ru 0921/200671 Ne elISLAND HOSPITAL 4 1-exposure www.islandhospital.com CONTENTS —} (04 - VACCINATION jy wage | Nutrition for growing up healthy sau 05 nTRODUCING THENEW 40 Food is important to nourish every 2) Mealtime canhea gon famitime ULTRASOUND age and stage in a childs life whether yrenttren ent th he faliesmealstend to vay and more MACHINE in infancy, toddler, preschool, School gun hana these econ cevlop solos ond ld go ae yeas or during adolescence Parents ung hasan ale mares recomend ere sed Oe 96 - CONGENITAL food choices which not only nourish but ** easton family men per dy. FEARTRoase | {08 choles, which ot only nourish but" Nah aver can elo lth cls appt a que 9 time before meals and snacks. This is to ensure food is taken safely and cETToKNOWOUR | Chile’ sociily, emotionally and {imebremeaand nds Theiso NEWCONSULTANTS | psychological No matter what the child's age is, 3) Children need to make their own food decision 08 SPEECH they need similar nutrients es aoults __Aschidan growl they wanttogevtp heron coc offood taNcuacE butlsdiferentuncunts They enjoy many _tvough th eset fod pode bythe parent ot ote THERAPY wane as ts aur But the Panam Respet thee peor fod pretence ard appet)encsrage a eee eather ckenenyce that then uy tewleods wou: rr orig oem: potrcate asd liane fuentanremesieseetoeeamse fomethe atest har orto hs lear Wit ORESE ep | andvespecttheiference and tomate Oviedo, experene anda CHMLDRENNEED, | food avaiable that are appropiate for Dasenetadlers or preschoolers serving that ror uth one Gitenatrsettimesnagiacelwie the thidthe eels Ofer caen ess thenyou tin hey wl st wvorAg YOUR | hus'Srateotier nd uiflesmntodscde Sowtr tole thomas ore-Agofsten tobe cgsiuge ces crite child onthe ther hand wil ea to deci ch tls youtiat ere il eset Chlsen opine to poet ak fod hes ma Seenou toss ter hunger Avo rang the cdo nah ser Jo -0AE\OTDACOUSTC fer foo Thiscan etn veering toe aveson EMISSIONS) HERE ARE SOME VALUABLE 4) Healthysnacks canbe partofachldSheathfuleatingpan OTE \ Sais an prove nutes and ney tat moy be ising fom 12 - BREASTFEEDING FOU INC YOUR CAND: testers nam meat Sac shoul be ured at supplement NEONATOLOGY toglt mensbut not oss replacement snadscan be sere rt les ioimprareating guides frclren Svea borers nteaec spt meine Aeparets wean ofr woto hres bowen te nan mens 13-:SPINECENTER ; when they 1) Most children perform best when they Choices of sriacks can range from fresh food to convenient food. Listed 15 - VISITATION TO eatata regular schedule here are afew creative suggestions to try. Breakfasts themostinpartantmealfora + sack ebots Ctra vgetates usin churk Sener then ISLAND HOSPITAL child. This is to-assst himor her to have a dontothin prevelstcls weDcaLcanrs | hes Chiten wetter seas «Yai Ca ey, camber Ieauaiycaayavidorersracungnirnoy 7 yeah a e-rusucneacth | Incluceumeatiy chotes suchas oo, TRTIMOW asa aut then incre mane Inga meaty cokes sic OS Ee «Banana ops Fela aranaan dip in yoo the incre Breit ener orchkien serch shown tht missing breakfast interferes with alertness, attention span, thinking, and memory IF your childs on a weightloss et, you should know that skipging breakfast op usually does ead to weiat los + Fruit shake-up - Put cup of lw ft fait yogurt and Ya cup of cold ‘ruitjuice and shake chem up before serving + Pudding shakes ~ Put 2 cup of aw fat fut yogurt and V/cupof cold ‘nutjuice and mix /2cup of mand 3 tablespoon of instant pudcing, Set the pudding in the refigrator before serving + Sandwich cutout -Use a cookee cutertocutthe bread into diferent ‘hapeslike stars or heats. Put some ham, cheese o rut jam in between to make asandwich, + Peanut butter ball - Mix peanut butter and comflakes /branin a bowl Then roll them in crushed graham biscuits + Icecream wiches Put a scoop of ice cream or frazen yogurt between two oatmeal biscuits or waflles. Make these ‘sandwiches and treze them. con poge2cont fom page} 5). Offer kids a variety of foods from the five food groups in the food pyramid Guide them totake mare af the loner calorie foods lik gains, egetables, ow fat dairy products and other rch protein food. Food nbe divided into basic qroups: milk products, meat / eggs grains, Fut, fndvegetables. The USDA revised the Dietary Guidelines for Americans in 2005. The recommended servings per day ate as listed below: rae Serving per day | Remarks Milk products (milk cheese, 240 3 servings 8 ounces is 1 servin ‘yogurt, icecream) Aupsceren 8 gene Meat/egns (red meats, > seryng, —- Sounces per day pouty, sh, and e505) total Grains (reads cereals servings | 1 sce ofbreadis tice, pasta) Gto11 servings | Serving Vegetables (juice o ect Pea Neseablar BteSsewings Vicupis | sewing Fruits Guice or solid fut) 2t04serings V2 cupis 1 serving 20%6 of a healthy diet should consist of mil, meat and eggs, and 80% should be vegetables us, and grins. 6) Getyourkids involvein food choices Let your child help plan ameal around thelr favourite foods, You could «also get them to help you select healthful choices inthe supermarket with Your guidance. You could also get them to help you prepare food for the ‘meal by arranging the food or assst you inthe cooking. ust be careful if there isheat involved in the preparation 7) Avoid labeling food ‘Yu can reward your kes with affection and attention but net food. By using foed 25 reward or punishment, we actualy instil unhealthy attitudes about food. As parents, we also must not let our food dislikes hinder our Chilren fom tying new foods. We can show good examples like eating ‘Vegetables and fruits 50 that our children wil flow. \We do not need to label food as bad or'goo! Al food can be apart of ‘our child's healthy eating plan. What is important isthe corect portion, ‘requency and the combination of food chowes given to our children. Teach them to plana balanced meal and taking high calorie food in moderatian 8) Fiveaday forkids One ofthe common prablemsin childrenis that they donot eat enough feutsand vegetables intheir daly intake. These two food groups are essential for children at all ages. Fruits and vegetables can prove good source of fibre, vitamin A, C, antioxidants, minerals ike catium, irr, folic acd to name afew, These wo groups also ensure good digestive function, bowel ‘output and also enhance the immunity ofthe children. Children should Gonsume at las 8 servings 4 cups in ta) of sand vegetables per ay. ‘+ Trytosenea fuitat every meal ‘fer fruits as dessert ane snacks. “+ Starteveryday with clas of fut juice Avoid excessive fut juices that ‘an cause ciathoea or decrease your child's appetite for other foods. ‘The American Academy of Paediatrics recommends the following limits {or fut uice pe day. © aunces for childeen age 6 months to 6 years and 12 ouncesfor children 7 to 18 years You should