Children with musculoskeletal symptoms are commonly seen by general practitioners (GPs). Those that present with atraumatic limp pose a particular diagnostic challenge. Although uncommon, Perthes disease (PD) is an important cause of atraumatic limp in children and may result in debilitating consequences if missed. We put forward a case of delayed diagnosis of PD in a child, thus highlighting the need for a greater index of suspicion among GPs in approaching any child with a limp.

Angina Pectoris ; complications ; Cardiomyopathies ; complications ; pathology ; Female ; Humans ; Middle Aged

Adult ; Community-Acquired Infections ; Humans ; Male ; Methicillin Resistance ; Myocarditis ; complications ; microbiology ; Pericarditis ; complications ; microbiology ; Pneumonia, Staphylococcal ; complications ; microbiology ; Shock, Septic ; microbiology ; Staphylococcus aureus ; drug effects

Background: Coronary heart disease (CHD) was the second leading cause of death in Malaysia in 2006. CHD has known risk factors including hypertension, diabetes mellitus, and obesity. Methods: This cross-sectional study examined the prevalence of cardiovascular risk factors among 260 participants aged 20 to 65 years in a rural community in Sarawak. Results: The prevalences of overweight and obesity in this study were 39.6% and 11.9%, respectively. Approximately 13% of participants had hypertension, and 1.5% had a random blood sugar greater than 11.1 mmol/L. Chi-square tests showed significant associations between obesity and gender (P = 0.007), low high-density lipoprotein cholesterol and race (P = 0.05), high total cholesterol and age (P = 0.007), age and hypertension (P = 0.011), smoking and gender (P < 0.001), and smoking and income (P = 0.050). Age-adjusted logistic regression showed that women were 0.246 times more likely to be obese, that older participants (> 45 years) were 0.395 times more likely to have high cholesterol and that those with a higher monthly household income (> RM830) were 2.471 times more likely to smoke. Conclusion: These findings indicate that we should be concerned about the high rates of overweight in this rural community to prevent obesity.

Double outlet right ventricle (DORV) is an uncommon congenital heart disease with a poor prognosis. We report a rare case of a girl with untreated DORV who survived until adolescence, but then developed infective endocarditis with florid complications and succumbed to it. Although infective endocarditis is seldom encountered in children in developed countries, a high index of suspicion is required for those with congenital heart disease. The roles of cross-sectional imaging are demonstrated, including the usefulness of magnetic resonance imaging not only in evaluating congenital heart disease, but also in detecting incidental lesions in the extracardiac structures.
Adolescent ; Double Outlet Right Ventricle ; complications ; Endocarditis ; diagnosis ; etiology ; Fatal Outcome ; Female ; Humans

Background: It is important to understand the prevalence of risk factors for cardiovascular disease, especially in a rural setting. Methods: A cross-sectional study was carried out in 238 rural households located in the Kuching and Samarahan divisions of Sarawak among individuals aged 16 years and above. Anthropometric measurements, blood levels of glucose and cholesterol, and blood pressure were collected. Results: Prevalence of blood pressure in the hypertensive range was 43.1%. The highest rates of blood pressure in the hypertensive range were found in individuals aged above 60 years (38.6%) and 50–59 years old (31.8%). Age was one factor found to be significantly associated with blood pressure in the hypertensive range (P < 0.001). Prevalence of obesity was 49.0%. The highest prevalence of obesity was found among those aged 40–49 years (41.9%) and 50–59 years (29.9%). Gender was significantly associated with obesity (P = 0.004). The prevalence of blood cholesterol at risk was 21.6%, and the highest rate was found in the 40–49 years age group (34.0%). Fifty percent of respondents were found to have hyperglycaemia, with the highest prevalence in the 50–59 years age group (37.5%). A significant association was found between obesity, blood pressure in the hypertensive range and blood glucose level. When compared with non-obese individuals, those who were obese were more likely to have blood pressure in the hypertensive range and hyperglycaemia. Conclusion: The risk of developing lifestyle-related diseases is no longer based on geographical or socio-economic factors.

Despite the advancements made in the knowledge and treatment of the human immunodeficiency virus (HIV) since it was first discovered, people living with HIV (PLWH) continue to be stigmatized. This paper presents the case of an HIV-infected patient who delayed the necessary treatment due to stigma and ultimately presented with AIDS. Through social support, however, he was able to overcome his internalized stigma; he was finally willing to start on antiretroviral treatment (ART). This case report addresses the effect of stigma on and the role of social support in the management of an individual with HIV.