Puducherry had reported regular dengue outbreaks since 2003 with many-fold increase in number of cases every year. This study was done to assess the intensity of dengue vector breeding and diversity of breeding habitats. Aedes surveys were conducted in 8 Primary Health Centres (PHCs) representing both rural and urban areas of Puducherry district throughout the year 2012. Containers inside and outside randomly (simple) selected houses and vacant sites around houses were examined for presence of Aedes mosquitoes. The containers containing water with immature larvae were designated as positive containers (PC), while the containers holding only water were designated as wet containers and all the larvae/pupae from the positive containers were collected and entomological indices were determined using standard WHO methods. The vectors, Aedes aegypti and Ae. albopictus were encountered in the survey, with Ae. aegypti present in high numbers in urban as well as rural areas. The plastic containers were found as the most productive indoor breeding habitat as the 27.2% of the total pupae collected was contributed by plastic containers followed by flower vase (22.8%) and grinding stone (17.6%). Larval indices were found to vary throughout the year and highest indices were recorded during the months of October and November indicating the potential risk of dengue fever during this period.

Proximal femur fracture in paediatric patients are very rare and can easily be missed especially when the history of trauma is so trivial, and associated with pathological fracture. We report a case of 6-year-old girl with a history of left knee pain following a fall from a height of 2 feet. She was treated as a soft tissue injury of the left knee as the left knee radiograph was normal. She was reassessed at day 3 of injury with worsening symptoms. Radiograph of the pelvis and left knee revealed a comminuted intertrochanteric fracture of left femur with an underlying bone cyst. We would like to highlight this case report to avoid missing a proxima femur fracture where a trivial trauma resulted In the presentation of a non-specific knee pain. Femur fracture in peadiatric age group can result in the significant complication of growth such as osteoporosis.

Introduction: Mak nyahs are locally known male-to-female transgenders in Malaysia. In Western countries, medicalization of transgenderism allows strictly selected patients to undergo sex reassignment surgery. However, a standardized treatment system is not yet available in Malaysia. A number of mak nyahs underwent sex reassignment surgery at their own will. This study aimed to explore mak nyahs’ knowledge and perception on sex reassignment surgery. Materials and Methods: A qualitative research was carried out from 13th July 2016 till 31st August 2016 among 8 adult mak nyahs in Kuantan, Pahang. Snowball sampling was used. Participants who gave verbal consent were interviewed individually and in focus groups. Data obtained was transcribed and used as the primary data source. Results: All informants were Malays and Muslims. They generally had some knowledge about the standard procedures and risks in sex reassignment surgery. All informants expressed their desire to have the surgery, but chose not to. Reasons discouraging them from having the surgery were: i) religion, ii) forbiddance from family, iii) fear of regret, iv) death from surgery, and v) the lack of necessity. Factors driving them to have the surgery: i) more income from sex work, ii) pressure from sex clients, iii) securing a stable relationship, iv) self-satisfaction, and v) hope for a better future. Conclusion: Religion seemed to be the main reason refraining them from undertaking the surgery. Counselling mak nyahs should include the advantages and disadvantages of sexual reassignment surgery. Islamic religious preaching is very important to help reduce high risk behaviours, as well as teaching mak nyahs to cope with challenges in adult life. Further research is necessary to show association between religious knowledge and successful rehabilitation of the mak nyahs’ community.

Losing of an ear can be a fatal experience for a patient. The deformed appearance of the face resulting after an oncosurgery or an accidental trauma may results in psychological as well as social embarrassment for the patient. It is a challenge to manage such defect on the face with surgery/artificial prostheses. Prosthetic rehabilitation of auricular defects can be a demanding procedure due to a broad variety of clinical presentations and a wide array of treatment options. The defect can be restored with custom made auricular prosthesis made up of silicon elastomeric material, which gives life-like appearance and also improves the quality of life of the patient. The patient can feel more comfortable and accepted in the social circle. A multidisciplinary approach and team management are essential in providing more accurate and effective rehabilitation of such defects. This article describes an easy technique of using silicone auricular prosthesis, with thin flash extending around the defect for better retention and orientation. Moreover it is more aesthetically acceptable and economically cost effective and such prosthesis helps patients who refuse to undergo second surgery for implant supported prosthesis.