Comparative study on the evaluation of patient's satisfaction on esophagogastroduodenoscopy and colonoscopy between a pre-filled and standard hand-written consent form in Hospital Kuala Lipis.

INTRODUCTION: Informed consent is the patient's selfdetermination authorization of a choice made by themself before any intervention is performed by the health care provider. It should be a structured process that includes the disclosure of relevant procedural information, benefit, risk, and other treatment option. MATERIALS AND METHODS: An open-label static group comparison experimental design was conducted in a singlecentred study starting from April 2021 until January 2022 among patients who were going for OGDS and Colonoscopy at Hospital Kuala Lipis. The patients were stratified by 2-by- 2 randomization to either the standard hand-written prefilled consent forms. The satisfaction was assessed using Gastrointestinal Endoscopy Satisfaction Questionnaire version 2. The difference in the satisfaction was analyzed using multifactorial ANOVA. RESULTS: The percentage score of satisfaction on the endoscopic procedure using pre-filled was significantly higher than standard form consents (mean difference: 18.36 (95%CI: 14.15, 22.58)) and the effect size was large (partial ή = 0.399). The difference in percentage score of satisfaction was associated with gender (p = 0.003) and medical officers' years of working experience (p < 0.001). CONCLUSION: The pre-filled consent form fulfils the ethical and legal aspects of the informed consent process and should be used in endoscopic and other invasive procedures in Malaysia. It is suggested that a formal training, exposure to course in communication skills, breaking bad news on patient consent among junior doctors need to be taken to improve patients' satisfaction of the endoscopic procedure to make them more satisfied.

Effective connectivity between precuneus and supramarginal gyrus in healthy subjects and temporal lobe epileptic patients.

INTRODUCTION: The effective connectivity (EC) when the brain is resting and how a neuronal system exerts influence over other regions of the brain, in different groups of subjects are still being investigated. Limited information was seen about the relationship between precuneus (PRE) which is a wellknown resting state hub with supramarginal gyrus (SMG) in healthy subjects (HS) and temporal lobe epilepsy (TLE) participants. MATERIALS AND METHODS: Fourteen HS and 14 TLE patients with age and gender matched underwent resting state functional magnetic resonance imaging (rsfMRI) scanning using a 3-Tesla MRI machine to investigate the EC and percentage of amplitude fluctuation (PerAF) involving SMG and PRE. The rsfMRI data were analysed using Statistical Parametric Mapping (SPM12) and Spectral Dynamic Causal Modelling (spDCM) from which causal models were specified, estimated and inferred. RESULTS: Model with bidirectional connections between PRE and SMG was chosen as the winning model. The EC from PRE to SMG is positive but the EC from SMG to PRE is negative in both hemispheres and in HS and TLE. Based on the findings from the EC analysis, there is an excitatory effect shown by PRE to SMG connection indicating a dominant role of PRE over SMG in both groups. CONCLUSION: There is important evidence showing that PRE might also have influence on areas outside resting state network and the influence changes in the presence of brain abnormality.

Viscous placebo and carbohydrate breakfasts similarly decrease appetite and increase resistance exercise performance compared with a control breakfast in trained males.

Given the common view that pre-exercise nutrition/breakfast is important for performance, the present study investigated whether breakfast influences resistance exercise performance via a physiological or psychological effect. Twenty-two resistance-trained, breakfast-consuming men completed three experimental trials, consuming water-only (WAT), or semi-solid breakfasts containing 0 g/kg (PLA) or 1·5 g/kg (CHO) maltodextrin. PLA and CHO meals contained xanthan gum and low-energy flavouring (approximately 122 kJ), and subjects were told both 'contained energy'. At 2 h post-meal, subjects completed four sets of back squat and bench press to failure at 90 % ten repetition maximum. Blood samples were taken pre-meal, 45 min and 105 min post-meal to measure serum/plasma glucose, insulin, ghrelin, glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations. Subjective hunger/fullness was also measured. Total back squat repetitions were greater in CHO (44 (sd 10) repetitions) and PLA (43 (sd 10) repetitions) than WAT (38 (sd 10) repetitions; P < 0·001). Total bench press repetitions were similar between trials (WAT 37 (sd 7) repetitions; CHO 39 (sd 7) repetitions; PLA 38 (sd 7) repetitions; P = 0·130). Performance was similar between CHO and PLA trials. Hunger was suppressed and fullness increased similarly in PLA and CHO, relative to WAT (P < 0·001). During CHO, plasma glucose was elevated at 45 min (P < 0·05), whilst serum insulin was elevated (P < 0·05) and plasma ghrelin suppressed at 45 and 105 min (P < 0·05). These results suggest that breakfast/pre-exercise nutrition enhances resistance exercise performance via a psychological effect, although a potential mediating role of hunger cannot be discounted.

