Evaluation of the retention of knowledge, skills and competency of post-neonatal resuscitation training among house officers.

INTRODUCTION: The Neonatal Resuscitation Programme (NRP) was first introduced in Malaysia in 1996 to train doctors and nurses working in paediatrics and obstetrics departments who are involved with the care of newborns soon after delivery. Prompt and effective neonatal resuscitation has been documented to reduce mortality and neonatal asphyxia. The programme has been revised every five years and is now in the 8th edition. NRP training was made into a key performance indicator (KPI) by the Ministry of Health in 2016 for all house officers to be trained in this programme during their 2-year posting and this is usually conducted during the paediatric posting. This study aims to evaluate the retention of their knowledge, skills and competency at 3, 6, and 9 months after the initial NRP training. MATERIALS AND METHODS: A total of 34 house officers were enrolled in the study on joining the paediatric unit of Hospital Kulim. They were given the "Textbook of NRP" to prepare for the theory paper that consisted of 30 multiplechoice questions (MCQs). Two to four weeks later they went through a day of training on the resuscitation of the newborn using low-fidelity simulation manikins. They were taught to recognise a newborn who needed resuscitation after delivery, prepared the equipment for resuscitation and learned the skills of resuscitation. The skills included the initial steps, bag valve mask ventilation, intubation, cardiac massage, umbilical vein cannulation and use of medications. They were also taught the performance of objective structured clinical examination (OSCE) A and B. They were evaluated at 3, 6, and 9 months after the completion of their training using the MCQs and the performance checklist in the NRP textbook. RESULTS: The results showed that there was a significant reduction in their knowledge retention as shown by their performance in multiple choice questions. Similarly, there was a significant loss of competency in their skills and competency in resuscitation using bag mask ventilation, intubation and performance of OSCE A and OSCE B. However, their performance at initial steps showed no significant reduction. CONCLUSION: In view of the observed deterioration a refresher course in NRP before transferring out to the districts is recommended to improve their overall performance.

Quality of life (QoL) and International Normalized Ratio (INR) control of patients attending anticoagulation clinics.

OBJECTIVES: To investigate association between quality of life (QoL) and International Normalized Ratio (INR) control, with the secondary aim of assessing QoL using generic and anticoagulation-specific, the Short Form Health Survey (SF-12) and the Duke Anticoagulation Satisfaction Scale (DASS). STUDY DESIGN: This study assessed anticoagulation related QoL at three time intervals in two groups of patients on long-term warfarin therapy. METHODS: Data of 326 randomly sampled patients (163 patients each in DASS and SF-12 groups) who had been on warfarin therapy for at least one year at anticoagulation clinics were analysed. QoL was assessed at three time intervals: at the start, six months and one year of warfarin therapy. Indications and target INR ranges and subjects INR values were recorded. Time in Therapeutic Range (TTR) was estimated for four subject subgroups, based on target ranges of INR for clustered indications. RESULTS: Of the total, 43% of the subjects were aged between 50 and 64 years, and 51% were female. DASS assessed subjects older than 35 years perceived significant decrease in overall mean scores of anticoagulation related QoL, whilst all SF-12 assessed subjects perceived an increase in QoL. The mean percentage days in range for all INR target range subgroups did not exceed more than 60% but there was only a weak correlation (Rs = 0.104, P > 0.05) between INR control and overall QoL. CONCLUSION: Malaysian urban outpatients on warfarin treatment longer than one year report a significant overall decrease in QoL, as measured using a validated condition-specific instrument. These patients appeared to adapt well to lifestyle limitations imposed by long-term anticoagulation.

Mini review: surveillance of Lyme borreliosis in Southeast Asia and method of diagnosis.

Lyme borreliosis is caused by the Gram-negative spirochetes Borrelia spp., particularly Borrelia burgdorferi sensu lato complex. The disease is transmitted through the bite of the infected black-legged Ixodes tick. Lyme borreliosis extensively occurs in the Northern Hemisphere, mainly in the United States. Lyme borreliosis cases are also detected in Asian countries including Korea, Nepal, China, Taiwan, and Japan. However, there is an inadequate understanding of Lyme borreliosis in the Southeast Asian region. Hence, this review aims to provide a brief update on the prevalence of Lyme borreliosis infection in Southeast Asia based on the latest literature on this issue. Lyme borreliosis has been discovered in human serum in Indonesia, Malaysia, and Singapore. The human serum samples were mainly examined with ELISA test using Borrelia spp. IgG and IgM antigens. Borrelia spp. also has been detected in ticks found on host animals such as Sundamys muelleri and Python in Malaysia, Thailand, and Laos. Polymerase chain reaction (PCR) is used to detect the presence of Borrelia DNAs in the samples. The published studies have demonstrated that Borrelia spp. exists in Southeast Asia and although the incidence is relatively low, it is believed that Lyme disease cases are under-reported.