serve 100% fut juices, not fut dink, Fruit drinks mainly contain water and sugars. They cont count asa serving of fut, ‘= From practical standpoint, futs and vegetable are interchangeable. Don't force chien to eat vegetables they don‘ lik. Offer ones they dolike orsubstitute fut. ‘© When making casseroles increase the amount of vegetables and decrease the amount of meat. Serve moce vegetable in soup, ‘+ Encourage more cereals for breakfast ‘+ Use more wholegrain bread in making sandwiches. Very large fruit eg. papaya, melon, pineapple 1 sce Died fruit Yocup Guava va medum fut Cooked fut or vegetables or dark green vegetables - von Salad or lam yap Fruit juices Yegiass 9). Maintainan adequate caleium intake Calcium i important for building strong bones, thereby preventing broken bones in children and soft bones (osteporosis in ater adulthood [Most ofthe calcium that gives heathy bone density laid down between ages 9 and 18 years. During this time calcium intake should be 1200 mq por day ‘A.cup (8 cunces) of milk contains 300 mg. so optimal intakes 4 servings cof mik products per day One cup of mikis equal to 8 ounces yogurt, 5 funces of cheese (approximately 2 ses) or 1 cup of calcu fried fut juice Whole, 2%, 14 and skim mika contain te same amount of aicum be cup. Cider age 1 to 4 years need 2 servings of calcium per day and {hose 4 to 9 years need 3 servings per day if chidof any age doesnt ike the taste of mil, intake can easily be improved by serving favoured milk 10) Include an adequate amount ofiron inthe diet “Throughout ou lveswe need enough rn inourdietsto prevent anemia {and forthe childrens mental development, Everyone should know wich foods are good sources of rn, Red meats, fish, poultry and eggs ae the best. Having 2 servings per day ofthese foods will provide adequate iron ‘Although Ine ia good source afro, it has 16 times mar cholesterol than beet and should be avoided For young children who refuse meats in general, use some low-fat luncheon meat asa meat source. ron's also found or-enviched cereal, beans of alltypes, peanut butter raisins une jie, sweet potatoes, spinach, ‘and egg yolks. The ton in these foods better absorbed ifthe meal also Contains uit uie or ruts igh in vitaminFor the greatest journey you'll ever take Maximising Neuron Connections BRAIN BRAIN DEVELOPMENT BRAIN PERFORMANCE FORMATION Pregnancy Stage Breastfeeding Stage Growing Up Stage Baby's bran begins to Baby is born with over 100 bllon brain cells. She stares to develop Your child's brain starts her formas early as 27 bran functions tke depth perception. speech and motor sk. accelerated growth and reaches ays after conception. 0% of adie sza by age 3. <—o NTF e oo — ors oe Anmum, Cr po pe Anmum rueor| cempotion of resend lp With the right stimulation and nutrition, you can help to optimise your child’s learning ability and memory. Fonterra Brands believes that breast milk is best for babies and we support breastfeeding as the natural and unequalled way to providing the best food for optimal growth and development of babies. Govtores)) —‘entera ands Sb Bi: Lt 1, Subag eh nd Park ats Th, ‘Measles * Mumps + ‘bela (Cerman Measles) * Varicella (Chicken ox) *v Preumococeus *b Japanese B Encephalitis *y Hepatitis" Rotavirus *v Influenea * Meningococaus*b ‘Human Pepillome Vitus * Cholera" Typhoid * cee iesesrvpdbse acraon ‘Sree felonedy Kenerean ‘stan aay ay of ath) ‘by aenotes bacon Vente vs ‘Vaccines make use ofthe inactivated part ofthe infectious agent (usually bacteria or Vis) morderto stimulate the body to produce "atural antibodies against it. This could be @ living attenuated vis (avira rendered weak ‘soitwil not be pathogenicand cannot cause disease tan inactivate antigenic material (parts ofthe dead virus or bacteria which con stimulate a protective antibody response). This \aczine subsequently produces a degree of immunity that lasts for a certain period of time, sometimes indefinitely. YVaccnesare administered ina muittude ofways + by nection subcutoneousy (SC) (under theskin os in most cases, eg lphthera, pertussisond tfanusand HB) + byinjcton intramuscularly (h) into the ‘muscle as in Hepatitis A and 8 and Preumococeal vaccine) + by injection intdermaly (10) (BC6) or + by oral route (PO) (Rotavirus, Typhoid) * by multiple routes (eg. Poliomyelitis con be given orally as the inactivated Ining vitusor by subcutaneous injection othe ‘antigenic material) What about the safety of vaccines? Modern vacines are usualy fee from rajor de effects Sometimes vere may be bain and swelling athe site ofthe injection which canto a ayo te Occasionally Sere ‘fever for a short duration, and inthe case the mealesvacie, some cough and oid ‘na fen vaccines two weet later, ‘The illustration that comes with this article [sland Hospitals Immunisation Schedule for infants an chron ts crawn Up mth mach thought and after aking nto Consideration, among othe factors, the disease pattern in Malaysia and the Convenience tothe patient At bith onthe fist Few days of fe, ACG is edminstered 1D inthe left upper Shoulder. Tisisa ve attenuated bactrim that offers protection against uberculoss, accination in Children It leaves a small scar that becomes visible after ‘one month o si weeks Sometimes ait of pus discharge oc during tis prod You need to Wwibeitof with wet cotton woo, endshould nat vor foo much {At bith or in the fst days fife, the baby born in sland Hospitals also admistered the frst dose ofa course of vaccinations to protect against Hepatitis 8. Hepatis 8 Vaceme (HBV) is administered In, andthe course consists of 3 doses, the other two being qven at | marth and months of age lathe event the mother sa Hepatitis B carer, another injection is given at this time, the Hepatitis B Immune Globulin (HEPABIC) for nmedae protection as HBV Takes time to bud up theinfant’ immunity ‘At 6 weeks ofage we recommend Rotavirus Vaccine (RVV) aven PO. Rotavirus she leading cause of chighood gastroenteritis (severe Girrhoe) Since the econ advent of RW. many tives around the word, notably in developing countries, have been saved. The second dose 8 ‘ven abouta mont later to complete the course. Infants ike she sweet taste ofthe vaccine ‘AL2 months, we adniister a cocktail ofS vactnes in one subcutaneous nection. They are Diphtheria Tetanus, Pertussis (Whooping Cough) (PTo), Haenophilusinfuenzee 8 (118) and Foliovrs. Diphtheria, which was a devastating ness ‘on account af ts effect an the tonal and throat and neck glands causing breathing alfeuly and respiratory obstructions aah Seen anymore because ofthe effectiveness of the vaccination programme Tetanus is also krown as locjaw because ‘ofthe severe muscle spasms produced by ‘neurotoxin leased by the bactenum which ‘resin deep seated wounds. + Whooping cough, as the