Ewingâ€™s sarcoma is a rare malignant tumor of the foot in children. We report a case of Ewingâ€™s sarcoma of the talus in a four-year-old Chinese girl to highlight the initial difficulty in diagnosis and the clinical course of the disease. She was initially diagnosed as osteomyelitis of the talus and died eight months after presentation with pleural and spinal metastases. To the best of our knowledge, Ewingâ€™s sarcoma of the talus in a young child has never been reported in Malaysia.
We studied the curve progression of untreated curves presenting to the Scoliosis Service of Hospital Kuala Lumpur. One hundred and fifty-two (152) patients were included in this study. The median rate of curve progression of idiopathic scoliosis curves was 7.03 degrees per year, for neuromuscular scoliosis curves as 17.39 degrees per year; and congenital scoliosis curves were 3.67 degrees per year. These rates are similar to the reported rates in the literature. Data for sixty-one (61) surgically treated patients were reviewed to determine the early curve correction of the curves of different aetiology. The mean age of surgery was 14.15 years old, the mean preoperative curve size was 71.61 degrees; and the mean postoperative curve size was 43.78 degrees. The mean duration of follow up after surgery was 2.44 years. The revision and removal of instrumentation rate was 8.3%.
Over a seven-year period, 170 cases of humerus fractures were plated in Hospital Melaka. Of these, 131 cases were successfully traced for this study. Besides looking at fracture epidemiology, its relationship with radial nerve injury was examined. The incidence of post-traumatic wrist drop in closed and compound fractures were 14.9% and 35.3% respectively. In relation to the site of fracture, lower third fracture had the highest incidence of wrist drop (29%). The recovery from post-traumatic wrist drop was 83%. The average duration taken for recovery was 11.8 weeks. The incidence of post-operative wrist drop was high at 17.6% but all recovered during follow-up.
Inborn errors of metabolism (IEM) are a group of disorders that causes abnormal function of biochemical pathways. Archibald Garrod des-cribed the first inborn error of metabolism in 1893. He described alkaptonuria in a patient whose urine turned black on standing and the development of arthritis in adult life.' Subse-quently, Garrod encapsulated the idea of IEM in 1908 with the concept of 'chemical indivi-duality'. Beadle and Tatum proposed the concept of one gene - one enzyme in 1945.2 Phenyl-ketonuria (PKU) was described in 1934 and amongst the first to be recognised as a cause of mental handicap with a biochemical basis.' Effective treatment for PKU with low pheny-lalanine diet was introduced in 1955. Molecular characterisation of genetic defects localised to alleles in various chromosomes were performed in the last two decades
The problem-based learning (PBL) curriculum, which originated primarily from the Faculty of Health Sciences at McMaster University in 1969, has had a major impact on the thinking and practice in medical education. It is one of the most important developments in the health profession's education in the latter part of the twentieth century) The PBL process incorpo-rates fundamental educational principles such as those derived from adult learning theory' and this gives the PBL approach a greater effective-ness for the acquisition of basic knowledge and clinical skills.
Significant advances in perinatology and neonatology in the last decade have resulted in increased survival of extremely premature infants.' Survival rates at 25 and 26 weeks of gestation age ranging from 60% to 82% and from 75% to 93%, respectively, have been reported.' In Malaysia, the survival rates among premature very low birth weight infants (< 1500 g) were reported to be between 69% and 78%.2,3 Such improvements of survival have been attributed to the advances in the management of respiratory disease and intra-ventricular haemorrahge in the premature infants.',2 Thus, attention have recently been focused on the need to secure adequate nutrient intake of these premature infants. Parenteral nutrition has often been used to manage the transition between transplacental nutrition in-utero and post-natal enteral nutrition, but is associated with cholestasis and sepsis.4 However, the ability to deliver nutrition is limited not only by immature absorptive or digestive function but by inadequate motor activity. Gastroesophageal efflux (GER) and feeding intolerance are the major gastro-enterological problems of the premature neonates.
Vaccines, used appropriately and efficiently, have changed the landscape of infectious diseases. Poliomyelitis is almost completely eliminated globally. In many industrialised countries, there has been over 99 percent reduction in incidence of diphtheria, tetanus, measles, mumps, rubella, Haemophilus in-fluenzae b meningitis and over 97 percent reduction in whooping cough.',2Unlike anti-biotics, most vaccines have remained equally effective despite years of continuous usage.
