MyMedR

Fulltext Ophthalmology inpatient consultation: does it make a difference to inpatient management?

Tajunisah I, Azida J, Zurina ZA, Reddy SC

Med J Malaysia, 2009 Jun;64(2):130-3.

PMID: 20058572 MyJurnal

Ophthalmology consultation is one of the commonest requested services for inpatients in a tertiary hospital. A total of 290 ophthalmology consultation requests were received over a period of six months (average 12 consultation requests per week) and from these, 222 patients were examined. The patient demographics, the hospitalization data, type of consultations (screening, new problem, preexisting problem), reasons for consultations and the ophthalmology diagnosis were determined. Out of 290 consultation requests, internal medicine services requested the highest number (95, 32.8%); the commonest type of consultation was screening for eye diseases (161, 55.5%) and the most common reason for consultation was to rule out diabetic retinopathy (125, 43.1%). The top five ophthalmology diagnoses after examination were diabetic retinopathy (45, 20.3%), diabetic retinopathy ruled out (37, 16.6%), conjunctivitis (12, 5.4%), refractive error (11, 4.8%) and normal ocular examination (11, 4.9%). Inpatient ophthalmologic procedures were performed in 146 patients, the commonest of which was retinal laser photocoagulation. A total of 133 (59.9%) inpatients had a change in their management as a result of the ophthalmology consultation.

Matched MeSH terms: Infant, Newborn

Impact of a training intervention on use of antimicrobials in teaching hospitals

Akter SF, Heller RD, Smith AJ, Milly AF

J Infect Dev Ctries, 2009 Jul 01;3(6):447-51.

PMID: 19762958

BACKGROUND: Antimicrobials are often used inappropriately in paediatric wards of medical college hospitals in Bangladesh. Most of the antimicrobials are prescribed based on clinical grounds-signs and symptoms. This intervention study assessed the effectiveness of a training intervention on antimicrobials prescribing by physicians in paediatric wards of tertiary care level hospitals.

METHODOLOGY: This study was conducted at medical college hospitals in Bangladesh during the period from 1998 through 2000. The pre-intervention survey of antimicrobial use was conducted during 1998 in five hospitals. The post-intervention survey was conducted after the interactive training during the succeeding year in three of the original five hospitals, of which one was the intervention hospital and two control hospitals. A total of 3,466 admitted paediatric patients' treatment charts (2,171 in the pre-intervention and 1,295 in the post-intervention surveys) were reviewed.

RESULTS: The most commonly used antimicrobials were ampicillin, gentamicin, amoxicillin, cloxacillin and ceftriaxone. Appropriate antimicrobial therapy for the most common infectious diseases, pneumonia and diarrhoea, increased by 16.4% and 56.8% respectively in the intervention hospital compared with the two control hospitals and these improvements were significant (p = < 0.001 and p = 0.002, for pneumonia and diarrhoea respectively).

CONCLUSIONS: An interactive, focussed educational intervention, targeted at physicians, appears to have been effective in improving appropriate antimicrobial prescribing for the most common paediatric infectious diseases in a medical college hospital in Bangladesh.

Matched MeSH terms: Infant, Newborn

Fulltext First isolation of Burkholderia tropica from a neonatal patient successfully treated with imipenem

Deris ZZ, Van Rostenberghe H, Habsah H, Noraida R, Tan GC, Chan YY, et al.

Int J Infect Dis, 2010 Jan;14(1):e73-4.

PMID: 19482535 DOI: 10.1016/j.ijid.2009.03.005

We report the first case of a human Burkholderia tropica infection. The patient was a premature neonate who had necrotizing enterocolitis with bowel perforation requiring surgical intervention. The stoma care and difficulties in feeding were a chronic problem. At the age of almost 4 months he developed septicemia due to B. tropica. Three consecutive blood cultures grew this organism. The organism was cleared from the blood after a course of imipenem and resolution of post-operative ileus. Our case suggests that environmental and plant pathogens can cause human infection especially in those in an immunocompromised condition.

