A 5-month-old Malay boy presented with purpuric papules and plaques on the face and extremities accompanied by fever, coryzal symptoms and bilateral lower limb oedema. There were also bullous linear purpuric lesions on the right upper limb. Blood and culture tests were normal. Histopathological tests showed leucocytoclastic vasculitis, confirming the diagnosis of acute haemorrhagic oedema of infancy. The patient achieved complete recovery after 2 weeks with no recurrence.
Blister ; Purpura ; Infant ; Erythema elevatum diutinum

Thyrotoxicosis results in alteration in functioning of nervous system in some patients. However, these mental disturbances may be severe in rare cases in the form of manic-depressive, schizoid or paranoid reaction. The pathophysiological basis of these nervous system findings is not well understood.

The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent.

Damage Control Resuscitation and Surgery is the concept of controlled hypotension, haemostatic resuscitation and abbreviated surgical procedures following severe trauma; the practice of which has resulted in improved mortality and morbidity. We describe a rare case of thoraco-abdominal impalement successfully managed based on the concept of Damage Control Resuscitation.
Hypotension

Chronic Myeloid Leukaemia (CML) is a disease characterised by a distinctive marker that is the Philadelphia Chromosome and an ability to transform into blast phase, which confers a poor prognosis. The median survival was reported to be between three to six months in correlation to blast phase. Extramedullary involvement with CML to sites such as pleural, meningeal and bones have been reported. We report a case of 41-year-old man who was diagnosed with CML in blast phase and presented with ascites. Ultrasound of abdomen showed coarse echotexture of liver suggestive leukaemic infiltration to the liver. The liver profile was severely deranged and associated with coagulopathy. Flow cytometry analysis of the peritoneal fluid revealed presence of myeloblasts consistent with CML in blast crisis with leukaemic ascites. Bone marrow biopsy also confirmed disease transformation. He received standard induction chemotherapy for acute myeloid leukaemia with dose modifications based on liver enzymes performance. Our case highlights an unusual presentation of CML in blast crisis with leukaemic ascites and the challenges in managing cytotoxic treatments due to the liver infiltration.
Leukemia, Myeloid, Acute

Child restraint system (CRS) can protect children in the event of crash and reduce the severity of injuries. As such, it is crucial to understand the prevalence of CRS usage and knowledge attributes on CRS usage among drivers. This study aims to assessdrivers’ knowledge on CRS usage.A semi-structured questionnaire was developed and pilot tested to verify its validity and reliability. The questionnaireaddressesdrivers’ knowledge about CRS currently available in the Malaysian market, the types of restraints used and views on fitting restraints to passenger vehicles. Seventy four percentfrom 500 respondents cited that they are usingor theyhave used CRS,64% knowabout CRS and its function, and 43% areawareof ISOFIX. In short, majority of the respondents are aware of CRS use and functions. Awareness and education program should berigorously introduced to public towards the implementation of the CRS law.
Child restraint system ; children passenger safety ; road traffic accident ; child injury

Adult ; Airway Obstruction ; etiology ; Cervical Vertebrae ; diagnostic imaging ; injuries ; Fatal Outcome ; Humans ; Male ; Tomography, X-Ray Computed ; Tracheostomy ; Wounds, Gunshot ; complications ; diagnostic imaging

This study aims to review existing studies on the relations between indoor dampness and mould in different public occupied buildings with the risk of adverse health effects among both children and adults. This study specifically focused on the dampness-related problems from countries with tropical climate. A systematic literature search of ScienceDirect, PubMed, Google Scholar and Wiley Online Library from 2000 through December 2015 was conducted. Furthermore, the reference lists of recent reviews and of relevant articles were identified in our search. Crosssectional, case-control, and cohort studies in children or adults were selected according to a priori criteria. The search yielded a total of 18 studies on damp buildings, dampness and mould in buildings and indoor mould. Dampness and mould exposure in buildings is a risk factors for respiratory symptoms, wheeze, cough, bronchitis, rhinitis, eczema and upper respiratory tract infection as well as general symptoms such as headache and tiredness. Evident strongly suggested increased asthma development and exacerbation of current or ever diagnosis of asthma in children. Based on the results of the review, indoor dampness and mould problems in buildings are associated with substantial and increases in prevalence of a variety of respiratory and asthma-related health outcomes.
Indoor dampness ; mold contamination ; health ; review

Introduction: A cross-sectional study was conducted to determine the familial and socio-environmental predictors of overweight and obesity among 1430, 9- 12 year-old primary school children and their parents in Selangor and Kuala Lumpur. Methodology: Body weight and height were measured and body mass index was calculated. Modified Child Feeding (CFQ) and Determinants of Adolescent Social Well-being and Health (DASH) questionnaires were used to measure familial and socio-environmental factors. Results: A total of 17.9% of the children were overweight while 16.0% were obese. Positive relationships were found between child’s BMI and parent’s BMI (r = 0.129, p < 0.01), concern about child’s weight (r = 0.125, p < 0.01) and restriction (r = 0.057, p < 0.05) to unhealthy foods. However, negative relationships were found between child’s BMI with pressure to eat (r = -0.135, p < 0.01) and neighbourhood safety perception (r = -0.053, p < 0.05). The logistic regression analysis showed that being male (Exp (β) = 0.538; 95% CI = 0.421-0.687), higher parent’s BMI (Exp (β) = 1.055; 95% CI = 1.028-1.082), higher concern about child’s weight (Exp (β) = 1.082; 95% CI = 1.030- 1.127), low pressure to eat (Exp (β) = 0.857; 95% CI = 0.801-0.916) and low perception of neighbourhood safety (Exp (β) = 0.951; 95% CI = 0.913-0.990) were significantly associated with increased risk of overweight. Conclusion: Parents should be the main target for education to modify children’s weight status. Further research should be carried out to understand the mechanism of influence of parents and the socio-environment on child’s health.

A pure ovarian choriocarcinoma is a very rare disease which can be either pregnancy related (gestational), may not be related (non-gestational), or commonly correlated with different type of germ cell; teratocarcinoma, dysgerminoma or undifferentiated carcinoma. A pure non-gestational primary ovarian choriocarcinoma is astronomically uncommon and we recorded such condition in 14-year-old teenage girl’s ovary. An abdominal operative procedure with the help of a careful histopathology examination revealed choriocarcinoma in absence of other type of germ cell element. Multiple courses of Etoposide/Methotrexate/Actinomycin-D (EMA) regime of chemotherapy were shown to be effective in this case.
Choriocarcinoma