Between 1976 and 1979, hand radiographs of 112 Malay children, 55 males and 57 females aged from 12 to 28 months, from higher socio-economic class families were obtained and studied by two radiologists. These children were part of a longitudinal study on growth and development. A total of 268 hand and wrist radiographs were taken, which the radiologists read independently of each other using the Greulich and Pyle Atlas. The bone age was then compared with the chronological age and the difference, if any, was noted and 'scored'. It was found that 83.4% of cases for males and 94.8% of cases for females matched within the +/- 6 months discrepancy range. For practical purposes therefore, our population may use the Greulich-Pyle Atlas with a good degree of confidence. Typical hand radiographs of male and female Malay children at 12, 18 and 24 months of age are also presented and these may be used as standards for Malaysian children at the respective age groups.
126 Malaysian children, 65 boys and 61 girls from higher income families were followed-up regularly from birth to six years of age in the University Hospital, Kuala Lumpur. Their physical growth, development, dietary and illness patterns were measured at each visit. The study confirms the observations of previous studies that boys are, on the average, heavier and taller than girls and that Asians are smaller in size with relatively shorter legs compared with children of European ancestry. These racial differences are due to a combination of genetic and environmental differences. Since there are genetic differences in the size and shape of children, standards applicable to the specific population should be used to obtain the best results when assessing the health of an individual child. The growth charts presented in this paper can be used as standards to monitor the growth of Asian infants and pre-school children.
Over the past hundred years in industrialised countries and recently in some developing countries, children have been getting larger and growing to maturity more rapidly. This paper compares the growth of Malaysian children with similar socioeconomic backgrounds but born about twelve years apart. Data were obtained from records of 227 children born between 1968 and 1973 and 238 children born between 1980 and 1985. The children were followed-up regularly at the University Hospital Child Health Clinic in Kuala Lumpur for a variable period from birth to five years of age. Measurements for their weight, length and head circumference were taken at each visit. There is a directional indication that boys and girls of the 1980-1985 cohort are taller, heavier and have bigger head circumferences from birth to five years of age and the difference widens as the child grows older. This study clearly shows that a positive secular trend has taken place in the last decade, reflecting an improvement of living conditions with time. The factors involved in the positive secular trend are manifold and the most important is probably nutrition.
126 Malaysian children, 65 boys and 61 girls from higher income families were followed-up regularly from birth to six years of age in the University Hospital, Kuala Lumpur. The study shows that for boys and girls, there is a progressive increase in the left mid-upper arm circumference from birth to six years of age. However the rate of growth is not even, being most rapid during the first four month of infancy, then rapidly decreases during the middle third of infancy and thereafter it decreases slowly and by the second year of life, there is hardly any increase in the arm circumference. The left triceps skinfold thickness curves for boys and girls rise rapidly after birth to reach a peak at about three to five months before commencing to decline and then flatten off from the second year of life. The study also shows that on the whole, boys have slightly bigger arm circumference than girls during the first two years of life. From two years of age, girls on the average have more fat than boys. However this difference is statistically not significant at the ages tested. This paper also presents the left mid-upper arm circumference and left triceps skinfold percentile charts of Malaysian boys and girls from birth to six years of age.
The puffer fish belongs to the family Tetraodontidae and has one identifying characteristic which is the ability to inflate itself by gulping in large quantities of air or water. They are commonly found in estuarine and inshore water. The viscera (ovaries, testes and liver) of puffer fish contain varying amounts of extremely potent toxins [tetraodontoxin). The most violent form of fish poisoning is produced by ingestion of tetraodontoid or puffer-like fishes and this has been reported. The putftoad, Tetradon maculatum, has caused fatal poisoning? Despite the high toxicity of this group of fish, the meat is commonly consumed by some fisherman in Sabah without much morbidity. In Japan, puffer fish, called "fuqu" commands the highest prices in food fish and are prepared and sold in special restaurants where specially trained cooks are employed to prepare the "fuqu". Nevertheless it is still the primary cause of food poisoning in Japan especially among the lower socio-economic classes who fail to take the necessary precautions. In Sabah, four cases of puffer fish poisoning resulting in one death have been documented." We report herewith another incidence of puffer fish poisoning in which 18 persons from seven families were affected with nine deaths from two families.
A retrospective analysis of 285 patients who had sustained maxillojacial fractures over a period of a decade was undertaken. The commonest cause of injury was motor vehicle accidents (71.9%). The mandibular body was the most common site fractured. 80% of the patients were males and almost 50% were Chinese. Practically all types of fixation were employed. The results obtained were satisfactory.
A retrospective study of intraocular foreign bodies treated at the University Hospital over 10 years from 1970 - 1979 was carried out. Of the 48 cases reviewed, nine were anterior chamber foreign bodies while the rest were posterior segment foreign bodies. The anterior chamber foreign bodies had better visual prognosis as compared to the posterior segment foreign bodies. Most of the patients were young Chinese males and most of the injuries were due to accidents at work involving the 'hand hammer' (includes other implements used as a hammer).
