Experts Call For New Ways To Tackle Dengue In S'pore

Experts Call For New Ways To Tackle Dengue In S'pore

By Jackson Sawatan

SINGAPORE, Oct 1 (Bernama) -- Singapore's previous success in controlling dengue may have contributed to the ongoing outbreak of the disease in the republic, according to a finding by a panel of expert formed to advise the government on ways to tackle the problem.

"The success of the Singapore programme has reduced the Aedes aegypti (the mosquito which transmits the disease) population to such a low level that conventional methods of assessing populations such as the house index are no longer sufficient.

"Moreover, an increase in the Aedes population is not always a pre-requisite for increased dengue transmission," Clinical Professor and Assistant Chief Executive Officer of National Healthcare Group Dr Chee Yam Cheng told a press conference.

Dr Chee chairs the panel comprising seven members from local and international institutions whose job is to advise the government on ways to tackle the outbreak that has left the authorities baffled on why Singapore, a highly health conscious nation, has to deal with the disease that is more associated with filthy surroundings.

Twelve people had died of the disease from about 11,000 cases reported this year -- a record high.

The panel agreed that Singapore's dengue control programme is one of the best in the world, which has resulted "in sustained suppression of the Aedes aegypti mosquitoes for three decades".

But Dr Chee said: "Aedes is highly adaptable and exploits hard-to-find habitats in the urban environment. The increase in the dengue cases in Singapore may include importation of new strains of dengue virus with greater epidemic potential into a densely populated Singapore population".

He also said that Singapore's prior success in dengue control programme "has resulted in a highly susceptible human population".

The panel acknowledged that the problem was not unique to Singapore.

"Dengue is a resurgent problem globally; and being endemic to the region, Singapore can expect dengue to recur on a regular basis. The current dengue outbreak in Singapore coincides with the increase in the number of dengue cases in the region," Dr Chee said, adding that public education on dengue prevention and community participation in control activities remained the key to stop dengue transmission.

The panel recommended a host of short-and-long-term measures to deal with the problem including the need for an "active laboratory-based disease surveillance programme to provide early warning for epidemic transmission".

"Laboratory methods should include the latest technology in both serologic and virologic diagnosis. Quality control for this programme should be provided by a national reference laboratory for infectious diseases," Dr Chee said.

A continuing medical education programme should be implemented to increase the knowledge of physicians on clinical diagnosis, management, prevention and control.

"It is a common perception that most dengue transmission occurs at home. However, recent epidemiologic evidence indicates that significant transmission also occurs at sites away from the home. Current emphasis on active clusters does not provide an adequate understanding of transmission dynamics.

"This limits the effectiveness of vector control measures, because in the present situation, it appears that 60 to 70 per cent of all notifications occur outside of known clusters and in some instances transmission is not reported," Dr Chee said.

Emphasis should now be placed on new and innovative methods of entomologic surveillance to assess the impact of control activities on Aedes populations, he said.

Mosquito control activities, including those by private pest control operators, must continue to be subjected to stringent and improved quality control measures using new techniques, he said.

Long-term measures include: to maintain Aedes populations at a low level that will prevent epidemic dengue transmission, to use vaccines and antiviral drugs when they become available and to use new validated technologies as they become available.

The quarantine of dengue patients is not recommended, he said.

"Infected people can infect mosquitoes with dengue viruses 24 to 48 hours before showing any symptoms. Infected people, who do not show any symptoms may also infect mosquitoes. With Singaporeans being highly mobile and the local dispersal of mosquitoes, the virus may be widespread in the community before it is reported," he said.

-- BERNAMA

It looks like dengue is going the way of Hepatitis A. In the local scene, improvement in sanitation has resulted in a small population of immuned individuals in the community. This paradoxically has resulted in a "more susceptible population" as the number of individuals with antibodies against the Hepatitis A virus is smaller. And when an epidemic occurs, more individuals are infected and affected.
Fortunately, for Hepatitis A there is an effective vaccine available and vaccinating those without antibodies can help to stop an epidemic. Such a vaccine is not available for Dengue.
So for Dengue, mosquito control measures are important and need to be maintain all the time. As mentioned quarantine of dengue patients are not helpful. So for such vigilance, all need to play their part.