Matched MeSH terms: Infant, Newborn

Cost of dengue cases in eight countries in the Americas and Asia: a prospective study

Suaya JA, Shepard DS, Siqueira JB, Martelli CT, Lum LC, Tan LH, et al.

Am J Trop Med Hyg, 2009 May;80(5):846-55.

PMID: 19407136

Despite the growing worldwide burden of dengue fever, the global economic impact of dengue illness is poorly documented. Using a common protocol, we present the first multicountry estimates of the direct and indirect costs of dengue cases in eight American and Asian countries. We conducted prospective studies of the cost of dengue in five countries in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and three countries in Asia (Cambodia, Malaysia, and Thailand). All studies followed the same core protocol with interviews and medical record reviews. The study populations were patients treated in ambulatory and hospital settings with a clinical diagnosis of dengue. Most studies were performed in 2005. Costs are in 2005 international dollars (I$). We studied 1,695 patients (48% pediatric and 52% adult); none died. The average illness lasted 11.9 days for ambulatory patients and 11.0 days for hospitalized patients. Among hospitalized patients, students lost 5.6 days of school, whereas those working lost 9.9 work days per average dengue episode. Overall mean costs were I$514 and I$1,394 for an ambulatory and hospitalized case, respectively. With an annual average of 574,000 cases reported, the aggregate annual economic cost of dengue for the eight study countries is at least I$587 million. Preliminary adjustment for under-reporting could raise this total to $1.8 billion, and incorporating costs of dengue surveillance and vector control would raise the amount further. Dengue imposes substantial costs on both the health sector and the overall economy.

Matched MeSH terms: Infant, Newborn

Retinopathy of prematurity in extremely low birth weight infants in Malaysia

Choo MM, Martin FJ, Theam LC, U-Teng C

J AAPOS, 2009 Oct;13(5):446-9.

PMID: 19840721 DOI: 10.1016/j.jaapos.2009.06.008

To identify differences in incidence, risk factors, and outcomes of retinopathy of prematurity (ROP) between 2 birth weight categories within a cohort of extremely low birth weight (ELBW) infants in Malaysia.

Matched MeSH terms: Infant, Newborn

Genetic susceptibility to childhood acute lymphoblastic leukemia shows protection in Malay boys: results from the Malaysia-Singapore ALL Study Group

Yeoh AE, Lu Y, Chan JY, Chan YH, Ariffin H, Kham SK, et al.

Leuk. Res., 2010 Mar;34(3):276-83.

PMID: 19651439 DOI: 10.1016/j.leukres.2009.07.003

To study genetic epidemiology of childhood acute lymphoblastic leukemia (ALL) in the Chinese and Malays, we investigated 10 polymorphisms encoding carcinogen- or folate-metabolism and transport. Sex-adjusted analysis showed NQO1 609CT significantly protects against ALL, whilst MTHFR 677CT confers marginal protection. Interestingly, we observed that NQO1 609CT and MTHFR 1298 C-allele have greater genetic impact in boys than in girls. The combination of SLC19A1 80GA heterozygosity and 3'-TYMS -6bp/-6bp homozygous deletion is associated with reduced ALL risk in Malay boys. Our study has suggested the importance of gender and race in modulating ALL susceptibility via the folate metabolic pathway.

Matched MeSH terms: Infant, Newborn

Fulltext Early presentation of right adrenal mass, hepatoblastoma and hepatic cavernous haemangioma in Beckwith-Wiedemann Syndrome

Teh SH, Ong GB

Med J Malaysia, 2007 Oct;62(4):345-6.

PMID: 18551945 MyJurnal

Beckwith-Wiedemann Syndrome (BWS) is associated with early development of embryonal tumours usually in the first four years of life. We describe a patient who presented with a right adrenal cyst in the first month of life and hepatoblastoma in the third month of life. A cavernous haemangioma was subsequently found in the resected tumour.