name suggests, ‘uses distesinginessespecally in inaney. ‘The Pertussis vaccine protects against this its acelir unite previous one, vary eftecive and dees nat induce high fever and convulsions, + The Polio vaccine we use isthe injectable ‘one (PV) as it has better immunogenicity ‘than the oral form. Polio whicn cause Senous debility because of limb weakness and paralysis, with muscle atrophy, has been praca wiped of the face ofthe earth ecause of vacation ‘+ Hibisa bactrim which can cause meningitis aswelas blood, chest and ear ifecions and iS often mixed up with infvenza whi a Vitus that causes cad, ever, body aches and ‘ough due to benchitsandpoeumonia, ich ‘anotien be fatal inthe elder. “This cacti of DPTa, 8 and PV isrepeated 213, 4,18 and 60 months fo a taal of 5 doses ‘The Preumococcal Vaccine (is offered as an option Itcan be given thee doses, wo monhs apart each time (eg. 2.46 7 3.57, 05,7), 10 ‘he fst year of hfe with a booster dose at 14 months. This vaccine protects against serious illness perpetuated by the Pneumococcus bacterium, induding blood infection, preumoni, ear infcion nd mening [tone year old, we offer the infant MMR (Measles Hurmps and Rubella) Sc. There's good feason to induce permanent protection against these infectious diseases + Measesisa common ial disease of childhood ‘using high fever and generalized rash, ‘Compliatons include Pneumonia and rely aseveretypeo brain encephalitis aed SSP ‘by Dr Michael Khor Kok Seng ox Consultant Paecatician Hs uo ts) FY) FF, ad) FA ‘+ Mumps causes fever and swelling and inflammation ofthe parotid glands and in ‘boys occasionally invades the testicular ces causing eri ‘+ Rubella also know as German Measles, follows ‘a milder course of dsease ast namesake but ‘an be devastating if it occurs in the first trimester of pregnancy for the unborn foetus may be born with mental retardation, ‘deafness heart disease and blindness. ‘A boosters given at § years old. We ae in the process of reviewing new evidence for Ideal timing ofthe booster foc better protection against ‘meases, and may in future recommend thatthe booster should be given eatlier (eg. at 2 years oid) ‘At.13 months old, the Varicella vaccine (odministered SC) gives protection against chicken ox another highly contagious viral infection of Ehldhood which results in a vesculartype of ash (ivith blistering) that can sometimes leave sears and pockmarks anc be permanent disfiguring in Severe instances Ithasbeen recently agreed that aboosteris probably required at 5 years or eal. ‘Aer the age of 18 months, the inactivated vaccine against Japanese 8 encephalits (6) vius isan option. eis given in three doses the second follows he fist after 2 0-4 weeks and the tics a booster a year afer the fist. JE which is a ‘mosquito borne virus isthe leading cause of bain infection in Asia and ocursin outbreaks. Pigsand wild bird ae reservoirs ofthe disease. causes 9 devastating often fatalliness attacking the brain, and causing high fever with malaise, headache, fits and coma, Survivors are frequently leRt with lifelong neurological defects (such as dearess, paralysis) and mental subnormaiiy. Another vaccine to protect against brain infection sthe Meningococcal vaccine. Its caused by the bacterium Newser meningiides, There ate various strain and the anes causing disease are ABCXY and W135. itis transmitted from Person to person through close contact through ‘Salva and cough secretions) and can spread like wile in barracks and schol and callege hestels. It sa particular problem for those going on the hj to Mecca and vaccination against W135 is ‘mandatory This infection sa medical emergency, 45 the untreated condition Is often fatal. tnt ‘nly involves the meninges (the tissue covering the brain) but causes bleeding into the skin (purpura), andithisinvlves the extremeties may lead to huge scars and amputation ofthe limb involved. We use the conjugate vaccine called Mencevax (against ACW). Itcan be given as a single dose to selected children over 2 years ld (9. close contacts or during cutoren). ‘Therefore to recap, Island Hospital has four vaccines avaiable to protect against 4 different ‘types of infectious agents which attack the brain (Hi8, Preumococcus JEand Meningococcus). Three ate bacteria (HIB, Fr, Ar) and one virus J). The bacteria cause mainly meningitis while the cont pagevirus causes mainly encephalitis, which i even ‘At 2 years ol, we recommend Hepatitis A vaccine (IM). Hepatitis Aisa liver virus ie. it ‘attacks the liver andin the acute stage, the patient ante ilwith nausea, vomiting an yellon whites ‘of the eye, together with passage of dark tea ‘Coloured urine, A couts of 2 injections six months ‘pat offers lifelong immunity, and our pate {do not have to worry about taking partially uncooked food such as the cockles in char Koay teow! As opposed to Hepatitis A which is a self limiting disease, Hepatitis B infection often ends Up with the patient being a life long carter of the disease withthe vitus residing in the liver permanently, and eventually causing harm tothe liver, Hepatitis B is transmitted from mother to chil at birth or through contaminated blood twansfusion and sex in late life. The affected patient who enters a carier stage can get liver GGurhosis which i a hardening of the liver with destruction of the liver architecture, This in turn ‘often leads to hepatoma (cancer of the lve). ‘Thisis the reason why Hepatitis B vaccination is mandatory and newborn babies are started early fon a coutse of vaccination to protect them throughout life, asthe cartier rate in Malaysia is5%, ‘Another vaccine available for widespread useis the Influenza Vaccine IN. Influena isa vieus ‘commonly known as flu and has symptoms of (old, running nose and fever not responsive to ‘antibiotics. it can be complicated by severe bronchitis and preumonia, especially inthe very young an old: The vaccine is against the three ommonest strains ofthe vitus. Due tothe virus changing rap ovr time a vaccine formated inone yar soften ineffective the nex, hence the reed vaccinate every yarn adtian stains inthenorthern hempere der rom the south, anda too the vacines ier. The South train Vaccine wich we uses avaiable in March ard the North sain 6 months later and protects against the fsseasonntherrth during winter. Anewesciing vaccination to protect women agaist cancer of th cani snow avaable 2rd iff major medical breakthrough. thas been Giscveted thatthe cause of cancer ofthe cervix isthe oncogenic (concer causing) vu, Human Paloma Vins (4PY). New vaccines agaist HPV are now avaiable in Malaysia and can be given togitsrom puberty (about 12 yeas od) onan ‘Thecouseconsstsothree doses the second dose tain gven2 months after te frst andthe thi sixmont late. VACCINES FOR TRAVELERS CCholeais