MOre Dengue Deaths in Penang

Young Pregnant Mother Third Dengue Victim In Penang

PENANG, Sept 25 (Bernama) -- A young mother in her first pregnancy is the third victim to have succumbed to the dengue fever in the state.

Fairuz Aziz, 25, who is believed to be carrying twins, died yesterday after she was admitted to the Penang Hospital on Thursday for dengue haemorrhagic fever.

Her seven-month-old fetuses also did not survive, a state health department spokesman said.

Fairuz, a housewife from Taman Sahabat in Teluk Kumbar here, was in a critical condition when she was admitted to the hospital. She died at about 6am yesterday.

The dengue outbreak reported in several areas in the state claimed two lives last week -- a 46-year-old woman from Bukit Gelugor and a 21-year-old man from Kampung Binjal in Bayan Lepas.

State Executive Councillor for Health P. Subaiyah said the Health Ministry would be alerted of the rising dengue cases.

He said while the health department was carrying out fogging in dengue-prone areas, the public must do their bit by destroying aedes mosquito breeding grounds.

Bayan Lepas, Teluk Kumbar and Sungai Nibong are among the dengue-prone areas, he added.

-- BERNAMA

No Aedes, No Dengue,
No Dengue, No Dengue Haemorrhagic Fever,
No DHF, No Deaths

HOSPITEL::A combination of Hospital & Hotel

Bernama.com
Malaysian National News Agency

Pusrawi Spearheads "Hospitel" Concept In M'sia
General
September 22, 2005 14:06 PM
By Faizah Izzani zakaria

KUALA LUMPUR, Sept 22 (Bernama) -- If you pass by Jalan Tun Razak here, you will see a new building, "Hotel Putra KL", beside the National Library.

The three-star hotel, developed together with the Pusat Rawatan Islam (Pusrawi) Hospital building, not only will be the new landmark in the city, but would be pioneering a new service concept in the health tourism industry currently being promoted in this country.

The "hospitel" concept, a combination of hospital and hotel, might be new to the Malaysian society but it would be spearheading the change in the country's health services in the future.

Hospitel could provide accommodation for the patients' family members, its outpatients, as well as for local and foreign tourists to stay at the hotel while receiving treatment.

Pusrawi Hospital Corporate Development Manager Mohd Azlan Md Arshad said Hospitel, among others, targetted tourists from Indonesia and West Asia.

He said Pusrawi Hospital, which was now operational at Jalan Ipoh here, was scheduled to expand its services when the new hospital and hotel buildings at Jalan Tun Razak began their operation by year end.

The new hospital is quite special because it offers medical services based on Islamic teachings and at the same time provides hotel facilities, he said.

Mohd Azlan said the hotel rooms would undoubtedly be a great convenience to the family and friends of patients from out of Kuala Lumpur, and it would also be open to other visitors who needed comfortable and affordable accommodation.

He said the hospital would have 250 beds as compared to 90 beds at the present hospital at Jalan Ipoh, while the hotel would provide 102 rooms.

The Hospitel construction project began with the first phase in 2000 and the second phase began in 2003, comprising the construction of a nine-storey hospital building and an 11-storey Hotel Putra KL which were linked to each other.

Owned by the Federal Territory Islamic Religious Council (MAIWP), the RM100 million project was leased to Pusrawi Hospital and Hotel Putra KL, who would be cooperating to promote health tourism, he said, adding that the cost was covered by a subsidiary of Tabung Haji Board, TH Properties Sdn Bhd.

Mohd Azlan said the hospital and hotel's location was very strategic as it was in the heart of the city and situated just in front of the National Heart Institute (IJN).

Indirectly, Hotel Putra KL would also be offering hotel accommodation to IJN visitors, he said.

"Hospitel, which adopts the Islamic concept, would be equipped with the latest facilities such as laboratories and blood bank, operation theatre, X-ray, pharmacy, circumcision services, creches and a 24-hour emergency service.

"The hotel would be offering facilities including seminar and meeting rooms, cafeteria and over 200 parking spaces," he said.

Mohd Azlan said the Islamic concept applied in the Hospitel services, would not be restricted to Muslim patients but to all patients regardless of religious or racial background.

He said Muslim patients would be treated based on Islamic teachings such as the staff would say a prayer prior to a surgery and the hospital and hotel staff would always be dressed according to the Muslim way by covering their "aurat".