Matrix proteins from smoke-exposed fibroblasts are pro-proliferative.

Airway remodeling decreases lung function in chronic obstructive pulmonary disease (COPD). Extracellular matrix (ECM) deposition is increased in remodeled airways and drives cellular processes of proliferation, migration, and inflammation. We investigated the role of cigarette smoke in altering the ECM deposited from human lung fibroblasts. Lung fibroblasts isolated from patients with COPD or other lung disease were exposed to cigarette smoke extract (CSE) and 5 ng/ml transforming growth factor-ß1 for 72 hours; in some experiments, inhibitors of signaling molecules were added. Deposition of perlecan, fibronectin, and elastin were measured by ELISA, as was release of IL-8 and IL-13. Unstimulated fibroblast cells were reseeded onto deposited matrix and assessed for proliferation and cytokine release. CSE (5%) increased deposition of fibronectin and perlecan from only COPD fibroblasts. Fibronectin and perlecan deposition was attenuated by addition of the NF-κB inhibitor, BMS-345541, and the signal transduction and activator of transcription-1/3 inhibitor, pyridone 6, respectively. CSE (5%) increased IL-8 release from COPD fibroblasts more than non-COPD fibroblasts. This increase was attenuated by BMS-345541. Matrix deposited after 5% CSE stimulation increased proliferation of fibroblasts, but did not alter cytokine release. ECM produced from COPD fibroblasts after CSE exposure has proproliferative effects. Thus, the ECM in patients with COPD may create an environment that promotes airway remodeling.

Near-miss Thoracic Spine Solitary Plasmacytoma with Neurological Deficit during Pregnancy: A Case Report.

Solitary plasmacytoma (SPC) account for only 5% of plasma cell neoplasms, and the literature hardly reports spinal SPC with a neurological deficit. Furthermore, spinal surgical intervention during pregnancy is rarely encountered and often requires multidisciplinary collaboration and management. The objective of this case report is to highlight this near-miss diagnosis and spinal surgical intervention during pregnancy. A 31-year-old woman with 24 weeks gestation presented with sudden paralysis and incontinence, with an underlying history of chronic backpain over a two-month period. Initially, she was treated for musculoskeletal back pain by obstetric colleagues during an antenatal visit, and no radiograph was performed. A non-contrasted spinal MRI was eventually requested when she started to show bilateral lower limb weakness, numbness and incontinence. The MRI highlighted thoracic vertebrae T11 vertebra plana with kyphotic deformity and a paraspinal soft tissue mass compressing the spinal cord causing spinal cord oedema. Our initial working diagnosis was spinal tuberculosis (TB), considering TB is highly endemic in Malaysia. However, TB workup was negative, and we proceeded with spinal surgery and transpedicular biopsy. Neurology improved significantly after surgery. Eventually, serum protein electrophoresis reported plasma dyscrasia, and HPE confirmed plasmacytoma. The patient was referred to a haematologist for steroidal and chemotherapy treatment.

Femoral Neck Non-Union - A Biomechanical Solution with Valgus Sliding Subtrochanteric Osteotomy: A Case Report.

Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman.

Motion artifacts in standard clinical setting obscure disease-specific differences in quantitative susceptibility mapping.