an acutediahoea| disease caused by the Vibriocholerae bacterium. The typical larchoea is very watery. t looks like rice water, and because ofthe large volume, causes severe Gehydration and in the extreme case, death, Cholera has a effective oral vaccine (given in two doses two weeks apart). Typhoid is a bacterial infection which causes high fever, sweating, abdominal pain ad ciarrhoea, Typhoid infection Can be protected by 4 oral capsules of te live attenuated virus given inthe dosage of capsule every 2 days Transmission ofboth cholera and ‘yphoidis by contaminated food or dinks often in oor sanitation reas In dsastorstruckareas such astsunam's and earthquakes, these two dseases {ohand in hand and can spread ike wl. These Vaccines is recommended for food handlers and patients going ocountries where the disease is endemic like India, Africa and South ‘America. Personal hygiene and cleanlinessare the mtrstay of prevention ofboth Epa Lot me just mention in passing about a ‘new vaccine inthe offing: a vaccine against the deadly bird Mu Bird Mu (HSN) a newly ‘emerging infectious disease which is very \rulent and often fatal, The patient suffers from fever, cough and cold, leading to breathlessness and a rapidly progressive pneumonia not responsive to treatment ‘The HSNI virus has the capacity to cause 2 ‘world pandemic, wreaking widespread illness ‘anddeath nitspath. vaccine against HSN has been produced and tested safely in children and hopeful, wil be available for widespread use soo, What of the future? What about a vaccine fr the HIV vius which causes AIDS? ‘And for Malaria, which ils millns every ‘year? And for EV71, whichis the pathogenic enterovirus identified in cases of fatal Hand Foot and Mouth Disease? These are ‘akan datang’ all orojecsfor research and testing, ‘with no oficial Iunch dates yet Finally, often as paediatricians, we sympathise wth patents an their itle infants ‘nd children when they have to come fat ‘multiple visits to get their multiple shots. In the notteo distant future, we hope that there willbe a truly universal vaccine, where one shot protects againstall disease " € Introducing our new by Dr Mahalakshmi Ratnavale Consultant Obstetricians & Gynaecologists eas iso Mie 86H) ‘The unborn baby’s persona can now be captured with even greater clarity before bith These almost newborn lookalike thre dimersional (2D) pictures isa testament to the new GE VolusonE8. Four mensional scanning (4D scanning) are vdeocips that capture baby sleeping, smiling, frowning ‘rimacing, yawning or sucking finger, or toes. ‘Mum can tell wno baby takes after and parents ‘mind you, you wil be secretly pleased. Social Scanning has been in vogue even before Tom Crulsehad an ultrasound machine at home to view his unborn baby. This upgraded innovative technology with improved resolution and multiple functions, has made many parents speechless with |ey. The images and clips can be copied toa CO, DVD or thumbdtive almost immediately fr future home viewing, Three dimensional (20) scanning was first introduced in 1984, whereas two dimensional (20) scanning or the conventional ultrasound In Obstetrics, since 1960, Overtime, as in all ‘technology, machines get smarter, faster and friendlier Detailed two dimensional scanning (2D) in the fist uimeseste (nuchal trarstucency and nasal bone identification) and second trimester (fetal ‘anomaly can) isimportant in obstetric scanning and cannot be overemphasised. Good to Gimensional imaging is crucial before images can be translated to three dimensional (30) or four dimensional (40) imaging where pixels gettranslated to voxels, which results in @ 3D image or photograph. Four dimensional (4D) translated to voxels, which results na 3D image ‘or photograph, Four dimensional (40) imaging iS 3D imaging in tealtme, hence a videoclip Ultrasound came in handy, almost half a century ago when the fetus was ist visualized only asa blur form in relation to its environment. Nowadays we can see the Unborn baby in greater detail and identify an ‘anomaly a potential problem, ar an imminent problem within the womb and manage the ase accordingly. Mare Importantly parents fate reassured, counseled appropriately, informed fully and in readiness with the ‘outcome. “| VOLUSON EBngenital } leart Disease “S by Dr Dan Giap Liang Consultant Paediatrician & Paediatric Cardilogist ACP, Df Congenital Heart Disease is the most common malformation. The incidence 's quoted as 8 per 1000 lve births. The presentation can be diverse with some presenting dramatically at birth whilst some sreony agnosed incerta when techic {sseen for ther common childhood conditions Generally congenital heart disease can be vided into two main groups. The fist isthe ‘janotictype which means that te child ips {anc fingers appear blush. This issometimes ‘very marked in the very complicated disorders like transposition af the great arteries ot eat ad yONG MING aay OM eonLT, pulmonary aves, These condtions ere gent Medea ateion during the newborn pete os the baby canbe very unstable and ray need immediate media attention. Some ofthese Conditions can be stabilises with ntavenous mnecicatonsbutsome wilneed urgent suey f0 Corrector palate he conden Some of tase neat diseases may be vey compleated andthe bay wl ets numberof Stage procedures to complete te oa rept “Tsmean thatthe nial operatonstostse Thecnldsconon to eae that baby able to fon wel ar thive planning he eer Stages sargry Caria sgn tesetypes af completes have improved werencoaly Ser the past 2 decades. any ofthese babes havestnned arhavegronn opi adrecents teten yeas ago, nox oul have been gen Upasterminal andinopeabe cases, “he more commen heart condtion are the cyanotic ype Children with tes ea eons Sppear pink The most common hear conaiton inh group tho venus aptldtet ar whats commonly calles hole m te hear Imehiseen where the ol smal mst vil at needanyfomotteatent Thee agoodehance spontaneous closure overtime and these Enirer nee only beaioned up realy with ‘cane Honeer nen vnerethe ole age the ch wl present nth signs and symptom ke poor weight gain, feeding aifiultes Breathlessness a eit. These eniren wil ned 0 te treated with mecicnes fora pevod afte to monitor any progress However there i no Improvement in heels condtian,sugial closure othe hae willbendete. Insome congenital lesion ike a steness or nartoving ofthe valves in the her, Balloon Aistation canbe cared out withovt the end having to undergo surgery. This eared aut in the catia eathetersaton borat. A balloon Catheter in nrouced int the heart hugs a puncture noneof the esses inthe rn. Under fadiologcal guidanco, the athete is then inoguce’intthe nore vale nde balloon ittes. Th then dit the narowe ab. ‘he baloonetheter then wtheraan an the {hid cred. Ths new development