Non-Muslim patients would be treated like any normal hospital patients while discounts would be given to the needy but for Muslim patients from the low income group, they are entitled to apply for the wakaf fund aid, he said.

Meanwhile, Hotel Putra KL Senior Marketing Manager Normawati Zainal Abidin said the hotel would be offering a service which would suit the middle and low income groups.

She said the hotel had not decided on the room rates or whether it would be offering special rates for clients who were dealing with Pusrawi Hospital, but added that the room rates would be affordable and reflected the hotel's standard.

--BERNAMA

Another Horror Epidural Tale

Sometime ago there was an incident, reported in the American media, where an epidural was involved, the victim turned out to be the husband of the patient who had the epidural. Now here is another unfortunate incident involving a labouring patient who had an epidural. In this case both the patient and her husbands became victims. Let the husband tell their story in full as found in the letter section of Malaysiakini ::

Local healthcare? Not for me...

I am a doctor in one of the hospitals. I have always wondered why patients are complaining about us doctors. I have been doing my best, and still they complain and complain. That is until my wife became a patient when she was about to deliver.

My wife recently gave birth via cesarean section after an unnecessary complication caused by an inexperienced and unsupervised doctor. This is our first baby and I was very concerned about my wife's well being as she was post-dated one week.

A miracle happened when her water broke and she was having very good contractions. As she was unable to tolerate the pain, we were offered an epidural to reduce the labour pain.

When the anesthetist came, he was very impolite. He never spoke or greeted me. I let him proceed with the epidural as I was confident that our doctors are well-trained. After waiting for 10 minutes, my wife’s room door remained closed. My suspicion grew as the anesthetist walked past me twice without even talking to me. I then went to check on my wife.

To my horror, my wife was on oxygen and barely conscious. Her systolic blood pressure was 44 when the epidural was given (this, my wife later told me after she had the operation). The anesthetist apparently was just standing there looking at his mobile - he did not call a red alert, he did not inform me my wife was in critical condition and my baby’s safety was compromised.

They later called an obstetrician and my wife went off for an emergency caesarean. My wife and baby survived the ordeal. After calming my nerves, l went to find out why would my wife with a healthy, low-risk pregnancy suddenly went into a complication.

The hospital immediately went into a defensive mode. The anaesthetist who did the procedure had only three months experience. This period is so brief that I would not be surprised if my wife was among his first few patients.

The hospital’s resident anesthetist who was supposed to be on standby was not available that day and later called me up without any apology or remorse to say that the doctor that day was good enough and that I was too stressed out. She said I should have let them take care of things.

Excuse me, had I not checked on my wife, that doctor would have waited until my wife went into coma. What wouldn’t I be stressed out? I placed my wife in the hands of the system which I am part of and look what happened.

I can really understand now why people complain about doctors and how they are treated by the latter. I received a phone call early in the morning the next day from the hospital’s administrator who told me there are people who would ‘get very angry’ if l lodged a formal complaint.

He said a little drop in blood pressure was to be expected and my wife was mistakenly thought to have a low blood pressure. I later spoke to another anesthetist who came all the way to check my wife and he noticed that the epidural was too high, too deep and there was an inadequate one-sided nerve block.

I immediately went mad. Is this how a loyal, seven-year in-service doctor gets treated? Is this the system l believed in? Is this what our director-general of health thinks we should be?

I am very frustrated and really thinking of quitting soon. The system does not care for its own, what more the public. Should I keep quiet because some people who want a promotion have threatened me about complaining?

I am now in depression and do not think l can ever use government health-care again especially for pregnancies. I really sympathise with those who have had the same problem. I do know now why patients complain.

I cannot do anything as I am being asked to keep quiet or people would get ‘upset’. I have nobody to turn to.

---Malaysiakini

As reported by the husband, it appears in this case the epidural, done by an inexperienced doctor, was not properly carried out. And a complication had resulted. Fortunately, at the end of the day, the patient and her baby came to little harm. But the treatment of the husband and the patient after the event was certainly uncalled for. The way the hospital authorities went into 'defensive mode' and the seemingly unacceptable explanations and subtle threats were certainly unwarranted. The patient and her doctor husband obviously had every cause to be very annoyed, frustrated, upset, depressed with the system. But all is not lost, if he wants to, he should take up the case with our new DG of Health and he may yet get satisfaction. According to media reports the DG is super-efficient and will not tolerate fools. He can definitely be expected not to expect his own MOH doctor to be so shabbily treated by the system.