Respiratory syncytial virus (RSV) is isolated in 15-25% of young Malaysian children with bronchiolitis.',2 Although this observation is consistent with experience reported in other developing nations in the tropics,3•4 it is lower than that of temperate developed nations where RSV is isolated in 60 - 80% of young children with viral bronchiolitis.5,6 The majority of infections are mild, easily cared for at home and only 1% of children with RSV bronchiolitis require in-hospital care.' However, several categories of children have been identified to develop severe RSV bronchiolitis that is asso-ciated with an increased risk of mortality and significant morbidity. This 'high-risk' group includes children who are very young, ex-premature (gestation less than 36 weeks), children with chronic lung disease, congenital heart disease and immunodeficiency, namely, haematological transplant recipients.8'9 It is for this category of children in whom effective therapeutic strategies for the treatment of RSV bronchiolitis are most important.
Dengue and dengue hemorrhagic jiever are still a serious public health problem among people in developing countries. The study was conducted to assess the knowledge, attitude and practice among students in University Technology of MARA in Shah Alam Selangor, Malaysia, and to determine its association withprevious infection. A total of 218 students were selected randomly fom several residential colleges within the university main campus. They were interviewed for their perception of risk to dengue and their blood were taken for serological examination (Dengue IgG). It was found that 49.1% of students have had previous infection, however onlv 0.9% had history of symptomatic dengue infection. Males students originating fom urban areas were more at risk of being infected. The perception of risk to dengue was good among students but this factor is
unable to explain the magnitude of infection among them. Further study should look at the interaction between behaviour and environment among students who are sero negative.
MeSH terms: Dengue; Developing Countries; Fibrinogen; Immunoglobulin G; Malaysia; Male; Perception; Public Health; Students; Universities; Severe Dengue
Diabetes mellitus and its main complication, nephropathy, ajjbcts the economic wellbeing and quality of Iife of the sufferers and the population. A matched case control study was conducted in September 1998 to investigate the factors involved with nephropathy such as diabetic control, smoking, hypertension, familv history of diabetes and diabetic duration. Respondents were classyied based on the presence of microalbuminuria or macroalbuminuria, Seventy-two pairs of case and control were studied Duration of diabetes Q2 = 0.005), presence of lethargy and weakness prior to diabetes diagnosis @7 = 0.019), duration of smoking @7 = 0.014), duration of hypertension @2: 0.000), systolic hypertension Qu= 0e 025), uncontrolled diabetes with poor HbA1c level (v= 0.02Q and lack of diabetes knowledge Q2 = 0.037) were jbctors which related signyicantlv to nephropathy by univariate anahrsis. In multivariate anahrsis, systolic hypertension (p = 0.0015), lack of diabetes knowledge (17 = 0.0197), presence of lethargy symptom Q7 = 0.0027), prolonged diabetic duration @ = 0.0301) and higher body mass indices (p = 0. 0213) were predictors to diabetic nephropathy.
MeSH terms: Albuminuria; Ambulatory Care Facilities; Diabetic Nephropathies; Humans; Hypertension; Health Knowledge, Attitudes, Practice; Malaysia; Surveys and Questionnaires; Smoking; Body Mass Index; Case-Control Studies; Lethargy
A study was undertaken amongst private primary care providers in three urban centres of Malaysia to understand the organizational structure of the facilities and to assess the cost of running such services. A total of 150 clinics were involved in the study. Data was collected through interviews with owners of the clinics using semi-structured questionnaires. Solo-practitioners owned 64.7% of the clinics while 35.3% of them were owned by group practice. This study showed that the mean number of patients visited the clinics daily was 49.3 with the average operating hours of 79.4 hours/week (range 28.0 - 168.0 hours/week). Group practice clinics operates 23.9 hours longer than solo-practice clinics. Group practice clinics were more likely to offer 24 hours service than solo-practice clinics. Most of the clinics were manned by a single doctor (57.3%), 30.0 % had two doctors and only 12.7% were run by more than two doctors. On average, group practice employed greater number of supporting staff than solo-practice clinics (6.0 vs 4.3 people). The mean annual cost to run each facility was found to be RM 444,698. The mean cost per patient was found to be RM 32.09 for solo-practice clinics and RM 38.55 for group practice. Wages represented the highest proportion in the recurrent cost (61.1%) followed by drugs (29.2%) and consumables (2.7%). Building cost (67.9%) and equipment cost (25.9%) were the major capital costs for the clinics. This study could serve as a basis to reimburse private primary care providers in the future health financing scheme in Malaysia. To improve efficiency and contain cost in primary care settings, efforts should be targeted towards cost of wages and drugs utilised by the providers in their daily practice.