means that hildren wth lesion ke these need no longer nrg open heart bypass surge Inanother common heat canon called the potent ducts otros, a Blodvessel which s Potentinfetaifein the mothers womb remains TT aoa D Ventricular Septal Defect (VSD) Opening beaveen ences AO- aorta RA right atrium PA-pulmonaryartery LV — left ventricle 1A ~ eft atrium AV right ventricle. open ae dvy. Thi vse open might result n hear fare ora bacterial infection Calle infective endocarditis n the cardiac Catheters teat, thsleson can be dosed with ny calhich aga can be mroduces wth Catheters itediced though the aon estes ‘hase cals wnen placed ae te Gt wi sa offthect Thiet another example whereby Openheaesigey eno lngernecensy tocar Chngental heat esos Although i used abe traumatic to parents to laa about ther ehdren having 8 heart Condon, wth eat and prompt dagosis proper Sd caret management, mos of these chiseon Gan be tested and wil Grow up tbe neathy Chien and normal chiden Trea perenne ate oa eer ee ees cee)Enhanced nutrients your baby needs with the natural fibre of oat, wheat and prunes. A healthy tummy sunt with NESTLE® GOLD® Infant Cereal Stage 2. Mac with the goodnem of raturl ont, wheat andl prames, NESTLE® GOLD® Infant Cereal Sage 2 gives aby el ea ei ys kg Th ated fucon of our special BL BIFIDUS® formulation, which increases the population of endl cee ara eee else etc essential mavens, Your baby is asured of complete mutton and a more comfortable star To learn more, goto weweweaningcm my NESTLE very own formulation which increases friendly bacteria popalations and reduces diarrhea. Strikesja Kien Eng '& Language Therapist) We often take the ability o speak for Granted When someone that we know loses ‘the blityto talk and to understand language, Itaffecs every aspect of our lives. Besides ‘twill also lead to frustration isolation and academic failute fr those affected WHAT IS SPEECH / LANGUAG THERAPY? Speech and language therapy services deals ith people witha speech language, communication end swallowing afecly ‘Aspeechandlanguage therapist pathologht is potesionaly qualified person wh i Sled indenting, assessing and eating Speech language communication and Shalowing corde in chlten and adult. INDICA THERAPY Speech therapy may be beneficial to individuals wth the following conditions: CHILDREN © Language processing difculty Articulation disorder Phonological delay Aitention deficit disorder /Attention Gefct& hyperactive disorder + Learning difficulty + Autism + Hearing impairment * Down Syndrome IONS FOR SPEECH Cerebral palsy (let ip ond palate Stammering / stuttering ‘ADULT + Stroke and head injury Dysphagia — swallowing / feeding aiffculty + Tracheostomised individuols * Head and neck concers Motor Neuron disease + Porkinson’ disease ‘Multiple sclerosis Voice disorder Stammering / stuttering S MY CHILD A NATURAL E TALKER OR IS HE / SI ENCING A REAL SPEECH LANGUAGE DIFFICULTY? According ta UKstaisti, “One in every ten chiliren s found to have o speech ard language diffu of ome degree of sveriy.* Is your child one of them? Is your childs speech and language delayed? ‘A child's speech and language development varies greatly fom one child to another. However as anoim, 2 child at one year would normally utter his fist word, {ecognizes his name when called, imitates famibar words understandssimpleinstucions an at 18 months would point to common objects when named. “However ify chilis ‘wo-yer old and stil not talking shouldbe concern? Most people else thet tis quite ‘normal to gto child who tals lot especialy Fitisa bor and probably he hs fongueded too.*asked a parent. Tenguetied isnot a common cause fora services in Island Hospital childs speech and language delay anditis usually not the reason fora child not speaking. A child ‘whois genuinely tongue-tied can usualy talk very ‘wel except that his speech is unclear. Even that, 2 lotof the unclear speech in children is also not ‘due to tongue-tied but due toa ‘phonological delay (the porto the brain that controls the sound production system s delayed nis development). “There are few things that you may want to ‘observe to help you decide whether your child is areal natural late talker or is hea child who is experiencing a real speech and language ficult? Ask yourself these questions: If you are in doubt about your child's performance inte above questions necessary ‘that you send your cldtoa speech andlanquage ‘therapist for ful assessment to find out whether your childs real natural sow talker. Do not take ‘hancesorwait and hope that yout childs problem will resolve by itself your child i experiencing 2 real speech and language difficulty, itis important that you discover early so that helps given to your child, ealy intervention isthe key toa successful remediation. Speech and language delay can affect your chil’s academic achievement later on, o you don't want to wait until that happens. SPEECH AND GE PROBLEMS EARLY Wen should the referral be made toa speech and language therapist pathologist?” 1) Tech isno talking ty the age of2 2) His/Her speech 's sgnificanly dificult to inderstond oer age 3 3) He/She leaving of many begining and / or ending consonants ater the age oF 3 eg the chid says hu Tor house orn fr snd 4) He/She stil not using 23 word phrases byoge’s 5) His/ ter speech consists mostly of vowel ‘sounds 6) His/ er sentence structure is quite faultyot ge 4. He/she sil doesnot mote a proper Sentence, 27) He/She smoking speech sound errors afer a6. 8) His Her voce quality is hoarse, especialy fe /shesreans tequenth 9) The child sounds as if he /she is talking tneugh hie’ her nese ras he/she has @ Cold when he/she does. 10) He/She snoiceobynor-uent 11) Thechidisembarased and/or bothered by ins ner speech or any age. Case One Chin Hanis a two-year old boy, He has no recognisable words nde pulsand whines toget tibneeds He doesnot understand whats salto him butoccasinaly he responds when gestures are used He plays maint by mse moves around the house constantly, does nots tl doesnot respondto isnamemest ofthe ime andhe does tok imitate any speech sounds salto fim. Case TW0 Sher isa three and a half year od it She say ony one word at ie and bereh ianguage when she esto tale move. Se pla meaningful and s vey goodwathsnapes nots nd puis, However she doesnot Understand all that is said to hel and tenés to “tune out” wmtatotterssaid to er. se doesnot respond to instructions unlespnting and gestures aeused. She does not understand Yes/No questions, of answer “what” or "who" questions. he doesnot make chtce or tarceonversations and wi ony speatsuen spoken. Case Tree ‘Ming Er sa 4 and a half year old boy. He speaks nino or tree word phases He also has 2 pronunlton problem anche would pall the Sounds with icion eg. /97,/17,01/3h7,/eh7 wath /4/ sound, He ago ends to put /t/ and ‘47 sounds or // too. esha to understand fim because is semences areal bled upand tis speech funcear. His understanding | als oor his age He cannot answer simple "What, Fomere"or aby question, end he ent folon twostep directors: ive me the pene and put the book onthe shell” ITyou area parent ora kindergarten teacher and come across any child with some ofthese problems, ts recammended that you have tis Enid speech ad language sil be evaluated Share ae speech and inguage terapets based inmost big general hospital and private hospitalsWhy obese children need physiotherapy? 