A prospective study of 94 burned children was carried out from January 1993 to October 1994. Scalding was the predominant cause of injury affecting mainly toddlers between 1 and 3 years old. Ninety-six per cent of the injuries occurred at home. There was 1 death following an 81% flame burns. An intense campaign to make parents aware of the hazards is required as almost all the injuries were preventable.
Eighty-five children who presented with stridor were reviewed in order to determine the aetiology of stridor in these cases. Congenital causes accounted for 57.6% of cases. Laryngomalacia was the commonest congenital abnormality (77.5%). Other common causes of stridor were a foreign body in the airway (acquired) and laryngotracheobronchitis (33.3%) (infective). Tracheostomized children are a problem in developing countries, requiring prolonged hospitalization. We overcome this problem by teaching parents how to maintain the tracheostomy tube at home.
This study was done to determine the anthropometric measurement patterns of Malay children from wealthy families in Malaysia and to make a comparison with NCHS reference population. A population of 900 children aged between 3-12 years old from Taman Tun Dr Ismail, Kuala Lumpur (TDI), were examined but only 871 of them were eligible for the study. Weight, height, mid-arm circumference and skin fold thickness were measured. The increment pattern of anthropometric measurements of TDI children was quite similar to NCHS except for having a lower median weight for age and height for age. There was prepubescent increase in skin folds thickness in both sexes, followed by a midpubescent decrease and a late pubescent increase. The study indicated that Malay children from a wealthy background have growth rates comparable to children in the West, hence NCHS percentile charts are suitable as a reference for comparing the nutritional status of Malay children in Malaysia.
Twelve cases of purulent pericarditis seen over 6 years are described. Staphylococcus aureus was the most common causative organism (six patients), and a respiratory infection was the most common preceding illness. The chest radiograph and echocardiogram were useful pointers to the diagnosis, but the electrocardiogram was not reliable. Antibiotics, surgical drainage, and pericardiectomy were used in all 12 cases. There was one death (8.3%), which occurred in a patient who was seen late. A review of the literature dealing with the diagnosis and management of this condition is presented. The importance of early diagnosis before a significant degree of cardiac tamponade occurs is noted. Although there is general agreement that surgical drainage is mandatory, the approach, methods of drainage, and extent of pericardial resection have been the subject of some discussion, and at least seven techniques are available. We conclude that pericardiectomy has a definite place in the management of purulent pericarditis.
A J-shaped suction catheter was tailored to facilitate aspiration of the right upper lobe bronchus during rigid bronchoscopy in pediatric patients. This suction catheter was used successfully in three patients.
An investigation of the prevalence and distribution of hypodontia was carried out in Malaysian children between the ages of five to fifteen years. Hypodontia occurred in 2.8 per cent of these children. A greater number of females were found to have hypodontia, the ratio of affected females to males is 1.6:1. The teeth most frequently missing were the maxillary lateral incisors followed by the mandibular lateral incisors, then the mandibular second premolars. The aetiology of the condition is discussed. It is noteworthy that studies showing the lower second premolars to be most commonly missing have younger subjects. This suggests delayed development of these teeth in some individuals.
From 1973 to 1982,40 children with respiratory distress was bronchoscoped for suspected foreign body in the trachea-bronchial tree. In 31 children, foreign bodies were found and were successfully removed. The condition appeared to be confined to the early toddler group. Six children had pulmonary complications post-operatively. There was no death. A plea is made for early diagnosis and referral to lessen the likelihood of residual pulmonary damage.
Study site: University Hospital, Kuala Lumpur, Malaysia (current name: University Malaya Medical Centre)
The role of breastfeeding in preventing malnutrition is considered in relation to the Bostock classification of early human development, its relevance to different forms of malnutrition and to general ecological considerations, including economics and the management and prevention of diarrhoea.
Percentile growth charts of weight, length and head circumference, from birth to six years of age, for boys and girls, are presented. These can be used to monitor the growth of Malaysian children.
This communication describes a survey on 94 cases of alleged paraquat poisoning for a period of one-and a-half years in Perak state. The highest prevalence of such cases was noted in the district of Batang Padang. The incidences between males and females as well as between married and single persons were found to be equal, 81.9% were Indians and 73.4% were suicidal cases. More than 80% of the cases were in the 10-to-40-years age group.
Correlation analysis of mid-arm circumference (MAC), weight-for-age and weight-for-height obtained from 807 Malay preschool children aged 12-71 months show that MAC had a relatively low correlation with weight-for-age (r = 0.59, P <0.001) and weight-for-height (r = 0.63, P<0.001). MAC percentiles and sensitivity-specificity analysis indicate that when weight-for-age and weight-for-height were used separately to define 'true' malnutrition, MAC was not sensitive enough to detect Malaysian children with only mild to moderate protein-energy malnutrition (PEM). The value of MAC as a screening measure in malnutrition is only limited to identifying the more severe forms of PEM in young children and the present study indicates that a MAC of 13.0-13.7 cm may be used for identifying moderate to severe PEM and under 13.0 cm for severe PEM.
