This is a cross-sectional study investigating the profile of children with disability registered with the primary health care clinics in Malaysia. The purpose of the study was to assess the developmental stage of children with disability. Secondary data from the pilot project conducted by the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study period was for six months from 1st August 2004 until 31st January 2005. A total of 900 disabled children were selected in this study. Schedule of Growing Scale (SGS) II was used for analysis. Results showed more boys than girls were affected with a ratio of 6:4. The mean total SGS score increases as the age of the child increased. The score was highest in delayed speech cases and lowest in cerebral palsy cases. The performance among children with delayed speech was the highest while children with cerebral palsy were the lowest. There was a statistically significant difference between the major ethnic groups in delayed speech and attention deficit hyperactive disorder.
Questionnaire: Denver Developmental Assessment Test II chart; DSST; Schedule of Growing Scale II; SGS
Identifying clinical features that differentiate acute febrile thrombocytopaenia from acute febrile illness without thrombocytopaenia can help primary care physician to decide whether to order a full blood count (FBC). This is important because thrombocytopaenia in viral fever may signify more serious underlying aetiology like dengue infection.
OBJECTIVE: The natural history of asymptomatic (silent) gallstones has been inadequately studied. Existing information derives from studies based on oral cholecystography or relatively small sample sizes. We planned a retrospective cohort study in subjects with gallstones to determine conversion rates from asymptomatic to symptomatic.
METHODS: We extracted data from computerised databases of one government hospital and two private clinics in Malaysia. Files were scrutinised to ensure that criteria for asymptomatic gallstones were fulfilled. Patients were called on telephone, further questioned to confirm that the gallstones at detection were truly asymptomatic, and asked about symptoms that were consistent with previously defined criteria for biliary colic. Appropriate ethical clearances were taken.
RESULTS: 213 (112 males) patients fulfilled the criteria for asymptomatic gallstones and could be contacted. 23 (10.8%) developed pain after an average follow up interval of 4.02 years (range 0.1-11 years). Conversion rates from asymptomatic to symptomatic gallstones were high in the first two years of follow up, averaging 4.03±0.965 per year. Over time the conversion rates slowed, and by year 10 the annual conversion rate averaged only 1.38±0.29. Conversion rates were much higher for females compared to males (F:M hazard ratio 3.23, SE 1.54, p>z 0.014). The lifetime risks for conversion approached 6.15% for males, and 22.1% for females.
CONCLUSION: In conclusion, asymptomatic gallstones are much more likely to convert to symptomatic in females than in males. Males in whom asymptomatic stones are discovered should be advised conservative treatment. Surgery may be preferable to conservative management if the subject is a young female.
m radiology records of Hospital
Study site: Computerised database, Hospital Selayang, Selangor; private clinics, Kuala Lumpur, Malaysia
Many patients have erroneous views with regard to depression and its management, and it was noted that these attitudes and beliefs significantly affected their adherence rates.
Primary sinonasal clear cell carcinoma is a rare neoplasm classified under malignant epithelial tumours of salivary gland - type carcinomas under World Health Organization (WHO) classification. We report a case which occurred on a 69 year old gentleman presented with epistaxis and nasal endoscopy examination showed tumour arising from the right ethmoid cells. Endoscopic excision of the tumour was done and histopathological examination revealed clear cell carcinoma. In addition, other secondary or primary sites of the lesion were excluded by clinical, immunohistochemical and radiological examinations. 10 months into the postoperative period, patient remains well without recurrence of the tumour.
IN CONCLUSION: We report a rare case of primary sinonasal clear cell carcinoma in addition to the limited literature available and emphasize the differentials with other probable tumour through meticulous microscopic examination and use of special immunostains.
Keywords: Melaka
A study on infant feeding practices was conducted during the implementation of the Baby Friendly Hospital Initiative (BFHI) in a district hospital. The aim was to identify which population subgroups had lower breastfeeding rates at 4 months and the effect of attendance of antenatal breastfeeding education on breastfeeding practices. All infants delivered in May 1996 were followed-up. 204 respondents were analyzed. This study demonstrated a higher exclusive and any breastfeeding rates at 4 months than some other studies. (48% and 76% respectively). It was found that the Malays were more likely to be breastfeeding exclusively at 4 months (72%) than the Indians (32%) and the Chinese (4%). (P < 0.01). There were more non-working mothers breastfeeding exclusively at 4 months than working mothers. (60% versus 26%) P < 0.01. Antenatal breastfeeding education in the form that was given appeared to improve breastfeeding rates at 4 months. Future efforts to promote breastfeeding should target the Chinese mothers and the working mothers.
A cross-sectional study on a normal clinical myopic population reveals that there is a difference in the pattern of myopic progression between Malays and Chinese in Malaysia. It shows that while myopia in Malays stays relatively constant throughout 10 to 50 years of age, myopia in Chinese progresses rapidly from 10 to 20 years of age, after which it starts to show hyperopic shift, reaching a level of myopia similar to that of Malays at around 35 years of age. In view of the above finding it is postulated that the difference in myopia between the two races may be due to excessive accommodation in Chinese, causing a temporary increase in crystalline lens power and hence an increase in myopia. Because the magnitude of myopia for both races for 10 +/- 1 years age group is relatively high, i.e. about -2.00 D, it is postulated that myopia in these ethnic groups may start much earlier than 10 years of age.