9 ‘by Mr Avery Tan (Physio As primary health professionals, physiotherapists are ideally suited to identify exercise strategies targeted for overweight individuals and to coordinate comprehensive ‘obesity management programs Physiotherapists have specific education in biomechanics, ‘therapeutic exercise and exercise prescription measurement and physiological and anatomical mechanisms on health and disease Physiotherapists also play @ major role in motivating and supporting individuals in maintaining their exercise programs which will also bring about a successful change in theit testy Obesity in and of itself is a major health problem. On top ofthat, there are sercusdiseases for which obesity is a'majr risk factor to, for ‘example, atherosclerosis cadiacdisease, diabetes [high biood pressure Obese children ickin dally physical activity The American Heart Associaton Fecommends that children and adolescents Paicipaten at least 60 minutes of maderate to Vigorous physica activity every day. Physical activity produces overall physica psychological and social benefits Inacivechikren 218 likely to become inactive adults, Physical ‘ctvity helps with © controling weight * reducing blood pressure * raising HDL (“good cholesterol reducing teri of deabetes ord cercn kind Iinproved psychological well being including airing more selfconfidence ond higher Selfesteem Physical ativtyis any movementof the bo hata wt fu skal ues Inturnrequies energy expenditure. This ener Soendtute sbanetowelghtertol ‘Aerobic exercise prescriptions must oband in hand with reduced food intake, and the progression of activity shouldbe gradual and {alored indivcually Weight oss wil usualy occur ‘ith moderate intensity exercise (55% - 69% of ‘maximal heart) for about 45 hours pr week that cesuls in an energy expenditure ofa least 2000 calories per week in combination with reduced energy intake. Exercises may be intermittent eg. severa 10-75 minutes sessions cadtng up to ftal of 30- 40 minutes pet day) continuous (one 30- 40 minutes stead) Aerobicererosemay be pescibedusingmuiple diferent types of exerts, including walking, Jogging, treadmil elliptical, glides, bicycling (Stationary, moveable, apriah, recumbent arm cycling /upper extremity ergometer), rope Itmoingstats/ steppers limber ross courtry sking Ses roving machine andaerobcdosses (dance step, wate. Ieisimportant tha the physiotherapist ind the most appropiate type of atiuty Tor the individual, who overweight or cbese so that they will no only enjoy the activ but alsa have a greater chance of saying int. The mode may also bevaied in what mghtbe considered asa Gieut program (15 minutes of breyling on recumbent bee 15 minutesof weodmil waking ‘and 15 minutes of wir). Resistance /sirenath raining exercises are alco important inthe management of obesty and ‘nil result not oniyin increased muscle trent, but als increased fat free mass and redu body fat Strength taining has been shown to decrease total and intra-abdominal fat. A decrease in trunk obesity may in turn lead to improved breathing and posture. Resstance/ strength taining may also use various diferent mades to achieve the end ‘results These may include ree weight elastic bands and tubes, machines, body weight, weighted bars medicine balls, pulleys, and body blade Again the important aspectisthe physotherapt nding the ght medeforhe Individual. The progression for strength ttainingonthe overveightorcbese individual shouldbe gradual, with lowerintensty forthe first 2 weeks to permit adaptation £0 as to ‘reduce the risk of injury. The duration wil be Increased initially followed bythe intensity, ‘and subsequently increased gradually to reach {60% - 80% of the individual’ capability. Combining serobic conditioning and resistance /strength traning mates ita fun and interesting way to exercise. Thus, there fre numerous types of exercise prescriptions that the physiotherapist can establish in combating the ever increasing obesity epidemic, The sooner the nations ofthis world ‘adopt such ntiaives an programs the lesser ‘he weight will be on thetr respective health system in eliminating ths problem, & Myopia and your child In the Asian population, myopia or short sightedness isthe most common eye problem ‘mong school chien. Various epidemiological Feviewsin Singapore, Taiwan and Hong Kong have shown the prevalence of myopia of up to 90% in some populations. Myopia affects one in four 7 yeats od, two in three 12 years old and four in five 18 years old Asthe caus of myopiainchidren isnot known, ithas become a significant health The Singapore School Cohort Stud ofthe Risk Factors for Myopia (SCORM) was initiated in 1999 {Dstudy the prevalence of myopia armong children ‘aged 7109 years ld To date, over 2000 children have been recruited. t was found that of those chilcen who were short-sighted, over 50% were not wearing spectacles wit the appropiate correction. Tis is due tothe rapid progression of myopia during the pre-teen and eatly teenage years The SCORM study foundan average increase in myopia of 100 degrees (-1.00D) per year. The implication of this finding is that children wear spectacles with underpowered lenses leading to oor vsion anc poor performance inthe classoom, 1n-2006, the Singapore ye Research institute began a pilot project at a primary school in Singapore to study the effect ofthe NeuroVision technology in controlling childhood myopia progression. Allthe children induded in his study had atleast 100 degrees of shortsightedness at ‘the beginning of the study. NeuraVision is a computer-based therapy based on the concept of perceptual learning It was developed over 20 ‘years ago to improve vision and contrast in amblyopia (lazy eyes}. As its a non-invasive ‘therapy which does nat involve medication oF ‘surgery the NeuroVision treatment was deemed ‘to pose no risk to the children involved. Of the children who completed the program, 83.3% achieved an imorovement of 2 lines or more in ‘visual city Thismeant that those children could ee well with less spectacle power. More Significantly, ofthe 27 children whowere followed ot | year, the average increase in myopia was 5 degrees -0.50D) compared to almost 100 degrees (1000) in chileren in the SCORM study who dic ot undergo the NeuroVision treatment. The outcome of thistrial offers proof that the 'NeuroVsion therapy improved the quay futon in primary school chien. Results after | year of follow-up nicate that th progression of myopia ‘was lower than average in those wo underwent the NeuroVision therapy. NeuroVision is now conducting a larger study in conjunction withthe bby Ms Lim Kooi Ling (8. Optom (Hons) Singapore Ministry of Heath in order to vesfy the outcomes ofthe pilot stucy. ilaser Centre has been a certified NeuroVision centre since 2005. The ‘NeuroVision technology has applications for childhood myopia, adult myopia, amblyopia lazy eyes} presbyopia age-related Tongsightedness) and post LASIK.