The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital.

Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively

The Pattern of Spinal Tuberculosis in Sarawak general Hospital

This is a retrospective study of 53 patients with spinal tuberculosis treated in Sarawak General Hospital from 1994 until 1998. The study showed that the mean age in patients with spinal tuberculosis was 40.2 years, and was more common in male (70%) and in Iban population (50%). The clinical presentation included backache (94%); abscess (45%); neurological deficit (44%); and gibbus deformity (22%). The percentage of patient without BCG scar was 82% and 18% had evidence of pulmonary tuberculosis. The most common vertebra involved was the ninth thoracic vertebra and the least common was the third cervical vertebra. The average number of vertebra affected per patient was three. The most common radiological type of lesion was paradiscal (47%). The percentage of patients diagnosed by histological examination was 44%. All patients were given chemotherapy for 12 months' duration; 57% were treated surgically and 43% were treated conservatively. Twenty-four of patients (40%) had an excellent and good results and 28 of patients had a fair result and only one patient had poor result. In 23 of patients treated conservatively showed increment of 8 degrees of kyphosis angle and 22 of patients had a fair result and only one patient had poor outcome after 6 months of treatment. In 30 of patients treated surgically showed correction of 4 degrees of kyphosis angle and 24 of them had excellent and good outcome, where 6 of them had fair outcome after 6 months of treatment

Ewing’s Sarcoma of the Talus in a Four-Year-Old Child

Ewing's sarcoma is a rare malignant tumor of the foot in children. We report a case of Ewing'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, Ewing's sarcoma of the talus in a young child has never been reported in Malaysia

A modified method of traction for young children with congenital dislocation of the hip as a preliminary to reduction

Many authors agree that preliminary traction prior to closed or open reduction for congenital dislocation of the hip is helpful. Different ways of traction have been used and each of them has its own advantages and disadvantages. One of the problems in the very young child is the difficulty in maintaining a suitable traction that is biomechanically effective. We found that using a rocker bed made the traction more "user friendly" for the child, the parent and the doctors

The Role of Polymerase Chain Reaction (PCR) in Diagnosis of Spine Tuberculosis after Pre-operative Anti-tuberculosis Treatment

Objective: The aim of this study was to evaluate the role of polymerase chain reaction (PCR) in the diagnosis of spinal tuberculosis after 2 weeks of preoperative anti-tuberculosis treatment and to compare PCR to the Löwenstein - Jensen Culture (LJC) and histopathological examination (HPE) methods. Methods: Twenty-five patients were included in this study. Sixteen patients were diagnosed and treated for spinal tuberculosis based on clinical and radiological evidence. Nine patients were controls. The LJC method and HPE of the specimen were performed according to hospital protocol. PCR was performed using primer encoding insertion of sequences IS6110 for mycobacterium tuberculosis complex. Clinical findings and radiological features were the gold standard for comparison. Results: PCR results were 15 positive and one negative. The sensitivity and specificity of PCR was 94% and 100% respectively (with 95% confidence interval [CI] 67% to 99% and 63% to 100%, respectively). HPE results showed 13 were positive and 3 negative in the spinal tuberculosis group; for the control group, all were negative. Sensitivity and specificity value of HPE was 82 % and 100% respectively (with 95% confidence interval [CI] 54% to 95% and 63% to 100%, respectively). Use of LJC showed only one was positive and 15 were negative in the spinal tuberculosis group whole all nine in the control group were negative. Sensitivity and specificity value of LJC was 6% and 100% respectively (with 95% confidence interval [CI] 0.3% to 32% and 63% to 100%, respectively). Conclusion: Our findings showed that the PCR for Mycobacterium tuberculosis is reliable as a method for diagnosis of spinal tuberculosis, even after of 2 weeks of anti-TB treatment, with an overall sensitivity of 94% and specificity of 100%

Characterisation of crude and partially purified peptides with antimicrobial activity from the skin of Bornean frogs

Antimicrobial peptides are one of the most promising antibiotic candidates with the effectiveness in killing the microorganisms, can be found largely in the frog skin. In this study, the antimicrobial properties of the crude and partially purified peptides from the frog skin of Bornean frogs; Chalcorana raniceps, Limnonectes kuhlii, Meristogenys jerboa, Odorrana hosii, Staurois guttatus and Limnonectes leporinus were determined. Crude peptides from the skins of these frogs were partially purified using C18 Sep Pak columns. The antimicrobial activities tested were disc diffusion, minimum inhibitory concentration and minimum bactericidal concentration test. L. leporinus and L. kuhlii peptides displayed the lowest MIC value against P. aeruginosa (62.5 µg/ mL) and S. typhimurium (125 µg/mL). Moreover, L. leporinus peptide showed the lowest MIC value against S. aureus (31.25 µg/mL). Both L. kuhlii and L. leporinus peptides share the lowest MBC value of 125 µg/mL against S. aureus and P. aeruginosa. Peptides from L. kuhlii exhibited the lowest MBC values against MRSA (125 µg/mL), E. coli (62.5 µg/mL) and S. typhimurium (125 µg/mL). It can be concluded that all extracted skin peptides have antimicrobial activity against the selected bacteria, with the skin peptides from L. kuhlii and L. leporinus frogs being more potent than other species studied. The antimicrobial characteristics of peptide samples imply that there is a potential of novel AMPs from the frog species of Borneo. For future study, the peptides of frog skin extracts should be further purified