As quantitative susceptibility mapping (QSM) is maturing, more clinical applications are being explored. With this comes the question whether QSM is sufficiently robust and reproducible to be directly used in a clinical setting where patients are possibly not cooperative and/or unable to suppress involuntary movements sufficiently. Twenty-nine patients with Alzheimer's disease, 31 patients with mild cognitive impairment and 41 healthy controls were scanned on a 3 T scanner, including a multi-echo gradient-echo sequence for QSM and an inversion-prepared segmented gradient-echo sequence (T1-TFE, MPRAGE). The severity of motion artifacts (excessive/strong/noticeable/invisible) was categorized via visual inspection by two independent raters. Quantitative susceptibility was reconstructed using 'joint background-field removal and segmentation-enhanced dipole inversion', based on segmented subcortical gray-matter regions, as well as using 'morphology enabled dipole inversion'. Statistical analysis of the susceptibility maps was performed per region. A large fraction of the data showed motion artifacts, visible in both magnitude images and susceptibility maps. No statistically significant susceptibility differences were found between groups including motion-affected data. Considering only subjects without visible motion, significant susceptibility differences were observed in caudate nucleus as well as in putamen. Motion-effects can obscure statistically significant differences in QSM between patients and controls. Additional measures to restrict and/or compensate for subject motion should be taken for QSM in standard clinical settings to avoid risk of false findings.

Relationship between measured maximal oxygen uptake and aerobic endurance performance with running repeated sprint ability in young elite soccer players.

AIM: The aim of the study was to determine the relationships between maximal oxygen uptake (VO(2max)) in a maximal treadmill run and the aerobic endurance performance in the 20-m multistage shuttle run (MST) test, with the performance indices obtained in the running repeated sprint ability (rRSA) test, in elite youth soccer players. METHODS: Thirty-seven adolescent male outfield players performed on separate days and in random order the treadmill run test and the MST, to obtain their measured VO(2max) and aerobic endurance performance (via the number of completed shuttles in the MST), respectively. Players also completed the rRSA test of 6x20-m all-out sprints, interspersed with 20 s of active recovery. RESULTS: There was a significant moderate correlation between measured VO(2max) (in L . min(-1) and mL . kg(-1) . min(-1)) and MST results (r=0.43 and 0.54, P<0.05, respectively). There was no significant correlation between measured VO(2max) and aerobic endurance performance with any of the performance indices in the rRSA test (all P>0.05). CONCLUSION: The moderate association between the measured VO(2max) and MST suggests that both tests were plausibly measuring different aspects of a player's aerobic fitness. The lack of association between measured VO(2max) and aerobic endurance performance in the MST with performance in the rRSA suggests that aerobic fitness per se is poorly associated with performance in the rRSA in elite youth soccer players.

Measuring and predicting maximal aerobic power in international-level intermittent sport athletes.

AIM: The purpose of this study was to measure actual VO2max during the multi-stage fitness test (MSFT) and to compare this with predicted values obtained using previously established, commonly used methods. We also wanted to determine a new and more accurate regression equation for the prediction of VO2max in intermittent sport athletes. METHODS: Twenty-six, elite, male, intermittent sport athletes performed the MSFT with oxygen uptake (VO2) and heart rate (HR) measured throughout. Paired t-tests were used to compare measured VO2max with predicted VO2max. Linear regression was used to determine the equation for the prediction of VO2max from the total number of shuttles completed. RESULTS: There were no differences between the two methods of predicting VO2max, however, both predicted values (53.6+/-3.9 and 51.3+/-4 mL x kg(-1) x min(-1)) were significantly lower (9.3% and 13.2%, respectively) than measured VO2max (59.1+/-6.6 mL x kg(-1) x min(-1), P < 0.001). Correlations between measured and predicted VO2max were similar for both prediction methods (r = 0.61, P = 0.013 and r = 0.68 and P = 0.004). We present a new prediction equation [Y (VO2max, mL x kg(-1) x min(-1)) = 0.38 x total number of shuttles completed +25.98] (where R = 0.69; R2 = 0.48; SEE = 4.9 mL x kg(-1) x min(-1); SEE% = 8.3) which provides a more valid method of predicting actual max in intermittent sport athletes. CONCLUSIONS: A new regression equation to predict VO2max in intermittent sport athletes has been established. Whilst some error in predicting VO2max still exists, the new equation will provide coaches and sport-scientists with a more suitable equation with which to predict VO2max in intermittent sport athletes.

Measured maximal oxygen uptake in a multi-stage shuttle test and treadmill-run test in trained athletes.