Role of carbohydrate in central fatigue: a systematic review.

Carbohydrate (CHO) depletion is linked to neuromuscular fatigue during exercise. While its role at peripheral level is relatively well understood, less is known about its impact centrally. The aim of this systematic review was to critically analyze the effects of CHO on central fatigue (CF) assessed by various neurophysiological techniques. Four databases were searched using PRISMA guidelines through February 2016. The inclusion criteria were: CHO as intervention against a placebo control, fatigue induced by prolonged exercise and assessed using neurophysiological measures [voluntary activation (VA), superimposed twitch (SIT), M-wave, electromyography], alongside maximal voluntary contraction (MVC). Seven papers were reviewed, where exercise duration lasted between 115 and 180 min. CHO improved exercise performance in three studies, whereby two of them attributed it to CF via attenuation of VA and SIT reductions, while the other indicated peripheral involvement via attenuation of M-wave reduction. Although a few studies suggest that CHO attenuates CF, data on its direct effects on neurophysiological outcome measures are limited and mixed. Generally, measures employed in these studies were inadequate to conclude central contribution to fatigue. Factors including the techniques used and the lack of controls render additional confounding factors to make definitive deductions. Future studies should employ consistent techniques and appropriate neurophysiological controls to distinguish CHO effect at central level. The use of pharmacological intervention should be incorporated to elucidate involvement of central mechanisms.

Analysis of selected glutathione S-transferase gene polymorphisms in Malaysian type 2 diabetes mellitus patients with and without cardiovascular disease.

Type 2 diabetes mellitus (T2DM) is believed to be associated with excessive production of reactive oxygen species. Glutathione S-transferase (GST) polymorphisms result in decreased or absent enzyme activity and altered oxidative stress, and have been associated with cardiovascular disease (CVD). The present study assessed the effect of GST polymorphisms on the risk of developing T2DM in individuals of Malaysian Malay ethnicity. A total of 287 subjects, consisting of 87 T2DM and 64 CVD/T2DM patients, as well as 136 healthy gender- and age-matched controls were genotyped for selected polymorphisms to evaluate associations with T2DM susceptibility. Genomic DNA was extracted using commercially available kits, and GSTM1, GSTT1, and α-globin sequences were amplified by multiplex polymerase chain reaction. Biochemical parameters were measured with a Hitachi autoanalyzer. The Fisher exact test, the chi-square statistic, and means ± standard deviations were calculated using the SPSS software. Overall, we observed no significant differences regarding genotype and allele frequencies between each group (P = 0.224 and 0.199, respectively). However, in the combined analysis of genotypes and blood measurements, fasting plasma glucose, HbA1c, and triglyceride levels, followed by age, body mass index, waist-hip ratio, systolic blood pressure, and history of T2DM significantly differed according to GST polymorphism (P ˂ 0.05). Genetically induced absence of the GSTT1 enzyme is an independent and powerful predictor of premature vascular morbidity and death in individuals with T2DM, and might be triggered by cigarette smoking's oxidative effects. These polymorphisms could be screened in other ethnicities within Malaysia to determine further possible risk factors.

The effect of relaxin on the musculoskeletal system.

Relaxin is a hormone structurally related to insulin and insulin-like growth factor, which exerts its regulatory effect on the musculoskeletal and other systems through binding to its receptor in various tissues, mediated by different signaling pathways. Relaxin alters the properties of cartilage and tendon by activating collagenase. This hormone is also involved in bone remodeling and healing of injured ligaments and skeletal muscle. In this review, we have summarized the literature on the effect of relaxin in musculoskeletal system to provide a broad perspective for future studies in this field.

