms: Facial Pain; Gingiva; Gingival Hemorrhage; Pilot Projects; Public Health; Students; Toothache; Prevalence; Tooth Loss; Oral Ulcer
Human saliva contains a large number of proteins which can be separated using polyacrylamide gel electrophoresis (PAGE). In this study the protein profiles of whole saliva of diabetic and non-diabetic were compared. Considerable variations between individuals in the protein profiles were observed. The saliva from diabetic patients appeared to have more of proline-rich protein bands in the molecular weight region below 56 KOa. Further investigations using individual gland saliva should be carried out.
The current status and directions for changes of issues related to quality care in health services in Asian countries--Malaysia, China, Singapore, Japan and Korea are overviewed. In countries with public sector dominated health care systems such as Malaysia. China and Singapore, governmental leadership in quality care is prominent along with legislative backup. Japan and Korea have private sector dominated health care systems and quality care activities are mainly carried out by non-governmental organisations. Hospital accreditation programs are in the developing stages in most countries, although China and Korea started in 1980. Most Asian countries are at the initial stages in quality care activities and focus has been placed on education and training. Asian countries are not exempted from efforts to enhance quality care activities and a new horizon in quality health care is emerging.
MeSH terms: Accreditation; Attitude of Health Personnel; China; Delivery of Health Care/legislation & jurisprudence; Delivery of Health Care/standards*; Hospitals/standards*; Hospitals/trends; Japan; Korea; Malaysia; Quality Assurance, Health Care/legislation & jurisprudence; Quality Assurance, Health Care/trends*; Singapore; Staff Development
The ability of hospitals to fulfil their roles--of information processing and dissemination, and of quality patient care provider--is influenced by the availability of supporting information systems. Using computers in wards, which is a change process, introduces new working practices accompanied by attitudinal and knowledge alterations in the users. This paper suggests that as a practical approach users need to be consulted and assessed prior to the introduction of computers in their work places. A questionnaire survey, the main purpose of which was to determine the potential users' responses and to measure their computer competencies, was sent to 183 nursing staff in several hospitals. Results show that the respondents have slightly positive attitudes towards computers even though 85% of them were computer illiterate. A training strategy is needed to increase competencies and to develop more favourable attitudes, which can be monitored using four training indicators.
MeSH terms: Adult; Attitude to Computers*; Computer Literacy*; Computer User Training/methods*; Humans; Malaysia; Nursing Staff, Hospital/education*; Organizational Innovation*
Research on health assessments has shown the importance of social relations as a factor influencing health, especially among older people. Drawing upon sociological theories of social integration and social exchange, this research examines two domains of social relations which are expected to influence assessed health. In addition, the study uses a cross-national sample (N = 3,407) of noninstitutionalized older people from the Republic of Korea, Fiji, Malaysia, and the Philippines to determine if modernization conditions the relationships between social relations and health. Results indicate that social integration has a positive effect on subjective health assessments in all nations, whereas social contributions are significant only in Korea. Findings suggest that health assessments by elders in the most modernized nations appear to be much more influenced by the contributions they make to the social order than is the case in nations which are less modernized.