This is a cross-sectional study which investigated the association between non-exclusive breastfeeding and maternal, paternal, obstetric and infant factors. Data on maternal, paternal, obstetric and infant factors were collected through face-to-face interview using a structured questionnaire from 498 mothers with four-week-old infants who attended government clinics in Klang district between 17 and 28 July 2006. The prevalence of non-exclusive breastfeeding at four weeks was 45.8%. Factors significantly associated with non-exclusive breastfeeding at four weeks included Indian ethnic mother (OR = 4.06), working mother (OR = 3.55), mother from high household income (OR = 1.90), mother who smokes (OR = 7.27), primiparous (OR = 1.97), infant not sharing a bed with mother (OR = 1.75) and infant born prematurely (OR = 7.69). Identification of risk factors should assist in targeting women who are at increased risk of non-exclusive breastfeeding.

Key points o Spend time taking a good history and performing a physical examination even though the majority of patients have “functional” symptoms. Exclude “non-dyspepsia” conditions and be careful in excluding a “surgical” abdomen. o Consider gastroscopy or an ultrasound or CT scan of the abdomen, if alarm symptoms are present. The threshold to investigate should be lower with older male patients as there is a higher chance of organic disease. o When patients’ symptoms are unclear, a close follow-up and review is useful. Symptoms persisting over many months or years are unlikely to have an organic basis. o Explore, understand and address patients’ concerns including psychological problems. Patients need to be reassured. o Sensible advice on food/meal and lifestyle modifications is useful. Antacids often give immediate relief to acute dyspeptic symptoms. Gastroesophageal reflux symptoms may be atypical − a trial of PPI therapy may be useful. Patients with wind, bloating and discomfort often benefit from a course of prokinetic agents.

The Orang Asli of Malaysia continue to experience poor health. There appears to be stagnation of certain aspect of their health status. Underweight (low weight-for-age) and stunting (low height-for-age) are significant amongst Orang Asli children. Worm infestation such as Ascaris, Trichuris and hookworm continue to afflict Orang Asli communities in Malaysia. Orang Asli communities can also be afflicted by other kinds of parasites, e.g. malaria parasites, microsporida parasites and Cryptosporidium parasites. Thus, primary care doctors who treat Orang Asli patients should be on the lookout for malnutrition and its effects (including anaemia, iodine deficiency, Vitamin A deficiency) as well as worm and parasite infestations. Such patients may need to undergo de-worming at regular intervals because of the tendency to get re-infected. Primary care doctors also need to be aware of possible interactions between infestations and nutritional deficiencies.
Population Groups ; Health

Vancomycin bead is an important ancillary treatment for osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA). However, red-man syndrome, which can be a life-threatening complication of vancomycin, may occur from the use of vancomycin beads albeit rarely. We report our first case of red-man syndrome caused by vancomycin bead's insertion for chronic osteomyelitis. Symptomatic treatment was not effective and removal of the vancomycin beads seems to be the best treatment for this condition.

This was a cross-sectional study which attempts to assess the effectiveness of the 18- hour lactation management course organised by Klang District Health Office for its health staff. The course was conducted for three days from 19 to 21 September, 2006 with a total of 18 hours, comprising 15 hours of lectures and three hours of supervised clinical experience. There were a total of 46 participants for the course. The pre- and post-test scores of the participants from the course were used for analysis. This study showed that the mean pre-test versus mean post-test scores were 12.63 and 19.87. The difference in the mean score was statistically significant (p < 0.001, 95%CI -8.285, -6.193). The difference was significant for the staff nurse, community nurse and assistant nurse but not for doctors. In conclusion, the 18-hour duration lactation management course was effective at improving the knowledge and skills on breastfeeding management for the health staff.

Giant cell tumours of bone are best treated by extended curettage and filling in of the defect with cement or bone graft. In more advanced stages, when there is extensive loss of cortical bone cover, containment of the filling material is not possible and resection and reconstruction is required. We report a case of a recurrent giant cell tumour of the distal tibia in a 21 year old female with extensive cortical bone loss in which polypropylene surgical mesh was used to contain the bone cement, thus avoidi
Orthopaedic

Pelvic lipomatosis is a rare disease of unknown cause, characterised by overgrowth of benign mature fat cells commonly located in the perivesical and perirectal spaces. The disease is rare amongst Asian population and has a wide range of presenting symptoms varying from lower urinary tract symptoms to bowel symptoms. However, this disease can be easily diagnosed based on certain characteristic radiological imaging techniques. We report a case of pelvic lipomatosis in an asymptomatic Chinese gentleman, who presented with classical radiological features of pelvic lipomatosis but provided us with challenging therapeutic scenario. (JUMMEC 2010; 13(2): 111-114)

The JXA area of the AVF is often best treated as a unit, and JXA stenting achieves good short and medium term patency rates. Ultrasonography follows up enable us to pick up problematic fistula but it reduces Primary patency rate. Long term result of JXA stenting need to be followed up.

We report a method for removing the distal segment of a broken locked intramedullary nail secondary to nonunion of the femur following radiotherapy for fibromatosis. A Kirschner wire with one tip fashioned into a hook was used to remove the distal segment without opening with the nonunion site. Details of the procedure are described.