AIM: The aims of the study were: i) to compare the measured maximal oxygen uptake (MVO2max) during the 20 m multi-stage shuttle test (MST) with MVO2max during an incremental treadmill-run test (TRT), and ii) to establish the reliability of MVO2max during MST, in trained athletes. EXPERIMENTAL DESIGN: 8 well-trained endurance-athletes (END) and 8 athletes involved in team games (GAM) performed the MST twice (i.e. MST1 and MST2) and the TRT once, in 3 separate sessions. MEASURES: MVO2maxx attained in the MST and TRT was measured using a portable respiratory analyser (model K4 RQ, Cosmed). RESULTS: MVO2max attained in the MST and TRT were significantly different for the END athletes (4.1+/-0.28 vs 4.45+/-0.31 Lxmin-1, P<0.05) but not for GAM athletes (4.01+/-0.51 vs 4.1+/-0.59 Lxmin-1, P>0.05). The 95% limits of agreement for MVO2max in the MST in Lxmin-1 were -0.67 to 0.27. MVO2max in MST1 and MST2 were not significantly different for END athletes (4.18+/-0.39 vs 4.1+/-0.28 Lxmin-1, P>0.05) and GAM athletes (4.01+/-0.55 vs 4.01+/-0.51 Lxmin-1, P>0.05). Reliability indicators for MVO2max in Lxmin-1 for MST test-retest were: typical error (TE)=0.14, coefficient of variation (CV)=3.5 and intra-class correlation (ICC)=0.90. CONCLUSION: MVO2max in the MST was lower than that measured in the TRT for the END athletes but not for the GAM athletes. Sport-specificity was an important consideration, especially when testing END athletes for VO2max. MVO2max in the MST showed acceptable levels of reproducibility.

Haemophilus influenzae meningitis in Malaysia.

OBJECTIVE: To determine the pattern of postneonatal childhood meningitis in Malaysia. METHODS: Retrospective cross-sectional study involving five pediatric departments in Malaysia. RESULTS: There were 435 cases of clinical meningitis admitted to the five centers. More than 90% of the patients were <5 years old, and one-half were <6 months of age. The estimated overall incidence of childhood meningitis in the first 5 years of life was 76.7 per 100000 per year. However, of the 435 cases only 71 (16.3%) fulfilled laboratory diagnostic criteria and in only 58 of these was an organism isolated. Nearly one-half (48%) of all bacteriologically proved cases were caused by Haemophilus influenzae type b (Hib). The mortality rate was 12.5% and 21 patients (30%) suffered neurologic sequelae. CONCLUSIONS: More than one-half of all cases of culture-positive childhood bacterial meningitis were caused by Hib, although successful isolation of a pathogen occurred in only a small proportion of cases. For this reason the true incidence of Hib meningitis in Malaysia remains unknown. These findings are consistent with previous studies in Malaysia.

A stair-climb test of cardiorespiratory fitness for Singapore.

OBJECTIVE: The purpose of this study was to develop a stair-climb test of cardiorespiratory fitness for adult Singaporeans, particularly those staying in Singapore Housing and Development Board (HDB) flats. METHOD: 103 subjects [56 males, of mean (SD) age 44.8 (13.9) years and Body Mass Index, or BMI, 23.3 (3.2); and 47 females, of age 43.2 (12.9) years and BMI 21.9 (2.8)] were first assessed for their cardiorespiratory fitness, measured using maximal oxygen uptake (or VO2max) on a treadmill, before undergoing a stair-climb test up to the 12th storey (11 floors) of a typical HDB flat (180 steps, vertical height 27.0 metres). RESULTS: The mean (SD) time taken for the climb (CT) and heart rate at the end of the climb (HRend) averaged 111.3 (16) seconds and 154.4 (13.4) beats.min-1 respectively for males, and 121.0 (18.1) seconds and 164.6 (15.7) beats.min-1 respectively for females. Regression equations were developed to predict VO2max from age (years), BMI, CT (seconds), HRend (beats.min-1): For males: VO2max (ml.kg-1.min-1) = 133 - 0.273 (Age) - 0.672 (BMI) - 0.236 (CT) - 0.232 (HRend). For females: VO2max (ml.kg-1.min-1) = 66.69 - 0.135 (Age) - 0.249 (BMI) - 0.128 (CT) - 0.021 (HRend). Validation of the regression equations conducted on a different sample consisting of 18 subjects (11 male and 7 female) showed significant correlations between the predicted and directly measured VO2max (males, r = 0.81 and females, r = 0.90; p < 0.01). There were no significant differences between the means of predicted and directly measured VO2max. CONCLUSION: A stair-climb test using HDB stairs was developed which was able to estimate cardiorespiratory fitness with reasonable accuracy.

The relationship between maximal oxygen uptake and repeated sprint performance indices in field hockey and soccer players.