Methods Used for Reconstruction in Aggressive Bone Tumours: An Early Experience

Improvements in the overall treatment of patients with aggressive, large tumours involving the bone have made it possible to preserve and salvage limbs instead of amputating them. Each patient is unique in his clinical presentation and social circumstance. The different reconstructive options available allow us to choose the most appropriate method suited to the particular patient and with minimal delay, even when resources are limited. The patient and the relatives actively participate in the choice. The early experience of the different techniques for reconstructing these bone defects at our hospital are presented in this paper

Wide Survey on Online Teaching and Learning During Movement Control Order in Malaysia due to Covid-19 Pandemic

“Prepare for the new norm” is a common saying among Malaysians since the federal government introduced the Movement Control Order on March 18th, 2020. Among the many enforced measures to control the spread of the Covid-19 virus are the stay-at-home ruling and the ban on mass gatherings. These measures force Higher Education providers (HEPs) to drastically change the way Teaching and Learning (T&L) activities are conducted at their institutions. Conventional guided face-to-face (f2f) T&L and assessments are no longer tenable; the only workable solution is converting the remaining course plan to full online mode. Universiti Malaysia Sarawak’s (UNIMAS) students and academics are relatively familiar with the concept of blended learning. UNIMAS had started using Learning Management System two decades ago and the current system, e-Learning Enrichment and Advancement Platform or eLEAP, is actively used by all UNIMAS students. However, most of the courses were designed with blended learning relegated to supporting act status; existing only to complement the guided f2f T&L activities. The Movement Control Order (MCO) requires blended learning to be delivered in substitution mode, which is to replace the f2f sessions instead of merely complementing them. To assess the status of UNIMAS’s academics and students for this scenario, an online survey was conducted from March 22nd till March 31st. A total of 640 academics and 6,871 students had participated in the survey. This paper reports on the survey findings that provide insights on how to mitigate the infrastructure and policy shortcomings as to afford effective blended learning (in substitution mode) delivery in UNIMAS as well as to minimise inequitable education for students from diverse online learning readiness

Development of adjustable foot corrective device for clubfoot treatment

Congenital talipes equinovarus (CTEV) or clubfoot is a complex deformity of the foot that is characterised by four main deformities; forefoot cavus and adductus, hindfoot varus and ankle equinus. Currently, the Ponseti method is the most general and recognized treatment with a high success rate of over 90%. The treatment involves gentle manipulation and serial casting. However, the casting method could create complications for the patients such as soft-tissue damage and inconvenience in following the treatment schedule especially for those living far away from hospital. The aim of this research is to develop an adjustable corrective device for clubfoot treatment based on the techniques in the Ponseti method and at the same time attempt to eliminate the side-effects. The prototype consists of six adjustable movements from six different mechanisms to correct the four deformities. The prototype was developed using 3D printing method and the main material used is polylactic acid (PLA), rubber, aluminium and cotton fabric with sponge. The total weight of the prototype is around 300 g

A preliminary study on the distribution of beta defensins copy number variable gene in different ethnics of Sarawak, Malaysian Borneo

The indigenous groups of Sarawak that are well-known for diverse ethnicity featuring different cultures, languages and lifestyles, are among the earliest resident of Malaysian Borneo. The high survivorship of these early inhabitants had triggered an interest on their ability to develop immune or defense mechanisms towards the environment. Beta defensin is one of the well-studied adaptive immune functional gene of human. Beta defensins gene family plays a major role in innate and adaptive immune systems that are located in a cluster of at least seven genes on chromosome 8p23.1 with highly variable copy number. The ability of the indigenous people populating new settlements has been linked to their resistance or susceptibility towards certain disease which is influenced by the effectiveness of beta defensins adaptability. Hence, investigation on the distribution of beta defensins copy number variable gene in ethnics of Sarawak was conducted by investigating two microsatellite regions within the gene cluster. The result from 78 respondents comprising of the Iban, Bidayuh, Selako, Bugis and Jawa on the immediate copy number typing range from 2 to 8 copies. Interestingly, the copy numbers are not unique to the ethnics. They show a broad overview of shared copy number typing between them. All the sampled ethnics showed an agreement of copy number typing with modal copy of four based on EPEV1 and EPEV3 except for the Selako population. Pearson’s correlation shows excellent agreement between the samples with R2=1. The differences in copy number typing between populations were mostly due to genetic drift within the population. Natural selection had caused small populations to develop defence mechanisms and adaptability towards the environment. Furthermore, intercultural marriage within small populations has discouraged gene flow and limits genetic drift which later becomes a mechanism of evolution for beta defensins copy number gene. This study highlights the diversity and distribution of beta defensins copy number variable gene between ethnics and localities. These may serve as the basis for our understanding of the evolution of the beta defensins gene within ethnicities and their ability in expansion of population due to resistant towards the environmental stress and natural selection