Matched MeSH terms: Infant, Newborn

Fulltext Quality of life of dengue patients

Lum LC, Suaya JA, Tan LH, Sah BK, Shepard DS

Am J Trop Med Hyg, 2008 Jun;78(6):862-7.

PMID: 18541760

Although the disease burden of dengue is increasing, the impact on the quality of life (QoL) has not been investigated. A study to determine the QoL of confirmed dengue patients using the EuroQol visual thermometer scale was carried out at the University Malaya Medical Center. Of the 207 participants, 40% were ambulatory and 60% were hospitalized. Of eight health domains, 6.2 and 5.0 domains were affected in the hospitalized and ambulatory cohorts, respectively (P < 0.001), with cognition and interpersonal activities affected most. All patients experienced a drastic decrease in their QoL from the onset of symptoms. The QoL deteriorated to the lowest point (40% of healthy status) between the third and seventh days of illness. The duration of impaired QoL (9 days for ambulatory or 13 days for hospitalized patients) was longer than the duration of fever (5 and 7 days, respectively). Symptomatic dengue has major effects on patients' health.

Study site: e outpatient or inpatient care at the University Malaya Medical
Center.

Matched MeSH terms: Infant, Newborn

Phytoestrogens levels determination in the cord blood from Malaysia rural and urban populations

Mustafa AM, Malintan NT, Seelan S, Zhan Z, Mohamed Z, Hassan J, et al.

Toxicol Appl Pharmacol, 2007 Jul 1;222(1):25-32.

PMID: 17490695

This study is a result of an analysis of free and conjugated phytoestrogens daidzein, genistein, daidzin, genistin and coumesterol in human cord blood plasma using LCMS. Cord blood was collected from urban and rural populations of Malaysia (n=300) to establish a simple preliminary database on the levels of the analyzed compounds in the collected samples. The study also aimed to look at the levels of phytoestrogens in babies during birth as this may have a profound effect on the developmental process. The sample clean up was carried out by solid-phase extraction using C18 column and passed through DEAE sephadex gel before analysis by LCMS. The mean concentrations of total phytoestrogens were daidzein (1.4+/-2.9 ng/ml), genistein (3.7+/-2.8 ng/ml), daidzin (3.5+/-3.1 ng/ml), genistin (19.5+/-4.2 ng/ml) and coumesterol (3.3+/-3.3 ng/ml). Distribution of phytoestrogen was found to be higher in samples collected from rural areas compared to that of urban areas.

Matched MeSH terms: Infant, Newborn

Mother with post-partum group B Streptococcus meningitis and cerebellar abscess

Ghani NA, Jaafar R, Ishak S, Zainuddin AA, Mukari SA, Mahdy ZA

J Obstet Gynaecol Res, 2007 Apr;33(2):195-8.

PMID: 17441895

We report the case of a 25-year-old Malay woman, admitted for preterm delivery at 35 weeks' gestation. Vaginal swab did not isolate any organism. She delivered a baby girl who developed respiratory distress syndrome, requiring ventilation. Although chest radiograph showed hyaline membrane disease with pneumonia, septic workout was negative. The mother was discharged on the next day. Seven days postpartum, the mother presented with fever and fits and was diagnosed to have meningo-encephalitis. Lumbar puncture isolated group B Streptococcus (GBS) and MRI revealed a superior cerebellar abscess. She was treated and survived the episode. This case illustrates the uncommon situation where GBS infection was confirmed via maternal septic workout rather than neonatal, although both presented with severe disease.

Matched MeSH terms: Infant, Newborn

alpha1-Antitrypsin deficiency is not an important cause of childhood liver diseases in a multi-ethnic Southeast Asian population

Lee WS, Yap SF, Looi LM

J Paediatr Child Health, 2007 Sep;43(9):636-9.

PMID: 17688648

We conducted a prospective study to determine the role of alpha1-antitrypsin (alpha1AT) deficiency in the pathogenesis of neonatal cholestasis and other childhood liver diseases in a multi-ethnic Southeast Asian population.