Key words: Private practice; primary care; costs; Malaysia.
MeSH terms: Ambulatory Care Facilities; Costs and Cost Analysis*; Cross-Sectional Studies; Group Practice; Humans; Malaysia; Physicians; Primary Health Care; Private Practice; Surveys and Questionnaires; Running; Salaries and Fringe Benefits
Due to the increasing demand or modern medical treatment and modern cosmetics by society, traditional sources have been neglected by younger generations. This study assesses the baseline level of Malay high school adolescents' use and perceptions of traditional medical treatment and cosmetics. 100 Malay high school students in Kuala Lumpur were administered a sbt- art uestionnaire. It was found that the amil is a strong external influence in their choice of medical treatment, (2) a wide variety of services are used by choice when they become ill, (3) a majority (68.8%) ofthese adolescents have a ddinite "loose " beliefin traditional medical treatment and related cosmetics; and (4) they would welcome promotion and information about these for the purposes of promoting their health and preserving their cultural heritage. Further study and action to broaden adolescent knowledge of traditional medical treatment and cosmetics are essential to ensure the continuance of this type of health promotion for the next generation.
MeSH terms: Adolescent; Health Promotion; Humans; Schools; Societies; Students
The objective of this study was to find out whether integration of Information and Communication Technology (ICT) in a Primary Health Care Clinic improves client’s waiting time. This was a descriptive study based on a total of 588 clients, i.e. 291 clients from an ICT integrated primary health care clinic, which was Putrajaya Health Clinic and 297 clients from a manual health clinic, which was Salak Health Clinic, from 5th December 2000 until 10th January 2001. Clients attending both clinics during this study period were systematically random sampled. Information was obtained from structured questionnaires. Data were analysed with Statistical Package for Social Sciences (SPSS) version 10.0. Selected quantitative time variables, their mean and standard deviation were calculated. Integration of ICT in a primary health care clinic did not improve client’s waiting time. It was demonstrated by this study that the integration of ICT in Putrajaya Health Clinic led to significantly longer average waiting time (39.76 minutes) and longer average total time spend in the clinic (57.14 minutes) as compared to a manual clinic, Salak Health Clinic where its average waiting time was only 23.13 minutes and average total time spend in the clinic was 39.15 minutes. Based on the findings, it is possible that integration of ICT in a primary health care clinic could not play as a significant factor for improving or reducing client’s waiting time in Putrajaya Health Clinic yet, at least not for the time being. This is the first study to document waiting times specifically in our first ICT integrated primary health care clinic. Since it was found that integration of ICT in a primary health care clinic had made client’s waiting time significantly longer than the waiting time in a manual clinic, it could be interesting for future research to look into client’s satisfaction in an ICT environment clinic.
Key words: ICT, client satisfaction, primary care
MeSH terms: Adult; Ambulatory Care Facilities; China/ethnology; Cross-Sectional Studies; Female; Humans; India/ethnology; Malaysia; Malaysia/ethnology; Male; Primary Health Care; Surveys and Questionnaires; Patient Satisfaction*
Injury Hncluding home injury} is an important contributor to the nations’ statistics on mortality and morbidity. However, statistics on injury is still lacking in Malaysia. In 1996, the National Health and Morbidity Survey was conducted nationwide that includes injury as one ofthe scope studied at the community level. It was found that the prevalence of sefreported home injury in Malaysia was 2.5%. The prevalence was higher among the 0-4 years and more than 80 years groups. There was no dwzrence in the prevalence of injury by urban/rural location, ethnicity, citizenship, religion, marital status, level of education, income group or type of occupation. Females however reported a slightht higher figure than males (2. 7% i· 95% CI and 2.3% i 95% CD. Recommendations made include planning and designing of preventive intervention strategies and sreas for future studies.
