We have studied residual limb length inequality following femoral shaft fractures in 62 children. From 61.2% of the children who had shortening of more than 1 cm at union, 34.21% still maintained the shortening at the completion of study. The longitudinal femoral overgrowth occurred significantly during the first 18 months of the fracture in 77.4% of the children, with an average of 1.17 cm. Children with proximal-third fractures and those who sustained the fractures before eight years of age have higher capability to correct the limb length disparity.
This paper reports a second outbreak of acute haemorrhagic conjunctivitis due to coxsackievirus A24 in peninsular Malaysia. Between June 2002 and early October 2003, 10,327 patients, comprising 3,261 children and 7,066 adults, were treated for acute conjunctivitis in 11 government health clinics in the Melaka Tengah district of the state of Melaka. The figure grossly underestimates the size of the outbreak; as no patients treated in private clinics in the same district were included. Institution and household surveillance showed that the commonest presenting clinical feature of the illness was eye-discharge (91.2%), followed by foreign body sensation (81.8%), pain (78.3%) and subconjunctival haemorrhage (74.4%). The mean duration of illness was 6.5 and five days for patients with and without subconjunctival haemorrhage respectively.
Open fracture of the tibia is very common among motorcyclists. The morbidity associated with this injury is well-documented as treatment of severe open fractures is very difficult. There is currently no study done in the literature to see the relationship between fracture severity and the side of the injury.
AIM: To study the outcome of gradual reduction by skin traction of supracondylar fracture of the humerus in children with swollen elbow, who seek treatment two days or longer after the injury.
METHOD: Fifteen children aged between 4 and 11 years (average 7 years 11 months), who had initially consulted a traditional practitioner, reported between 2 and 21 days (average 7.5) after the injury were treated by skin traction with the elbow kept straight and the forearm in position of comfort.
RESULTS: The average duration of stay in hospital was 14 days. All fractures healed; there was no incidence of myositis ossificans or neurovascular deficit. All patients had functional range of movements at the elbow within 6 months. Five patients developed cubitus varus deformity greater than 5 degrees, they were classified as poor result. Four out of these 5 patients had sought treatment after a delay of 7 days or longer. There were 9 good (60%), 1 fair (7%) and 5 poor (33%) results.
CONCLUSION: Gradual reduction by skin traction is safe. It is possible to achieve satisfactory reduction if the delay is up to 7 days. The results with regards to deformity and function were comparable with those obtained following open or closed Kirschner wire fixation.
A pilot study to determine the seroprevalence of anti-HCV among children from Kuala Lumpur, Malaysia, was conducted using microparticle enzyme immunoassay. Serum samples were obtained randomly from children, aged between one to 16 years of age, admitted to the paediatric unit of University of Malaya Medical Centre, Kuala Lumpur for various medical reasons. Of the 179 samples assayed, only one was positive, giving the prevalence rate of 0.6%. It is reasonable to conclude that the seroprevalence of anti-HCV among children from Kuala Lumpur is low, less than 1%.
Cystic fibrosis (CF) is a rare disease among Asians. Three Malay children with CF presenting with recurrent pulmonary symptoms, malabsorption and failure to thrive are reported. Problems in their management include availability of pancreatic enzymes, compliance to medications and climate factors.
The production of heat-labile (LT) and heat-stable (ST) enterotoxins, colonisation factor antigens (CFAs) and haemagglutinins was investigated amongst 310 Escherichia coli (E. coli) isolates obtained from 62 children under the age of five, with diarrhoea. Twenty-one isolates were found to produce enterotoxins, of which fifteen (71%) isolates produced ST only, 2 (10%) produced LT only and 4 (19%) produced both LT and ST. However, none of the isolates demonstrated any of the common CFAs identified to date, but 8 out of the 21 isolates demonstrated haemagglutination with rabbit, sheep or human group A erythrocytes, suggesting the presence of putative CFAs, yet unidentified.
The purpose of this study was to review the results of our patients with congenital canal atresia after implantation of bone-anchored hearing aids (BAHA). The occurrence of complications was also reviewed.
We conducted a retrospective audit on the inpatient assessment and care of children admitted with febrile convulsion to Hospital Batu Pahat, a district hospital in Malaysia, using the Malaysian national clinical practice guidelines and the American Academy of Paediatrics practice parameters on febrile convulsion as the reference standards.