As Of 2008 Heart Patients Need Not Wait Long

KUALA LUMPUR, Aug 29 (Bernama) -- Heart patients who currently have to wait anything from six months to a year to receive treatment or undergo an operation at the National Heart Institute (IJN) need not wait long by 2008.

Health Minister Datuk Dr Chua Soi Lek said that under the expansion plans for a new block of the IJN building, estimated to cost RM209 million, heart patients will only have to wait three to six months.

"Ten years ago, IJN only received 50,000 outpatients a year and 8,000 warded patients. Now, IJN has 122,000 outpatients a year and 12,000 patients in the wards," he said at the agreement signing ceremony for the appointment of the project contractor, here Monday.

IJN was represented by Chief Executive Officer (CEO) Mohd Radzif Mohd Yunus and Medical Director Datuk Seri Dr Robaayah Zambahari, whereas the construction companies, UEM Construction Sdn Bhd and Intria Bina Sdn Berhad Joint Venture, were represented by Datuk Mohd Nor Idrus and Abdul Hamid Abdul Rahim, respectively.

Speaking to reporters later, Dr Chua said that the government had subsidised RM144 million last year to cover the medical expenses of civil servants and the needy, compared to only RM35 million in 1992.

"When the expansion project is completed, IJN will have an additional 158 beds, 12 in the Intensive Care Unit (ICU). After this IJN should receive more outstation patients, with health tourism being a source of income," he said.

He also complimented the IJN for its decision to obtain funding by creating what is called Islamic Bonds (Sukuk Musyarakah), rated by the Malaysian Rating Corporation Berhad (MARC) as "AAA", for RM100 million to mature in seven years or less.

Dr Chua also denied claims that in the last three years a large number of IJN staff had resigned because only three consultants and eight clinical specialists had resigned during that period.

-- BERNAMA

It maybe true that by 2008, the long wait maybe over but will things at IJN prove to be beyond the reach of many financially. Already many patients are finding it difficult to pay for their treatment there. This is what happens when corporatisation comes into the picture.

Malaysian Haze Fighters in Indonesia Sick

12 Malaysian Firemen Fall Sick In Riau, One Admitted To Hospital

By Mohd Nasir Yusoff

PEKANBARU (Riau, Indonesia), Aug 18 (Bernama) -- Twelve Malaysian firemen who are members of a team sent here to help douse forest fires in the Rokan Hilir district, have fallen ill with one of them in serious condition and admitted to the hospital in Kota Dumai.

Riau Environment Management Agency head Khairul Zainal told reporters here today that three other firemen were treated at a clinic in Simpang Bangko and the remaining eight at the clinic in the Malaysian camp.

"They fell sick two days ago but I don't know the nature of the illness, whether it is a common cold or fever," he said.

The 128-member Malaysian team, comprising men of the Fire and Rescue Department and the Special Malaysian Disaster Assistance and Rescue Team (Smart), arrived here on Aug 15 to assist Indonesia to put out the forest and peat soil fires which have blanketed the region, including Malaysia, with a thick haze.

They are assisting about 300 Indonesian firefighters made up of firemen and volunteers.

Riau land and forest fire management centre head Wan Abu Bakar said at least 20,000 hectares of peatland in seven out of the 11 districts in Riau province were burning.

Abu Bakar, who is also the vice governor of Riau, said it was difficult to put out the fires because they were fanned by strong winds and the fires had penetrated deep into the peat soil.

"The fires on the surface have been doused but the soil underneath is still burning," he said.

He said many new fires had started in different districts, such as in Kota Dumai where there were still no firefighters.

Meanwhile, a 54-member Singapore civil defence corps team arrived at the Sultan Sharif Kasim II airport this afternoon to join the firefighting effort.

Khairul Zainal said the Singaporeans would be sent to Rokan Hilir where many fires were still burning.

-- BERNAMA

Poser Hospital Kulat

Poser Over When Sultan Ismail Hospital aka Hospital KulatWill Reopen

JOHOR BAHRU, Aug 18 (Bernama) -- No one knows when the Sultan Ismail Hospital will reopen after it was closed almost a year ago following a fungus attack.

Deputy Health Minister Datuk Dr Abdul Latif Ahmad visited the hospital, Thursday, and the press were invited but he had nothing to say to the reporters and photographers who had waited for more than three hours.