BACKGROUND: The purpose of this study was to examine the relationship between maximal oxygen uptake and repeated sprint performance in field hockey and soccer players. EXPERIMENTAL DESIGN: a descriptive study on the aerobic-anaerobic performance of intermittent team game players. SETTING: the study was conducted at the Sports Medicine and Research Centre. PARTICIPANTS: forty male national team game players (22.6+/-4.2 years; 1.73+/-0.07 m and 63.7+/-6.2 kg) were involved in the study. MEASURES: all subjects completed a treadmill run test to exhaustion to determine maximal oxygen uptake and 8x40 m sprints either on the field or running track to determine repeated sprint ability performance. RESULTS: Body mass-normalised maximal oxygen uptake of 58.0+/-4.9 ml x kg(-1) x min(-1) of the group is comparable to values reported in the literature for team game players. No significant correlations were established between the fastest 40 m sprint time and maximal oxygen uptake (r=-0.21 and -0.08, p>0.05). Moderate correlations were established between maximal oxygen uptake and total time for the eight sprints (r=-0.346 and -0.323; p<0.05). CONCLUSIONS: Maximal oxygen uptake was not correlated with the fastest 40 m sprint time but was moderately correlated with total sprint time. Since the shared variance between maximal oxygen uptake and total sprint time was only 12%, improving aerobic fitness further will only be expected to contribute marginally to improving repeated sprint performance of the team game players. It remains possible that a high level of aerobic fitness enhances other aspects of match play in games like soccer and hockey.

Physical activity patterns of Singaporeans in 2001.

INTRODUCTION: This study was conducted on Singaporean males and females to determine the extent of involvement in sport, work-based and home-based physical activities, and other activities such as walking and stairclimbing. METHODS: A Physical Activity Questionnaire was designed and data collected in conjunction with the Singapore National Sports Participation Survey 2001. RESULTS: Three hundred and ten households with 605 respondents (287 males and 318 females) completed the questionnaire, representing a response rate of 81 percent. Males spent more time doing sports, work-based physical activity and walking and stairclimbing activities while females spent more time in housework. However, females spent more time (568 versus 410 minutes per week) on overall physical activity, mainly due to their heavier involvement in housework. Compared with a similar study in 1997, males and females were doing more sports activities and walking and stairclimbing activities, but had reduced involvement in work-based and home-based activities. Overall, respondents in 2001 were spending about 31 percent less time (457 versus 598 minutes per week) on physical activities than respondents in 1997. There was a reduction in physical activities among males from 476 minutes per week to 410 minutes per week, and a sharper drop among females from 904 minutes per week to 567 minutes per week. CONCLUSION: Singaporean males and females in 2001 are spending less time on overall physical activities. The trend towards a reduction in overall physical activities from 1997 to 2001 is cause for concern. Relevant organisations would, therefore, need to continue promoting sports and physical activities to the Singapore population.

Grip strength measurement in competitive ten-pin bowlers.

BACKGROUND: In an attempt to find a more specific grip strength test for bowlers, the conventional grip strength test was modified such that only the fingers used in holding the ball are tested. The objective of this study was to assess the test-retest reliability of this modified bowling grip strength test, to assess the agreement between the bowling and the conventional grip strength tests, and to examine the correlation between the modified test and bowling performance in competitive bowlers. METHODS. EXPERIMENTAL DESIGN: This research was conducted in two parts, each with a different study sample. Study I was a cross-sectional study to assess the correlation between the bowling grip strength and the bowling score. Study II was a comparative study to obtain the test-retest reliability for both the bowling and conventional grip strength tests, and to assess the agreement between the two tests. SETTING AND SUBJECTS: for study I, the subjects were 39 members (26 males and 13 females) of the Singapore National Ten-Pin Bowling Training Squad. Bowling grip strength was measured within one month prior to the selection trials for the national squad, the results of which were used as a measure of bowling performance. For study II, the subjects were 21 members (12 males and 9 females) of the Singapore National Ten-Pin Bowling Squad that was formed after the selection trials. INTERVENTIONS: none. MEASURES: Bowling grip strength, conventional grip strength, and bowling score. RESULTS: The test-retest reliability of the bowling grip strength measurement (r = 0.91, p < 0.01) was comparable to that of the conventional five-finger grip (r = 0.93, p < 0.01). The single measure intraclass correlation coefficient between the bowling and conventional grip strength tests was 0.77; the 95% confidence interval was 0.51 and 0.90. However, the correlation coefficient between the bowling grip strength test and bowling score (r = 0.27) was not significant. CONCLUSIONS: The bowling grip strength test has a high test-retest reliability, and a moderate agreement with the conventional grip strength test. However, despite using only the bowling fingers, the test was unable to predict bowling performance in elite bowlers.