Mowat-Wilson syndrome (MWS) is a recently delineated mental retardation; a multiple congenital anomaly syndrome characterised by a typical facial gestalt, Hirschsprung disease or severe constipation, genitourinary anomaly, congenital heart defects, agenesis of corpus callosum and eye defects. Some cases also present with epilepsy, growth retardation with microcephaly and speech impairment. MWS was first described in 1998 by Mowat et al, and approximately 180 cases have been reported as of August 2008. The syndrome occurs as a result of heterozygous mutations or deletions in the zinc finger E-box-binding homeobox 2 gene, ZEB2, previously called ZFHX1B (SIP1). Most cases reported so far were sporadic occurrences; however, rare cases of sibling recurrence have been cited. The facial phenotype is particularly important for the initial clinical diagnosis and provides the hallmark, warranting ZEB2 mutational analysis even in the absence of Hirschsprung disease. We present the first two molecularly confirmed Malaysian MWS patients, one of whom has a novel mutation.
Malignant osteopetrosis is associated with petrous carotid canal and internal carotid artery stenosis in the skull base. We present a four-year-old boy with malignant osteopetrosis who developed right frontal lobe infarction as a result of bilateral internal carotid artery hypotrophy.
Thalassaemia is one of the major public health problems in Malaysia. Regular monthly blood transfusion remains the main treatment for severe thalassaemia patients. One of the complications of blood transfusion is the formation by the recipients of alloantibodies and autoantibodies against red blood cell (RBC) antigen. The purpose of this study was to determine the prevalence of RBC autoantibodies among multiple-transfused thalassaemic patients in our institution and factors that contribute to its development.
Diagnosis and treatment of acute tonsillitis are one of the most common problems seen at an otorhinolaryngology clinic in both adult and paediatric populations. Much has been written about bacteriology of recurrent tonsillitis but it remains a controversial topic. Despite the fact that tonsillitis is so common, consensus seems to be lacking as to the main causative organism and the differences between children and adults. The tonsillar core bacteriology of 233 patients with recurrent tonsillitis who underwent tonsillectomy from January 2000 to June 2003 is presented.
Study site: inpatients, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Paracetamol is available as an over-the-counter medication in many countries including Malaysia. This drug has been implicated in many poisoning cases admitted to hospitals throughout the country.
To determine the prevalence of iron deficiency (ID) and iron deficiency anaemia (IDA) in Kelantanese pre-school children and to identify risk factors that best predict the presence of ID.
Benign epilepsy of childhood with centrotemporal spikes (BECT) was studied in Malaysian children, and was observed in Chinese, Malay and Indian children in the ratio 10:6:5. There were 12 boys and 9 girls. Fit frequency varied from almost daily to a single fit. The age of onset ranged from 2-13 years and BECT was not noted in any child over 13 years old. There was a strong circadian rhythm and fits occurred mainly in sleep. Generalised seizures were more common than partial seizures. During the 3-year study from April 1989 to April 1992, 21 children with BECT were identified from the EEG records done at the University Hospital and it was found that this genetic epilepsy which is autosomal dominant with age dependent penetrance occurs in approximately 4.8% of our epileptic children. In addition there were 3 children in whom petit mal co-existed with a BECT EEG trait.
Patients on a moderate red cell transfusion programme have iron overload where the concentrations of the serum ferritin were inappropriate to increases in the transfusion load as a result of limitations of apoferritin synthesis and conversion of ferritin into haemosiderin. This study confirms the limitations for the use of estimations of the serum ferritin to evaluate the iron status in patients with expected high overload as would be seen in patients on many years of maintenance red cell transfusions in the absence of iron chelation therapy. Poor compliance, inadequate dosage of Desferal (deferoxamine), and the late initiation of iron chelation therapy were factors that were considered in the patients with failure of response to iron chelation.
A descriptive study of 143 cases of clinically diagnosed measles in patients under the age of 12 years admitted to the Duchess of Kent Hospital, Sandakan, Sabah, during the year 1990 was carried out. The median age of the patients was one year and 13.3% of the cases were between the ages of 6 and 9 months. The male to female ratio was 1.3:1. The majority of the cases (85.3%) were not immunised against measles while 60.0% of the cases were malnourished. Most of the cases (86.0%) had at least one complication with 32.9% of the cases having more than one complications. The main complications were pneumonia (74.1%) and diarrhea (38.5%). Other complications were convulsions, otitis media and corneal ulceration/scarring. A case of pneumonia with mediastinal emphysema and subcutaneous emphysema was noted. The case fatality rate was 1.4% while blindness was the long term morbidity in 1.4% of the cases. Measles remains an important cause of morbidity in children in Sabah.