A study was carried out in theJengka Triangle in Pahang to find out the prevalence and a practical cum effective method of treatment and control of scabies. Scabies was the commonest skin lesion among the 5590 people examined. its prevalence being 11.6%. Both sexes were equally affected. Prevalence was high among children and teenagers, the worst affected being the 10 to 14. 2 to 4, 15 to 19 and 5 to 9 year olds. The problem of scabies in Jengka could be due to inadequate and irregular water supply, plus lack of mothers' supervision of the personal hygiene of their children aged > 2 years. The persistence of scabies since 1976 is very likely due to the people's non-compliance with standing instructions on treatment with Benzyl benzoate emulsion A comparative study of treatment of scabies with Gamma Benzene Hexachloride [GBH] and with Benzyl benzoate emulsion [BBE] showed GBH to be the medication of choice. It was more effective and convenient, giving 97.9% cure rate with one application. A hot bath was not necessary. The patients preferred GBH to BBE since it was painless and without side-effects. The cost of treatment with GBH [1 application] was also much less than that with BBE [2 applications]. Only 28.7% of the cases and contacts complied with instructions to do 2nd application of the medication on their own, making it imperative that application be done by the health Staff or under their direct supervision. The majority [87.2%] complied with instructions to place their used clothes in large polythene bags and air these in the sun for two days. This procedure should replace the instructions to boil personal clothes as it is just as effective. yet more convenient and economical. A regular, biannual screening of all kindergarten and primary school children is recommended. Application of GBH to all scabies cases and all close contacts should be done by the health worker. The whole body from neck to soles of feet should have the application, and the people should be instructed to bathe only after 24 hours. They are to go to the nearest clinic or hospital on the 7th day for second application of GBH, if the itchness or lesions persist or reappear. Such supervised medication is possible and will minimise misuse of GBH.
This prospective study was performed to quantify glucose-6-phosphate dehydrogenase (G6PD) enzyme activity in deficient males and female heterozygotes. The methods used in the study were the fluorescent spot test, G6PD enzyme electrophoresis on cellulose acetate and quantitative assays. Forty-seven children who had been detected as spot screen deficient at birth were rescreened. Their first degree relatives were also included in the study. The mean enzyme activity of deficient males was 0.74 iu/g Hb (s.d. +/- 0.8), of female heterozygotes was 6.5 iu/g Hb (s.d. +/- 3.2) and of normal males was 12.1 iu/g Hb (s.d. +/- 3.5). The mean activity in deficient males was 6.1% of normal males. Most (35 of 47) of these fell into class 2 in Beutler's classification of G6PD variants. This indicates a population which may be susceptible to favism. Female heterozygotes had an intermediate enzyme activity with a wide scatter. Using a cut off point of enzyme activity of below 9.0 iu/g Hb gave sensitivity and specificity of 87% and 84% in detecting female heterozygotes. This group could be defined more accurately by combining quantitative assays with family studies.
Type IVa choledochal cysts with cylindrical dilatation of the intrahepatic ducts constitute a relatively less recognized variety of choledochal cysts, and differ from cystic dilatation of intrahepatic ducts in their clinical manifestations and response to treatment. Five patients with type IVa choledochal cysts and cylindrical dilatation of major intrahepatic ducts who underwent cyst excision and Roux-en-Y hepaticojejunostomy are reported. The duration of symptoms was less than 1 year in all patients. Palpable abdominal mass and abdominal pain were present in 3 patients. The traid of jaundice, abdominal pain and mass was present in only 1 patient. The intrahepatic dilatation regressed after excision of the extrahepatic cyst just below the hilum of the liver. The surgical technique is described and the need for excision of the cyst is emphasized.
Thirty one patients were investigated for the main complaint of easy bruising. These patients had normal platelet count with no past history of immune thrombocytopenia or systemic disorders known to predispose to bruising and a negative drug history. The evaluation of these patients included clinical review (history and physical examination) plus coagulation tests consisting of bleeding time, prothrombin time, partial thromboplastin time, thrombin time, fibrinogen level, FXIII screen and platelet functions test. Seven of the paediatric patients had acquired platelet dysfunction with eosinophilia (APDE). In 17 (94.4%) of the 18 adult patients no abnormality was demonstrated. Hence APDE was the commonest cause of easy bruising in children while the haemostatic defect contributing to easy bruising in adults remained unknown.
Various alloplastic and autogenous tissues have been used in attempts to restore facial height and reconstruct temporomandibular articulation. A case is presented where an ectodermal rib graft was used to reconstruct the temporomandibular joint after arthroplasty in a young child.
A retrospective study of 137 patients with blood culture-positive typhoid fever admitted to the paediatric unit of the Hospital Universiti Sains Malaysia was carried out to study epidemiological, clinical, laboratory and treatment aspects of typhoid fever in Kelantanese children in hospital. The male:female ratio was 1:1.1. School-children were the most affected. Cases were seen throughout the year. The five most frequently presenting features were fever, hepatomegaly, diarrhoea, vomiting and cough. Rose spots were seen in only two patients. Complications included gastritis, bronchitis, ileus, psychosis, encephalopathy, gastro-intestinal bleeding and myocarditis. Relative bradycardia was not seen. Blood and stool cultures were positive in the 1st, 2nd and 3rd weeks of illness. There was no significant difference between percentages of elevated O and H titres, whether done during or after the 1st week of illness. A four-fold rise in (O) titres occurred in 50% of cases tested. We would miss 50% of typhoid fever cases if a titre (O) equal to more than 1/160 were relied upon for diagnosis. Altogether, 46% of patients had leucopenia. Chloramphenicol was the most commonly used antibiotic. There were two deaths.