Matched MeSH terms: Infant, Newborn

Two outbreaks of Burkholderia cepacia nosocomial infection in a neonatal intensive care unit

Lee JK

J Paediatr Child Health, 2008 Jan;44(1-2):62-6.

PMID: 17640280

An outbreak of Burkholderia cepacia septicaemia occurred in our neonatal unit over a 9-week period in 2001, affecting 23 babies and two died. A second outbreak lasting 8 days occurred a year later, affecting five babies.

Matched MeSH terms: Infant, Newborn

Paediatric deaths in Kuala Lumpur

Kumar V, Jumali IB

Med Sci Law, 2006 Oct;46(4):301-9.

PMID: 17191633

The main aim of this study was to determine the causes and epidemiological aspects of paediatric death. Data was collected on 143 cases of paediatric death from a total of 2,895 autopsies performed in University Malaya Medical Centre (UMMC), Kuala Lumpur, over a five-year period from 2000 to 2004. There were 78 males and 65 females. The largest number of cases (32.9%) were stillborn. The highest proportion of cases (30.1%) were Chinese. The majority of cases of paediatric death were non-traumatic (74.8%) of which intrauterine death (IUD) was the most common (32.9%). Amongst the traumatic deaths (25.2%), accidental injury (23.8%) was observed in the majority of cases.

Matched MeSH terms: Infant, Newborn

Fulltext Neonatal posterior fossa haemorrhage associated with vacuum extractor

Ghani AR, Prakash RG, Abdullah J

Med J Malaysia, 2006 Mar;61(1):100-2.

PMID: 16708744 MyJurnal

We report one case of posterior fossa intracranial haemorrhage in a full-term Malay baby boy following vacuum assisted delivery. The patient, a term baby boy was delivered by a vacuum extraction and later developed signs of increased intracranial pressure 72 hours after birth. Computed tomography (CT) of the brain showed a posterior fossa intracranial haemorrhage with acute obstructive hydrocephalus. He was initially treated with isolated ventricular shunting which later caused an upward cerebellar herniation. An immediate suboccipital craniectomy for evacuation of cerebellar haematoma was performed which resulted in a gradual recovery.

Matched MeSH terms: Infant, Newborn

Fulltext Audit of birth defects in 34,109 deliveries in a tertiary referral center

Noraihan MN, See MH, Raja R, Baskaran TP, Symonds EM

Med J Malaysia, 2005 Oct;60(4):460-8.

PMID: 16570708

The objective of the study is to determine the proportion and different types of birth defects among the children born in Hospital Kuala Lumpur. A cross-sectional study was conducted for a period of 18 months where all consecutively born infants, dead or alive were included. There were total of 34,109 births recorded during this period. The proportion of birth defects in Hospital Kuala Lumpur was 3.1% (n = 1056). The commonest involved were the hematology system, (157.7 per 10,000 births), the central nervous system, genitourinary system and chromosomal anomalies. The proportion was significantly higher in males and in the Chinese (p < 0.001). The commonest abnormalities are Glucose 6 Phosphate Deficiency (157.7/10000), Down's syndrome (12.6/10000), thalassaemia (8.8/10000), cleft lip and/or palate (7.6/10000) and anencephaly (7.3/10000). Neural tube defect is common and ranked second after G6PD deficiency. There is a need for a birth defect registry to assess the extent of the problem in Malaysia.

Matched MeSH terms: Infant, Newborn

Fulltext Culture-proven bacterial keratitis in a Malaysian general hospital

Hooi SH, Hooi ST

Med J Malaysia, 2005 Dec;60(5):614-23.