Mice engrafted with human fetal thymic tissue and hematopoietic stem cells develop pathology resembling chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) is a significant roadblock to long-term hematopoietic stem cell (HSC) transplantation success. Effective treatments for cGVHD have been difficult to develop, in part because of a paucity of animal models that recapitulate the multiorgan pathologies observed in clinical cGVHD. Here we present an analysis of the pathology that occurs in immunodeficient mice engrafted with human fetal HSCs and implanted with fragments of human fetal thymus and liver. Starting at time points generally later than 100 days post-transplantation, the mice developed signs of illness, including multiorgan cellular infiltrates containing human T cells, B cells, and macrophages; fibrosis in sites such as lungs and liver; and thickened skin with alopecia. Experimental manipulations that delayed or reduced the efficiency of the HSC engraftment did not affect the timing or progression of disease manifestations, suggesting that pathology in this model is driven more by factors associated with the engrafted human thymic organoid. Disease progression was typically accompanied by extensive fibrosis and degradation of the thymic organoid, and there was an inverse correlation of disease severity with the frequency of FoxP3(+) thymocytes. Hence, the human thymic tissue may contribute T cells with pathogenic potential, but the generation of regulatory T cells in the thymic organoid may help to control these cells before pathology resembling cGVHD eventually develops. This model thus provides a new system to investigate disease pathophysiology relating to human thymic events and to evaluate treatment strategies to combat multiorgan fibrotic pathology produced by human immune cells.

Effect of CO2 flow rate on the Pinang frond-based activated carbon for methylene blue removal.

Activated carbons are regularly used the treatment of dye wastewater. They can be produced from various organics materials having high level of carbon content. In this study, a novel Pinang frond activated carbon (PFAC) was produced at various CO2 flow rates in the range of 150-600 mL/min at activation temperature of 800°C for 3 hours. The optimum PFAC sample is found on CO2 flow rate of 300 mL/min which gives the highest BET surface area and pore volume of 958 m²/g and 0.5469 mL/g, respectively. This sample shows well-developed pore structure with high fixed carbon content of 79.74%. The removal of methylene blue (MB) by 95.8% for initial MB concentration of 50 mg/L and 72.6% for 500 mg/L is achieved via this sample. The PFAC is thus identified to be a suitable adsorbent for removing MB from aqueous solution.

Colonic and small bowel metastasis from ductal carcinoma of the breast : a case report.

No abstract available.

Antiphospholipid antibodies among women experiencing fetal loss.

The presence of antiphospholipid antibodies (aPLs) is closely associated with thrombotic events and pregnancy complications such as recurrent pregnancy loss, preeclampsia and placental insufficiency. We investigated the presence of aPLs and its frequency among female patients with a history of fetal loss in a Malaysia population. Serum samples were collected from 108 patients who had (1) one or more unexplained deaths of morphologically normal fetuses at or beyond the 22nd week of gestation, or (2) one or more premature births of morphologically normal neonates at or before the 24th week of gestation due to eclampsia or preeclampsia, or recognized features of placental insufficiency, or (3) three or more unexplained, consecutive, spontaneous miscarriages before the 20th week of gestation. Serum was tested for aPLs subtypes: anticardiolipin (aCL), anti-beta-2- glycoprotein I (aß2GPI), anti-beta-2-glycoprotein I dependent cardiolipin (aß2GPI dependent CL), anti-phosphatidylcholine (aPC), anti-phosphatidylethanolamine (aPE), anti-phosphatidylinositol (aPI), anti-phosphatidylserine (aPS) and anti-sphingomyeline (aSph) by using the enzyme-linked immunosorbent assay (ELISA) method. The mean age of patients was 30±5. Four patients (3.7%) were found positive for at least one aPLs subtype. Four aPLs subtypes were detected. The most common subtypes was aß2GPI dependent CL (3.7%), followed by aCL (2.7%), aß2GPI (0.9%), and aPE(0.9%). In conclusion, frequency of aPLs among women with fetal loss (3.7%) in Malaysia was low with subtype aß2GPI dependent CL being the most prevalent aPLs.

The effects of injury prevention warm-up programmes on knee strength in male soccer players.