Eight cases of dermatomyositis were seen in the Skin Department, Hospital Besar Kuala Lumpur between 1989 and 1993. There was one case of juvenile dermatomyositis. There was a majority of Chinese patients (87.5%). There were three patients (37.5%) with underlying malignancies, two of which (66.7%) were nasopharyngeal carcinomas; all were under the age of fifty years. It is important to screen all adult patients for underlying malignancies, even those in the younger age group.
Thirty consecutive patients from peninsular Malaysia with clinically definite multiple sclerosis were studied; 80% were ethnic Chinese, with a female-male ratio of 5:1. The average age at onset was 29.7 years, with one relapse average every 1.9 years. Optic-spinal recurrence was the most common clinical pattern of the disease, accounting for 63.3% (19/30) of the cases. All the patients had spinal cord involvement sometime during the course of the illness. The mortality was high at 36.7% (11/30), with an average duration of symptoms of 7.6 years. There was characteristic severe residual visual and motor disability. At the time of the last examination, 12 patients had bilateral optic atrophy with blindness or severe visual acuity impairment. Sixteen patients were bedridden or confined to a wheelchair. The severe motor disability reflected the severe spinal cord involvement. It was the main factor that accounted for the high mortality. The cerebral, cerebellar, and brain-stem involvements were, however, generally transient. None of the patients' had a family history of similar illness despite the average sibling size of six. There was no example of Devic's disease. The clinical pattern was closest to those patients who presented from Taiwan.
Following the opening of the University Hospital of the University of Malaya in 1967, over 126,000 patients (excluding obstetric patients) have been admitted. A retrospective review, run concurrently with a prospective study, of over 200 patients thought to have suffered from systemic lupus erythematosus (SLE) revealed that, up until the 31st December 1975, 175 patients fulfilled the criteria for the diagnosis of SLE. There was a highly significant increase in the diagnosis of SLE over this period among Chinese patients compared to all other races, and no significant differencein the diagnosis of SLE among Indian and Malay patients. A review of the literature revealed that SLE appears to be a worldwide disease, reported frequently from Chinese communities but infrequently from tropical Africa. It is concluded that SLE is more common in the Chinese from Peninsular Malaysia than the other races, and that a careful study of geographical and racial factors in SLE may contribute to further understanding of its pathogenesis.
Eighty-six children diagnosed as child abuse and/or neglect were admitted to the Paediatric wards of the General Hospital, Kuala Lumpur during 1985 and 1986. Of these cases, 62 were of physical abuse, six of sexual abuse, one case of both physical and sexual abuse and 17 of neglect. There were 25 boys and 61 girls. Thirty-four of these children were Malays, 16 Chinese, 26 Indians, three mixed and seven illegal immigrants. Twenty-one were below the age of one year, 24 from one to four years, 25 from five to nine years and 16 were ten years and above. The abusers were mainly close members of the family. Of these children, 24 were sent back to their parents and 11 to their relatives home. Twenty-seven were taken into care by the Ministry of Social Welfare and the remaining seven children who were illegal immigrants, were deported with their parents. Only one child was successfully fostered. Eleven children were taken away from the hospital by their parents or guardians without the knowledge of the health staff. There were five deaths in the series.
Susuks or charm needles are a form of talisman inserted and worn subcutaneously, in the face and other parts of the body, in the belief that they will enhance or preserve the wearer's beauty, youth, charisma, strength or health, or bring success in business. This mystic practice is found among some south-east Asian people, especially Malayan and Muslim females. Most susuk wearers are secretive about their hidden talismans, but these gold or silver needles are being discovered with increasing frequency now that radiographs are used more widely. An understanding of this practice and an awareness of its existence is important to avoid misdiagnosis and mismanagement of these patients. The practice of susuk wearing and its relevance to dentistry is discussed. Nine cases of facial susuk wearers are presented and previous reports are reviewed.
The evidence for a hypothesis that eating salted fish is associated with nasopharyngeal carcinoma (NPC) is reviewed. The hypothesis was tested among Malaysian Chinese using a matched case-control design. The kinds of salted fish and patterns of use were also investigated in a control group comprising 100 Chinese, 50 Malay and 50 Indian households. During 1980, in Selangor, Malaysia, interviews with 100 Chinese cases of NPC and 100 non-disease controls indicated that salted fish consumption during childhood was a significant risk (relative risk = 3.0, P = 0.04), with an elevated risk for daily as opposed to less frequent consumption. Salted fish consumption during adolescence was a less significant risk, and current consumption not at all. There were 19 kinds of fishes reported as being eaten as salted fish by the 200 control households. There were marked differences between ethnic groups in preference for different kinds: Chinese preferred red snapper (74% of households), Malay jewfish (54%) and Indian red snapper (28%). Salted fish was hardly ever eaten daily by any household; weekly was a moderate frequency in all ethnic groups; less than weekly most common. There were no statistically significant differences between Chinese NPC case and non-disease control participants in kind of salted fish eaten. Results were the same when the data were analyzed by sex, subethnic group and income.
Thirty-four patients with intracranial arteriovenous malformations seen in the University Hospital, Kuala Lumpur, over a is-year period were reviewed. A VM was found to be more common in young, male patients with preponderance Chinese origin. The advent of the Cl-scan has increased the detection of small A VMs and intracerebral haematomas proportionally. The majority of the lesions were situated in the posterior half of the brain unlike the distributions in patients in the West and in Singapore. On the other hand, most of the intracranial bleeding were subarachnoid haemorrhage; a presentation similar to the western community, but unlike that reported from Singapore. The treatment policy is not unlike the western community with good results in 82% of patients selected for surgery.