PMID: 16515113

One hundred patients (101 eyes) with culture-proven bacterial keratitis were treated in the Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, over a 4-year period. The majority of patients was male (63%), Malay (60%), from the Johor Bahru district (62%) and aged between 41 to 50 years (20%). The ocular predisposing factors were ocular trauma (41 eyes), ocular surface disease (28 eyes) and contact lens wear (26 eyes). The corneal ulcers were mainly large (50.5%), central (59.4%) and colonized by Gram-negative bacteria (78.1%). The most frequently isolated microorganisms were Pseudomonas aeruginosa (67 eyes), Staphylococcus aureus (12 eyes), Acinetobacter baumanii (6 eyes), Klebsiella pneumoniae (5 eyes), Corynebacterium sp. (3 eyes:) and Streptococcus pneumonliae (3 eyes). Twelve eyes (11.8%) had polymicrobial infection. A good visual outcome occurred in 52.5% of eyes analysed. Prognostic factors for visual outcome include presenting Snellen visual acuity, time to presentation after onset of ocular symptoms, ocular predisposing factor, corneal ulcer location and corneal ulcer size.

Matched MeSH terms: Infant, Newborn

Fixed presurgical orthopaedics for bilateral cleft lip and palate

Abu-Rub N, Samsudin AR, Abdullah AB, Abdullah N

Aust Orthod J, 2005 May;21(1):39-43.

PMID: 16433080

Presurgical orthopaedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. It is accepted that presurgical orthopaedic plates facilitate lip repair and balanced orofacial growth.

Matched MeSH terms: Infant, Newborn

A study of sudden natural deaths in medico legal autopsies in University Malaya Medical Centre (UMMC), Kuala Lumpur

Kumar V, San KP, Idwan A, Shah N, Hajar S, Norkahfi M

J Forensic Leg Med, 2007 Apr;14(3):151-4.

PMID: 16914354

The main aim of this study is to determine the causes and the epidemiological aspects of sudden natural deaths. Data were collected from 545 sudden natural autopsies in UMMC, Kuala Lumpur over a five-year period, from 1st January 2000 to 31st December 2004. There were 475 males and 70 females. The largest number of sudden natural deaths was in the age group of 41-50 years. 35.8%, 30.5% and 11.7% of the patients were Chinese, Indian and Malay, respectively. A majority of the patients were married (59.8%) and came from the semiskilled-unskilled group (30.6%). The monthly distribution was almost constant. Cardiovascular diseases were the most important cause contributing 64.9% in sudden natural deaths.

Matched MeSH terms: Infant, Newborn

Prenatal detection of birth defects in a Malaysian population: estimation of the influence of termination of pregnancy on birth prevalence in a developing country

Ho JJ, Thong MK, Nurani NK

Aust N Z J Obstet Gynaecol, 2006 Feb;46(1):55-7.

PMID: 16441696

We studied 253 women with a pregnancy complicated by a birth defect and 506 controls to determine the frequency and type of prenatal tests and the types of defects detected antenatally. Most women had at least one ultrasound examination, but the frequency of other screening tests was low. Only 38 (15%) of defects were detected antenatally (37 by ultrasound). Birth prevalence is unlikely to be affected by pregnancy termination.

Matched MeSH terms: Infant, Newborn

Parotid abscess: a five-year review--clinical presentation, diagnosis and management

Tan VE, Goh BS

J Laryngol Otol, 2007 Sep;121(9):872-9.

PMID: 17112392

Parotid abscess is an uncommon complication of suppurative infection of the parotid gland parenchyma, commonly bacterial or viral. Ductal ectasis, primary parenchymal involvement, or infection of the intraparotid or periparotid lymph nodes can result in abscess formation. Parotid abscess may arise from ductal ectasis, primary parenchymal involvement, or infection of the subcapsular lymph nodes. The operative records for all the patients who underwent surgeries in the Department of Otorhinolaryngology, Head and Neck Surgery of the National University Hospital, Kuala Lumpur, Malaysia between January 2001 and December 2005 were retrospectively reviewed. Our case series comprises 15 patients, with 10 males and five females with a median age at presentation of 51 years old. Diabetes mellitus is a significant comorbid factor, with six patients being diabetics. Among the diabetics, two patients presented with facial nerve palsy and one of them also died due to overwhelming septicaemia. Here, we discuss the presenting symptoms, predisposing factors, investigations, microbiology and complications of this condition.

Matched MeSH terms: Infant, Newborn

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