The study investigates the effects of the 11+ and HarmoKnee injury prevention programmes on knee strength in male soccer players. Under-21-year-old players (n=36) were divided equally into: the 11+, HarmoKnee and control groups. The programmes were performed for 24 sessions (20-25 min each). The hamstrings and quadriceps strength were measured bilaterally at 60°·s(-1), 180°·s(-1) and 300°·s(-1). The concentric quadriceps peak torque (PT) of the 11+ increased by 27.7% at 300°·s(-1) in the dominant leg (p<0.05). The concentric quadriceps PT of HarmoKnee increased by 36.6%, 36.2% and 28% in the dominant leg, and by 31.3%, 31.7% and 20.05% at 60°·s(-1), 180°·s(-1) and 300°·s(-1) in the non-dominant leg respectively. In the 11+ group the concentric hamstring PT increased by 22%, 21.4% and 22.1% at 60°·s(-1), 180°·s(-1) and 300°·s(-1), respectively in the dominant leg, and by 22.3%, and 15.7% at 60°·s(-1) and 180°·s(-1), in the non-dominant leg. In the HarmoKnee group the hamstrings in the dominant leg showed an increase in PT by 32.5%, 31.3% and 14.3% at 60°·s(-1), 180°·s(-1) and 300°·s(-1), and in the non-dominant leg hamstrings PT increased by 21.1% and 19.3% at 60°·s(-1) and 180°·s(-1) respectively. The concentric hamstrings strength was significantly different between the 11+ and control groups in the dominant (p=0.01) and non-dominant legs (p=0.02). The HarmoKnee programme enhanced the concentric strength of quadriceps. The 11+ and HarmoKnee programmes are useful warm-up protocols for improving concentric hamstring strength in young professional male soccer players. The 11+ programme is more advantageous for its greater concentric hamstring strength improvement compared to the HarmoKnee programme.

Ultrastructural changes during asexual multiple reproduction in Trichomonas vaginalis.

Trichomonas vaginalis, a flagellated protozoan parasite, is commonly found in the genitourinary tract of humans. Its mode of reproduction has always been reported to be binary fission. The high parasite numbers seen in a relatively short period in in vitro cultures led us to believe that there must be other modes of reproduction. The present study for the first time provides transformational evidence at the ultrastructural level seen in tropohozoites of T. vaginalis undergoing a multiple asexual mode of reproduction. The findings show that the single cell with a nucleus is capable of dividing to as many as eight nuclei within the cytoplasmic body. Before the commencement of division, the nucleus remained round or ovoid in shape with condensed chromatin masses and only a few endoplasmic reticula surrounding the nucleus. During the division, the nucleus started to elongate and become irregular in shape with visible chromatin masses condensing with the accumulation of numerous endoplasmic reticula. Nuclear division gave rise to as many as eight nuclei within a cell, which could be seen to be connected by numerous endoplasmic reticula. In addition, a high number of hydrogenosomes and vacuoles can be seen in multinucleated T. vaginalis compared with single nucleated T. vaginalis. This study confirms that multiple modes of nuclear division do exist in T. vaginalis and are a precursor to progeny formation.

Human NKT cells direct the differentiation of myeloid APCs that regulate T cell responses via expression of programmed cell death ligands.

NKT cells are innate lymphocytes that can recognize self or foreign lipids presented by CD1d molecules. NKT cells have been shown to inhibit the development of autoimmunity in murine model systems, however, the pathways by which they foster immune tolerance remain poorly understood. Here we show that autoreactive human NKT cells stimulate monocytes to differentiate into myeloid APCs that have a regulatory phenotype characterized by poor conjugate formation with T cells. The NKT cell instructed myeloid APCs show elevated expression of the inhibitory ligand PD-L2, and blocking PD-L1 and PD-L2 during interactions of the APCs with T cells results in improved cluster formation and significantly increased T cell proliferative responses. The elevated expression of PD-L molecules on NKT-instructed APCs appears to result from exposure to extracellular ATP that is produced during NKT-monocyte interactions, and blocking purinergic signaling during monocyte differentiation results in APCs that form clusters with T cells and stimulate their proliferation. Finally, we show that human monocytes and NKT cells that are injected into immunodeficient mice co-localize together in spleen and liver, and after 3 days in vivo in the presence of NKT cells a fraction of the myeloid cells have upregulated markers associated with differentiation into professional APCs. These results suggest that autoreactive human NKT cells may promote tolerance by inducing the differentiation of regulatory myeloid APCs that limit T cell proliferation through expression of PD-L molecules.

Oil droplets and solid particles removal using circular separator with inclined coalescence mediums: comparison between co-current and counter-current flow.