This is a report of a case of vulvovaginitis due to Shigella flexneri in a three-year-old child. This is probably the first documented case of shigella vulvovaginitis In Malaysia. The patient was successfully treated with cotrimoxazole. Extraintestinal infections by Shigella are rare and are briefly reviewed in this article.
The prevalence of goitre was investigated in a sample from six longhouses and five primary schools located at varying degrees of remoteness along the Tinjar river, Sarawak. Together with this, a survey was made on the type of salt used by the households. The main ethnic groups in these communities were the Kenyah/Kayan and the Iban. The overall prevalence of palpable goitre detected from the age group 5-14 years were 71.7 percent and 77.0 percent for males and females respectively and 77.7 percent for females aged 15 years and above. The prevalence for both Iban and Kenyah/Kayan of either sex and for all age groups varied from 63.4 percent to 80.4 percent. The prevalence at each location did not differ significantly. On questioning 126 households, only 9 (7.1 percent) used iodized salt whilst 74 (58.7 percent) households used only uniodized coarse salt and 7 (5.6 percent) used only uniodized fine salt. The remaining 36 (28.6 percent) households used both fine and coarse uniodized salt. Undoubtedly at this point in time legislation on "table" salt iodization must be interpreted to mean not only the iodization of fine table salt, but in the case of the rural longhouse communities as are found in the Tinjar area, the iodization of coarse salt as well.
In a 3 year period 73 cases of perforated peptic ulcers were treated by simple closure. The overall mortality of 3.77 percent is acceptable when compared with other reports. There was a marked male preponderance (11 males: female 1). Biopsy results confirmed the operatiue findings that perforations were seven times more common in gastric peptic ulcers than duodenal ones. The disease affected young adults, the middle aged and elderly, the peak incidence occurring between the fifth and seventh decades oflife. Simple closure was an effective surgical procedure for our group of patients.
The results of the food consumption study suggested that the calorie and protein intakes of ID and 20 malnourished preschool children in the study area were much lower than the RDA and thus these children should benefit from a supplementary feeding project. However, after 42 days of supplementation with Nutri-Pak, the project's objective of increasing by 5%, the percent standard weight for age of at least 60% of the subjects was not achieved since only one child's weight reached this target. From the records of monitoring, it was noticed that the low consumption of Nutri -Pak. a partial replacement by the the food supplement of the children's diet in the home. uncooperative mothers, and illness or disease factors had contributed to the much lower weight gains than expected in most of the children.
Malignant neoplasms diagnosed histologically in the state of Sabah during the period November 1983 to October 1988 were analysed to determine the distribution of malignant neoplasms according to site, age, sex and major ethnic groups. The five commonest malignant neoplasms in males were carcinomas of the nasopharynx, stomach, skin, lung and liver. In females the five commonest malignant neoplasms were carcinomas of the cervix uteri, breast, ovary, thyroid and skin. There was variation in these frequencies among the major ethnic groups. The most striking of these was the high frequency of nasopharyngeal carcinoma among Kadazan and Chinese males but not in males of the other indigenous groups. A significant number of patients with nasopharyngeal carcinoma was found in the younger age groups and most of the patients in the younger age groups were Kadazans. A relatively high frequency of carcinoma of the stomach, skin and liver was seen among Kadazans and other indigenous groups while carcinoma of the lung was seen relatively frequently among Chinese males. Among females carcinomas of the breast and cervix uteri were the most frequent malignant neoplasms in all the main ethnic groups. Possible reasons for these findings are discussed.
Retinoblastoma was clinically diagnosed in 38 patients in the University Hospital between 1968 to 1988. White pupil or cat's eye reflex, found in 25 patients, was the most common symptom. Four patients refused any form of treatment. Of the 27 histopathologically confirmed cases, 16 were males and 11 were females. There was no ethnic group predominance, although a male preponderance was observed among Malay patients (M:F 3:1, p less than 0.05). Treatment in cases with unilateral disease, without extra ocular extension consisted of enucleation of the involved eye, with close examination of the contralateral eye in follow-up. In cases presenting with bilateral tumour the worse eye was removed. Of 20 cases of histopathologically proven unilateral retinoblastoma treated surgically, 12 patients survived for a mean period of 4.5 years (Range: 1-19 years). The defaulter rate for this group of patients was 55%. None of the 7 cases of bilateral retinoblastoma survived beyond 5 years (Mean survival 2.5 years).
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.