Dr Latif, who emerged from a room where he had apparently listened to a briefing, just gestured at the waiting newsmen and left.

None of the hospital management staff attended to the journalists, who were left wondering why they were invited when it was supposed to have been a closed-door function.

Last September, the hospital was forced to close just two months after it had opened because of a fungus attack that was deemed hazardous to health.

Subsequently, the Works Ministry directed the contractor to undertake the necessary repairs.

In June this year, Health Minister Datuk Dr Chua Soi Lek was reported to have said that the repairs were expected to be completed this month.

-- BERNAMA

To Snore or Not to Snore

To snore or not to snore, that is the RM3000 to RM4000 question. For many of our spouses who complain of snoring spouses, the cure is at hand. A 15 minute operation is all that is required. But like most things these days with rising fuel prices and toll hikes, the cure does not come cheap even though the procedure is short. HUKM is proud to announce that Malaysia is the second country in Southeast Asia to start this innovative "pillar procedure" for the treatment of snoring. HUKM in Cheras is also the first hospital in BolehLand to adopt the technique.
So all you snorers out there, are you or your sleeping partner(s) ready to cough up that amount for peace and quiet and better sleep? Before deciding you might want to view this and this[requires WMP].

Read the BERNAMA report for more details ::

HUKM's Breakthrough In Snoring Treatment

KUALA LUMPUR, Aug 18 (Bernama) -- Though there is no data on snoring, it can cause discomfort to one's sleeping partner and sometimes it can be more embarrassing if celebrities and VIPs snored in public.

However, the phenomenon common in all age groups, both male and female, can now be overcome by a new technique called "pillar procedure".

The technique has been introduced in Malaysia by a leading provider of medical devices to treat sleep disordered breathing, Restore Asia Pte Ltd, through its company in Singapore.

The Universiti Kebangsaan Malaysia Hospital (HUKM) in Cheras is the first to adopt the technique.

Disclosing the technique Thursday, HUKM's Head of Ear, Nose and Throat Department, Prof Dr Abdullah Sani Mohamed, said snoring was divided into habitual snoring (without sleep apnoea) and snoring with sleep apnoea.

He said snoring was a sign of obstruction of the upper airway during sleep and sleep apnoea occurred when the obstruction was completed.

Sleep apnoea might be graded as mild, moderate and severe, he said.

Dr Abdullah Sani said HUKM offered and had performed the full range of surgery from aggressive uvulo palato pharyngo plasty and laser uvuloplasty to the newer radio frequency ablation techniques.

He said the ideal cure for snoring caused by floppiness of the soft palate was to stiffen it without doing any cutting of the tissue.

These could be done with the pillar procedure, he said.

The procedure was designed to reduce airway obstruction where three inserts made from multiple polyester materials woven together about 18mm in length and 2mm in diameter, embedded in the soft palate using a specially designed preload delivery tool, he said, adding the palate was neither cut nor removed.

"It can be done in less than 15 minutes in the clinic with minimal pain. The patient can go home with normal diet and daily activities almost immediately," he said.

The pillar procedure, first introduced in the United States in April 2003, is now available in Australia, China, Hong Kong, Ireland, Israel, South Korea, Portugal, Singapore, South Africa and Turkey.

Malaysia is the second country in Southeast Asia to start this innovative treatment.

Dr Abdullah Sani, who performed the technique on five patients this year, said the complication risk was very low.

He said the therapy costs between RM3,000 and RM4,000 at HUKM.

He performed the technique on his fifth patient today, Syaiful Izam Jabar, 26, a secondary school teacher in Melaka.

After the implant procedure, Syaiful Izam, who has been snoring since Standard Four, said he did not feel any pain and was glad for the RM2,200 treatment he underwent.