This research investigated the effects of co- and counter-current flow patterns on oil-water-solid separation efficiencies of a circular separator with inclined coalescence mediums. Oil-water-solid separations were tested at different influent concentrations and flowrates. Removal efficiencies increased as influent flowrate decreased, and their correlationship can be represented by power equations. These equations were used to predict the required flowrate, Q(ss50), for a given influent suspended solids concentration C(iss) to achieve the desired effluent suspended solids concentration, C(ess) of 50 mg/L, to meet environmental discharge requirements. The circular separator with counter-current flow was found to attend removal efficiencies relatively higher as compared to the co-current flow. As compared with co-current flow, counter-current flow Q(ss50) was approximately 1.65 times higher than co-current flow. It also recorded 13.16% higher oil removal at influent oil concentration, C(io) of 100 mg/L, and approximately 5.89% higher TSS removal at all influent flowrates. Counter-current flow's better removal performances were due to its higher coalescing area and constant interval between coalescence plate layers.

Prevalence and subtype distribution of Blastocystis sp. in cattle from Pahang, Malaysia.

Blastocystis sp. is a common enteric protozoan parasite found in humans and various type of animal worldwide. Recently, genotypic distribution of Blastocystis sp. was revealed in insects, rodents, avian and mammals, which exposed its potential of transmiting the infections to human. However, very little information on current level of Blastocystis sp. infection were reported in cattle from Malaysia. Herein, a total of 120 stool samples of cattles were collected. While the potential risk of infection such as age, gender, body score, diarrheic condition of the cattle were noted, the management of the farms was also recorded. All stool sample were cultured, but 80 samples were selected for PCR sequencing analysis. The cultivation and microscopic examination revealed only 25% of the cattle (30/120) were infected with Blastocystis sp.. But, 43.8% of the cattle (35/80) were found positive upon PCR sequencing. The study also found that age, body score condition, diarrheic condition and certain farm were associated with the infection (p<0.05). Six subtypes (STs) that were discovered during the study were ST10 (21.3%;17/35), ST5 (8.8%;7/35), ST3 (7.5%;6/35), ST1 (2.5%;2/35), ST4 (2.5%;2/35) and ST14 (1.3%;1/35). Thus, moderate infections of Blastocystis sp. and variants in the genotypic distributions of the cattle suggest its potential for zoonotic transmission. Therefore, this findings could be helpful for further understanding the parasite, which assist studies of its pathogenicity.

Effects of temperature on the detection of methicillin resistance in Staphylococcus aureus using cefoxitin disc diffusion testing with Iso-Sensitest agar.

OBJECTIVES: Cefoxitin is today the substance of choice for the phenotypic detection of methicillin-resistant Staphylococcus aureus (MRSA). We investigated the influence of incubation temperature in the standard range, i.e. 35-37 degrees C, and time, i.e. 18-20 h, versus a full 24 h. METHODS: Cefoxitin disc testing was examined at incubation temperatures of 35 and 36 degrees C and times of 18-20 and 24 h, respectively, for 94 mecA-negative and 49 mecA-positive S. aureus on Iso-Sensitest agar using a semi-confluent inoculum. RESULTS: Cefoxitin inhibition zones on Iso-Sensitest agar were larger at temperatures above 35 degrees C; two isolates (4%, 95% confidence interval=0.5-14%) incubated at 36 degrees C were falsely categorized as susceptible to methicillin. Incubation time across 18-24 h did not impact results. CONCLUSIONS: Detection of methicillin resistance in S. aureus using the cefoxitin disc method with a semi-confluent inoculum on Iso-Sensitest agar is influenced by incubation temperature, and the temperature should not exceed 35 degrees C for the reliable detection of MRSA.

Antiviral activity of a standardized root water extract of Eurycoma longifolia (Physta®) against dengue virus.

The aim of this study was to investigate the antiviral property of Eurycoma longifolia Jack (EL) against dengue virus. A propriety standardized extract of Eurycoma longifolia Jack (Physta®) was tested for anti-viral activity after viral adsorption in Vero cell line. Viral yield was measured by qRT-PCR in four serotypes of dengue virus. The antiviral activity was further investigated in an in vivo AG129 mouse model for dengue inhibitory candidates. 100 mg/kg EL extract was fed twice daily and challenged with a lethal dose of (~1x105 PFU per mouse) of DENV-2 over a period of six days. Antiviral activity with IC50 of 33.84, 33.55, 58.35 and 119 µg/ml for DENV-1, DENV-2, DENV-3 and DENV-4 serotypes respectively was observed. The selectivity index (SI) values determined as the ratio of cytotoxic concentration (CC50) to inhibitory concentration (IC50) was the lowest for DENV-2 at 28.9. The dengue virus (DENV) replication measured by qRT-PCR showed a reduction of 100% for DENV-1, DENV-2, DENV-3 and 80% for DENV-4 at day 2 of exposure. In the in vivo AG129 mouse model, a lower weight reduction, 30% lower viral load and 12% higher platelet in the extract group compared to the control was observed at day 6. The extract of E. longifolia has potential anti-dengue properties with improving trends in platelet counts. E. longifolia supplementation is potentially a two-pronged approach in treating dengue fever.