Study name: National Health and Morbidity Survey (NHMS-1996)
MeSH terms: Ethnic Groups; Female; Humans; Malaysia; Male; Morbidity; Occupations; Surveys and Questionnaires; Residence Characteristics; Prevalence; Marital Status
In August 2000, the Disease Control Unit of T erengganu noted an increase in the number of serologically confirmed cases of hepatitis A virus (HAH in Kuala Terengganu Hospital. Preliminary investigation revealed that there were an outbreak of hepatitis A in districts of Kuala Terengganu and Marang. Eventually, a total of 334 associated cases were reported among Kuala Terengganu residents and 59 cases among residents of Marang. The age of the patients range j9·om 2 years to 71 years old (median 16 years). Males accounted for ( 69.5% of cases and had a higher sex specyic attack rate (96.35/100,000) than females (42. 70/100,000). The highest attack rate (128.3/100,000} occurred among patients aged 10 — 14 years. The health staff of Kuala Terengganu and Marang District Health Ojice had investigated a total of 229 case. Most cases (62.4%) occurred amongst school children. A case control study was carried out amongst 35 cases that were matched with 71 controls by age group, class and sex, to identyy the potential source of injection. The results indicated that eating fried noodle with shelh‘ish significantly increased the risk of being infected during the outbreak (OR 16.38[4.2l-74.53]).
Mental nerve neuropathy is an important presenting complaint that may be encountered by dental surgeons in their daily practise. There are various pathological processes that could bring about this symptom, ranging. from simple dental cause to vague, life threatening diseases. We present three cases of mental paraesthesia of different aetiologies. A literature review on mental nerve neuropathy related to malignancies and infection is discussed. The importance of a thorough chair side history taking, clinical examination and relevant investigations are emphasised in a suggested clinical approach to obtaining the diagnosis of a numb chin.
MeSH terms: Chin; Hypesthesia; Mandibular Nerve; Medical History Taking; Neoplasms; Paresthesia; Peripheral Nervous System Diseases; Surgeons
The habit of chewing betel quid has been practised since ancient times. Although the world has gone through modernization, a significant proportion of people still practices this habit. Substantial evidence has shown that betel quid chewing is associated with the occurrence of oral cancer and precancerous lesions, which has a tremendous psychosocial impact on an individual's life. Thus it becomes significantly important to dentistry to look into this matter. Since betel quid chewing is one of the causes of oral cancer, effort in cha~ging this habit is essential. This article addresses this issue.
MeSH terms: Areca; Dentistry; Habits; Mastication; Mouth Neoplasms; Social Change
Polishing of dental ceramics has become an increasingly important procedure in restorative dentistry as allceramic restorations, which require post-cementation occlusal adjustment, are gaining in popularity. There are numerous studies in both dental and ceramic literature on polishing of dental ceramics and the effects of polishing on their mechanical properties. However, lack of standardization in polishing parameters, precludes comparison among these studies. A clear understanding is lacking of the relative roles and interdependence of handpiece speed, abrasive characteristic, and polishing load. This paper will discuss the mechanism of polishing and review the literature on polishing and its effect on the mechanical properties of ceramic restorations.
This paper attempts to review epidemiological studies of oral cancer and precancer in Malaysia. The defmitions of prevalence, incidence, risk habits and oral cancer and precancers were discussed to better understand' the different types of studies conducted, which would be important in making comparisons between studies. Currently, epidemiological data on oral cancer in Malaysia are sketchy. The only incidence data for oral cancer in Malaysia was reported by Hirayama in 1966, 35 years ago. He estimated that 3.1 new cases per 100,000 population were diagnosed for the year 1963. A number of histopathological data of oral and maxillofacial biopsies were reported. Oral cancer accounted for one-fifth of all oral biopsies. A national study on oral mucosal lesions in Malaysia carried out in 1993/4 reported that there was a variation seen in the occurrence of oral premalignancy among the ethnic groups. The Indians and the indigenous people of Sabah and Sarawak were identified as high risk groups for oral cancer and precancer. It was also observed that both of the ethnic groups chewed betel quid. In conclusion, the epidemiological studies have provided useful data, which may be used in planning for future oral health programmes and research towards enhancing Malaysia's on-going effort in preventing the occurrence of these diseases.
Until today there are still a high percentage of oral microorganisms have not been identified due to inability to isolate using the cultural method. However, identification of uncultivable microorganisms associated with disease will permits clinicians for a more accurate diagnosis, treatment and preventive measures. Unculturable microorganisms are also involved in disease and may account for treatment failure since their susceptibility to antimicrobial agents would be unknown. Thus, the opportunity for a rational approach to the treatment of disease relies on the state of knowledge concerning its aetiology and pathogenesis. Recently developed molecular methods have made it possible to characterise mixed microflora in their entirety, including the substantial numbers of unculturable bacteria. The development of rapid molecular methods like PCR provides a reliable identification of unculturable microorganisms. This paper will review the current literature regarding the PCR techniques used to identify uncultivable oral microflora.