-- BERNAMA

An Effective Avian Flu Vaccine

American government scientists say they have successfully tested in people a vaccine that they believe can protect against the strain of avian influenza that is spreading in birds through Asia and Russia.
Present worry is that the avian flu virus could mutate and combine with a human influenza virus to create a new virus, such a virus could spread rapidly through the world with humnan-to-human transmission.
Tens of millions of birds have died from infection with the virus and culling to prevent the spread of the virus. About 100 people have been infected, and about 50 have died from this strain of the avian influenza virus, called A(H5N1). So far there has been no sustained human-to-human transmission, but that is what health officials fear, because it could cause a pandemic. And that fear has driven the intense research to develop a vaccine.
Tests so far had shown that the new vaccine produced a strong immune response among the small group of healthy adults under age 65 who volunteered to receive it, although the doses needed were higher than in the standard influenza vaccine offered each year. The vaccine, developed with genetic engineering techniques, is intended to protect against infection, not to treat those who are sick. Further tests are required for groups over 65 years of age and children.
Additional tests are needed in part to determine the optimal dose of vaccine; the number of shots people will need for protection; and whether adding another ingredient called an adjuvant to the vaccine could raise the potency of lower doses, stretching the number of people that could be protected.
Though the vaccine needs further testing before it can be approved for general use, it could be released for use if a pandemic should occur.
See a graphic presentation of how the vaccine was developed here

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Health: New thalassaemia treatment gives hope

Health: New thalassaemia treatment gives hope
Aug 7:
The treatment can seem almost as bad as the disease but a new therapy in trials offers relief, writes MEERA MURUGESAN.

PAIN and inconvenience are often associated with treatment for thalassaemia, a genetic disorder that affects the body’s production of haemoglobin – the oxygen-carrying protein in red blood cells. This inherited disorder can cause severe anaemia and can be fatal without ongoing treatment.

With no cure, the only options for thalassaemia patients are regular blood transfusions and nightly injections through a slow infusion pump. These infusions, lasting up to 12 hours a day, five to seven days a week, limit social activities and interfere with patients’ intimate relationships.

Desferal infusions therapy, as it’s known, is also difficult for children who dislike needles and fear pain, says Professor Dr Chan Lee Lee, paediatric haematologist/oncologist at the University Malaya Medical Centre. Even older teens and young adults find these infusions extremely burdensome, he adds, and often will not comply with therapy even though they see first-hand the risks of not doing so.

But this painful procedure could soon be a thing of the past as Malaysian thalassaemia patients and their caregivers are looking forward to a clinical trial which offers an oral treatment for this condition.

Dr Chan is among three Malaysian investigators who will spearhead the trials to determine the safety and tolerability of the world’s first and only once-a-day iron chelator, ICL 670 (deferasirox).

The others include Dr Hishamshah Ibrahim, senior consultant in the paediatric department of the Kuala Lumpur Hospital and Professor Rahman Jamal, director of molecular biology at Universiti Kebangsaan Malaysia.

An easy-to-administer oral iron chelator in tablet form, ICL 670 is taken once daily after dissolving the tablet in a glass of water.

The drug was developed by pharmaceutical giant Novartis to extend the benefits of iron chelation to a greater number of patients receiving blood transfusions, and to address the needs of thousands of adult and paediatric patients who have been using Desferal (deferoxamine).

The three-centre, one-year study will cover 100 Malaysian patients. Besides Malaysia, trials are also being carried out in 12 countries across five continents ranging from the USA, Germany, Greece and Italy, to China, Hong Kong, Thailand and Taiwan.

The preliminary results of studies on paediatric patients treated with the oral chelator presented at the latest annual meeting of the American Society of Haematology, have been very promising, especially in terms of safety and tolerability, says Dr Chan.

“Oral therapy offers welcome relief and the Malaysian thalassaemic community and their professional caregivers are looking forward to the trial,” says Dr Chan.

ICL 670 would also redefine the clinical management of patients frustrated by years of inconvenience, bruising and scarring as a result of daily insertion of the deferoxamine infusion needle, says Dr Hishamshah.

“Their quality of life will drastically improve and this should impact positively on the overall treatment regime,” he says.

The Government, has also announced its intention to invest approximately RM40 million annually in the Thalassaemia Control and Prevention Programme, he adds, a move will which directly benefit the few thousand thalassaemia patients nationwide and the estimated 600,000 to one million Malaysians who are carriers of the thalassaemia gene.

---Malay Mail

Other related links::

• ICL 670- The New Oral Chelator being developed by Novartis
  
• IMPACT Children Foundation
  
• Study of Deferasirox for Treatment of Transfusional Iron Overload
  
• Thalassaemia drug trial in Malaysia
  
• Advances in Management of Thalassemia
  
• Thalassaemia Association Malaysia (TAM)
  
• Sarawak Thalassaemia Online::Links