Is Our Child Safe on the Escalator?

@#Introduction: This study aimed to explore the behaviour of Malaysian children aged 5 and less when traveling on the escalator. Methods: An observational study was conducted at six randomly selected shopping malls in the Kinta District of Perak State in Malaysia. Sample size of 258 caregiver-child pairs was calculated. Children and their caregivers were observed for unsafe behaviours by using a checklist consisting of 15 unsafe behaviours (e.g.: child sitting on escalator, travelling facing opposite direction, playing with the emergency stop button, not following caregivers’ instruction). The checklist was constructed from accredited escalator guidelines adapted from five different countries. A child was considered unsafe if there was at least one of the unsafe events observed. The proportion of child using escalator in an unsafe manner was analysed using IBM® SPSS® Statistics. Results: Of the 258 child-caregiver pairs observed, 149 (57.8%) children and 162 (63.8%) caregivers demonstrated at least one unsafe behaviour when using the escalator. ‘Not following caregiver’s instructions’ (28.7%) was the most common unsafe behaviour among children while the most common unsafe behaviour among caregivers was ‘not holding their child’s hand when using the escalator’ (41.7%). Four children used the escalator unattended. Conclusion: More than half of the children and their caregivers had used escalators in an unsafe manner and this required attention from the Public Health Department and the Department of Occupational Safety and Health to prevent unwanted injuries, especially among children.

A Cadaveric Study of Incidence, Morphology, Phylogeny and Classification of Extensor Digitorum Brevis Manus.

Introduction: A rare type of variation of extensor muscles on the dorsum of hand is extensor digitorum brevis manus (EDBM).It is a small muscle rarely present on the dorsum of the hand which can be misinterpreted a pathological mass on the dorsum of the hand. Aim: Aim of the present cadaveric study is to observe the incidence, anatomical morphology of EDBM and to study its phylogenetic significance. Material and Methods: Present study was conducted on 32 adult human cadaveric hands of which 24 were of male and 8 were of female cadavers. Results: The EDBM was observed in one incidence (3.1%) of the specimens. EDBM was found to be between the tendons of extensor digitorum for index and middle fingers. It was of Anatomical variant type I. Conclusion: The knowledge of incidence and morphology of EDBM is of greater relevance in clinical practice to rule out any pathological mass on the dorsum of the hand.

Association of Intracellular T(H)1-T(H)2 Balance in CD4+ T-cells and MIP-1alpha in CD8+ T-cells with Disease Severity in Adults with Dengue

BACKGROUND: We tested the hypothesis that dengue haemorrhagic fever (DHF) is associated with a T(H)1-skewed immune response as opposed to dengue fever (DF). METHODS: We estimated intracellular (in T-cells) and serum levels of designate T(H)1/T(H)2 cytokines [interferon-gamma (IFN-gamma), interleukin-4 (IL-4), and tumor necrosis factor-alpha] and macrophage inflammatory protein-1alpha (MIP-1alpha) at admission, 48 h, and day 5 in 20 adults with dengue (DF=10, DHF=10) and 10 dengue-naive healthy controls. RESULTS: At admission, intracellular IFN-gamma/IL-4 ratio in CD4+ T-cells and proportion of MIP-1alpha-positive CD8+ T-cells were significantly higher in patients with DHF [7.21 (5.36~10.81) vs. 3.04 (1.75~4.02); p=0.011 and 6.2% (3.2~8.2%) vs. 2.4% (2.0~3.6%); p=0.023]. The latter showed a significant positive correlation with IFN-gamma/IL-4 ratio in CD4+ T-cells (Spearman's rho=0.64; p=0.003), percentage-change in haematocrit (rho=0.47; p=0.048), and serum alanine aminotransferase level (rho=0.61; p=0.009). CONCLUSION: We conclude that DHF is associated with a T(H)1-skewed immune response. Further, MIP-1alpha in CD8+ T-cells is an important immunologic correlate of disease severity in dengue.

Malignant otitis externa or diabetic ear- Al Nahdha management protocol. Why it should be treated aggressively?

Malignant Otitis externa is an unusual but serious and potentially fatal condition. This is a study of 29 cases of malignant otitis externa admitted in our institution between January 1995 and December 2003. In this article a classification system defining the extent of disease, management protocol, indications for hyperbaric oxygen therapy, and overall effectiveness of treatment are reviewed. Correlating clinical, radiological, technetium 99 [Tc99] and gallium67 [Ga 67] scintigraphic findings and early therapeutic response, the disease was staged into stage I [mild], ll [moderate] and stage III [severe]. 15 patients of stage I disease were successfully treated with monodrug therapy- third generation cephalosporin [ceftazidime] only. Five patients of stage II disease were treated with parenteral ceftazidime and amikacin for 4-6 weeks. Of the remaining 9 cases with stage III disease, 6 were successfully treated with combination of antipseudomonal antibiotics [ceftazidime/ piperacillin and amikacin] for 8-12 weeks and adjuvant hyperbaric oxygen therapy. Site of granulations in the ear canal seems to be indicative of stage of the disease. 26 cases [89.7 percent] were treated successfully and are free of disease. Three patients [10.3 percent] died of disease recurrence. The presence of associated facial nerve involvement alone does not seem to be a poor prognostic sign. A new staging system is proposed and a guideline for therapy according to the stage of the disease is discussed

Dermoid cyst of lateral neck mimicking a branchial cyst. A case report

Dermoids on lateral aspect of neck are very rare. We present a case of benign dermoid cyst on the lateral neck mimicking a branchial cyst. The popular theory of their origin from embryonic rest cells in fusion lines does not explain their location in the lateral neck especially at the junction of upper and middle third neck. We discuss the pathogenesis, radiological findings and review the literature