(Otoacoustic Emissions) IA NEW DEVICE FOR UNIVERSAL INEWBORN HEARING SCREENING Approximately | in 1000 well babies Jn nursery are born with hearing loss and ate not detected. The incigence is twice in ‘neonatal intensive care and at-sk paediatric population. Studies have shown that babies with hearing loss identified before 6 months of age and rehabilitated early will evelop better language scores. Therefore, it Is ‘rucal 10 identify these babies and institute treatment as soon as possible eg speech therapy, hearing aid wearing and in profoundly deaf children a cochlear implant. Previous attempis to identity these well ‘abies with hearing lss were not posible due tonon availablity ofa suitable device thats portable, quick, reliable, accurate, painless 4nd subjective. This has changed with the availabilty of OAE device and in many ‘advanced countres ALL new-born babies are ‘ow routinaly screened using OAE davice. My baby appears normal should he /she undergo a @ neonatal screening? Itisadvisable that all newbom babies ‘undergo @ neonatal screening tests 8s the incidence of hearing loss is between 0.196 1003 9even though the baby appears normal ae Whoare theat-riskbabies with increased incidence of hearingloss? 1 ‘The atrists babies are premature | abies tow bith weight babies ss than 1 5k, babies with prolonged jaundice, neonatal infection eg. | niacalebroraties | 1 1 panantanasganenhine) ®OAE ‘What are OAES? Where are they produce and what do OAES result tellus? Kemp discovered that normal earsare not “ule and continually produce emisions. ‘These emissions are generated by the inner ear outer hai cls in the Organ of Corti. The presence of OAES indicate the inner earisnormal and the baby willbe able to herifthe mental evelopment isnormal How old does a child have tobe before OAE screenin; ‘OAE screening can be done rom newborn ‘to adult. In fact itis easier to do on neonate who is quiet, cooperative, nat struggling orerying Se by Dr Lee Guan Teik Consultant Ere Surgeon Maso) oS Wa ut) FS) Where are OAEs done and how long does it take? ‘ora sound proof heating test room. The tests normally take 5-10 minutes per eat y ae eee 1 ina straightforward case. 1 1 een What does a REFER result mean? | Test results are either PASS or REFER. | PASS denotes normal inner ear functions || _ REFER does not mean the child is DEAF. _ Htean be due to many reasons including wax, secretion in the ear canal or mile 1 ear fuid infection. ifthe test results || Continue to be REFER after clearing the 1 "ax and treating the middle ear infection then further more expensive and elaborate tests 8g. Brain Stem Audiometry, MAL brain are required to confirm that the baby has hearing loss. Protect Your Child 2 Preventive measures are always better than cure, Thus, immunisation is essential especialy forthe little ones. At Island Hospital, we provide all the necessary vaccines to ‘yout child. From the basic BCG to to the recent Japanese Encephalitis (JE) vaccine, and we do i step by step. Follow the development of your child fom birth right up to a little cheeky kid running around your home. Our personalised health record takes note of your child's ‘vaccinations, rowth and at the same time, making it fun. ‘and personal Keep this record and let itbe a sweet memory for your child later on.MS Announcing new Enfagrow A+ with MORE THAN 4X DHA. The next big news in DHA has arrived! StrongerChildren|learn) More)& Breastfeeding: act of love and the best gift for your baby ‘by Dr Hwang Yee Chern onsite Paeariian Suen 0 essa 0% ferent Incompettve modern-day society most parents have high Ropes fr thelr newborns iFthey dont aspire to give bth tothe new Einstein, they aye fo thelr cilren to at least graduate rom unversty Therefore ts Important for them thatthe chen ge the beststatilfe “A goodbecinningishl the success" “What we eat may determine what wecan be" With the above two sayings is ‘ot difcut to realize thatthe food we feed fur nenborns might be one of the most important decisions a parent wil ever make. Allof us know that "Brees s bes’, nd that breast milks the most important food {ocataby. But why so? Why shoulda mathe ump from the frying pan into the fire i ‘geting ridof the paraste"that she hasbeen Carrying for the pas eight months, oly to Ihave to nurse tat her breast Into the long nights socritcing her Beaty sleep in the process? Lets ing out why a woman shouts hoose to breastfed her baby, despite the fact that infant formula eso easly avaiable. Beas milks the designe's milk for human babies When we compare breast ik tocawsmilt@hemostcommoningredenin the mating info frmuta), breast miki Superior nal aspects Breast mil protein contains mre whe and lsscasenwichmeara that tis easetodges. Furthermore, reat mils whey ad casein are recogrzey the baby scgestve ste aa” and thus there sno rk ofan alergie reaion The levels of Olen (yee of faty acid comport of) teas are gh tan ‘hate Pamin antes, ant coupled with the presence of ipase (ete of erzmetnt breaks don fot) le reas ore esl digested Sand absorbeaint the babys mature digestve Sysom tao hasan sbundoncn eset faty 230 fic cow mils anatase ty 26 astnthe omato ofimponantealimenrane fn conroues tote he af tensed 1s for vitamins and minerals breastmilk contains snallamaunts fron Foweve the ron present inbreast ksi such aformthat an be easily absorbed by the baby's digestive system; Coniston ot designed that way. Theor nolron supplement willbe needed fhe baby breasted prowdedthe mother sotto dein. ‘The Vitamins Nand Cincowsmie are ao not $ufctnt for ababys growth (One imgoranteomenenf beast mi that can never be nitated by nfo formula the lvngnatireof reas ik rest mks mame ‘aed canges scott varies actoring ‘Dtheenvvonmentin wh the mater ane teins components change depending 00 the gestatanin which the mate's pregnant 4h the beginning o° end of feed ore mi and hind mii the weather (more cae ring hot eather). and the bate ord vies hat both {he mater and hid havebeen exposed to When 4 