The distribution of uranium and thorium in samples taken from different polluted marine environment.

Concentrations of uranium and thorium in seawater, sediment and some marine species taken from along the coastal areas of Malaysia were determined spectrophotometrically. The uranium and thorium concentrations in seawater were found to vary ranging from 1.80 to 4.1 and 0.14 to 0.88 microg/L, respectively. The concentration of uranium in sediment samples was reported to range from 3.00 to 6.60 microg/g while those of thorium were slightly lower ranging from 0.01 to 0.68 microg/g. The uptake of uranium and thorium in marine species was found to be rather low. Similar variations in total alpha activities in samples were also observed with the total alpha activities relatively lower than the beta activities in most samples.

Computed tomographic evaluation of the odontoid process for two-screw fixation in type-II fracture: a Malaysian perspective.

PURPOSES: To measure the diameter of the odontoid process in a Malaysian population using computed tomographic (CT) scan and determine the feasibility of treating type-II odontoid fractures using 2 cortical screws. METHODS: CT images of the odontoid process of 85 patients aged 18 to 80 years were analysed; 69 (81%) were male (mean age, 44 years) and 16 (19%) were female (mean age, 48 years). Both anteroposterior (AP) and transverse diameters of the odontoid process were measured via axial CT images at 3 different levels: the base of the odontoid process and 1.2 mm and 2.4 mm above the base. RESULTS: The mean AP and transverse diameters of the odontoid process in men were 11.3 (range, 10.0-12.6; standard deviation [SD], 0.7) mm and 10.2 (range, 8.5-12.3; SD, 0.8) mm respectively, whereas in women were 10.9 (range, 9.4-13.2; SD, 0.8) mm and 10.1 (range, 7.9-11.6; SD, 0.9) mm respectively. The difference in corresponding mean dimensions between men and women was not statistically significant. The mean AP diameter was significantly larger than the mean transverse diameter. At the base and 1.2 mm and 2.4 mm above the base, the respective transverse diameters of 4 (5%), 13 (15%), and 24 (28%) of the patients were <9.0 mm. None had an odontoid AP diameter of <9.0 mm at any level. CONCLUSION: Two 3.5-mm cortical screws appear too big for fixation in one third of our sample presenting with type-II odontoid fracture. Fixation by two 2.7-mm screws is recommended for Malaysians and other Asian populations.

Rubella outbreak amongst residential students in a military vocational school of Malaysia.

An outbreak of rubella occurred amongst 303 newly recruited residential Form IV students in a military vocational training school in Malaysia. Of the 303 Form IV students, 77 gave a history of acute illness. Rubella specific IgM was detected in the sera of 46.5% (141/303) whereas rubella specific IgG was detected in 100% of all Form IV students. Sixty five students with no clinical history of acute illness during the outbreak period had detectable rubella IgM in their sera and rubella specific IgM was detected in the sera of all symptomatic students except one. Maculopapular rash was the commonest presenting clinical feature among students with acute rubella infection in this outbreak (97.4%) followed by fever (88.2%). The duration of rash ranged from one to nine days with a mean of 4.6 days. Of the 65 students that had both fever and rash, 56 (85.2%) students had maculopapular skin eruption on the same day as the date of onset of fever, six (9.2%) developed the rash a day after the onset of fever and three (4.6%) had the rash after two days of fever. The duration of fever ranged from one to eight days with a mean of 3.5 days. The duration of conjunctivitis ranged from one to four days with a mean of 2.3 days, and all those who developed conjunctivitis had mild eye-discharge without photophobia. The duration of arthralgia ranged from one to three days with a mean of 2.1 days. The commonest type of joints affected was knee joints (66.7%, 12/18), followed by elbow and shoulder joints (27.8%, 5/18) and wrist joints (5.6%, 1/18). A good clinical history of the temporal relationship between the occurrence of rash and fever during the outbreak could easily differentiate rubella illness from that of measles.