Disease Outbreaks ; Humans ; Influenza, Human ; epidemiology ; therapy ; International Cooperation ; Patient Isolation ; Severe Acute Respiratory Syndrome ; epidemiology ; therapy ; Singapore ; World Health Organization

The aim of the study was to document the prevalence of learning disability among the children attending the Paediatric Clinic in Hospital Tuanku Ja’afar Seremban. The demographic distribution of these patients; the age of detection of the problem; the associated medical conditions and types of intervention received by these patients were documented. Patients who were between the ages of five to twelve years were included in the study. Learning disability was divided into three categories: speech and articulation problems, academic skills disorder and other categories which included developmental delay. Children with cerebral palsy were excluded from the study. Out of 1320 patients screened, 355 were found to have learning disorders. Majority were Malays, with the male to female ratio of 1.9:1. Most of the patients stayed in Seremban. The learning problem was most commonly detected at the age of 4 years and below. The commonest type of learning disorder was developmental delay, followed by academic skills disorder, speech and academic skills problems and speech disorders. Problems that were detected early were speech problems and developmental delay. Majority of the children had associated medical conditions. Most of the patients received some form of intervention but 11.3% did not attend any intervention program at all. A strategy should be formulated and implemented to help this group of children.

Assessment: Cognition ; Chronic cough

Aged ; Dental Health Services ; standards ; Health Services for the Aged ; standards ; Humans ; Nursing Homes ; Oral Health ; Singapore

No abstract available.
Mitral Valve Insufficiency* ; Mitral Valve*

No abstract available.
Ultrasonography*

A patient with beta hCG-secreting germ cell carcinoma of the pineal and suprasellar regions presented with hydrocephalus, Parinaud's syndrome, hypopituitarism and polyuria. Central diabetes insipidus was strongly suspected although the water deprivation test was not diagnostic. The polyuria however, responded to ADH analogue when the hypothyroidism and hypocortisolism were treated. Pubertal development was evident and serum testosterone was normal despite the low FSH/LH, suggesting hCG stimulation of Leydig cells. This case illustrates that a beta hCG-germ cell tumour of the suprasellar region causing hypopituitarism can mask the presence of central diabetes insipidus and hypogonadotrophic hypogonadism.
Germ Cells ; Hypogonadism ; Diabetes Insipidus ; MASKED ; Polyuria

Indication for pediatric tracheostomy has changed. Upper airway obstruction secondary to infectious disorders is no longer the commonest indication. The aim of this study was to establish data on indications, outcome and complications of pediatric tracheostomy. A retrospective analysis of pediatric tracheostomies carried out between March 2002 to March 2004 was done. Eighteen patients were identified. The commonest indication was prolonged ventilation (94.5%) followed by pulmonary toilet (5.5%). None was performed for upper airway obstruction. Postoperative complications were encountered in six patients (33.3%), the commonest being accidental decannulation notably in children less than six years of age. Twelve patients (66.6%) were successfully decannulated. The mortality rate was 16.6%. All death were non tracheostomy related. The commonest indication for tracheostomy was prolonged ventilation and tracheostomy in children is relatively safe despite complications.
Tracheostomy procedure ; Complications Specific to Antepartum or Postpartum ; Universities ; trends ; Obstruction

INTRODUCTIONWe describe an unusual case of acute hepatitis leading rapidly to acute liver failure.

CLINICAL PICTUREOur patient had known chronic hepatitis B with a regenerating nodule confirmed on imaging and histology. He was admitted initially for abdominal discomfort after a trip to China, and investigations showed acute hepatitis with alanine transaminase (ALT) and aspartate transaminase (AST) at 678 and 557 U/L, respectively. Initial differential diagnoses were acute exacerbations of chronic hepatitis B, and viral hepatitis A or E. However, acute Budd- Chiari syndrome was diagnosed on computed tomography (CT) scan of the abdomen, which showed extensive thrombosis of the hepatic vein, all the intrahepatic branches, inferior vena cava, up to the right atrium.

TREATMENTDue to the extensive nature of the thrombus, radiological or surgical intervention could not be performed.

OUTCOMEThe patient was managed conservatively but progressed rapidly and died of acute liver failure 16 days after presentation.

CONCLUSIONOur case highlights the rapidity of progression of acute Budd-Chiari syndrome. Diagnosis and management of Budd-Chiari syndrome are discussed.

Budd-Chiari Syndrome ; complications ; diagnosis ; diagnostic imaging ; Diagnosis, Differential ; Fatal Outcome ; Hepatic Veins ; diagnostic imaging ; Hepatitis B, Chronic ; diagnosis ; Humans ; Liver ; diagnostic imaging ; Liver Failure, Acute ; etiology ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; diagnostic imaging