breastfeeding mother comes down with an infecion te mothers metre mmune te al prodie aries ogo te vases or boca, ‘These anodes wi becclated inthe blood stream tothe beast and passed on tothe baby vin breast mk therfore protecting the baby ‘sont acer ondviuss Thus fa mother had 3 Cold and stopped breastcsig he baby woud not have the bene of receving te artbehes agaatthe ines Iisbeyon doubt that reastfebabeshave higher Ge and better acasemie achieverents Copared non essed babes Ths appies to both fulrarm an premature chlten, Doctors ent lOO sie what cones teh mage power, butt i speculated to be Docosahexanoic ‘Acid, DHA. An essental fatty acid long-chain ‘polyunsaturated fatty ocd) that cannot be made {inou bodies and therefore has tobe obtained in ‘ur diet. Ibis an essential component for making ofthe building biocks of our brain and nervous system. thas also been shown that breastfeeding ‘mothers whose diets are rich in DHA produce infants with better neuro developmental outcomes. Unless its fortified in infact formula, DHA isnot presentin cows milk Breastfeeding also reduces the incidence of childhood diabetes, asthma, eczema, inflammatory bowel disease, dsiexia, attention deficit disorder and hyperactity. Exclusively breastfed children do not need to have extra water Thisis because breast milkhas 8 natural thermostat to change the water content ofthe breast milk according to the weather that the mother and child have been exposed to. For example, the milkof a mother in Malaysia would have mare water content because Malaysia's 0 hot When the child depends solely onthe mother for nutition, and there Is o much skin-to-skin Contac, itis no surprise that a mother that breastfed her eld would have a closer bond with him or her. The mother is also emotionally and psychologically more satisfied because of the bonding. To add icing tothe cake, there are definite benefits instore for a mother Unat breastfeed her child. A breastfeeding mother loses fat more easily, and thus, itis easier for het to return to her pre-pregnancy figure. There will also be 3 feduced risk of breast and ovarian cancer and 3 Teducton in incidence of postdelvery anaemia. Not eneugh red blged cal) hiss because Guting reastfeeding, a type of hormone called oxytoxin willbe secreted, Not only does oxytoxin stimulate ‘the muscles in 2 woman's breast, t also helps the uterus return to its pre-pregnangy size by stimulating the muscles there. A larger uterus loses blood faster, and when auterusis tits pre- pregranc ste aroun blodsssnatialy Breastfeeding is time-consuming and tiring, but after knowing the above advantages, what a breastfeeding mother has to endure is surely a sill pice o payin return forthe immense benefits, iva child and the mothers lifelong well being Neonatology 2 bby Dr Hwang Yee Chern Smal with transparent skin, barely the sizeof the clenched st of her mthey she les there Her undeveloped lungsare gasping for aittiying to take in afew breaths of oxygen before they finaly give way. Her heartis barely pounding, barely able to sustain her delicate, bony frame for long As the doctors cut her umbilical cord, they inow that its a matter cof time before this poor baby gir less than 28 weeks old wll expire. She looks into het parents eyes forlomly a fsheisquestioning them fretting he le. Thisis now a thing of the past. With the evolution of neanatology, the expertise af neonatologists and the dedication of neonatal that almost every baby that is bora, be it premature or full-term, has a fighting chance of survival in this world Indeed, we have certainly come along way What is “neonatology”? Neonatology is a subspecialty of pedatvics that places emphasison the care ofnewborn infants especialy the il and premature. Neonatologiss, the key players in neonatology,eceve training as pediaticensand ‘fe then further trzined to acquire In-depth knoniledge in the care ofscknewbors especially the premature ones So, what does neonatology do to so i}Spine nd eal Se Cae new procedures. 1-Spine is a centre for learning and is accreditated by the Asia Pacific Orthopaedic Association for training spine surgery. Leading ‘surgeons from various centres in Japan, Germany, India, U.S.A. and. Taiwan meet here twice yeory for spine procedures. Surgeons from ‘India, Vietnam, China, Philippines and from our own local jn Malaysia also come to observe surgeries and to learn current and Academic activities of the Spi i-Spine Centre JAPANESE ORTHOPAEDIC ASSOCIATION AWARD Dr Oh Kim Soon, Island Hospital Spine Centre Consultant Orthopaedic & Spine Surgeon, was invited to present the results of his research at the 81" Japanese Orthopaedic Assocation Annual Scientific Congres in Sapporo, Hokkaido on May 21® 2008 as winner ‘af the JOA 2006 Travel Award, This award was accorded onthe basis ‘oFhisworkon cervical spine dynamics ins paper: ‘Comparing Range From left, Dr Oh Kim Soon (Consultant Orthopaedic & Spine ‘Surgeon of Island Hospital), Prof Kuniyoshi Abum (Sine Chiet ‘of Hokkaido Univesity Hospital) and Prof Or Arvind Shave (Head (of Spine Surgery, Bharat! Vidyapeeth University, Pune, India) at ‘the Japanese Orthopaedic Association Award Ceremony. (of Motion in Patients Receiving tifcial Disc Replacement vs Smith- Fobinson fusion’ ‘Thisseminal work wasan audi into quantifying the effectiveness, cof artificial disc devices in maintaining natural mobility inpatients ‘2 compared tothe classical method of fusing the cervical spine. ‘Aificial spinal dsc replacement is state-of the-art surgery and is ‘avaliable tthe [sland Hospital Spine Centre Dr Oh was invited last year to lecture on "The lsue of Primary {Instrumentation in Unstable Tuberculous Spine Infections” atthe Hokkaido Univesity KOREAN SPINE SOCIETY LECTURE “The :Spine Centre was also invited tothe Korean Spine Society ‘Conference in Api 2008 to spezk on madetn bone graft techniques DrOh spoke on his experience wth bath natura and artificial rats, ‘explaining the advantages ofboth techniques. ORTHOPAEDIC ASSOCIATIONS OF SOUTH INDIAN STATES CONFERENCE (OASISCON) 2008 From August 21 24% 2008, the #Spine Centre was involved ina series of lectures aswell as conduction of live surgery in case ‘of cervcaatficial disc replacement atthe Mahatma Gandhi Memorial University Hospital, Pondicherry, India. Dr Oh introduced te atfiial disc replacement ange of implants besides lecturing onthe ssues of Spine surgery in the very elderly. 7oemmeccenes = ac That may unravel great pia Love is your greatest gift So treasure him like gold NR cele Meco ate Reta Romo 1 Fee Re Re eects ene Tee Monies oem oe concen Y a) PRC e CU RNa Met en ee lgten ce milk formulas to help your child fulfill his potential. ¥ eer ee Treasure Them Like Gold ee ee ee Re a eee ato Island Hospitalc y . ' a Health Talks ree