Physiological characteristics of Singapore national water polo team players.

BACKGROUND: The purpose of this study is to describe the physiological characteristics of members of the Singapore national water polo team. EXPERIMENTAL DESIGN: a descriptive study on the physiological characteristics of members of a winning water polo team. SETTING: the study was conducted at the Sports Medicine and Research Centre. PARTICIPANTS: 13 male players (22.5+/-7.2 yrs; 178.5+/-3.9 cm and 71.0+/-8.4 kg). MEASURES: players completed body fat measurements, a submaximal cycling test to determine aerobic fitness and all-out maximal efforts (of arm-cranking and cycling) for 10 and 30 sec duration to determine anaerobic peak power, alactic and lactic acid work capacity for the upper and lower body. RESULTS: The physical measurements were compared with data of national players of various countries. The exercise test results were compared with available published data. CONCLUSIONS: Compared with elite water polo players from other countries, the Singapore water polo players are smaller in stature with a lower body mass. Relative to the limited published data, they are shown to possess a high level of aerobic fitness and anaerobic power and capacity for short-term work.

The role of the Singapore Sports Council in coronary artery disease prevention.

The Singapore Sports Council (SSC) is a statutory board (government body) which was set up in 1973. Its main responsibility is to implement the "SPORTS FOR ALL" policy of the Singapore Government. Physical activity has been found to be an important factor in coronary artery disease prevention. It is through its "SPORTS FOR ALL" policy, by promoting physical activity to all Singaporeans, that the SSC helps in coronary artery disease prevention. The SSC promotes physical activities (and sports) by providing facilities, running fitness schemes, organising instructional schemes for sports, sports training schemes and sports activities. The facilities available to the public include swimming pools, stadia with running tracks and playing fields, tennis courts, squash courts and badminton courts. A 1987 national survey showed that 28.3% of the population aged 15 and above engaged in sports one or more times a week. Those who exercised three or more times a week accounted for only 7.9%. The SSC will continue in its efforts to improve this rate of physical activity in the population, with coronary artery disease prevention as one of its main objectives.

Some possible benefits and dangers of non-aerobic exercise in cardiac rehabilitation programmes.

This paper reviews several recent studies on the possible benefits and dangers of non-aerobic exercises in cardiac rehabilitation programmes. It presents the case for including in such programmes, exercises which specifically improve components of overall physical fitness other than aerobic or cardiorespiratory endurance fitness. This is because many of these other components of overall physical fitness are required in the daily lives of patients in cardiac rehabilitation programmes and can best be acquired through non-aerobic exercises. These non-aerobic exercises include judicious callisthenic and isometric exercises to specifically improve on joint flexibility, agility, muscular strength, muscular endurance and coordination.

Management of gastroschisis in a peripheral hospital setting.

Ten patients (5 males and 5 females) with gastroschisis were treated in Alor Setar Hospital from January 1989 to December 1993. Two patients had associated congenital anomalies. Primary closure was possible in 9 patient while the other patient had stage closure. All patients received prophylactic antibiotics, 9 patients were ventilated electively in the post-operative period and 7 patients received parenteral nutrition. There were 9 survivors. Complications especially wound infection and breakdown were seen in 7 patients. The average hospital stay was 36 days.

Infantile myofibromatosis.

Infantile myofibromatosis (IMF) is a rare tumour with a wide spectrum of disease activity ranging from a solitary cutaneous nodule through to a multicentric form with widespread visceral involvement. It is characterised by its unique ability to spontaneously regress and has a typical histological appearance of actin-positive fibroblasts arranged in whorls or fascicles and vessels in a pericytomatous pattern. A male infant with multiple lesions involving the subcutaneous tissue and bone from birth is described and followed-up for two years. Treatment of IMF is dependent on the location of the tumour/s with surgery or chemotherapy reserved for rapidly progressive or symptomatic disease. However, due to the low rate of recurrence and the possibility of spontaneous tumoral regression, therapeutic abstention, as practised in our patient, is justified.